bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical management of ulnar styloid fractures: comparison of fixation with anchor suture and tension band wire
Authors: Chen Alvin Chao-Yu , Lin Yi-Hsuan , Weng Chun-Jui , Cheng Chun-Ying
Published: June 2020

Background: Limited reference is available regarding surgical management in symptomatic ulnar styloid fractures with small bony avulsion. The study goal is to report the surgical outcomes using anchor suture fixation with comparison to traditional tension band wire fixation.Methods: We retrospectively reviewed the medical records in patients who underwent surgical repair for unilateral ulnar styloid fractures with distal radioulnar instability between 2004 and 2017. A total of 31 patients were enrolled including two kinds of fixation methods. Anchor suture fixation plus distal radioulnar joint pinning was performed in ten patients with tiny avulsion bony fragments (group A); tension band wire fixation was performed in 21 patients with big styloid fracture fragments (group B). Patient characteristics and 2-year treatment outcomes were compared between two groups based on Mayo Modified Wrist Score (MMWS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), visual analog scale (VAS) and surgical complication. Descriptive statistics were used for calculation of key variables; a p-value of < 0.05 was considered statistically significant. Results: Based on Gaulke classification, there were five subtypes in group A and three subtypes in group B. Incidence of concomitant distal radius fractures was significantly higher in group B; other patient characteristics including age, sex, injury side, and time to surgery showed no significant difference. Outcome assessment regarding MMWS, QuickDASH and VAS was comparable between two groups. Bone-related complications including nonunion, DRUJ subluxation and styloid resorption were analyzed; the difference was not significant. Incidence of implant-related complications including migration and secondary removal surgery was significantly higher in group B (p = 0.021). Conclusion: Surgical fixation in symptomatic ulnar styloid fractures yields comparable treatment outcomes in both fracture patterns. Implant-related complication with secondary removal surgery is more common in tension band wire group. Anchor suture fixation is a feasible option for tiny styloid avulsion fragments with limited surgical complication.
Impact of recent influenza A virus infection on clinical characteristics and outcomes in severe coronavirus disease 2019 adult inpatients
Authors: Gao Chang , Yang Xianjun , Chen Long , Xu Hongyang , Liu Jialin , Wang Shanshan , Niu Haitao , Yu Wenkui , Huang Jian-an , Zhang Xiuqin , Shen Bo , Tasdogan Alpaslan , Ubellacker Jessalyn M. , Chen Jiahao , Yang Ling , Zhan Qingyuan , Guo Qiang
Published: June 2020

Background: Coronavirus disease 2019 (COVID-19) is a current global pandemic. However, impact of recent influenza A virus infection on the clinical course and outcomes of severe COVID-19 adult inpatients needs to be further explored.Methods: In this retrospective cohort study, severe, laboratory confirmed COVID-19 adult patients from Wuhan Tongji Hospital were included. Data were obtained from electronic medical records and compared between patients with and without recent influenza A virus infection.Results: 200 patients were included, 51.5% with recent influenza A virus infection. Recent influenza A virus infection group presented with longer persistence of cough and sputum from illness onset (35.0 vs. 27.0 days, P = 0.018) and (33.0 vs. 26.0 days, P = 0.015), respectively. Median time of progression to critical illness from illness onset was shorter (day 11.5 vs. day 16.0, P = 0.034). Time to clinical improvement and length of hospital stay were longer in recent infection group (23.0 vs. 19.0 days, P = 0.044) and (22.0 vs. 18.0 days, P = 0.030), respectively.Conclusions: Patients with recent influenza A virus infection showed a delay in time to clinical improvement and increased length of hospital stay. There is a high clinical need to improve the detection of common respiratory pathogens to identify co-infection during the epidemic of COVID-19.
Omadacycline efficacy against Streptococcus agalactiae isolated in China: in vitro activity, resistance analysis, clonality of MIC distribution, and the correlation between resistance and virulence gene and biofilm formation
Authors: Li Guiqiu , Wei Ying , Guo Yan , Lian Jie , Wu Shaoyuan , Yu Zhijian , Bai Bing , Deng Qiwei , Xu Guangjian
Published: June 2020

