bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiovascular disease risk prevention services by pharmacists in Saudi Arabia: what do policymakers and opinion leaders think?
Authors: Almansour Hadi A. , Aloudah Nouf M. , Alhawassi Tariq M. , Chaar Betty , Krass Ines , Saini Bandana
Published: May 2021

Background

Cardiovascular disease (CVD) is an emerging contributor to national morbidity and mortality in Saudi Arabia. CVD risk prevention services are limited, particularly with an over-utilised public health sector and an under-utilised and under-resourced primary care sector. Globally, there is evidence that community pharmacists can play a key role in CVD prevention within primary care. However, the perspectives of policymakers and opinion leaders are critical to successful translation of evidence into practice. Thus, the aim was to engage policymakers and professional leaders in discussions about implementing high-quality CVD risk prevention services in community pharmacy.

Methods

Qualitative semi-structured interviews were conducted, audio-recorded and transcribed verbatim. All transcripts were thematically analysed.

Results

A total of 23 participants (87% male) from government and non-government sectors were interviewed. Of these, almost 65% had pharmacy qualifications. Limited provision of CVD risks preventative services in primary care was acknowledged by most participants and building community pharmacists’ capacity to assist in preventive health services was viewed favourably as one way of improving the status quo. The data yielded four key themes: (1) future pharmacy CVD health service models; (2) demonstrable outcomes; (3) professional engagement and advocacy; and (4) implementability. CVD health services roles (health screening, primary and secondary prevention services), pragmatic factors and tiered models of care (minimal, medium, and comprehensive pharmacist involvement) were discussed. The need for humanistic, clinical, and cost effectiveness outcomes to be demonstrated and active involvement of professional bodies were deemed important for such services to be sustainable. Professional pharmacy governance to develop pharmacy careers and workforce, pharmacy curricular reform and ongoing education were posed as key success factors for novel pharmacy roles. Practice policies, standards, and guidelines were seen as required to adhere to stringent quality control for future pharmacy services provision. Participant’s implementation vision for such services included scalability, affordability, access, adoption and health system reform. Most discussions focused on the need for structural improvement with limited input regarding processes or outcomes required to establish such models.

Conclusions

Most participants favoured pharmacy-based CVD risk prevention services, despite the variability in proposed service models. However, prior to developing such services, support structures at the health system and health professional level are needed as well as building public support and acceptability for pharmacy services.
Creation of an artificial intelligence model for intubation difficulty classification by deep learning (convolutional neural network) using face images: an observational study
Authors: Hayasaka Tatsuya , Kawano Kazuharu , Kurihara Kazuki , Suzuki Hiroto , Nakane Masaki , Kawamae Kaneyuki
Published: May 2021

Background

Tracheal intubation is the gold standard for securing the airway, and it is not uncommon to encounter intubation difficulties in intensive care units and emergency rooms. Currently, there is a need for an objective measure to assess intubation difficulties in emergency situations by physicians, residents, and paramedics who are unfamiliar with tracheal intubation. Artificial intelligence (AI) is currently used in medical imaging owing to advanced performance. We aimed to create an AI model to classify intubation difficulties from the patient’s facial image using a convolutional neural network (CNN), which links the facial image with the actual difficulty of intubation.

Methods

Patients scheduled for surgery at Yamagata University Hospital between April and August 2020 were enrolled. Patients who underwent surgery with altered facial appearance, surgery with altered range of motion in the neck, or intubation performed by a physician with less than 3 years of anesthesia experience were excluded. Sixteen different facial images were obtained from the patients since the day after surgery. All images were judged as “Easy”/“Difficult” by an anesthesiologist, and an AI classification model was created using deep learning by linking the patient’s facial image and the intubation difficulty. Receiver operating characteristic curves of actual intubation difficulty and AI model were developed, and sensitivity, specificity, and area under the curve (AUC) were calculated; median AUC was used as the result. Class activation heat maps were used to visualize how the AI model classifies intubation difficulties.

Results

The best AI model for classifying intubation difficulties from 16 different images was generated in the supine-side-closed mouth-base position. The accuracy was 80.5%; sensitivity, 81.8%; specificity, 83.3%; AUC, 0.864; and 95% confidence interval, [0.731-0.969], indicating that the class activation heat map was concentrated around the neck regardless of the background; the AI model recognized facial contours and identified intubation difficulties.

Conclusion

This is the first study to apply deep learning (CNN) to classify intubation difficulties using an AI model. We could create an AI model with an AUC of 0.864. Our AI model may be useful for tracheal intubation performed by inexperienced medical staff in emergency situations or under general anesthesia.
Clinical efficacy of amniotic membrane with biphasic calcium phosphate in guided tissue regeneration of intrabony defects- a randomized controlled clinical trial
Authors: Venkatesan Nivedha , Lavu Vamsi , Balaji S. K.
Published: May 2021

Background

The concept of periodontal regeneration has been revolutionised since the introduction of growth factors and bioactive bone substitutes which ensures optimal regeneration of the diseased periodontium. The aim of the present study was to evaluate the efficacy of Amniotic membrane + Biphasic Calcium phosphate as compared to Collagen membrane + Biphasic Calcium phosphate for the management of periodontal intrabony defects.

Methods

50 systemically healthy patients with localised moderate to severe periodontitis, sites which had a Probing Pocket Depth (PPD) ≥ 6 mm and an intrabony component of ≥ 3 mm as detected on Intra oral periapical radiographs (IOPAR) and bone sounding were recruited based on specific inclusion and exclusion criteria. They were randomly allocated by computer generated tables to Collagen membrane + Biphasic Calcium phosphate and Amniotic membrane + Biphasic Calcium phosphate groups. The amount of bone fill and changes in Probing Pocket Depth, Clinical Attachment Level were measured at baseline and six months.

