bluuebunny/crossref_metadata_2025 huggingface dataset:
The incidence of Jarisch–Herxheimer reactions and associated risk factors in pregnant women and nonpregnant women: A retrospective chart review at a university hospital in Japan
Authors: Mori Hiroshi , Shibata Eiji , Kondo Emi , Sasaki Natsuko , Sawada Yu , Yoshino Kiyoshi
Published: February 2023

Aims

Jarisch–Herxheimer reactions (JHR) is a transient adverse event that occurs during initial antimicrobial treatment for syphilis patients, and is known to develop uterine contractions and fetal distress in pregnant women complicated with syphilis. The aim of this study is to identify risk factors for JHR in patients with syphilis, and to clarify whether pregnancy status is a risk factor for JHR, and to describe the characteristics of pregnant women who develop JHR.

Methods

This was a retrospective chart review in a singleton university hospital in Japan. We collected data of syphilis patients who were diagnosed and treated at department of obstetrics and gynecology, dermatology between January 2010 and May 2022. There were no validated diagnostic criteria for JHR, we defined JHR as one or more of the following in addition to raised body temperature (≧38.0°C) within 24 h of initial antibiotic treatment: headache, chills, myalgias, tachycardia (≧110 bpm), new rash.

Results

There were 30 syphilis patients. Of whom nine (30%) were pregnant women and all their neonates were not diagnosed with congenital syphilis. Five patients (17%) developed JHR at the time of initial treatment (JHR group, n = 5). There was no difference between JHR group and non‐JHR group (n = 25) in pregnancy status. Secondary syphilis was an only significant risk factor for JHR. Two pregnant women with JHR were both treated for secondary syphilis in the third trimester of pregnancy.

Conclusion

Pregnancy status was not a risk factor for JHR in syphilis patients. Further research is needed.
Investigating the Student in Returning to Learn After Concussion: A Systematic Review andMeta‐Analysis
Authors: Pei Yalian , Kemp Amy M. , O'Brien Katy H.
Published: February 2023

Purpose

Examine concussion effects on academic outcomes, including student perspectives.

Methods

This study included a systematic review and meta‐analysis examining post‐concussion school attendance, academic performance, perceptions of academic difficulty, and accommodations for students in elementary through college settings. The analysis considered pre‐ and post‐injury factors, along with injury factors that contribute to post‐concussion academic outcomes.

Results

The systematic review showed that students with concussion miss more school days and perceive higher levels of academic difficulty, but results about academic performance varied. Meta‐analysis yielded small concussion effects on school absence and academic performance and moderate effects on perceptions of academic difficulty. Female sex, older age, history of migraine, prior concussions, severe or persistent symptoms, vestibular‐ocular motor, and cognitive disruptions are risk factors, but these moderators were not identified in the meta‐analysis due to lack of effect sizes.

Implications for School Health Policy, Practice, and Equity

This study confirmed negative concussion effects on academic absences, performance, and perceptions of academic difficulty. Identified contributing factors will guide future practices to support students returning to learn after concussion.

Conclusions

Negative impacts to academics from concussion may be amplified by complicating factors. Future investigations are needed to confirm risk factors and mitigating effects of early identification and post‐injury supports.
Influence of abiotic factors on kinetics of viable populations of biocontrol agents in the phyllosphere of lettuce and strawberry leaves
Authors: Tut Gurkan , Magan Naresh , Xu Xiangming
Published: February 2023

There is little information on the effect of temperature, relative humidity (RH) and vapour pressure deficit (VPD) on the viable populations of two commercial biocontrol strains, Bacillus subtilis QST 713 (recently classified as B. velezensis) and Gliocladium catenulatum J1446 (syn. Clonostachys rosea). The PMAxx‐qPCR molecular assay was used to quantify the viable biocontrol agent (BCA) populations on fully extended lettuce and strawberry leaves under a range of temperature and RH combinations. Overall, there was a small decline in the population size of viable cells for the two biocontrol organisms on strawberry and lettuce leaves within 10 days of application. However, for most experimental runs, which contained general UK agronomy climates, such a decline was not statistically significant. Moreover, for a few runs, the viable populations increased significantly in optimal BCA growth temperatures with high RH. Only temperature (ambient) and dew point significantly affected the rate of temporal changes in the viable biocontrol population size. Thus, an increasing temperature led to decreased daily mortality. It should be noted that much of the variability in the estimated daily mortality rates remains unaccounted for, thus unless under extreme conditions, the biocontrol efficacy in practice is less likely to be affected by the survival of biocontrol microbes but more likely by other factors that influence the density of biocontrol cells in the phyllosphere, especially dilution due to rapid host leaf expansion, spray coverage and rain wash‐off.
Amikacin disaggregates platelet clumps inEDTAblood samples from cats and dogs when added postcollection
Authors: Vasilatis Demitria M. , Walker Naomi J. , Borjesson Dori L.
Published: February 2023

Background

Pseudothrombocytopenia may lead to the erroneous diagnosis of thrombocytopenia, resulting in unnecessary testing and treatment. The addition of exogenous substances to blood samples prior to collection has been shown to mitigate platelet (PLT) clumps in blood samples. Postcollection additives aiming to disaggregate PLT clumps have been largely unexplored.

Objectives

We aimed to determine if the addition of amikacin to blood samples postcollection aids in the disaggregation of PLT clumps in cats and dogs.