Purpose: This study aimed to evaluate activity，resistance, clonality of MIC distribution, and the correlation between virulence＆resistance gene and biofilm formation of omadacycline (OMC) in clinical for Streptococcus agalactiae isolates from China.Methods: 162 isolates were collected retrospectively in China from 2018 to 2019. The S. agalactiae were mainly collected from the body's cervical secretions, wound secretions, ear swab, secretions, semen, venous blood, cerebrospinal fluid, pee, urethral discharge, pus, umbilical secretions, wound secretions, reproductive tract secretions, sputum, gastric juice, throat swab, eye secretions and amniotic fluid. The MIC of OMC against S. agalactiae were determined by broth microdilution. Filter paper was used to measure the inhibition zone diameters of OMC and other common antibiotics. D-test detected the incidence of erythromycin resistance to inductively clindamycin. Multilocus sequence typing (MLST)，resistance＆virulence gene of the isolates were investigated using qRT-PCR. Biofilms were detected by crystal violet staining.Results: The OMC MIC of clinical S. agalactiae isolates ranged from ≤0.25 to 0.5 mg/L. 19.7% of the S. agalactiae isolates with an OMC MIC of 0.25 mg/L were found to be sequence type (ST) 17. The S. agalactiae had highly resistant to Minocyclin, Erytromycin, Solithromycin and Clindamycin and the resistance rate of OMA was 13.6%. The positive rate of D-test was 90.74 %. The formation of biofilm was related to scpB gene, and indicated the resistance of OMA may be related to the virulence gene scpB. Conclusion: OMC exhibited better activity against clinical S. agalactiae isolates from China than DOX or MIN, and scpB was related with biofilm formation in OMC- resistance S. agalactiae.
COVID Abdomen: SARS-CoV-2 Infection presenting as 'Acute Abdomen' in a Child
Authors: Periyakaruppan Muthiah , Kumar Sandip , Kandasamy Sasidaran , Thiagarajan Anand , Sangaralingam Thangavelu , Ganapathy Nandhini
Published: June 2020

Despite lesser incidence and disease severity of COVID-19 in children, growing evidence of heterogeneity in clinical presentation viz., extra-pulmonary manifestations and inflammatory syndromes emphasize the importance to understand atypical presentations. We describe an 11-year-old boy presented with fever, loose stool, transient maculopapular rash over both feet, severe abdominal pain with guarding suggestive of the acute abdomen that later turned out to be COVID-19 positive in the second RT-PCR swab based on suggestive lab parameters and high clinical suspicion. The child didn't have respiratory symptoms, and both parents were tested negative for COVID. Our case brief depicts one of the uncommon presentations – 'Acute Abdomen' of this novel virus infection in children, unravels the difficulties in reaching the diagnosis and discuss the treatment dilemmas involved in these hyper-inflammatory presentations. We hope this case would sensitize the paediatricians, pediatric surgeons to suspect COVID-19 in such conditions, especially before proceeding for surgical exploration.
Dasatinib loaded nanostructured lipid carriers for effective treatment of corneal neovascularization
Authors: Li Qingqing , Yang Xianwei , Zhang Peipei , Mo Fei , Si Peiru , Kang Ximeng , Wang Menghan , Zhang Jiye
Published: June 2020