Results

The results of the present study showed a mean reduction in the PPD of 2.89 ± 0.69 mm in the Collagen membrane + Biphasic Calcium phosphate group and 2.95 ± 0.57 mm in the Amniotic membrane + Biphasic Calcium phosphate group and CAL gain of 2.60 ± 1.43 mm in Collagen membrane + Biphasic Calcium phosphate group 3.18 ± 1.13 mm in the Amniotic membrane + Biphasic Calcium phosphate group at 6 months follow-up with no statistical significance between the groups. In terms of Defect resolution, 98.62 ± 6.51 % was achieved in Collagen membrane + Biphasic Calcium phosphate group and 98.25 ± 7.21 % in Amniotic membrane + Biphasic Calcium phosphate group.

Conclusions

Within the limitations of the present study, it can be concluded that AM can be used as a barrier membrane, in conjunction with Biphasic calcium phosphate, and provides comparable results to Collagen membrane with Biphasic calcium phosphate when used in the management of periodontal intrabony defects.
Non-invasive staging of liver fibrosis by two-dimensional shear wave elastography (2D-SWE) in patients with chronic hepatitis C and B
Authors: Alsowey Ahmed M. , Shehata Samar M.
Published: May 2021

Background

Non-invasive shear wave-based techniques have been developed for estimating liver fibrosis in patients with chronic liver diseases. Two-dimensional shear wave elastography provides in real-time, a tow dimensional quantitative map of tissue stiffness and enables measuring the stiffness by adjustment of a region of interest of tissue. The aim of this study was to highlight the role of tow dimensional shear wave elastography (2D-SWE) in detecting the degree of liver fibrosis in patients with chronic hepatitis C and B, in correlation with liver enzymes level and fibrotest.

Results

This study included 50 patients with chronic hepatitis C and B whose ages were (range, 30-65 years; mean, 48 years). Shear wave elastography cutoff values were 1.35 m/s, 5.48 KPa for (F>0); 1.66 m/s, 8.29 kPa for (F>1); 1.77 m/s, 9.40 kPa for (F>2); and 1.99 m/s, 11.9 kPa for (F>3). An excellent agreement was found between shear wave elastography and Fibrotest in staging of liver fibrosis in 88% of patients (κw=0.943, 95% CI, 0.88 to 1.00) achieving a highly statistical significance (P<0.001). There was a significant moderate positive concordance between US scoring and staging by 2D-SWE and staging by Fibrotest (rs, 0.49; P<0.01) and (rs, 0.48; P<0.01) respectively. However, no significant concordances were noticed between staging by AST and ALT and 2D-SWE and staging by Fibrotest (P>0.05).

Conclusions

2D shear wave elastography showed better diagnostic performance than visual assessment by conventional US for detection of chronic liver diseases, as well as for evaluation of their severity and prognosis. Elastograhy—Fibrotest combination gives best diagnostic performance in detecting the degree of fibrosis non-invasively and can be used reliably as a first-line pre-therapeutic evaluation of fibrosis in HCV and HBV-infected patients.
An Arm and a Leg: The Rising Cost of Cancer Drugs and Impact on Access
Authors: Leighl Natasha B. , Nirmalakumar Sharon , Ezeife Doreen A. , Gyawali Bishal
Published: May 2021

Increasing cancer drug prices present global challenges to treatment access and cancer outcomes. Substantial variability exists in drug pricing across countries. In countries without universal health care, patients are responsible for treatment costs. Low- or middle-income countries are heavily impacted, with limited patient access to novel cancer treatments. Financial toxicity is seen across cancer types, countries, and health care systems. Those at highest risk include younger patients, new immigrants, visible minority groups, and those without private health coverage. Currently, cancer drug pricing does not correlate with value or clinical benefit. Value-based pricing of oncology drugs may incentivize development of higher-value medicines and eliminate excess spending on drugs that yield little benefit. Generics and biosimilars in oncology can also improve affordability and patient access, offering dramatic reductions in drug spending while maintaining patient benefit. Oncologists can promote value-based care by following evidence-based clinical guidelines that avoid low-value treatments. Researchers can also engage in value-based research that critically explores optimal cancer drug dosing, schedules, and treatment duration and defines patient populations most likely to benefit (e.g., through biomarker selection). Cancer Groundshot proposes that we improve outcomes for today's patients with cancer, including broader global access for high-value treatments, promotion of affordable cancer control strategies, and reduction of cancer morbidity and mortality through low-cost prevention and screening initiatives. Moving forward, major oncology societies recommend promoting uniform global access to essential cancer medicines and avoiding financial harm for patients as key principles in addressing the affordability of cancer drugs.
Elevation of Fasting GLP-1 Levels in Child and Adolescent Obesity: Friend or Foe?
Authors: Kubota Sodai , Yabe Daisuke
Published: May 2021