Methods

For this prospective study, EDTA‐collected blood samples from 28 cats and 17 dogs were obtained from a hospital population at UC Davis Veterinary Medical Teaching Hospital. Samples had PLT clumps detected on blood smears and thrombocytopenia per analyzer count. Amikacin was added to samples postcollection, and an additional CBC was performed. Flow cytometry was performed to assess PLT‐fibrinogen binding in amikacin‐treated aliquots.

Results

PLT‐clumped samples treated with amikacin significantly increased PLT numbers by 134% and decreased mean platelet volume (MPV) values by 14% (P ≤ 0.0001) in cats, and increased PLT numbers by 32% (P = 0.04) and increased MPV values by 9% (P = 0.02) in dogs. Mean cell volume (MCV) slightly increased (<4%) for both species. No other CBC parameters were substantially affected by the addition of amikacin. Flow cytometry showed decreased PLT‐fibrinogen binding in the majority of cats but was not significant (P > 0.05).

Conclusions

Adding amikacin to PLT‐clumped blood samples postcollection may be a convenient solution for pseudothrombocytopenia in cats and dogs. Future studies are needed to elucidate the mechanism of amikacin and its effectiveness under different storage conditions. This is the first reported use of amikacin postcollection to disaggregate PLT clumps in blood samples from animals.
AN ESTIMATION OF NUMBER OF DAILY DEATHS DUE TO COVID-19 IN UNITED STATES OF AMERICA, UNITED KINGDOM AND TURKEY
Authors: Ülker Ezgi Deniz , Ülker Sadık
Published: February 2023

Covid-19 virus is threatening the world with health, social and economic implications and all around the world data is obtained continuously with pandemic for modelling and predicting the future. In this work, support vector regression technique was used to make some predictions on the daily death values due to Covid-19 virus. The models were created for the world, United States of America, United Kingdom and Turkey. All the regression models were tested using coefficient of determination (R2) and root mean square error (RMSE) values. The analysis was also conducted for comparing the suitability of linear, radial and polynomial kernels. The radial kernel produced relatively better results. In predicting the world data support vector regression with radial kernel produced 0.805262 R2 value on test data. In the models created for United States of America 0.723376 R2 value, for United Kingdom 0.95412 R2 value and for Turkey 0.875343 R2 value using test data were observed. Also, while the models were created for specific countries the comparisons were made between using only data for the country and also using the whole world data. In general modelling using the data for the world combined with the country data gave better prediction.
THE EFFECT OF MATERIAL STIFFNESS ON DENTAL IMPLANT STABILITY – A FINITE ELEMENT ANALYSIS
Authors: Ishak Muhammad Ikman , Daud Ruslizam , Mohd Noor Siti Noor Fazliah
Published: February 2023

The perseverance of dental implant system in restoration of occlusion is highly dependent on biomechanical overloading factors such as implant macro geometries, parafunctional oral habits, and material. Different implant materials could affect the load transfer at the bone-implant interface differently which is related to stress shielding phenomenon. To date, the role of various implant materials on the surrounding tissues as well as implant stability is still debatable and unclear especially when the implant failure is of concern. Through this study, implant body with different materials or stiffnesses that are zirconia, Ti-6Al-4V, cpTi, TiZr, and PEEK were investigated via 3-D FEA. The bone tissues were modelled based on CT image datasets and subsequently be processed in SolidWorks software. All geometries were converted into finite element models and analysed in ANSYS software. The bone and implant models were assigned with anisotropic and isotropic properties, respectively. A dynamic occlusal loading of 300 N and pretension of 20 N were applied on the implant body and screw, respectively. The results showed that the less stiff implant increased the bone stress and decreased the implant body stress values compared to the stiffer implant. Moreover, the implant with lower stiffness exhibited lower bone strain and higher implant deformation than the implant with higher stiffness. Of all implant materials analysed, PEEK is observed to be the most satisfactory. However, further modifications on PEEK would be necessary to improve inherent bioactivity and osseointegration.
NON-INVASIVE GRADING TECHNIQUE FOR RUBY GEMSTONE USING CHARGE-COUPLED DEVICE (CCD)
Authors: Mohd Rahalim Fatinah , Jamaludin Juliza , Raisin Syarfa Najihah
Published: February 2023

Ruby is one of the most popular and high-value gemstones that always attract the gemologist and jeweler in the diamond market. The wide use of ruby in various industries makes the grading of this gems more complicated due to a lot of synthetic and imitation rubies are made. The current grading techniques are mostly depending on the human visual assessment which prone to errors. This paper proposes a system that helps in grading the clarity characteristic of the ruby in non-invasive manner. The system includes a charge-coupled devices (CCD) and laser that is designed in the most suitable and effective way to conduct inspection on the light intensity of the ruby which will then determine the clarity of the ruby. CCD linear sensor is widely known as the reliable sensor especially when use in the optical system. The CCD linear sensor capture the light intensity from the ruby and convert it into the voltage value. The result shows a value of 1.7918 V obtained from the CCD linear sensor when ruby is placed in the system. This concludes that the CCD system can detect even slightest changes in the light intensity that can pass through the ruby and falls on the CCD linear sensor. The system is proven to be a reliable and effective system with 80% accuracy.
THE CRITICAL SUCCESS FACTORS OF PUBLIC-PRIVATE-PEOPLE PARTNERSHIPS (PPPPS) FOR EFFICIENT AND SUSTAINABLE INFRASTRUCTURE DEVELOPMENT IN THAILAND
Authors: Rakpanitmanee Supachai , Pathranarakul Pairote
Published: February 2023

