bluuebunny/crossref_metadata_2025 huggingface dataset:
Laparoscopic radical hysterectomy and tension-free vaginal tape-obturator (TVT-O) combined to treat cervical cancer complicating pelvic organ prolapse (POP) and stress urinary incontinence (SUI): A case report
Authors: Ran Yu , Yi Qiang , Li Cong , Zhou Qin
Published: April 2021

Background: Combined cervical cancer and pelvic organ prolapse (POP) is extremely uncommon and there is no standard treatment guideline for the complex comorbidity. We attempted to provide a treatment strategy and explore possible reasons for the comorbidities.Case presentation: We presented a 62-year-old patient seeking treatment for postmenopausal tissue prolapse and leakage of urine. Physical examination revealed procidentia with a 2.5 cm papillary and erosive lesion that was pathologically confirmed as cervical squamous cell carcinoma in stage Ib2. Clinical diagnosis included cervical squamous cell carcinoma in stage Ib2, prolapse of the anterior and posterior walls of the vagina and uterine, stress urinary incontinence (SUI). Then she was performed radical surgery for cervical cancer and tension-free vaginal tape-obturator (TVT-O). The urine function was good after operation. The surgery solved two diseases, which improved the quality of life (QOL) of patient and radically cured cervical malignancies at the same time.Conclusions: Surgical-based treatment seems to be more suitable that can cure the two diseases and improve the QOL. We should pay attention to the potential high incidence of HPV infection and HPV-related cervical cancer so that we should not ignore the screening for cervical cancer in the prolapse group and initiate surgery treatment strategies of cervical cancer or pre-cancerous lesions as early as possible to reach an optimal outcome of patient.
Urgent psychiatric consultations at Mental Health Center during COVID-19 pandemic: a retrospective observational study
Authors: Lorenzo Rosaria Di , Fiore Gianluca , Bruno Alessandra , Pinelli Margherita , Bertani Davide , Falcone Patrizia , Marrama Donatella , Starace Fabrizio , Ferri Paola
Published: April 2021

The coronavirus pandemic and related social distancing measures have brought about dramatic changes in people's lives. In particular, health workers have been forced to change their activities both for the different needs of patients and for preventive measures against the spread of the virus.This study is aimed at comparing the urgent psychiatric consultations (UPC) performed at the outpatient Mental Health Center (MHC) of Modena during the coronavirus outbreak period, from 1 March to 31 August 2020, with the same period in 2019. We retrospectively collected in a database the socio-demographic and clinical characteristics of patients who required UPC in the MHC during the 6-month observation periods in both 2019 and 2020. Data were statistically analyzed.We analyzed 656 urgent psychiatric consultations in 2019 and 811 in 2020, requested by 424 patients in 2019 and 488 in 2020, respectively. In the pandemic period, we observed an increase in the total and daily number of UPC which were more frequently required by patients in care at local outpatient services in comparison with the previous period. During 2020, an increased number of UPC were carried out remotely and the outcome was more frequently represented by discharge at home, avoiding hospitalization as much as possible.In the course of the coronavirus pandemic, MHC had to face an increased demand for clinical activity especially from the most clinically and socially vulnerable patients, who more frequently required UPC in outpatient psychiatric services.
Evaluating the Applicability of Phytoplankton Community Indices in Assessing The Ecological Quality Status (EcoQS) of a Coastal Ecosystem (Thane Creek, India): Mono-Metric vs Multi-Metric Approach
Authors: Hardikar Revati , Kesavan Haridevi Chanjaplackal , Deshbhratar Shantaj
Published: April 2021

The ecological quality status (EcoQS) of Thane Creek which is surrounded by a highly urbanized and industrialized sector of Mumbai was assessed by considering six phytoplankton community indices. Sampling was carried during Premonsoon to compare the efficiency of selected indices (Chl a, abundance, H′, MDI, IPI and MMPI) in the tropical setting. Ecostatus proposed by selected phytoplankton indices assigned a 'moderate-good' status to phytoplankton zone (PZ)-I, 'moderate-poor' to PZ-II while 'bad' to PZ-III. Comparatively, MMPI appeared to be the most efficient water quality index because of its capability in discriminating between 'acceptable' and 'not-acceptable' EcoQS. The gradient of anthropic activities along the creek plays a major role in deciding the EcoQS of Thane Creek. Limitations of all indices in evaluating environmental quality were also discussed in the present study. The investigation could provide a fillip to policymakers who are undertaking coastal water quality improvement initiatives.
Multi-Objective Genetic Algorithm Based Deep Learning Model for Automated COVID-19 Detection using Medical Image Data
Authors: Bansal Shrey , Singh Mukul , Dubey Rahul , Panigrahi Bijaya Ketan
Published: April 2021