Glucagon-like peptide-1 (GLP-1) receptor agonists have been gaining much attention as a therapeutic approach to type 2 diabetes and obesity. Stinson et al recently reported that fasting GLP-1 is higher in children and adolescents with overweight/obesity and that it associates with cardiometabolic risk factors in a cross-sectional study comprising more than 4000 subjects. Obvious questions include why fasting GLP-1 is significantly increased in children and adolescents with overweight/obesity and why this is correlated with cardiometabolic risks. It has been shown that the inflammatory cytokine interleukin-6 (IL-6) stimulates GLP-1 secretion from pancreatic α-cells. IL-6-induced GLP-1 secretion could therefore play a role in expanding the β-cell reservoir in compensation for increased insulin needs due to exacerbation of insulin resistance. On the other hand, augmented GLP-1 secretion leads to increased insulin secretion, thereby enhancing hepatic lipogenesis and stimulating adipogenesis, which might underlie the associations of fasting GLP-1 with % body fat, triglycerides, and alanine aminotransferase. It is also possible that GLP-1 levels are naturally increased to oppose body weight gain to maintain body weight. However, it is important to note the differing biological effects of GLP-1 at physiological and pharmacological levels, which are evident in body weight reduction by GLP-1 receptor agonists and DPP-4 inhibitors. The Stinson study clearly demonstrated that fasting GLP-1 associates with overweight/obesity and cardiometabolic risk factors in children and adolescents. However, additional experiments need to be carried out to fully understand the relevance of these observations to human disease and health.
Randomized Controlled Trial Evaluating the Use of Zoledronic Acid in Duchenne Muscular Dystrophy
Authors: Zacharin Margaret , Lim Angelina , Gryllakis James , Siafarikas Aris , Jefferies Craig , Briody Julie , Heather Natasha , Pitkin Janne , Emmanuel Jaiman , Lee Katherine J , Wang Xiaofang , Simm Peter J , Munns Craig F
Published: May 2021

Context

Patients with glucocorticoid-dependent Duchenne muscular dystrophy (DMD) have increased fracture risk and reduced bone mineral density (BMD), often precipitating mobility loss.

Objective

To investigate use of zoledronic acid (ZA) in DMD in improving BMD.

Methods

Two arm, parallel, randomized controlled trial, set in pediatric hospitals across Australia and New Zealand. Sixty-two (31 per arm) boys with glucocorticoid-dependent DMD between 6 and 16 years were included. Five ZA infusions (0.025 mg/kg at months 0, and 3, and 0.05 mg/kg at months 6, 12, and 18), plus calcium and vitamin D, were compared with calcium and vitamin D alone. The main outcome measures were change in lumbar spine (LS) BMD raw and Z-score by dual energy absorptiometry x-ray (DXA) at 12 and 24 months, secondary outcomes assessing mobility, fracture incidence, bone turnover, peripheral quantitative computerized (pQCT) and pain scores.

Results

At 12 and 24 months, mean difference in changes of LS BMD Z-score from baseline was 1.2 SD (95% CI 0.9-1.5), higher by 19.3% (14.6-24.0) and 1.4 SD (0.9-1.9), higher by 26.0% (17.4-34.5) in ZA than control arms respectively (both P < .001). Five controls developed Genant 3 vertebral fractures, 0 in the ZA arm. Mobility, pain, and bone turnover markers were similar between arms at 12 and 24 months. Trabecular BMC and vBMD pQCT at radius and tibia were greater at 12 months in the ZA cohort than control; the evidence for this difference remained at 24 months for radius but not tibia.

Conclusion

ZA improved BMD in glucocorticoid-dependent DMD boys. Although the small cohort precluded demonstrable fracture benefit, improved BMD might reduce incident vertebral fracture.
Development of a physiologically relevant and easily scalable LUHMES cell-based model of G2019S LRRK2-driven Parkinson's disease
Authors: Calamini Barbara , Geyer Nathalie , Huss-Braun Nathalie , Bernhardt Annie , Harsany Véronique , Rival Pierrick , Cindhuchao May , Hoffmann Dietmar , Gratzer Sabine
Published: May 2021

Parkinson's disease (PD) is a fatal neurodegenerative disorder that is primarily caused by the degeneration and loss of dopaminergic neurons of the substantia nigra in the ventral midbrain. Mutations in leucine-rich repeat kinase 2 (LRRK2) are the most common genetic cause of late-onset PD identified to date, with G2019S being the most frequent LRRK2 mutation, which is responsible for up to 1-2% of sporadic PD and up to 6% of familial PD cases. As no treatment is available for this devastating disease, developing new therapeutic strategies is of foremost importance. Cellular models are commonly used for testing novel potential neuroprotective compounds. However, current cellular PD models either lack physiological relevance to dopaminergic neurons or are too complex and costly for scaling up the production process and for screening purposes. In order to combine biological relevance and throughput, we have developed a PD model in Lund human mesencephalic (LUHMES) cell-derived dopaminergic neurons by overexpressing wild-type (WT) and G2019S LRRK2 proteins. We show that these cells can differentiate into dopaminergic-like neurons and that expression of mutant LRRK2 causes a range of different phenotypes, including reduced nuclear eccentricity, altered mitochondrial and lysosomal morphologies, and increased dopaminergic cell death. This model could be used to elucidate G2019S LRRK2-mediated dopaminergic neural dysfunction and to identify novel molecular targets for disease intervention. In addition, our model could be applied to high-throughput and phenotypic screenings for the identification of novel PD therapeutics.
The temperature sensitivity of memory formation and persistence is altered by cold acclimation in a pond snail
Authors: Fernell Maria , Rivi Veronica , Batabyal Anuradha , Lukowiak Ken
Published: May 2021