Public-Private Partnership (PPP) is a commonly used arrangement to develop public infrastructures. Traditional PPP focuses primarily on the public sector as contracting agency and private sector as project company. This research explores a major gap observed in such setup, namely the lack of attention on the people sector who is the end-users or groups impacted by these public infrastructures. Based on literature review, qualitative analysis involving executive interviews, and quantitative analysis involving survey of operational staffs, this study recommends a new Public-Private-People Partnership strategic stakeholder institutional framework along with its components of critical success factors for both policy and operational regulating frameworks to enhance PPP practice, both in Thailand and beyond.
DETERMINATION OF PROCESS VARIABILITY BY USING TRIANGULAR FUZZY NUMBER TO MINIMIZE PRODUCTION LEAD TIME IN A DYNAMIC VALUE STREAM MAPPING
Authors: Thulasi M. , Faieza A.A , Azfanizam A.S , Leman Z.
Published: February 2023

This paper shows the incorporation of Value Stream Mapping (VSM) with triangular fuzzy numbers to determine variability and uncertainty in a conveyor manufacturing company. VSM is a pen and paper tool which is used to indicate wastes and bottleneck processes graphically and develop an action plan to enhance the production line. However, some weaknesses are identified in the conventional VSM where it fails to consider variability in a dynamic manufacturing environment. As such, this paper fills up the research gap by using Triangular Fuzzy Number (TFN) to illustrate time intervals, inventories and other variables of VSM operation. The purpose of this paper is to minimize total production lead time (TPLT) and total value-added time (TVAT) in the current value stream of the conveyor chain. More accurate details of variability in the dynamic manufacturing environment can be illustrated by a Triangular Fuzzy Number (TFN) of VSM.  As a result, the future value stream map shows 50% and 22% reduction in TPLT and TVAT respectively compared to the current value stream. In conclusion, this paper also recommends that in order to optimize the accuracy of VSM analysis further, a discrete event simulation can be used to examine the fuzzy VSM.
HAND RECOGNITION SYSTEM BASED ON ELECTROMYOGRAPHY FOR REAL-TIME HAND PROSTHETIC CONTROL
Authors: Sae Jong Nida , Sa-e Sakariya , Tirasor Ahmad , Mama Nifadila , Dao Hassan
Published: February 2023

Upper limb amputation is a significant limitation for achieving routine activities. Myoelectric signals detected by electrodes well-known as Electromyography (EMG) have been targeted to control upper limb prostheses of such lost limbs. Unfortunately, the acquisition, processing and use of such myoelectric signals are sophisticated. Furthermore, it necessarily requires complex computation to fulfil accuracy, robustness, and time-consumption execution for the real-time prosthesis application. Thus, machine learning schemes for pattern recognition are a potential approach to improve the traditional control for hand prostheses due to the movement of users and muscle contraction. This paper presents real-time hand posture recognition based on three hand postures using surface EMG (sEMG) signals. sEMG signals are acquired by the electrode channel and simultaneously collected while making a hand posture. Performance evaluation relies on classification accuracy and time consumption. The performance of six real-time recognition models is evaluated which combine two projection techniques and three classifiers. Results indicate that EMG-based pattern recognition (EMG-PR) control outperforms the traditional control for hand prostheses in real-time application. The highest classification accuracy is approximately 96%, whereas the lowest time consumption is 4 ms. In addition, the accuracy is dropped when the number of electrodes decreases nearly to 3%. These outcomes can apply to real-time hand prostheses to alleviate the limited prostheses available.
Pengurusan Hutang Kad Kredit – Sorotan Literatur Bersistematik daripada 2010-2020 (Credit Card Debt Management – Systematic Literature Review from 2010-2020)
Authors: Mohd Alwi Mohd Afifie , Abdullah Azwan , Luqman Azyanee
Published: February 2023

This systematic literature review highlights debt management among credit card owners in Southeast Asia. Getting financing at any financial institutions in Southeast Asia is easy - if you have enough qualifications. However, the impact of indebtedness has caused problems in managing it. Therefore, the author reviews previous studies that focus on consumer debt management. Meanwhile, the study adopted the methods of Preferred reporting Items for Systematic Reviews and Meta Analyses (PRISMA) by using two major databases, Scopus and Web of Science. As a result, there were 12 articles that were systematically analysed. After going through the theme analysis process, five main research themes were identified namely demographics, financial literacy, behavior, credit card management and economics. In total, under these themes, the study was able to publish 18 sub-themes and some new suggestions and directions to future researchers.
Self‐adjoint Laplacians and symmetric diffusions on hyperbolic attractors
Authors: Alikhanloo Shayan , Hinz Michael
Published: February 2023