In early 2020, the world is amid a significant pandemic due to the novel coronavirus disease outbreak, commonly called the COVID-19. Coronavirus is a lung infection disease caused by the Severe Acute Respiratory Syndrome Coronavirus 2 virus (SARS-CoV-2). Because of its high transmission rate, it is crucial to detect cases as soon as possible to effectively control the spread of this pandemic and treat patients in the early stages. RT-PCR-based kits are the current standard kits used for COVID-19 diagnosis, but these tests take much time despite their high precision. A faster automated diagnostic tool is required for the effective screening of COVID-19. In this study, a new semi-supervised feature learning technique is proposed to screen COVID-19 patients using chest CT Scans. The model proposed in this study uses a three-step architecture, consisting of a Convolutional Autoencoder based unsupervised feature extractor, a Multi-Objective Genetic Algorithm based feature selector, and a Bagging Ensemble of Support Vector Machines(SVMs) based classifier. The Autoencoder generates a diverse set of features from the images, and an optimal subset, free of redundant and irrelevant features, is selected by the evolutionary selector. The Ensemble of SVMs then performs the binary classification of the features. The proposed architecture has been designed to provide precise and robust diagnostics for binary classification (COVID vs.nonCOVID). A Dataset of 1252 COVID-19 CT scan images, collected from 60 patients, has been used to train and evaluate the model. The experimental results prove the superiority of the proposed methodology in comparison to existing methods.
Stability and Sensitivity Analysis and Optimization Control of the Hydro-turbine Generator Unit
Authors: Shi Yousong , Zhou Jianzhong
Published: April 2021

The hydro-turbine governing system (HTGS) and shafting system are mutually coupled. However, the interaction between them has always been neglected. This paper aims to explore the stability and sensitivity of the governor control parameters to the HTGS and shafting system and make the optimal control of the stable operation for the hydro-turbine generator unit(HTGU). First, a novel HTGU motion equation is proposed, which can make connections between the HTGS and the shafting system of the HTGU. And on this basis, the nonlinear coupling mathematical model of the HTGS and the shafting system is established. According to the nonlinear mathematical model, the sensitivity of the governor control parameters on the operating stability of the HTGU is obtained. Then, a multi-objective governor control parameters optimization strategy is proposed. Furthermore, the chaotic-dominated sorting genetic algorithm II(NSGA-II) and multi-objective evolutionary algorithm based on decomposition(MOEAD) were introduced to obtain the optimal control parameter and mutually verify the effectiveness of the optimization effect. Finally, the nonlinear dynamic characteristics of HTGU under optimal control were revealed. The simulation results show that the rotation speed deviation and shafting system vibrations are sensitive on the PID parameters in some ranges and the stable region will be decreased when considering the shafting system vibrations. The multi-objective PID parameter optimization strategy shows good control performance on the nonlinear dynamic characteristics of the HTGU. The shafting system vibrations excited by the coupled vibration sources are quasi-period in 3D space. In addition to this, these results and the optimization strategy can provide some bases for the design and stable operation of the HTGU.
Asymmetric Impact of Energy Utilization and Economic Development on Environmental Degradation in Somalia
Authors: Warsame Abdimalik Ali , Sarkodie Samuel Asumadu
Published: April 2021

While there are enormous studies on climate change in stable countries, climate policy perspectives from conflict-prone regions including Somalia are limited. This study investigates the asymmetric impact of energy and economic growth on environmental degradation in Somalia—by employing nonlinear autoregressive distributed lag model (NARDL) and causal techniques from 1985 to 2017. We find asymmetric long-term cointegration among the variables, whereas energy consumption and economic growth asymmetrically affect environmental degradation. Besides, the causal inferences reveal unidirectional causality from environmental pollution to positive change in energy consumption. Additionally, we find unidirectional causality from negative shock in economic growth to positive shock in economic growth. Moreover, a bidirectional causality is observed between population growth and negative change in economic growth. A unidirectional causality is confirmed from positive shock in economic growth to population growth—from negative change in economic growth to negative shock in energy consumption—from positive change in economic growth to positive shock in energy consumption—and negative change in energy consumption to population growth. This calls for the implementation of clean energy investment policies, good farming methods, and improved grazing land policies. The adoption of these policies will improve both environmental quality and sustained economic development.
Comsolic solution of an elliptic cylindrical compressible fluid flow
Authors: Hussain Azad , Hassan Ali , Arshad Mubahar
Published: April 2021

In the present study, viscous compressible flow with heat transfer effects in high permeable elliptical cylinder is investigated. Flow is kept laminar through Reynolds number at about 100. The heat transfer in fluids physics has been chosen to couple with laminar flow. The time dependent outcomes of surface velocity, pressure distribution, temperature distribution, isothermal contour profiles and drag coefficient are discussed in results. The mesh created through COMSOL has been described statistically. This mathematical modeling of stated problem is done in COMSOL Multi-physics. The results will help greatly to understand characterizations of viscous fluids.
Analysis of a Tunable CMOS-compatible Multilayer Waveguide Structure for Dual Polarizer-modulator Operation
Authors: Santos Renan Silva , Martinez Maria A. G.
Published: April 2021