There are reports on the inability of inbred, laboratory-reared Lymnaea stagnalis to perform feeding and aerial respiration in the cold. It has also been suggested that laboratory-bred snails have an inability to perform aerial respiration in winter months in the laboratory. Here, we used an inbred, laboratory-reared strain of Lymnaea (the S-strain) to demonstrate that the snails are capable of performing those behaviours in a cold (4°C) environment after a 2 day acclimation period. In addition, the inbred snails were able to perform aerial respiration during winter months at room temperature (20°C) in the laboratory. The persistence of long-term memory (LTM) was extended for at least 4 weeks by placing S-strain snails into a 4°C environment following training. Typically, the cold block (CB) procedure (1 h at 4°C) immediately after a training session blocks LTM formation in the S-strain but not in a freshly collected strain. Four weeks at 4°C transformed the S-strain phenotype into one resisting the CB procedure. Thus, with a 4 week cold spell snails gain a resistance to the CB procedure, and that would explain why freshly collected snails are resistant to the procedure. However, we found that F1 progeny of a freshly collected strain reared in the laboratory were resistant to the CB procedure. This suggests that an unknown selection resulted in the S-strain being susceptible to the CB procedure.
Hot days are associated with short-term adrenocortical responses in a southern African arid-zone passerine bird
Authors: Moagi Lesedi L. , Bourne Amanda R. , Cunningham Susan J. , Jansen Raymond , Ngcamphalala Celiwe A. , Ganswindt André , Ridley Amanda R. , McKechnie Andrew E.
Published: May 2021

Relatively little effort has been directed towards elucidating the role of physiological stress pathways in mediating avian responses to global heating. For free-ranging southern pied babblers, Turdoides bicolor, daily maximum air temperatures (Tmax) between ∼35 and ∼40°C result in reduced foraging efficiency, loss of body mass and compromised breeding success. We tested the hypothesis that very hot days are experienced as stressors by quantifying relationships between Tmax and faecal glucocorticoid metabolite (fGCM) levels in naturally excreted droppings. On days when Tmax<38°C, fGCM levels were independent of Tmax (mean±s.d. 140.25±56.92 ng g−1 dry mass). At Tmax>38°C, however, fGCM levels increased linearly with Tmax and averaged 190.79±70.13 ng g−1 dry mass. The effects of Tmax on fGCM levels did not carry over to the following morning, suggesting that very hot days are experienced as acute stressors.
Surgery for Bismuth-Corlette Type 4 Perihilar Cholangiocarcinoma: Results from a Western Multicenter Collaborative Group
Authors: Ruzzenente Andrea , Bagante Fabio , Olthof Pim B. , Aldrighetti Luca , Alikhanov Ruslan , Cescon Matteo , Koerkamp Bas Groot , Jarnagin William R. , Nadalin Silvio , Pratschke Johann , Schmelzle Moritz , Sparrelid Ernesto , Lang Hauke , Iacono Calogero , van Gulik Thomas M. , Guglielmi Alfredo ,   Perihilar Cholangiocarcinoma Collaboration Group, Andreou A. , Bartsch F. , Benzing C. , Buettner S. , Campagnaro T. , Capobianco I. , Charco R. , de Reuver P. , de Savornin Lohman E. , Dejong C. H. C. , Efanov M. , Erdmann J. I. , Franken L. C. , Giovinazzo G. , Giglio M. C. , Gomez-Gavara C. , Heid F. , IJzermans J. N. M. , Isaac J. , Jansson H. , Ligthart M. A. P. , Maithel S. K. , Malagò M. , Malik H. Z. , Muiesan P. , Damink S. W. M. Olde , Quinn L. M. , Ratti F. , Ravaioli M. , Rolinger J. , Schadde E. , Serenari M. , Troisi R. , van Laarhoven S. , van Vugt J. L. A.
Published: May 2021

Background

Although Bismuth-Corlette (BC) type 4 perihilar cholangiocarcinoma (pCCA) is no longer considered a contraindication for curative surgery, few data are available from Western series to indicate the outcomes for these patients. This study aimed to compare the short- and long-term outcomes for patients with BC type 4 versus BC types 2 and 3 pCCA undergoing surgical resection using a multi-institutional international database.

Methods

Uni- and multivariable analyses of patients undergoing surgery at 20 Western centers for BC types 2 and 3 pCCA and BC type 4 pCCA.

Results

Among 1138 pCCA patients included in the study, 826 (73%) had BC type 2 or 3 disease and 312 (27%) had type 4 disease. The two groups demonstrated significant differences in terms of clinicopathologic characteristics (i.e., portal vein embolization, extended hepatectomy, and positive margin). The incidence of severe complications was 46% for the BC types 2 and 3 patients and 51% for the BC type 4 patients (p = 0.1). Moreover, the 90-day mortality was 13% for the BC types 2 and 3 patients and 12% for the BC type 4 patients (p = 0.57). Lymph-node metastasis (N1; hazard-ratio [HR], 1.62), positive margins (R1; HR, 1.36), perineural invasion (HR, 1.53), and poor grade of differentiation (HR, 1.25) were predictors of survival (all p ≤0.004), but BC type was not associated with prognosis. Among the N0 and R0 patients, the 5-year overall survival was 43% for the patients with BC types 2 and 3 pCCA and 41% for those with BC type 4 pCCA (p = 0.60).