We construct self‐adjoint Laplacians and symmetric Markov semigroups on hyperbolic attractors, endowed with Gibbs ‐measures. If the measure has full support, we can also conclude the existence of an associated symmetric diffusion process. In the special case of partially hyperbolic diffeomorphisms induced by geodesic flows on negatively curved manifolds the Laplacians we consider are self‐adjoint extensions of well‐known classical leafwise Laplacians. We observe a quasi‐invariance property of energy densities in the ‐conformal case and the existence of nonconstant functions of zero energy.
Obesity and gestational diabetes independently and collectively induce specific effects on placental structure, inflammation and endocrine function in a cohort of South African women
Authors: Musa Ezekiel , Salazar‐Petres Esteban , Arowolo Afolake , Levitt Naomi , Matjila Mushi , Sferruzzi‐Perri Amanda N.
Published: February 2023

Maternal obesity and gestational diabetes mellitus (GDM) are associated with insulin resistance and health risks for mother and offspring. Obesity is also characterized by low‐grade inflammation, which in turn, impacts insulin sensitivity. The placenta secretes inflammatory cytokines and hormones that influence maternal glucose and insulin handling. However, little is known about the effect of maternal obesity, GDM and their interaction, on placental morphology, hormones and inflammatory cytokines. In a South African cohort of non‐obese and obese pregnant women with and without GDM, this study examined placental morphology using stereology, placental hormone and cytokine expression using real‐time PCR, western blotting and immunohistochemistry, and circulating TNFα and IL‐6 concentrations using ELISA. Placental expression of endocrine and growth factor genes was not altered by obesity or GDM. However, LEPTIN gene expression was diminished, syncytiotrophoblast TNFα immunostaining elevated and stromal and fetal vessel IL‐6 staining reduced in the placenta of obese women in a manner that was partly influenced by GDM status. Placental TNFα protein abundance and maternal circulating TNFα concentrations were reduced in GDM. Both maternal obesity and, to a lesser extent, GDM were accompanied by specific changes in placental morphometry. Maternal blood pressure and weight gain and infant ponderal index were also modified by obesity and/or GDM. Thus, obesity and GDM have specific impacts on placental morphology and endocrine and inflammatory states that may relate to pregnancy outcomes. These findings may contribute to developing placenta‐targeted treatments that improve mother and offspring outcomes, which is particularly relevant given increasing rates of obesity and GDM worldwide.

image

Key points

Rates of maternal obesity and gestational diabetes (GDM) are increasing worldwide, including in low‐middle income countries (LMIC).

Despite this, much of the work in the field is conducted in higher‐income countries.

In a well‐characterised cohort of South African women, this study shows that obesity and GDM have specific impacts on placental structure, hormone production and inflammatory profile.

Moreover, such placental changes were associated with pregnancy and neonatal outcomes in women who were obese and/or with GDM.

The identification of specific changes in the placenta may help in the design of diagnostic and therapeutic approaches to improve pregnancy and neonatal outcomes with particular significant benefit in LMICs.
Evaluating response variables to the reversion of the ‘engurruñadera del cacao’ through the control of Aceria reyesi (Nuzzaci) (Acari: Eriophyidae) with abamectin and pruning
Authors: Santos Mírian S. , Stracieri Juliana , Sodré George A. , Oliveira Anibal R.
Published: February 2023

The cacao bud mite, Aceria reyesi (Nuzzaci), has been identified as the causal agent of the ‘engurruñadera del cacao’, characterized by the apparent accumulation of stipules on the buds, followed by die-back, with premature fall of leaves, shortening of internodes and proliferation of lateral branches, or witches’-broom, resulting in production losses or even in the death of plants. Our objective was to evaluate four response variables (numbers of leaves/plant, stipules/bud, internodes/branch and branches/plant) that could be indicative of a possible reversion of the ‘engurruñadera’ after the application of the acaricide abamectin and/or pruning. Two experiments were carried out between November 2020 and April 2021 in a greenhouse at UESC, with cacao seedlings of the genetic group ‘Forastero’ (cacao ‘Common’) infested with A. reyesi and showing typical symptoms of the ‘engurruñadera’. The first experiment was conducted with 4 treatments and 8 replicates, with the application of (1) Abamectin + pruning, (2) Abamectin without pruning, (3) Water + pruning and (4) Water without pruning (control). Sprays were carried out fortnightly with an Abamex® solution (18 g/L of abamectin, in a concentration of 2 mL/L of distilled water + neutral detergent). Pruning was performed only once, at the beginning of the experiment, by removing the apical 10 centimeters of all plant branches. Response variables were evaluated one day before the application of the treatments (Day 0), and afterward (~Days 75 and 150 after the first evaluation, respectively). The second experiment was conducted with 2 treatments and 12 replicates, with the application of (1) Abamectin (treated) and (2) Water (control). Pulverizations and evaluations were carried out as in the first experiment. The number of leaves/plant and internodes/branch were the only response variables that indicated some reversion of the ‘engurruñadera’ in both experiments among treated and control groups, although only 150 days after the application of abamectin and/or pruning. The number of branches/plant showed a significant increase from 75 days after the treatments with pruning, and no difference was found among treated and control groups in terms of numbers of stipules/bud in both experiments. We concluded that the numbers of leaves/plant and internodes/branch seem to be adequate monitoring tools to indicate the reversion of the ‘engurruñadera’ after the application of abamectin and/or pruning. Pruning was effective in the reversion of symptoms of the ‘engurruñadera’ on cacao seedlings as well as the abamectin application of a 2 mL dose of Abamex® per liter of water fortnightly.
A new species of Typhlodromus (Typhlodromus) Scheuten (Acari: Phytoseiidae) from Turkey, with a key to the Turkish species of the subgenus
Authors: Döker Ismail , Kazak Cengiz , Karut Kamil
Published: February 2023