A multilayer structure using graphene on a silicon waveguide is introduced and optimized to operate as a tunable TE-pass polarizer at 1310 nm or 1550 nm, a tunable TE/TM modulator at 1310 nm or 1550 nm, and a dual operation as a modulator at 1310 nm and a polarizer at 1550 nm. The analysis is based on the waveguide structure modal loss, the 2D graphene layer optical properties and its dependency on the applied chemical potential. The optimization is done by varying waveguide height and choosing the one with best figures of merit for each individual case and for the dual operation, the value that causes the least impairment overall is chosen. The polarizer tunability at 1310 nm or 1550 nm is attainable setting the applied chemical potential range from 0.55–0.65 eV or 0.45–0.55 eV, respectively. For the modulator tunability at 1310 nm or 1550 nm, the applied chemical potential range from 0.45–0.55 eV or 0.35–0.45 eV, respectively. The optimized waveguide silicon layer around 210 nm guarantees an extinction ratio better than 0.056 dB/µm for the polarizer and better than 0.045/0.133 dB/µm for the TE/TM modulator at 1310 nm, and better than 0.034 dB/µm for polarizer and better than 0.053/0.137 dB/µm for TE/TM modulator at 1550 nm. Further, the setting the chemical potential range at 0.45–0.55 eV, allows dual polarizer-modulator operation, with the modulator operating at 1310 nm and the polarizer operating at 1550 nm, presenting an extinction ratio better than 0.045 dB/µm and 0.034 dB/µm respectively. In all situations analyzed, insertion loss is lower than 0.007 dB/µm. The advantage of the structure in comparison with other similar devices relies in its versatility to operate as both modulator and polarizer, in different wavelengths, via a proper choosing of the applied chemical potential.
Structural, Morphological and Optical Bandgap Analysis of Multifunction Applications of Y2O3 -ZnO Nanocomposites : Varistors and Visible Photocatalytic Degradations of Wastewater
Authors: AlAbdulaal T.H , AlShadidi Manal , Hussien Mai , Vanga Ganesh , Bouzidi Abdel-Fatah , Rafique Saqib , Algarni Hamed , Zahran Heba , Abdel-wahab Mohamed Shaaban , Yahia Ibrahim
Published: April 2021

In this study, a combustion method as an efficient, easy, low-cost, and eco-friendly technique was used to synthesize nano-ZnO as a matrix with different yttrium doping ratios with different doping concentrations. Not only X-ray diffraction (XRD), but also scanning electron microscopy (SEM), and Fourier transformation Infrared spectroscopy (FT-IR) technique employed to characterize the structural and surface morphology of the Y2O3-ZnO nanocomposites. The obtained results supported ZnO's growth from crystalline to satisfactory nanoparticle structure by changing the yttrium doping concentrations inside ZnO nanoparticles. Moreover, UV-Vis diffuse reflectance spectroscopy, AC electrical conductivity, and current-voltage characteristics were considered to characterize the effects of yttrium doping on the energy bandgaps and electrical/dielectric properties and discussed the parameters of the ceramic varistors of the studied Y2O3-ZnO nano-complex oxides. The photocatalytic degradation efficiency of phenol, Methylene Blue, and Rhodamine B was investigated using all prepared Y2O3-ZnO nanostructured samples. As the yttrium doping ratios increased, the photocatalytic efficiency increased. After the addition of moderate Y3+ ions-doping, Further generation of hydroxyl radicals over ZnO. For Y2O3-ZnO (S5), the optimal photocatalyst is a degradation of 100 % of phenol, Methylene Blue, and Rhodamine B solutions compared to 80% of photocatalysis for ZnO stand alone. The prepared Y2O3-ZnO nanostructured materials are considered novel potential candidates in broad nano-applications ranging from biomedical and photocatalytic degradation for organic dyes and phenol to environmental and varistor applications.
Factors That Affect Recovery of Spontaneous Circulation by Patients With Cardiac Arrest Before Arrival at a Hospital in Daegu Metropolitan City, South Korea
Authors: Jung Hyun-Ok , Han Seungwoo
Published: April 2021

BackgroundThis study was conducted to investigate the factors that influence Return of Spontaneous Circulation (ROSC) in patients who suffered cardiac arrest before arriving at the emergency room in DMC, Korea. MethodsThis study considered data for cardiac arrest patients by 119 paramedics from January 1, 2019 to December 31, 2019 in Daegu. Chi-squared analysis was conducted to analyze whether the subjects showed ROSC before arriving at the emergency room. Binary logic regression analysis was conducted to identify the factors that affect ROSC. ResultsROSC when a mechanical compression device was used was reduced to 0.82 of that when it was not used (95% CI = 0.60 ~ 0.92). ROSC was 3.13 times higher when a first-aid defibrillator was used than when it was not used (95% CI = 1.40 ~ 6.99). ROSC was 657 times higher when epinephrine was injected than when it was not injected. Lastly, ROSC was 1.82 (95% CI = 1.04 ~ 3.19) times higher when intubation was used than when it was not used. ConclusionThis study suggests that continuous CPR education, securing financial support, and expansion of emergency rooms for local residents are necessary.
Mining and predictive characterization for resistance to leaf rust (Puccinia hordei Otth) using two subsets of barley genetic resources
Authors: Amouzoune Mariam , Amri Ahmed , Benkirane Rachid , Kehel Zakaria , Al-Jaboobi Muamer , Moulakat Adil , Abderrazek Jilal , Rehman Sajid
Published: April 2021