Conclusions

In this analysis of a large Western multi-institutional cohort, resection was shown to be an acceptable curative treatment option for selected patients with BC type 4 pCCA although a more technically challenging surgical approach was required.
Optimized scan delay for late hepatic arterial or pancreatic parenchymal phase in dynamic contrast-enhanced computed tomography with bolus-tracking method
Authors: Noda Yoshifumi , Kawai Nobuyuki , Ishihara Takuma , Tsuboi Yoshiki , Kaga Tetsuro , Miyoshi Toshiharu , Hyodo Fuminori , Matsuo Masayuki
Published: May 2021

Objectives:

To determine the optimal scan delay corresponding to individual hemodynamic status for pancreatic parenchymal phase in dynamic contrast-enhanced CT of the abdomen.

Methods:

One hundred and fourteen patients were included in this retrospective study (69 males and 45 females; mean age, 67.9 ± 12.1 years; range, 39–87 years). These patients underwent abdominal dynamic contrast-enhanced CT between November 2019 and May 2020. We calculated and recorded the time from contrast material injection to the bolus-tracking trigger of 100 Hounsfield unit (HU) at the abdominal aorta (s) (TimeTRIG) and scan delay from the bolus-tracking trigger to the initiation of pancreatic parenchymal phase scanning (s) (TimeSD). The scan delay ratio (SDR) was defined by dividing the TimeSD by TimeTRIG. Non-linear regression analysis was conducted to assess the association between CT number of the pancreas and SDR and to reveal the optimal SDR, which was ≥120 HU in pancreatic parenchyma.

Results:

The non-linear regression analysis showed a significant association between CT number of the pancreas and the SDR (p < 0.001). The mean TimeTRIG and TimeSD were 16.1 s and 16.8 s, respectively. The SDR to peak enhancement of the pancreas (123.5 HU) was 1.00. An SDR between 0.89 and 1.18 shows an appropriate enhancement of the pancreas (≥120 HU).

Conclusion:

The CT number of the pancreas peaked at an SDR of 1.00, which means TimeSD should be approximately the same as TimeTRIG to obtain appropriate pancreatic parenchymal phase images in dynamic contrast-enhanced CT with bolus-tracking method.

Advances in knowledge:

The hemodynamic state is different in each patient; therefore, scan delay from the bolus-tracking trigger should also vary based on the time from contrast material injection to the bolus-tracking trigger. This is necessary to obtain appropriate late hepatic arterial or pancreatic parenchymal phase images in dynamic contrast-enhanced CT of the abdomen.
Certification Relics: Entrepreneurship Amidst Discontinued Certifications
Authors: Eberhart Robert N. , Armanios Daniel Erian
Published: May 2021

We explore a key tension between certification and entrepreneurial entry. On the one hand, more stringent certifications may provide greater legitimacy. On the other hand, market entry may be facilitated by easing such standards. To reconcile this tension, we examine discontinued certifications. We draw on research into how new ventures use certifications to gain legitimacy, along with quantitative data from new venture credit records. We show that after a certification is discontinued, new ventures in emerging industries continue to conform to these discontinued certified standards. Our study shows that those whose attributes do not provide other sources of legitimacy (e.g., unconventional founders in emerging industries) are more likely than other new ventures to comply with discontinued certification. However, those with other legitimating attributes (e.g., elite institution alumni founders) can overcome such legitimacy deficits and take advantage of new rules easing entry. Overall, our findings show that discontinued certifications can become certification “relics” whose standards continue to linger and influence entry, even after they are no longer formally in effect. Our study and its findings enhance our understanding of institutional support for new ventures, as well as the repertoire of strategic actions available to new ventures to gain legitimacy and acceptance in the face of institutional change.
Factors Affecting Willingness to Pay for Outpatient Services at RSU Tangerang Selatan
Authors: Astrilia Farah Elena , Hadiwiardjo Yanti Harjono , Soeryo Gatot
Published: May 2021

Background: The government established a national health insurance program (NHI) to increase access to health services but the program is still not optimal, it affects the number of hospital visits and income. Therefore it required an analysis of patient’s willingness to pay out of pocket for outpatient services. The purpose of this study was to determine factors affecting patient’s willingness to pay. Method: This research is a cross sectional study involving 124 internal medicine outpatients at General Hospital (RSU) South Tangerang City in November 2019. Data were obtained from a questionnaire. Patient’s income, information, treatment experience, health insurance, distance to hospital, health service, ability to pay, and willingness to pay was investigated using chi square and logistic regression analysis. Results: The results outcomes showed that the level of willingness to pay of respondents is quite high and is influenced by patient’s income (p = 0.001), information (p = 0.045), treatment experience (p = 0.010), and ability to pay (ATP) (p = 0.001).  Factors that have the most significant associations were patient’s ability to pay (OR = 14,502). Conclusion: Patient’s income, information, treatment experience, and ATP affect the willingness to pay of patients.
Spatial Distribution of Dengue Hemorrhagic Fever (DHF) Casesin Sragen
Authors: Setyawan Dodiet Aditya , Setyaningsih Wiwik
Published: May 2021