Typhlodromus (Typhlodromus) tulinae sp. nov. Döker is described based on specimens collected from Carpinus betulus L. (Betulaceae) in Ordu Province on the Black Sea coast, Turkey. The new species can be easily distinguished from all known species of the subgenus by the combination of the following morphological characters: dorsal shield with three pairs of solenostomes (gland pores), peritreme extending to region between j3 and z2, sternal shield with two pairs of setae, ventrianal shield with four pairs of preanal setae and no preanal solenostomes, movable digit of chelicera with two teeth, genu II with eight setae, and spermatheca with large bulbous atrium and saccular calyx. A key to separate the Turkish species of the subgenus is also provided.
Pulsed laser induced atomic layer etching of silicon
Authors: Eliceiri Matthew , Rho Yoonsoo , Li Runxuan , Grigoropoulos Costas P.
Published: February 2023

We demonstrate the laser mediated atomic layer etching (ALEt) of silicon. Using a nanosecond pulsed 266 nm laser focused loosely over and in a parallel configuration to the surface of the silicon, we dissociate Cl2 gas to induce chlorination. Then, we use pulsed picosecond irradiation to remove the chlorinated layer. Subsequently, we perform continuous wave (CW) laser annealing to eliminate amorphization caused by the picosecond laser etching. Based on atomic force microscopy (AFM) and X-ray photoelectron spectroscopy (XPS), we observed strong evidence of chlorination and digital etching at 0.85 nm etching per cycle with good uniformity.
SARS-CoV-2 SUD2 and Nsp5 Conspire to Boost Apoptosis of Respiratory Epithelial Cells via an Augmented Interaction with the G-Quadruplex of BclII
Authors: Li Ying , Yu Quanwei , Huang Ridong , Chen Hai , Ren Hequan , Ma Lingling , He Yang , Li Weimin
Published: February 2023

SUD2, a unique protein domain closely related to the pathogenesis of SARS-CoV-2, has been reported to bind with the G-quadruplex (G4), a special noncanonical DNA structure endowed with important functions in regulating gene expression. However, the interacting partner of SUD2, among other SARS-CoV-2 Nsps, and the resulting functional consequences remain unknown.
Homologues of the Chlamydia trachomatis and Chlamydia muridarum Inclusion Membrane Protein IncS Are Interchangeable for Early Development but Not for Inclusion Stability in the Late Developmental Cycle
Authors: Cortina María Eugenia , Derré Isabelle
Published: February 2023

Obligate intracellular pathogens strictly rely on the host for replication. Specialized pathogen-encoded effector proteins play a central role in sophisticated mechanisms of host cell manipulation.
Supplemental Material: Geology of a Large Intact Extensional Oceanic Arc Crustal Section with Superior Exposures: Cretaceous Alisitos Arc, Baja California (Mexico)
Authors: Busby C. , al. et
Published: February 2023

SI-1: Whole-rock X-ray fluorescence (XRF) and inductively coupled plasma–mass spectrometry (ICP-MS) major- and trace-element geochemical data; SI-2: U-Pb zircon data; SI-3: Zircon Hf isotope data; SI-4: Description of all localities plotted on the geologic map (Fig. 4); SI-5: Analytical methods; SI-6: Modal summary for plutonic rocks; and Figure 4A: Geologic map of the Rosario segment of the Alisitos oceanic arc, Baja Calinfornia, Mexico. 
Congenital ichthyosis: a multidisciplinary approach in a neonatal care unit
Authors: Dias Joana Valente , Cardoso Kátia , Prado Sara Noéme , Cavaco Hugo
Published: February 2023

Congenital ichthyoses are a rare group of genetic disorders caused by defects in the two outermost skin layers, resulting in an abnormal barrier function. We report the case of a male preterm neonate presenting at delivery with thickened and scaling skin, ectropium and eclabium. Supportive care aiming at improving skin condition and handling possible complications was provided. Following gradual clinical improvement, he was discharged after 27 days. Molecular testing identified mutations in a gene encoding lipoxygenase (ALOX12B), associated with autosomal recessive congenital ichthyosis. This case highlights an uncommon disease that can determine significant morbidity and mortality in the first few weeks of life. Management of this complex disease benefits from a multidisciplinary approach. Molecular studies allow a more accurate diagnosis and enable genetic counselling.
Subdural hygroma as a rare complication after revision spine surgery
Authors: Park Yung , Lee Chang-Min , Ha Joong-Won , Shin Jae-Won
Published: February 2023

Spinal fusion surgery is the most commonly performed orthopaedic surgical procedure. However, subdural hygroma occurrence is a very rare complication after revision spinal fusion surgery. Here, we report a case of revision lumbar fusion surgery at the L3–4 level. The patient developed acute conus medullaris syndrome at 10 days postoperatively. MRI showed a subdural, extra-arachnoid area fluid collection following the T12–L2, cephalad to the area of revision spinal fusion. When patients have a decreased motor grade, difficulty in voiding urine and neurological abnormalities after lumbar spine surgery, conus medullaris syndrome with a possible occurrence of subdural hygroma should be considered. In this situation, immediate imaging investigations and emergency surgery might be necessary to reduce the pressure on the spinal cord.
Severe hypertrophic cardiomyopathy with left ventricular outflow tract obstruction identified with preprocedural point-of-care ultrasound before emergent tracheal repair
Authors: Biladeau Sara , Grell Ryan
Published: February 2023