Sustainable barley production will require access to diverse ex-situ conserved collections to develop varieties with high yields and capable of overcoming the challenges imposed by major abiotic and biotic stresses. This study aimed at searching efficient approaches for the identification of new sources of resistance to barley leaf rust (LR). Two subsets, Generation Challenge Program Reference set (GCP) with 190 accessions and leaf rust subset constructed using the filtering approach of the Focused Identification of Germplasm Strategy (FIGS) with 100 accessions, were evaluated for the seedling as well as the adult plant stage resistance (APR) using two LR isolates (ISO-SAT and ISO-MRC) and in four environments in Morocco, respectively. Both subsets yielded a high percent of accessions with a moderately resistant (MR) reaction to the two LR isolates at the seedling stage. For APR, more than 50% of the accessions showed resistant reactions in SAT2018 and GCH2018, while this rate was less than 20% in SAT2017 and SAT2019. Statistical analysis using chi-square test of independence revealed the dependency of LR reaction on subsets at the seedling (ISO-MRC), as well as at the APR (SAT2017 and SAT2018) stage. Furthermore, the test of goodness of fit showed that FIGS_LR yielded higher percentages of resistant accessions than GCP subset in case of ISO-MRC at the seedling stage, and in case of SAT2017 and SAT2018 at APR stage. Although some of the tested machine learning models had moderate to high accuracies, none of them was able to find a strong and significant relationship between the reaction to LR and the environmental conditions showing the needs for more fine tuning of approaches for efficient mining of genetic resources using machine learning.
Electronic Properties of Multi-Ablooms Flower-Like Quantum Dots: a 2- D Finite Element Study
Authors: ghorbani mehrzad
Published: April 2021

In this paper, we investigated the electronic properties of two dimensional multi-abloom nanoflower. Also, we approximated a typical form of the Schrödinger equation through an appropriate 2-D finite element approach, and then, we have investigated the effects of different parameters such as number of ablooms, number of rose, variety geometric domain shape and systems size on the energy levels, eigenfunctions, and dipole matrix elements.
Fe induced a dynamic and biased allocation of material flux within terpenoid metabolism is controlled by CbNudix in Conyza blinii
Authors: Zheng Tianrun , Zhan Junyi , Wang Maojia , Sun Wenjun , Yan Jun , Shan Zhi , Chen Hui
Published: April 2021

Conyza Blinii (C. blinii) is a unique traditional Chinese medicine growing in Sichuan, China, which has soils with an abundant iron content. This Fe enrichment environment contributed to a variety of terpenoids of C. blinii, blinin and saponin which can play an important role in the process of resisting abiotic stress. The relationship between Fe and terpenoid metabolism was studied to explore Fe tolerance mechanism of C. blinii. In this study, C. blinii was treated with ferrous iron solutions, and the effect of ferrous iron on the synthesis of blinin and saponins was further studied by spectrophotometry and liquid chromatography. Also, gene expression was detected by qRT-PCR. Under ferrous treatment, the blinin content of C. blinii increased, while the total saponin content decreased. When the ferrous concentration reached 200 μM, the difference in metabolite production was the largest. Furthermore, it was found that blinin and saponin have synchronous and opposite accumulation trends, accompanied by time dependence. The genes expression results of key enzyme in the MVA and MEP pathways showed the same trends. In this process, the expression of CbNudixs played a key role to switch the material flux between MVA and MEP, via catalyzed the dephosphorylation of isoprenoid diphosphate. This study explored the effect of ferrous iron on the saponin and blinin synthesis of C. blinii and found the unique role of CbNudixs in regulating material flux between diterpene and triterpene synthesis, which greatly deepened our understanding of the mechanism of Fe tolerance of C. blinii.
Applying the RE-AIM implementation framework to evaluate fall prevention interventions in community dwelling adults with cognitive impairment: A review 
Authors: Racey Megan , Markle-Reid Maureen , Fitzpatrick-Lewis Donna , Usman Muhammad Ali , Gagne Helene , Hunter Susan , Ploeg Jenny , Sztramko Richard , Harrison Lisa , Lewis Ruth , Jovkovic Milos , Sherifali Diana
Published: April 2021

Background: Cognitive impairment (CI) is a risk factor for falls due to environmental or living settings, balance, gait and vision impairments, as well as medications. While previous systematic reviews have focused on the effectiveness of fall prevention programs in adults with cognitive impairment (1-4), but very limited information is available on their implementation. This review examines what aspects of fall prevention interventions for community-dwelling adults with CI have been reported using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to support successful implementation.Methods: We examined the included studies from our systematic review, which searched 7 databases for fall prevention interventions involving community-dwelling adults ≥50 years with mild to moderate CI. Reviewers screened citations and extracted data for study characteristics and the 5 dimensions (62 criteria) of the RE-AIM framework.Results: 12 randomized controlled trials (RCTs) consisting of 8 exercise interventions, 3 multifactorial interventions, and 1 medication treatment were included in the review. Only 4 of 62 criteria were reported by all 12 included studies and 29 criteria were not reported by any of the studies. Five of the included studies reported on 20 or more of the 62 possible RE-AIM criteria and three of these studies were ones that self-identified as “feasibility” studies. While Reach was the best-reported construct by the included studies, followed by Effectiveness and Implementation, the criteria within the Adoption and Maintenance constructs were rarely mentioned by these studies. In general, there was also wide variation in how each of the criteria were reported on by study authorsConclusion: Based on the reporting of RE-AIM components in this review, we are unable to make connections to successful intervention components and thus practice-based recommendations for fall prevention in those with CI. The lack of detail regarding implementation approaches greatly limits the interpretation and comparisons across studies to fully understand inform future research efforts.
Inferior Vena Cava Collapsibility Index: A Precise Non-invasive Tool for Evaluation of Edema in Children with Nephrotic Syndrome.
Authors: El-Halaby Hanan , Bakr Ashraf , El-Assmy Mohamed , Abdalla Hussein Abdelaziz , Salem Marwa , Eid Riham
Published: April 2021