Background: Dengue Hemorrhagic Fever (DHF) had still become a health problem that often occurred and not least caused death for Indonesia especially in Sragen, Central Java. Distribution of DHF cases in an area could be described using Spatial analysis with Geographic Information Systems (GIS). Objective: This study aimed to provide spatial distribution of Dengue Hemorrhagic Fever cases and regional endemicity of DHF in Sragen during 2016-2018 using Geographic Information Systems. Method: Descriptive research design with Cross-Sectional approach using GIS was used to get the description of spatial distribution of dengue and the region endemicity of dengue in Sragen. The sample used was Saturated Sample which was secondary data about the incidence of DHF from District Health Office of Sragen from 2016 to 2018 totaling 1,349 cases. The subjects consisted of geographical areas which consisted of 20 subdistricts with DHF case. The collected data were analyzed descriptively by displaying a frequency distribution table and description of spatial distribution using Geographic Information System. Results: The results showed that the spatial distribution of DHF was spread randomly in all districts in Sragen. The average incidence rate (IR) of DHF during the last 3 years in Sragen was > 50 / 100,000 population. Spatial description showed that 58 villages out of 208 villages in Sragen were DFH endemic areas and generally all subdistricts in Sragen were endemic areas of DHF. Conclusion: Spatial description of DHF in Sragen showed that all subdistricts in Sragen were endemic areas for DHF.
Análise das complicações clínico-obstétricas em gestantes adolescentes segundo a Classificação de Robson
Authors: Cortez Mirelly Barbosa , Santos Amuzza  Aylla Pereira dos , Sanches Maria Elisângela Torres de Lima , Teixeira Larissa De Morais , Santos Larissa Thaís Omena dos , Alves Siane Mariano
Published: May 2021

Objetivo: analisar as complicações obstétricas de gestantes adolescentes por meio da Classificação de Robson. Método: trata-se de uma pesquisa quantitativa documental. Foram pesquisados 150 prontuários de gestantes adolescentes de alto risco. O estudo foi de setembro a novembro/2019 e iniciou após a aprovação do Comitê de ética em Pesquisa da Universidade Federal de Alagoas. Resultados: as taxas de cesáreas do grupo 1 foram o dobro do recomendado (18,92%), pela Classificação de Robson. No grupo 2, houve 100% de cesárea, enquanto recomendação é de 20 a 35%. No grupo 4 observou-se 100% de parto vaginal, enquanto que os grupos 5, 8 e 10 excederam o número de cesáreas em cerca de 15,40 a 20%. Conclusão: evidenciou-se, por meio da Classificação de Robson, que o tipo de parto das gestantes adolescentes que foram afetados por uma complicação clínico-obstétrica foi o parto cesáreo, com aumento nos grupos de gestante 1, 2, 5, 8 e 10.
Preschool Teachers’ Preparation Programs: The Use of Puppetry for Early Childhood Science Education
Authors: Ocal Erdinc , Karademir Abdulhamit , Saatcioglu Ozkan , Demirel Beyza
Published: May 2021

This paper investigated how puppetry could be used to improve the standards of early childhood science education. This study determined the effect of a puppet-making and puppetry workshop on preservice preschool teachers’ beliefs and attitudes towards science education and looked into their experiences during and after puppet-making. Although participants faced some difficulties during the workshop, they developed numerous socioemotional skills. Puppetry activities can help preservice teachers learn how to deliver child-centered, stimulating, and interactive classes. Using puppets in early childhood science education can help teachers develop positive attitudes towards science and offer students high-quality, engaging, and creative activities.
Cutting edge selection: learning from high reliability organisations for virtual recruitment in surgery during the COVID-19 pandemic
Authors: Hardie JA , Green G , Bor R , Brennan PA
Published: May 2021

Introduction

National selection for higher surgical training (ST3+) recruitment in the UK is competitive. The process must prioritise patient safety while being credible, impartial and fair. During the COVID-19 pandemic, all face-to-face interviews were cancelled. Selection was based on a controversial isolated self-assessment score with no evidence checking taking place. From 2021, selection will take place entirely online. Although this has cost and time advantages, new challenges emerge.

Methods

We review surgical selection as it transitions to an online format and suggest validated methods that could be adapted from High Reliability Organisations (HRO).

Findings

Virtual selection methods include video interviewing, online examinations and aptitude testing. These tools have been used in business for many years, but their predictive value in surgery is largely unknown. In healthcare, the established online Multi-Specialty Recruitment Assessment (MSRA) examines generic professional capabilities. Its scope, however, is too limited to be used in isolation. Candidates and interviewers alike may have concerns about the technical aspects of virtual recruitment. The significance of human factors must not be overlooked in the online environment. Surgery can learn from HROs, such as aviation. Pilot and air traffic control selection is integral to ensuring safety. These organisations have already established digital selection methods for psychological aptitude, professional capabilities and manual dexterity.

Conclusion

National selection for higher surgical training (ST3+) can learn from HROs, using validated methods to prioritise patient safety while being acceptable to candidates, trainers and health service recruiters.
Hearing Evaluation of ARthroplasty Surgeons: results from the HEARS study
Authors: Palmer JS , Wilson C , Fraig H , Wilson D , Garrett S
Published: May 2021

Aims

The aim of this study was to investigate whether the prevalence of hearing loss among arthroplasty surgeons was comparable to clinicians from other medical specialties and to explore the factors associated with hearing loss.

Methods

A cross-sectional prevalence study was carried out. Arthroplasty surgeons and non-surgical clinicians were recruited from orthopaedic and medical conferences. All participants were given a paper questionnaire including demographic details, hearing history and the Tinnitus and Hearing Survey. All participants were screened for hearing loss in a quiet room using the HearCheck Screener™ (HCS; Siemens, Munich, Germany). Logistic regression was used to identify factors associated with hearing loss. All statistical models were adjusted for age, gender, smoking status and personal noise exposure.

Results

The HEARS (Hearing Evaluation of ARthroplasty Surgeons) study recruited 188 participants (106 arthroplasty surgeons; 82 non-surgical clinicians). Prevalence of hearing loss identified by the HCS was 31% for arthroplasty surgeons vs 11% for non-surgical clinicians. The odds of failing the HCS were 3.7 times higher in arthroplasty surgeons compared to their non-surgical colleagues (p < 0.004). The odds of self-reported hearing using the Tinnitus and Hearing Survey were 2.79 times higher among arthroplasty surgeons (p < 0.003).