Corneal neovasularization (CNV) is one of the most important causes of visual impairment worldwide. Dasatinib, a poorly water-soluble tyrosine kinase inhibitor with dual Src family kinase and platelet derived growth factor receptor inhibiting capability, has a great potential in the treatment of CNV. In this study, dasatinib was successfully encapsulated into a nanostructured lipid carrier (dasa-NLC) and the size was approximately 78 nm with a small polydispersity index. The NLC increased the solubility of dasatinib by more than 1220 times, sustained the drug release, reduced the ocular toxicity and facilitated its penetration into the cornea. Dasa-NLC significantly inhibited the proliferation, migration and tube formation of HUVEC cells, the three most important angiogenesis-related cellular changes of the CNV. Next, the in vivo anti-CNV effect of dasa-NLC was evaluated by using an alkaline burned mice CNV model, in which the development of the CNV and pathological changes of the cornea were significantly inhibited. The immunohistochemistry analysis indicated that dasa-NLC could inhibit both the expression and activation of Src family kinase. Therefore, dasa-NLC showed considerable promise in the treatment of CNV.
Prevalence of Osteoarthritis and Health-Related Quality of Life in Stroke Patients: A Cross-Sectional Study Using Korean National Health and Nutrition Examination Survey VII
Authors: Jeong Kil-Yong , Lee Hyun Jung
Published: June 2020

Background: The purpose of this study was to analyze the risk factors affecting the prevalence of osteoarthritis and the health-related quality of life (HRQoL) of stroke patients from various angles, including demographic factors, socioeconomic factors, comorbidities, and lifestyle factors.Methods: A total of 13,959 patients ≥40 years of age (stroke group n = 416, non-stroke group n = 13,535) were identified from the 2016–2018 Korean National Health and Nutrition Examination Survey for analysis. The European quality of life-5 dimensions questionnaire was used to compare the differences in stroke patient’s HRQoL according to the presence or absence of osteoarthritis. Multiple regression analysis was performed to determine the factors affecting the HRQoL of the stroke group.Results: The prevalence of osteoarthritis was 21.72% in the stroke group and 12.49% in the non-stroke group. The prevalence of osteoarthritis in female patients who had strokes was 35.95% and was significantly higher than that of male patients who had strokes (10.23%). The European quality of life-5 dimensions index indicating HRQoL was significantly lower in stroke group with osteoarthritis. Factors that significantly influenced the HRQoL in the stroke group were the presence of osteoarthritis, aerobic exercise, drinking status, types of health insurance, and educational levels.Conclusions: This study confirmed that the HRQoL was significantly lower in stroke group with osteoarthritis. Findings were taken to suggest that the active management of osteoarthritis in stroke patients are important.
Probiotics Effect on the Immune System
Authors: Ng Jonathan Cho Kin
Published: June 2020

Background: Probiotics can provide health benefits to an individual by regulation of the immune system. Many clinical trials have found that probiotics can prevent upper respiratory tracts infections.Aim: To perform a systematic review and meta-analysis of available trials to investigate the effectiveness of probiotics in the prevention of upper respiratory tract infections in individuals of all ages.Methods: A database search was carried out with databases ScienceDirect, Wiley, Springer, Medline and Pubmed. Completed randomised double blind, placebo-controlled trials were selected.Selection criteria: Randomised placebo-controlled trials, with the objective of investigating probiotic effectiveness in preventing URTIs.Results: Five randomised controlled trials were included, as the extracted data could be meta-analysed. This included a total of 785 participants of different age groups, children and adults. It was found that probiotics were better compared to placebo in reducing the number of participants who experienced acute upper respiratory tract infections. Probiotics were found to reduce the mean duration of acute URTI episodes, antibiotic use compared to placebo and URTI or cold related absence. Side effects and adverse effects were found to be minor and not statistically significant.Conclusions: Probiotics were found to be better in reducing the number of participants who experienced acute URTI, the average duration per episode of acute URTI, use of antibiotics in URTI related cases and absence due to URTI. Side effects were found to be minor, making probiotics a good candidate for clinical use. This shows that probiotics are effective in preventing acute URTIs. However, due to limited studies and small sample size, the results are subjected to bias and should be interpreted with care.
Additive Main Effect and Multiplicative Interaction analysis for grain yield of early maturing sorghum [Sorghum bicolor (L.) Moench] varieties in drought prone areas of Central Tigray, Northern Ethiopia
Authors: Belay Fantaye , Meresa Hintsa , Syum Shambel
Published: June 2020