Evaluating the volume status in children with Idiopathic nephrotic syndrome (INS) is mandatory to guide treatment and avoid unnecessary possibly hazardous albumin use. This study aimed to evaluate and compare the available tools used for volume status assessment and differentiating type of edema in children with INS. Sixty children with active INS were included and subdivided into hypovolemic and non-hypovolemic groups based on fractional excretion of sodium (FeNa%) and clinical assessment. All patients were studied for Inferior vena cava collapsibility index (IVCCI), plasma atrial natriuretic peptide (ANP) concentration and Body composition monitor (BCM). Forty-four patients (77.3%) had non-hypovolemic and 16 (26.7%) had hypovolemic states. Plasma ANP levels didn’t differ between hypovolemic and non-hypovolemic subgroups. IVCCI was higher in hypovolemic group (p<0.001) with sensitivity 87.5% and specificity 81.8% for hypovolemia detection while BCM-over hydration (BCM-OH) values were higher in non-hypovolemic group (p=0.04) with sensitivity= 68.2% and specificity =75% for detection of hypervolemia. FeNa% showed negative significant correlation with IVCCI (r= -0.578, p <0.001) and positive significant correlation with BCM-OH (r= 0.33, p=0.018), while FeNa% showed non-significant correlation to plasma ANP concentration (p=0.25). Conclusion: Non-hypovolemic edema is more frequent in edematous INS children than hypovolemic states. IVCCI is a reliable non-invasive bedside tool for evaluating volume status in INS children and is superior to BCM while plasma ANP levels can’t discriminate type of edema in INS.
A Mixed-Method Service Evaluation of Health Information Exchange in England: Technology Acceptance and Barriers and Facilitators to Adoption
Authors: Watkinson Fiona , Dharmayat Kanika , Mastellos Nikolaos
Published: April 2021

Background: The need for information exchange and integrated care has stimulated the development of interoperability solutions that bring together patient data across the health and care system to enable effective information sharing. Health Information Exchange (HIE) solutions have been shown to be effective in supporting patient care, however, user adoption often varies among users and care settings. This service evaluation aimed to measure user acceptance of HIE and explore barriers and facilitators to its wider uptake.Methods: A mixed-method study design was used. A questionnaire was developed using the Unified Theory of Acceptance and Use of Technology and administered to HIE users to assess technology acceptance. Pearson Chi2 tests were used to examine differences in acceptance between user groups and care settings. Web-based, semi-structured interviews were conducted drawing on the Normalisation Process Theory to explore barriers and facilitators to adoption. Interview data were analysed thematically using the Framework Approach.Results: A total of 105 HIE users completed the survey and another 12 participated in the interviews. Significant differences were found in HIE acceptance between users groups and care settings, with high adopters demonstrating higher acceptance and social care users showing lower acceptance. Participants identified several drivers to adoption, including increased information accessibility, better care coordination, informed decision-making, improved patient care, reduced duplication of procedures, and time and cost savings. However, they also highlighted a number of barriers, such as lack of awareness about the solution and its value, suboptimal communication strategies, inadequate training and lack of resources for knowledge dissemination, absence of champions to support the implementation, lack of end user involvement in the implementation and evaluation of HIE, unclear accountability and responsibility for the overall success of the programme, and patient confidentiality concerns.Conclusions: Working to better engage stakeholders, considering the needs of users from different care settings, providing users with training resources and support to increase their knowledge and confidence in using the system, developing implementation strategies to seek user feedback and monitor performance, and using communication strategies to increase awareness of the product and its value, can help improve uptake and adoption of HIE.
Operationalizing the distribution of oral HIV self-testing kits to men who have sex with men (MSM) in a highly homophobic environment: The Nigerian experience
Authors: Sekoni Adekemi , Tun Waimar , Dirisu Osasuyi , Ladi-Akinyemi Temitope , Shoyemi Elizabeth , Adebajo Sylvia , Ogunsola Folasade , Vu Lung
Published: April 2021

Background Self-care health interventions are innovative approaches for improving health and achieving the SDGs. MSM have been disproportionately affected by HIV. In spite of this, stigma from healthcare workers has reportedly prevented MSM from accessing HIV testing in health facilities. This paper explored the operationalization of using KOLs to distribute HIVST kits to MSM.Methods This qualitative survey used a combination of IDI with HIVST users and FGDs with KOLs to collect data three months after distribution of the test kits by the KOLs. Thematic analysis of the data was carried out.Results Three themes were generated namely: KOLs serve as a trusted resource to promote and support HIVST for the MSM community; Skills and qualifications of KOLs required to effectively distribute and promote uptake of HIVST; and Effective strategies used to create demand and promote uptake of HIVST.Conclusions This study showed the practical steps involved in operationalizing KOL support system distribution of HIVST that positively influenced the testing experience for the participants irrespective of the HIV status and engagement in care. KOLs are a reliable resource to leverage on for ensuring that HIV self-test is utilized and positive individuals are linked to treatment and care in homophobic environments.
Responding to Inmates' Health Needs in Zambia: A Policy Analysis
Authors: Muchinda Elizabeth K. , Zulu Joseph Mumba , Mweemba Chrispin , Chisela Chileshe , Mutale Wilbroad
Published: April 2021