Conclusion

The prevalence of hearing loss among arthroplasty surgeons is significantly higher than in their non-surgical colleagues. Noise generated during arthroplasty surgery should be recognised and managed to create safer working conditions.
Trammel net design engineering for operation with the sweeping method (Ciker net)
Authors: Wassahua Zainal , Martasuganda Sulaeman , Baskoro Mulyono Sumitro , Sondita Muhammad Fedi Alfiadi
Published: May 2021

The active operation of a trammel net by a sweeping technique is commonly used by fishermen in Cilacap, which are often referred as ciker nets. They are operated by lowering the net in a straight line and pulling the tail end from a ship moving in a full circle, while the other end functions as a circular axis. The effect of active operation allows for changes in performance with time, such as easy lifting or less buoyancy, and the unstable display of gears. This makes it necessary to perform design engineering, especially on buoys, sinkers, and high nets. However, the suitable quantity of these components for ciker net has never been ascertained. Calculations about how many buoys, sinkers, and net height to add need to be done to enhance ciker net construction for active operation. This research aimed to determine the optimum configuration of buoys, sinkers, and net height, and determine the engineering design of ciker nets based on the optimum ratio of buoyancy force to the sinking force of the trammel net. Therefore, the parameters measured include hanging ratio, stretched net length, buoyancy force, and sinking force. The results showed that the optimum configuration of buoys, sinkers, and net height was 59 pieces, 341 pieces, and 1.5 m respectively. Changes in the design of ciker nets, especially in the three components that affect the addition of buoyancy and sinking force ratio were based on the comparison of the trammel nets which was 1:5 greater than the design owned by fishermen at 1:4.Keywords:Bouyancy forceSinking forceCiker netTrammel netShrimp
QoT assessment of the optical spectrum as a service in disaggregated network scenarios
Authors: Kaeval Kaida , Fehenberger Tobias , Zou Jim , Jansen Sander Lars , Grobe Klaus , Griesser Helmut , Elbers Jörg-Peter , Tikas Marko , Jervan Gert
Published: May 2021

The potential to operate third-party terminals over multi-domain transparent optical networks attracts operators and customers to implement optical spectrum as a service (OSaaS). Because infrastructure information cannot always be shared with OSaaS end customers, alternatives to off-line quality of transmission (QoT) estimation tools are required to assess the performance of the spectrum slot to estimate achievable throughput. In this paper, commercially available sliceable coherent transceivers are used to assess the generalized signal-to-noise ratio (GSNR) based QoT of the OSaaS in a live production network for both narrowband and wideband OSaaS configurations. Extended channel probing based on symbol rate variability is combined with spectral sweeping and operation regime detection to characterize OSaaS implementations on 17 links with different underlying infrastructure configurations to maximize capacity and increase service margins in a low-margin operation regime. We achieve 0.05 dB estimation accuracy in the GSNR for wideband spectrum services and 0.32 dB accuracy for narrowband spectrum services. Based on the GSNR profile, spectral misalignment, spectral ripple, and operation regime are detected and service margin improvements are demonstrated. Finally, we discuss the network optimization perspective based on acquired data from channel probing and propose use cases for continuous channel probing in transparent optical networks.
Agile spectral tuning of high order harmonics by interference of two driving pulses
Authors: Schuster Vittoria , Hilbert Vinzenz , Klas Robert , Liu Chang , Tschernajew Maxim , Bernhardt Birgitta , Rothhardt Jan , Limpert Jens
Published: May 2021

In this work, the experimental realization of a tunable high photon flux extreme ultraviolet light source is presented. This is enabled by high harmonic generation of two temporally delayed driving pulses with a wavelength of 1030 nm, resulting in a tuning range of 0.8 eV at the 19th harmonic at 22.8 eV. The implemented approach allows for fast tuning of the spectrum, is highly flexible and is scalable towards full spectral coverage at higher photon energies.
High-performance tunable resonant electro-optical modulator based on suspended graphene waveguides
Authors: Rezaei Mir Hamid , Shiri Mehrdad
Published: May 2021

The exceptional tunable waveguiding characteristics of graphene surface plasmons have remained unrivaled since it has inspired many electro-optical (EO) devices in terahertz (THz) and mid-infrared (MIR) photonic circuits. We propose and numerically investigate a low-loss, highly extinctive resonant EO modulator based on a suspended graphene plasmonic waveguide. Unlike other resonance-based modulators, the input power has negligible interaction with lossy resonance cavity in on-state, remarkably reducing the losses. Achieving the insertion loss (IL) of 1.3 dB and the extinction ratio (ER) of 22 dB within a footprint less than 3 µm2 substantiates the superiority of the proposed structure. The charge transport simulations are first conducted to calculate the steady-state charge distribution. The three-dimensional finite-difference time-domain (3D-FDTD) method is utilized to monitor the guided wave propagation and modulation properties. We show that the transmission spectrum is highly dependent upon geometric parameters of the structure, and the modulator can be effectively tuned to operate at the desired wavelength by applying a suitable gate voltage. Simulation results show the modulation bandwidth of 71 GHz corresponding to the total capacitance of 4.8 fF within the active area. The novel EO modulator structure has shown great potentiality and flexibility to find other applications in MIR and THz integrated circuits like controllable notch filters and switches.
Inverse design of a Raman amplifier in frequency and distance domains using convolutional neural networks
Authors: Soltani Mehran , Da Ros Francesco , Carena Andrea , Zibar Darko
Published: May 2021