A woman in her 60s was brought to the operating room directly from the trauma bay for emergent intervention to repair a tracheal rupture sustained during a reported fall from standing height. She was intubated and sedated prior to arrival by paramedics for respiratory distress. Her family reported that the patient had dizziness after standing followed by the patient fainting and striking her neck. During a preprocedural point-of-care cardiac ultrasound examination, we discovered severe left ventricular hypertrophy with a significantly increased ejection fraction and decreased left ventricular cavity size. This prompted emergent cardiology consultation, which confirmed the presence of severe hypertrophic cardiomyopathy with left ventricular outflow tract obstruction. After a brief delay to optimise her heart rate and volume status, the patient successfully underwent an open reduction and internal fixation of the laryngeal cartilage and was discharged in stable condition with plans to undergo a septal myotomy.
How has Guinea learnt from the response to outbreaks? A learning health system analysis
Authors: Millimouno Tamba Mina , Meessen Bruno , Put Willem Van De , Garcia Marlon , Camara Bienvenu Salim , Christou Aliki , Delvaux Therese , Sidibé Sidikiba , Beavogui Abdoul Habib , Delamou Alexandre
Published: February 2023

Introduction

Learning is a key attribute of a resilient health system and, therefore, is central to health system strengthening. The main objective of this study was to analyse how Guinea’s health system has learnt from the response to outbreaks between 2014 and 2021.

Methods

We used a retrospective longitudinal single embedded case study design, applying the framework conceptualised by Sheikh and Abimbola for analysing learning health systems. Data were collected employing a mixed methods systematic review carried out in March 2022 and an online survey conducted in April 2022.

Results

The 70 reports included in the evidence synthesis were about the 2014–2016 Ebola virus disease (EVD), Measles, Lassa Fever, COVID-19, 2021 EVD and Marburg virus disease. The main lessons were from 2014 to 2016 EVD and included: early community engagement in the response, social mobilisation, prioritising investment in health personnel, early involvement of anthropologists, developing health infrastructure and equipment and ensuring crisis communication. They were learnt through information (research and experts’ opinions), action/practice and double-loop and were progressively incorporated in the response to future outbreaks through deliberation, single-loop, double-loop and triple-loop learning. However, advanced learning aspects (learning through action, double-loop and triple-loop) were limited within the health system. Nevertheless, the health system successfully controlled COVID-19, the 2021 EVD and Marburg virus disease. Survey respondents’ commonly reported that enablers were the creation of the national agency for health security and support from development partners. Barriers included cultural and political issues and lack of funding. Common recommendations included establishing a knowledge management unit within the Ministry of Health with representatives at regional and district levels, investing in human capacities and improving the governance and management system.

Conclusion

Our study highlights the importance of learning. The health system performed well and achieved encouraging and better outbreak response outcomes over time with learning that occurred.
Occupation and SARS-CoV-2 seroprevalence studies: a systematic review
Authors: Boucher Emily , Cao Christian , D’Mello Sean , Duarte Nathan , Donnici Claire , Duarte Natalie , Bennett Graham ,   SeroTracker Consortium, Adisesh Anil , Arora Rahul , Kodama David , Bobrovitz Niklas
Published: February 2023

Objective

To describe and synthesise studies of SARS-CoV-2 seroprevalence by occupation prior to the widespread vaccine roll-out.

Methods

We identified studies of occupational seroprevalence from a living systematic review (PROSPERO CRD42020183634). Electronic databases, grey literature and news media were searched for studies published during January–December 2020. Seroprevalence estimates and a free-text description of the occupation were extracted and classified according to the Standard Occupational Classification (SOC) 2010 system using a machine-learning algorithm. Due to heterogeneity, results were synthesised narratively.

Results

We identified 196 studies including 591 940 participants from 38 countries. Most studies (n=162; 83%) were conducted locally versus regionally or nationally. Sample sizes were generally small (median=220 participants per occupation) and 135 studies (69%) were at a high risk of bias. One or more estimates were available for 21/23 major SOC occupation groups, but over half of the estimates identified (n=359/600) were for healthcare-related occupations. ‘Personal Care and Service Occupations’ (median 22% (IQR 9–28%); n=14) had the highest median seroprevalence.

Conclusions

Many seroprevalence studies covering a broad range of occupations were published in the first year of the pandemic. Results suggest considerable differences in seroprevalence between occupations, although few large, high-quality studies were done. Well-designed studies are required to improve our understanding of the occupational risk of SARS-CoV-2 and should be considered as an element of pandemic preparedness for future respiratory pathogens.
Prevalence and risk factors of hypothyroidism after universal salt iodisation: a large cross-sectional study from 31 provinces of China
Authors: Li Jiashu , Li Yongze , Shi Xiaoguang , Teng Di , Teng Xiaochun , Teng Weiping , Shan Zhongyan
Published: February 2023

Objectives

To investigate the prevalence and risk factors of hypothyroidism after universal salt iodisation for 20 years in mainland China.

Design

Nationwide, cross-sectional survey.