Introduction{Fazel, 2011 #25}Worldwide, the rates of infectious and non-infectious diseases in prisons is generally higher than that of the general population. Although Zambia has adopted international and local guidelines to address prisoners’ health, the disease burden remains high in Zambian prisons. This study therefore explored barriers to translation and implementation of the legislative acts and guidelines that deal with health for inmates in correctional facilities. MethodsThis was a case study. Data was gathered through key informant interviews with stakeholders supporting inmates’ health in Zambia. These included the Ministry of Home Affairs, Ministry of Health (MoH), Ministry of Justice, Zambia Correctional Service, NGOs and UN agencies. The policy triangle was used to guide data collection, organization and analysis. Data was analysed using thematic analysis. Nvivo software version 12 was used for data coding. ResultsContext: There was political will and commitment to address inmate’s health in Zambia but was constrained by inadequate resources, infrastructure and trained Health Care Workers. Actors: Many key actors were not aware of key policy documents and guidelines addressing inmates’ health in Zambia. Coordination among partners was poor and efforts were underway to address lack of coordination in providing good health services to inmates. The role of the Ministry of health, as the lead partner, was emphasised going forward. Process: It was revealed that the policy development and implementation process was not consultative. There was weak inter-ministerial collaboration and lack of completion of the domestication process of the international guidelines, and this resulted in poor coordination and implementation of legal provision on inmates’ health.ConclusionDespite the existence of key legal and policy guidelines to address prisoners’ health in Zambia, there remain several barriers to implementation. These include lack of resources, lack of awareness and poor coordination among partners working in this sector. It will be important for the Ministry of Health to provide leadership and resources to raise awareness about prisoners’ health and a policy provision to support this process. Resources and infrastructure will be key to addressing the current challenges related to providing quality care for inmates in Zambia.
Menstrual Hygiene Management Challenges Among In-School Deaf Adolescents in Ghana
Authors: Mprah Wisdom Kwadwo , Sackey Emmanuel , Duorinaah Juventus
Published: April 2021

Background: Whiles challenges associated with menstrual hygiene management among adolescents are universal, some sub-populations, such as deaf girls, have peculiar challenges that requires special attention. Although there have been numerous studies on menstrual hygiene management among adolescents in the school setting in Ghana, the experiences of students with disabilities, particularly, deaf girls have not attracted adequate scholarly attention.Objective: The objective of the study was to generate new empirical evidence on menstrual hygiene management challenges of deaf adolescent girls in the special schools for the deaf in Ghana. The overall objective was to obtain data that could be used to improve menstrual hygiene practices among the target population, and, to bridge the gap in the existing literature regarding menstrual hygiene management experiences of in-school adolescent deaf girls in Ghana.Method: This study adopted a mixed method approach to investigate the menstrual hygiene management challenges of in-school deaf adolescent girls in Ghana. A total of 152 participants comprising 118 schoolgirls, 15 boys, seven school heads, six teachers, and six school housemothers from seven special schools were involved in the study.Results: The findings identified five challenges facing the girls. These are inadequate access to sanitary pads, inappropriate school WASH facilities, health related problems, negative attitude of male colleagues, and academic related challenges.Conclusion: The findings indicate that the quality of WASH facilities in the schools require improvement. We recommend that access to sanitary kits for underprivileged girls should be made a priority issue, boys and male teachers should be included in all menstrual hygiene management awareness programs, whiles the capacity of school housemothers on menstrual hygiene management should be enhanced. The study made important contributions to the existing literature on disability and menstrual health in Africa.
Late Occurrence of Hyperbilirubinemia and Renal Dysfunction During Nilotinib Treatment for an Elderly Chronic Myeloid Leukemia: A Case Report
Authors: Huang Jiayu , Lian Yun , Zhu Yu , zhao huihui
Published: April 2021

Background: Compared with the first-generation tyrosine kinase inhibitor (TKI), Nilotinib exhibited potent inhibition for BCR-ABL kinase activity, approved of the first-line and second-line TKI treatment of CML patients. Nilotinib was generally well tolerated with mild hematologic and non-hematologic adverse events. Hyperbilirubinemia, the most common non-hematologic adverse events, was confirmed presented mostly with grade I-II, rarely with grade III-IV in several large-scale clinical trails and real-world treatment. Case presentation: we report a rare case of elderly CML with severe bilirubin and creatinine elevation after receiving Nilotinib as second-line treatment for 2 years. After TKI suspension, hepatic and renal function improved quickly, but degree IV bone marrow suppression persisted for rather a long time. Monosomy 7 clone was detected at the point when renal dysfunction occurred, which indicated disease progression to accelerated phase. When Imatinib and Dasatinib were administrated alternately, a large area of acute cerebral infarction occurred unexpectedly after blood cell count recovered. So far, Imatinib treatment was continued, the patient is still stable state at the 6 months follow up.Conclusions: The report alerted clinicians to obsereve the incidence of adverse events during long-term TKIs therapy. Also, clinicans might consider the occurrence of monosomy clone when faced with poor efficacy or intolerance.
A 5- Year Surveillance of Nosocomial Infections in a University Hospital: A Retrospective Analysis
Authors: Erdem Ilknur , Yildirim Ilker , Safak Birol , Karaali Ritvan , Erdal Berna , Ardic Enes , Dogan Mustafa , Kardan M Enes , Kavak Caglar , Karadil Kubra Sahin , Yildiz Emre , Topcu Birol , Kiraz Nuri , Arar Cavidan
Published: April 2021