We present a convolutional neural network architecture for inverse Raman amplifier design. This model aims at finding the pump powers and wavelengths required for a target signal power evolution in both distance along the fiber and in frequency. Using the proposed framework, the prediction of the pump configuration required to achieve a target power profile is demonstrated numerically with high accuracy in C-band considering both counter-propagating and bidirectional pumping schemes. For a distributed Raman amplifier based on a 100 km single-mode fiber, a low mean set (0.51, 0.54, and 0.64 dB) and standard deviation set (0.62, 0.43, and 0.38 dB) of the maximum test error are obtained numerically employing two and three counter-, and four bidirectional propagating pumps, respectively.
Optical camera communications link using an LED-coupled illuminating optical fiber
Authors: Teli Shivani Rajendra , Eollosova Klara , Zvanovec Stanislav , Ghassemlooy Zabih , Komanec Matej
Published: May 2021

In this Letter, we propose and demonstrate a novel wireless communications link using an illuminating optical fiber as a transmitter (Tx) in optical camera communications. We demonstrate an indoor proof-of-concept system using an illuminating plastic optical fiber coupled with a light-emitting diode and a commercial camera as the Tx and the receiver, respectively. For the first time, to the best of our knowledge, we experimentally demonstrate flicker-free wireless transmission within the off-axis camera rotation angle range of 0–45° and the modulation frequencies of 300 and 500 Hz. We also show that a reception success rate of 100% is achieved for the camera exposure and gain of 200 µs and 25 dB, respectively.
Overcoming the rate–distance limit of device-independent quantum key distribution: erratum
Authors: Xie Yuan-Mei , Li Bing-Hong , Lu Yu-Shuo , Cao Xiao-Yu , Liu Wen-Bo , Yin Hua-Lei , Chen Zeng-Bing
Published: May 2021

In this Erratum the funding and references sections of Opt. Lett. 46, 1632 (2021)OPLEDP0146-959210.1364/OL.417851 have been updated.
Absorption and multi-phonon quenching in nanocrystal doped SiO2 fibers
Authors: Steinke Michael , Spelthann Simon , Rühl Axel , Ristau Detlev
Published: May 2021

SiO2 fibers doped with rare-earth-doped nanocrystals are promising to overcome the strong SiO2 multi-phonon quenching and could yield novel laser gain materials. So far, no attention has been paid to the question how well the nanocrystals can suppress the quenching depending on the properties of the SiO2 host glass. Here, a novel analytical model was applied to study the impact of the glass purity and composition on the quenching efficiency. Only a few experimentally accessible material and design parameters are required to compute the average quenching rate inside the nanocrystals. It is demonstrated that sufficiently low levels of quenching can only be expected for SiO2 free of impurities or dopants that increase the multi-phonon absorption. This indicates that high-purity aluminosilicate glasses, in contrast to phosphosilicate and borosilicate glasses, are ideal hosts.
An Introduction to Finite Element Methods for Inverse Coefficient Problems in Elliptic PDEs
Authors: Harrach Bastian
Published: May 2021

Several novel imaging and non-destructive testing technologies are based on reconstructing the spatially dependent coefficient in an elliptic partial differential equation from measurements of its solution(s). In practical applications, the unknown coefficient is often assumed to be piecewise constant on a given pixel partition (corresponding to the desired resolution), and only finitely many measurement can be made. This leads to the problem of inverting a finite-dimensional non-linear forward operator $\mathcal{F}:\ \mathcal{D}(\mathcal{F})\subseteq \mathbb{R}^{n}\to \mathbb{R}^{m}$
F
:

D
(
F
)
⊆

R
n

→

R
m

, where evaluating ℱ requires one or several PDE solutions.

Numerical inversion methods require the implementation of this forward operator and its Jacobian. We show how to efficiently implement both using a standard FEM package and prove convergence of the FEM approximations against their true-solution counterparts. We present simple example codes for Comsol with the Matlab Livelink package, and numerically demonstrate the challenges that arise from non-uniqueness, non-linearity and instability issues. We also discuss monotonicity and convexity properties of the forward operator that arise for symmetric measurement settings.

This text assumes the reader to have a basic knowledge on Finite Element Methods, including the variational formulation of elliptic PDEs, the Lax-Milgram-theorem, and the Céa-Lemma. Section 3 also assumes that the reader is familiar with the concept of Fréchet differentiability.
Modelling optimal vaccination strategy for SARS-CoV-2 in the UK
Authors: Moore Sam , Hill Edward M. , Dyson Louise , Tildesley Michael J. , Keeling Matt J.
Published: May 2021

The COVID-19 outbreak has highlighted our vulnerability to novel infections.

Faced with this threat and no effective treatment, in line with many other countries, the UK adopted enforced social distancing (lockdown) to reduce transmission—successfully reducing the reproductive number R below one. However, given the large pool of susceptible individuals that remain, complete relaxation of controls is likely to generate a substantial further outbreak. Vaccination remains the only foreseeable means of both containing the infection and returning to normal interactions and behaviour. Here, we consider the optimal targeting of vaccination within the UK, with the aim of minimising future deaths or quality adjusted life year (QALY) losses. We show that, for a range of assumptions on the action and efficacy of the vaccine, targeting older age groups first is optimal and may be sufficient to stem the epidemic if the vaccine prevents transmission as well as disease.