Shortage of widely adapted and high yielding variety is one of the major bottlenecks for production and productivity of sorghum in dry lowlands of Tigray region, northern Ethiopia. A field experiment was conducted during the main seasons of 2017and 2019 at four locations using randomized complete block design with three replications to evaluate the performance of ten early maturing sorghum genotypes for grain yield using AMMI (Additive Main Effects and Multiplicative Interaction) model. The combined analysis of variance revealed highly significant (P≤0.01) genotype (G), environment (E) and genotype × environment interaction (GEI). The significant genotype by environment interaction effects were further partitioned in to two significant interaction principal components by using AMMI model. The AMMI analysis of variance showed that the genotype, environment and interaction sum squares contributed 41.55 %, 28.67 % and 29.78 % to the treatment sum squares for grain yield respectively. In addition the first two IPCAs and interaction residual were significant. The first two IPCAs accounted for a total of 82.20 % of the interaction sum square. The results revealed that the observed yield variation among genotypes were due to genetic potential of genotypes and interaction rather than location differences. The highest yield was obtained from ESH-1 (3276 kg ha-1), while the lowest was from Grana-1 (2094 kg ha-1) and the average grain yield of genotypes was 2462 kg ha-1. Therefore, ESH-1 is selected as the best stable hybrid with consistent yielding performance across the testing environments in dry lowland areas of Abergelle and similar agro-ecologies in Tigray region, northern Ethiopia.
Persistent pneumonic consolidations due to secondary organizing pneumonia in a patient recovering from COVID-19 pneumonia: A case report
Authors: Bae In-Gyu , Hong Kyung-Wook , Yang Jung Wook , Moon Kyunglan , Kim Jong Duk , Ju Sunmi , Cho Min-Chul
Published: June 2020

Background: In individuals with coronavirus disease 2019 (COVID-19) pneumonia, radiographic pneumonic infiltrates may persist for several weeks, even after viral clearance, thereby making it difficult to decide on an appropriate treatment and infection control strategy.Case presentation: We describe a 46-year-old woman with COVID-19 pneumonia who had persistent radiographic pneumonic infiltration and respiratory symptoms for almost 4 weeks after illness onset, despite viral clearance, and was subsequently diagnosed with secondary organizing pneumonia using video-assisted thoracoscopic lung biopsy. Intravenous methylprednisolone was administered at an initial dose of 50 mg/day (1 mg/kg) for 7 days and was tapered to a dose of prednisolone 30 mg/day following improvement in the patient’s respiratory symptoms and chest radiographic findings. The patient was discharged from the hospital 14 days after initiation of corticosteroid treatment. The dose of prednisolone was tapered to 20 mg/day after a month at the outpatient clinic, with further reduction of pneumonic infiltrations seen in a follow-up CT scan on Day 46 of the illness.Conclusions: To the best of our knowledge, this is the first case report of a pathologically confirmed secondary organizing pneumonia occurring during the convalescent period of COVID-19 pneumonia. Secondary organizing pneumonia should be considered in the differential diagnosis of patients with COVID-19 pneumonia with persistent respiratory symptoms and radiographic pneumonic infiltrations during the recovery phase. In such situations, treatment with steroids may be required, and prolonged isolation of patients with airborne precautions may be unnecessary.
Neurological manifestations of COVID-19: A systematic review
Authors: Chen Xiangliang , Laurent Sarah , Onur Oezguer A. , Kleineberg Nina N. , Fink Gereon R. , Schweitzer Finja , Warnke Clemens
Published: June 2020