OBJECTIVE: ‘Nosocomial infections’ or ‘healthcare associated infections’ are a significant public health problem around the world. This study aimed to assess the rate of culture confirmed nosocomial infections (NIs), frequency of nosocomial pathogens and the antimicrobial resistance patterns of bacterial isolates in a University Hospital. METHODS: A retrospective evaluation of NIs in a tertiary hospital, between the years 2015 and 2019 in Tekirdag, Turkey. RESULTS : During the five years, the overall incidence rates (NI/100) and incidence densities (NI/1000 days of stay) of NIs were 2.04% (range 1.76-2.41/100) and 3.50/1000 patients-days (range 2.85-4.64/1000), respectively. 57.4 % of the infections were originated from the Intensive Care Units. The most common NIs according to the primary sites were bloodstream infections (55.3 %) and, pneumonia (20.4%). 67.5% of the isolated microorganisms as nosocomial agents were Gram negative bacteria, 24.9% of Gram positive bacteria and 7.6 % of candida. The most frequently isolated causative agents were Esherichia coli (16.7%) and Pseudomonas aeruginosa (15.7%). The rate of extended spectrum beta-lactamase production among E. coli isolates was 51.1%. Carbapenem resistance was 29.8% among isolates of Pseudomonas aeruginosa; 95.1% among isolates of Acinetobacter baumannii, 18.2% among isolates of Klebsiella pneumoniae. Colistin resistance was 2.4% among isolates of Acinetobacter baumannii. Vancomycin resistance was 5.3% among isolates of Enterococci.CONCLUSION: Our study results demonstrates the microorganisms of isolated from Intensive Care Units demonstrates high level resistance to many antimicrobial agents. The rising in incidence of multidrug-resistant microorganisms indicate that more interventions are urgently needed to reduce NIs in our ICUs.
IL6/STAT Signaling Pathway and PPARα are Involved in Mediating the dose Dependent Cardioprotective Effect of Fenofibrate in 5-fluorouracil induced Cardiotoxicity
Authors: refaie marwa , Shehata Sayed , Bayoumi Asmaa M.A. , El-Tahawy Nashwa Fathy Gamal , Abdelzaher Walaa Y.
Published: April 2021

Purpose: Cardiotoxicity of anticancer drugs such as 5-fluorouracil (5FU) and anthracyclines is a major complication that challenges their clinical usefulness. There is a critical need for finding new protecting drugs to defense against these harmful side effects. Up till now, there are no studies evaluate the possible cardioprotective effects of fenofibrate (FEN) in 5FU-induced cardiotoxicity. So that, we aimed in current model to evaluate such effect of FEN and explore different mechanisms mediating it.Methods: we used FEN (25, 50,100 mg/kg/day) orally for 7days with induction of cardiotoxicity by intraperitoneal (i.p.) injection of 5FU (150 mg/kg) on 5th day. Results: current study showed that 5FU succeeded in induction of cardiotoxicity and manifested by significant elevation of cardiac enzymes, tissue malondialdehyde (MDA), interleukin 6 (IL6), signal transducer and activator of transcription 4(STAT4) and caspase 3 levels. Furthermore, 5FU group showed toxic histopathological changes of marked cardiac damage and significant decrease in reduced glutathione (GSH), total antioxidant capacity (TAC) and peroxisome proliferator activated receptor alpha (PPARα) expression. FEN could reverse 5FU-induced cardiotoxicity by different mechanisms including upregulation of PPARα, inhibition of IL6/STAT signaling pathway, anti-inflammatory, anti-apoptotic and anti-oxidant properties.Conclusion: FEN had a significant cardioprotective effect against 5FU induced cardiac damage.
Is Viral Load a Prognostic Indicator for Outcome of Covid-19 Patients? A Prospective Cohort Study in Iran
Authors: Balajelini Mohammad Hosein Taziki , Rajabi Abdolhalim , Mohammadi Masoud , Tabarraei Alijan , Nikoo Seyed Mohammad Hadi Razavi , Ghourchaei Araz Berdi , Hosseini Seyed Mehran
Published: April 2021

Background: Covid-19 has different clinical symptoms and severity. Predicting its progress and results is clinically important. Hence, in this study, we investigated the relationship between virus load and the outcomes in Golestan Province. Methodology: We conducted a retrospective cohort study of COVID-19 diagnosed with RT-PCR testing from May 2020 to December 2020. According to the severity of the disease, the study groups were divided into three groups: outpatient, inpatient, and inpatient with death. SARS-CoV-2 viral load was assessed using cycle threshold (Ct) values from a reverse transcription-polymerase chain reaction assay applied to nasopharyngeal swab samples. Demographic properties, Clinical characteristics, and CT values of the studied patients were compared. Data were analyzed using STATA Version 16.0 software.Results: Of 1318 included subjects, 599 were outpatient, and 719 were hospitalized. Of the hospitalized patients, 487 were recovered and 232 died. The mean age (year) of patients was 48.81±18.40 and 51.9% were female. There were significant differences between the age and the severity of the disease, the mean age of patients who died was higher than other patients (p<0.001). The mean CT value of all patients was 26.80±4.43, which was higher in outpatients than inpatients' cases (p <0.001). We did not find any significant differences for the Ct values between recovered and dead cases (p=0.66). CT value levels were not significantly different between age and sex groups. Conclusions: According to the results of the study, CT value can be used only as a factor to determine the severity of the disease at the time of admission, but the load of the virus is not a factor to predict the outcome.
Effects of Coalescence and Isospin Symmetry on the Freezeout of Light Nuclei and Their Anti-particles
Authors: Waqas M. , Peng G. X. , Liu Fu-Hu , Wazir Z.
Published: April 2021