Setting and participants

The Thyroid Disorders, Iodine Status and Diabetes epidemiological study included adults from 31 provinces of China. Data included demographic, physical characteristics, urine, serum thyroid-stimulating hormone (TSH), thyroid-peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb) and thyroid ultrasonography. Subclinical hypothyroidism (SCH) was classified into severe SCH (TSH >10 mU/L) and mild SCH (TSH 4.2–9.9 mU/L). A total of 78 470 (38 182 men and 40 288 women) participants were included in the final analysis.

Results

The prevalence of hypothyroidism was 13.95%. The prevalence rates of overt hypothyroidism (OH) and SCH were 1.02% and 13.93%, which mild SCH was significantly higher than severe SCH (12.18% vs 0.75%). Prevalence was higher in women than in men, and this gender difference was noted among all age groups. The prevalence of mild SCH, severe SCH and OH increases by 1.16%, 1.40% and 1.29% for every 10 years older. TPOAb or/and TgAb positive were significantly associated with OH and severe SCH (OR 15.9, p<0.001). However, SCH was positively correlated with increased urine iodine concentration, but this correlation was only in antibody-negative female patients. In non-autoimmune and male populations, there was a U-shaped relationship between severe SCH and OH and urine iodine concentration.

Conclusions

Mild SCH is the most common form of hypothyroidism, which is related to iodine intake. Severe SCH is more similar to OH which autoimmune is the main cause. The various effects of iodine on hypothyroidism depend on thyroid autoimmune and gender.
Identification of delayed diagnosis of paediatric appendicitis in administrative data: a multicentre retrospective validation study
Authors: Michelson Kenneth A , Bachur Richard G , Dart Arianna H , Chaudhari Pradip P , Cruz Andrea T , Grubenhoff Joseph A , Reeves Scott D , Monuteaux Michael C , Finkelstein Jonathan A
Published: February 2023

Objective

To derive and validate a tool that retrospectively identifies delayed diagnosis of appendicitis in administrative data with high accuracy.

Design

Cross-sectional study.

Setting

Five paediatric emergency departments (EDs).

Participants

669 patients under 21 years old with possible delayed diagnosis of appendicitis, defined as two ED encounters within 7 days, the second with appendicitis.

Outcome

Delayed diagnosis was defined as appendicitis being present but not diagnosed at the first ED encounter based on standardised record review. The cohort was split into derivation (2/3) and validation (1/3) groups. We derived a prediction rule using logistic regression, with covariates including variables obtainable only from administrative data. The resulting trigger tool was applied to the validation group to determine area under the curve (AUC). Test characteristics were determined at two predicted probability thresholds.

Results

Delayed diagnosis occurred in 471 (70.4%) patients. The tool had an AUC of 0.892 (95% CI 0.858 to 0.925) in the derivation group and 0.859 (95% CI 0.806 to 0.912) in the validation group. The positive predictive value (PPV) for delay at a maximal accuracy threshold was 84.7% (95% CI 78.2% to 89.8%) and identified 87.3% of delayed cases. The PPV at a stricter threshold was 94.9% (95% CI 87.4% to 98.6%) and identified 46.8% of delayed cases.

Conclusions

This tool accurately identified delayed diagnosis of appendicitis. It may be used to screen for potential missed diagnoses or to specifically identify a cohort of children with delayed diagnosis.
Measuring concordance of data sources used for infectious disease research in the USA: a retrospective data analysis
Authors: Majumder Maimuna S , Cusick Marika , Rose Sherri
Published: February 2023

Objectives

As highlighted by the COVID-19 pandemic, researchers are eager to make use of a wide variety of data sources, both government-sponsored and alternative, to characterise the epidemiology of infectious diseases. The objective of this study is to investigate the strengths and limitations of sources currently being used for research.

Design

Retrospective descriptive analysis.

Primary and secondary outcome measures

Yearly number of national-level and state-level disease-specific case counts and disease clusters for three diseases (measles, mumps and varicella) during a 5-year study period (2013–2017) across four different data sources: Optum (health insurance billing claims data), HealthMap (online news surveillance data), Morbidity and Mortality Weekly Reports (official government reports) and National Notifiable Disease Surveillance System (government case surveillance data).

Results

Our study demonstrated drastic differences in reported infectious disease incidence across data sources. When compared with the other three sources of interest, Optum data showed substantially higher, implausible standardised case counts for all three diseases. Although there was some concordance in identified state-level case counts and disease clusters, all four sources identified variations in state-level reporting.

Conclusions

Researchers should consider data source limitations when attempting to characterise the epidemiology of infectious diseases. Some data sources, such as billing claims data, may be unsuitable for epidemiological research within the infectious disease context.
Comparison of modified anterior and traditional posterior accesses for ultrasound-guided superior laryngeal nerve block in awake endotracheal intubation: study protocol for a randomised non-inferiority clinical trial
Authors: Hua Yusi , Huang Qiyuan , Chen Guo , Zhu Tao
Published: February 2023

Introduction

Awake tracheal intubation (ATI) involves placing a tracheal tube in an awake, spontaneously breathing patient. Superior laryngeal nerve block (SLNB) can effectively abolish the glottic closure reflex, and blunt the sensation of the structures above the cords. A method that consists of SLNB along with translaryngeal injection (TLI) can provide satisfactory anaesthesia and intubating conditions. We present a novel modified access of SLNB, ultrasound (US)-guided anterior SLNB, to aid awake videolaryngoscopes-assisted endotracheal intubation in adult elective surgery patients, and we compare the effectiveness and safety to traditional US-guided posterior SLNB.