Objective: To study the frequency of neurological symptoms and complications in COVID-19 patients in a systematic review of the literature. Methods: Relevant studies were identified through electronic explorations of PubMed, medRxiv, and bioRxiv. Besides, three Chinese databases were searched. A snowballing method searching the bibliographies of the retrieved references was applied to identify potentially relevant articles. Articles published within one year prior to April 20th, 2020 were screened with no language restriction imposed. Databases were searched for terms related to SARS-CoV-2/COVID-19 and neurological manifestations, using a pre-established protocol registered on the International Prospective Register of Systematic Reviews database (ID: CRD42020187994).Results: A total of 2441 articles were screened for relevant content, of which 92 full-text publications were included in the analyses of neurological manifestations of COVID-19. Headache, dizziness, taste and smell dysfunctions, and impaired consciousness were the most frequently described neurological symptoms, the latter more often among patients with a severe or critical disease course. To date, only smaller cohort studies or single cases have reported cerebrovascular events, seizures, meningoencephalitis, and immune-mediated neurological diseases, not suitable for quantitative analysis. Conclusions: The most frequent neurological symptoms reported in association with COVID-19 are non-specific for the infection with SARS-CoV-2. Although SARS-CoV-2 may have the potential to gain direct access to the nervous system, so far, SARS-CoV-2 was detected in the cerebrospinal fluid in two cases only. Standardized international registries are needed to clarify the clinical relevance of the neuropathogenicity of SARS-CoV-2.
Safety of urologic elective surgery in a Covid-hospital: our experience in Milan
Authors: Blezien Oskar , Signorini Claudia , Guzzo Sonia , Vaccaro Chiara , Molinari Filippo , Vizziello Damiano , Conti Andrea , Carmignani Luca
Published: June 2020

Purpose To demonstrate safety of a new internal protocol for patients and health workers adopted for elective urologic surgical activity during COVID-19 pandemic.Methods From March 9 to April 24, 2020 we have retrospectively evaluated 62 patients who underwent elective surgery in the urology department of IRCCS Policlinico San Donato which became a COVID-hospital. We identified non-deferrable patients that needed to be treated within one month. All patients followed a dedicated pathway from the day-hospital till the discharge. Clinical data, nasopharyngeal swabs, chest X-ray, type of anaesthesia, surgical procedure and days of hospitalization were collected. All patients were interviewed 14 days after surgery to check any Covid-related complications.Results The population included 48 (77.42%) men and 14 (22.58%) women, aged between 17 and 88 years old. We performed sixty-four (64) preoperative screenings and two (2) patients were excluded. 47 (75.81%) patients underwent oncological procedures while 15 (24.19%) patients underwent non-oncological surgery. The average hospitalization time was 2.39±2.21 days.After at least 14 postoperative days (25.00±10.35 days), we interviewed all patients to check their conditions. No patients showed symptoms related to COVID-19, except for 2 (3.23%) who manifested coryza, 28 and 35 days after discharge respectively. Neither patients nor hospital workers developed COVID-19 infection.Conclusion The duration of pandemic period is undefined; therefore, our protocol could be considered a good model for every type of surgery and its application could ensure a continuous treatment for non-deferrable conditions, in a safe way for both the patients and health workers.
Spektral Açı Haritalama Tekniği İle Aşağı Seyhan Ovası Tarsus - Karataş Arasının Arazi Değişiminin Belirlenmesi
Authors: TRAORE Mamadou , TEKİN Senem , ÇAN Tolga
Published: June 2020