The transverse momentum spectra of light nuclei (deuteron, triton and helion) produced in various centrality intervals in Gold-Gold (Au-Au), Lead-Lead (Pb-Pb) and proton-Lead (p-Pb) collisions, as well as in inelastic (INEL) proton-proton (pp) collisions are analyzed by the blast wave model with Boltzmann Gibbs statistics. The model results are nearly in agreement with the experimental data measured by STAR and ALICE Collaborations in special transverse momentum ranges. We extracted the bulk properties in terms of kinetic freeze-out temperature, transverse flow velocity and freezeout volume. It is observed that deuteron and anti-deuteron freezeout later than triton and helion as well as their anti-particles due to its smaller mass, while helion and tri-ton, and anti-helion and anti-triton freezeout at the same time due to isospin symmetry at higher energies. It is also observed that light nuclei freezeout earlier than their anti-nuclei due to the large coalescence of nucleons for light nuclei compared to their anti-nuclei. The kinetic freezeout temperature, transverse flow velocity and kinetic freezeout volume decrease from central to peripheral collisions. Furthermore, the transverse flow velocity depends on mass of the particle which decreases with increasing the mass of the particle.PACS: 12.40.Ee, 13.85.Hd, 25.75.Ag, 25.75.Dw, 24.10.Pa
Alkalinity Cycling And Carbonate Chemistry Decoupling in Seagrass Mystify Processes of Acidification Mitigation
Authors: Miller Cale A. , Kelley Amanda L.
Published: April 2021

The adverse conditions of acidification on sensitive marine organisms has led to the investigation of bioremediation methods as a way to abate local acidification. This phytoremediation, by macrophytes, is expected to reduce the severity of acidification in nearshore habitats on short timescales. Characterizing the efficacy of phytoremediation can be challenging as residence time, tidal mixing, freshwater input, and a limited capacity to fully constrain the carbonate system can lead to erroneous conclusions. Here, we present in situ observations of carbonate chemistry relationships to seagrass habitats by comparing dense (DG), patchy (PG), and no grass (NG) Zostera marina pools in the high intertidal experiencing intermittent flooding. High-frequency measurements of pH, alkalinity (TA), and total-CO2 elucidate extreme diel cyclicity in all parameters. The DG pool displayed frequent decoupling between pH and aragonite saturation state (Ωarg) suggesting pH-based inferences of acidification remediation by seagrass can be misinterpreted as pH and Ωarg can be independent stressors for some bivalves. Estimates show the DG pool had an integrated ΔTA of 550 μmol kg-1 over a 12 h period, which is ~60 % > the PG and NG pools. We conclude habitats with mixed photosynthesizes (i.e., PG pool) result in less decoupling between pH and Ωarg.
The effects of premedication with methadone on intraocular pressure in dogs and cats
Authors: Delgado Esmeralda , Silva André Delgado da , Nunes Mariana Pinto
Published: April 2021

Background: The effects of premedication agents on the ocular physiology should be thoroughly understood by the ophthalmic surgeon so that intraocular pressure (IOP) values are kept stable. The purpose of this study was to determine the effects of methadone as a solo-agent of anaesthetic premedication on IOP in healthy dogs and cats.The study group included 60 clinically normal patients, 40 dogs and 20 cats. Ophthalmological examination, including baseline IOP (T0) of the subjects, was performed before methadone administration at a dosage of 0.2 mg kg-1. IOP variations were registered fifteen (T15) and thirty (T30) minutes later. IOP values were compared at each speciﬁc timepoint (T0, T15 and T30) using a repeated-measures analysis of variance (ANOVA) and differences were considered signiﬁcant when P < 0.05. Results: The sedative effect of methadone did not affect the ocular globe or nictitating membrane position nor the menace response, dazzle reﬂex, corneal blink reﬂex or palpebral reflexes in any case. None of the animals studied presented with the secondary effects associated with opioids such as salivation, nausea, vomit, defecation, dysphoria or a clear modification of the respiratory pattern, The mean ± SD baseline (T0) and post-treatment (T15, T30) IOP values were, respectively, 16,8 ± 3,84 mmHg, 17,6 ± 3,01 mmHg and 16,1 ± 3,28 mmHg for dogs and 17,1 ± 3,31 mmHg, 16,6 ± 3,40 mmHg and 16,61 ± 2,81 for cats. There were no statistically significant differences between baseline and post-treatment values in dogs (p=0,107) or cats (p=0.077). Conclusions: The administration of methadone as a solo-agent of anaesthetic premedication at a dosage of 0.2 mg kg-1 did not cause significant changes on IOP values in dogs or cats. Methadone presented as a safe alternative for sedation, anaesthetic premedication or analgesia in ophthalmological patients since it did not interfere with IOP regulation.