Methods and analysis

A total of 100 adult elective surgery patients requiring general endotracheal anaesthesia will be randomly assigned to the modified group (modified US-guided anterior SLNB) or the traditional group (traditional US-guided posterior SLNB). After SLNB, all participants will be performed with TLI. The primary outcome is the proportion of acceptable intubation conditions based on intubation scores. Secondary outcomes include: (a) the first-attempt intubation success rate, (b) haemodynamic changes during ATI, (c) time taken for airway anaesthesia and intubation, (d) recall of intubation, (e) participant perception of comfort during intubation, (f) perioperative complication rate. This report describes the study design of this randomised controlled trial.

Ethics and dissemination

The study protocol has been approved by an ethical committee of the West China Hospital (Sichuan University), and registered at the Chinese Clinical Trials Register (www.chictr.org.cn). Results will be published in a peer-reviewed journal.

Trial registration number

ChiCTR2200058086.
Characterisation of medical conditions of children with sickle cell disease in the USA: findings from the 2007–2018 National Health Interview Survey (NHIS)
Authors: Gyamfi Joyce , Tampubolon Siphra , Lee Justin Tyler , Islam Farha , Ojo Temitope , Opeyemi Jumoke , Qiao Wanqiu , Mai Andi , Wang Cong , Vieira Dorice , Ryan Nessa , Osei-Tutu Nana H , Adenikinju Deborah , Meda Shreya , Ogedegbe Gbenga , Peprah Emmanuel
Published: February 2023

Objectives

We used the National Health Interview Survey (NHIS) data set to examine the prevalence of comorbid medical conditions; explore barriers to accessing healthcare and special educational services; and assess the associations between sickle cell disease (SCD) status and demographics/socioeconomic status (SES), and social determinants of health (SDoH) on comorbidities among children in the USA.

Design

Cross-sectional.

Setting

NHIS Sample Child Core questionnaire 2007–2018 data set.

Participants

133 481 children; presence of SCD was determined by an affirmative response from the adult or guardian of the child.

Main outcome measures

Multivariate logistic regression was used to compare the associations between SCD status, SES and SDoH for various medical conditions for all races and separately for black children at p<0.05.

Results

133 481 children (mean age 8.5 years, SD: 0.02), 215 had SCD and ~82% (weighted) of the children with SCD are black. Children with SCD were more likely to suffer from comorbid conditions, that is, anaemia (adjusted OR: 27.1, p<0.001). Furthermore, children with SCD had at least two or more emergency room (ER) visits (p<0.001) and were more likely to have seen a doctor 1–15 times per year (p<0.05) compared with children without SCD. Household income (p<0.001) and maternal education were lower for children with SCD compared with children without SCD (52.4% vs 63.5% (p<0.05)). SCD children with a maternal parent who has < / > High School degree were less likely to have no ER visits or 4–5 ER visits, and more likely to have 2–3 ER visits within 12 months.

Conclusion

Children with SCD experienced significant comorbid conditions and have high healthcare usage, with black children being disproportionately affected. Moreover, maternal education status and poverty level illustrates how impactful SES can be on healthcare seeking behaviour for the SCD population. SDoH have significant implications for managing paediatric patients with SCD in clinical settings.
Economic evaluations of interventional opportunities for the management of mental–physical multimorbidity: a systematic review
Authors: Banstola Amrit , Pokhrel Subhash , Hayhoe Benedict , Nicholls Dasha , Harris Matthew , Anokye Nana
Published: February 2023

Objectives

Economic evaluations of interventions for people with mental–physical multimorbidity, including a depressive disorder, are sparse. This study examines whether such interventions in adults are cost-effective.

Design

A systematic review.

Data sources

MEDLINE, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Scopus, Web of Science and NHS EED databases were searched until 5 March 2022.

Eligibility criteria

We included studies involving people aged ≥18 with two or more chronic conditions (one being a depressive disorder). Economic evaluation studies that compared costs and outcomes of interventions were included, and those that assessed only costs or effects were excluded.

Data extraction and synthesis

Two authors independently assessed risk of bias in included studies using recommended checklists. A narrative analysis of the characteristics and results by type of intervention and levels of healthcare provision was conducted.

Results

A total of 19 studies, all undertaken in high-income countries, met inclusion criteria. Four intervention types were reported: collaborative care, self-management, telephone-based and antidepressant treatment. Most (14 of 19) interventions were implemented at the organisational level and were potentially cost-effective, particularly, the collaborative care for people with depressive disorder and diabetes, comorbid major depression and cancer and depression and multiple long-term conditions. Cost-effectiveness ranged from £206 per quality-adjusted life year (QALY) for collaborative care programmes for older adults with diabetes and depression at primary care clinics (USA) to £79 723 per QALY for combining collaborative care with improved opportunistic screening for adults with depressive disorder and diabetes (England). Conclusions on cost-effectiveness were constrained by methodological aspects of the included studies: choice of perspectives, time horizon and costing methods.

Conclusions

Economic evaluations of interventions to manage multimorbidity with a depressive disorder are non-existent in low-income and middle-income countries. The design and reporting of future economic evaluations must improve to provide robust conclusions.

PROSPERO registration number

CRD42022302036.