Yaşam alanlarını oluşturan kara parçalarının bilinçsiz ve kontrolsüz kullanımı nedeni ile ortaya çıkan olumsuzlukların, doğada neden olduğu tahribatı engellemeye yönelik doğayı ve doğal kaynakları koruma düşüncesi arazi kullanım planlamalarının önemini artırmaktadır. Bu çalışmada, Çukurova’nın güney kesiminde ekolojik olarak öneme sahip olan doğal koruma alanlarından biri olan Akyatan yaban hayatı geliştirme sahasını da içeren ve Ramsar koruma alanlarının da yer aldığı, bir kısmı ile Seyhan ovası içerisinde bulunan Tarsus (Mersin) ile Karataş (Adana) arasındaki bölgede, 1985, 2000 ve 2019 yılları arasındaki arazi kullanımında meydana gelen değişimler incelenmiştir. Analizlerde 30 m mekânsal çözünürlüğe sahip Landsat-5TM 1985, Landsat-5TM 2000 ve Landsat-8 OLI 2019 uydu görüntüleri kullanılmıştır. Uydu görüntüleriyle öncelikli olarak geometrik, radyometrik kalibrasyon ve atmosferik düzenlemelerden oluşan ön işleme çalışmaları gerçekleştirilmiştir. Arazi kullanım değişim tespitinde Spektral Açı haritalama yöntemi kullanılmıştır. Elde edilen sonuçlara göre 1985-2019 yılları arasında yerleşim, ekili olmayan tarım, orman ve yarı doğal ve lagün/göller alanlarında %192, %37, %7 ve %8’lik büyüme gelişirken, çıplak ve ekili tarım alanlarda ise %43 ve %21’lik oranlarda azalmalar meydana gelmiştir. Aynı zamanda ülkemizde bulunan aktif fay hatlarından biri olan Karataş fayı civarında 500, 1000 ve 2000 m’lik tampon bölgeler içerisinde yerleşim birimlerinde meydana gelen değişimler değerlendirilmiştir. Karataş fayı civarında ise yerleşimin 1985 ile 2019 yılları arasında yapılaşmaların %192 oranında arttığı belirlenmiştir. Yapılan kontrollü sınıflama çalışmalarının doğruluğu kappa istatistiği ile değerlendirilmiş olup 1985, 2000 ve 2019 yılları için sırasıyla 0.80, 0.84, 0.87 olarak hesaplanmıştır.
Informação ou resíduo? Panfletagem no Município de Feira de Santana, Bahia, Brasil
Authors: Lauton Denise Costa Rebouças , Nunes Virginia de Jesus , Lima Denise Pastore de
Published: June 2020

A panfletagem, embora venha a ser um mecanismo de marketing eficiente para muitas empresas, pode acentuar um grande problema socioambiental, que é o acúmulo de resíduo sólido. Resíduos sólidos ao serem lançados em via pública causam diversos problemas envolvendo a saúde pública e ambiental. No Município de Feira de Santana a panfletagem parece ser um mecanismo de marketing bastante utilizado, desprovido de orientações de produção ou uso, sem regulamentação ambiental. Este trabalho foi proposto objetivando entender a contribuição da panfletagem na divulgação de produtos e serviços e na composição de resíduos sólidos no município de Feira de Santana. Para tanto, utilizou-se de uma avaliação local com intuito de observar a atitude dos munícipes de Feira de Santana que recebem e distribuem panfletos, dando maior suporte às discussões, e de questionário do tipo auto-preenchido de forma on-line para registrar a percepção destes. No total, 142 pessoas participaram da pesquisa que aponta que a panfletagem é utilizada no município e que esta contribui para o aumento no volume de resíduos sólidos, assim como, pelo seu descarte inadequado, favorece a poluição visual, enchentes e proliferação de vetores. Dos munícipes participantes da pesquisa 99,3% dizem receber panfletos e alegam receber com frequência. Embora os participantes leiam os panfletos recebidos, muitos não utilizam para apoio no momento das compras (56,03%). Todos (100%) alegam já terem encontrado panfletos descartados em via pública. Conscientes dos danos, uma significativa parcela dos participantes (70,5%) não considera a panfletagem indispensável para fomento do comércio e indicam a internet e as redes sócias como meio prático para adquirir informação. Com estes dados, percebe-se a necessidade da regulamentação da panfletagem no município e do fomento de trabalhos de conscientização que tenham como intuito a redução da quantidade de panfletos oferecidos e lançados em via pública.
Gestión del agua para uso doméstico: Estrategias familiares en los entornos rural y urbano de Tecali de Herrera, Puebla, México
Authors: Sánchez García Mayely , Ocampo Fletes Ignacio , Villarreal Manzo Luis Alberto , Méndez Espinoza José Arturo , Hernández Rodríguez María De Lourdes
Published: June 2020

El objetivo del estudio fue identificar las estrategias de gestión del agua para uso doméstico, utilizadas por familias rurales y urbanas de una región semiárida del estado de Puebla, México. Para generar información de los hogares se aplicó una encuesta a 83 familias. Los resultados muestran que en ambos contextos los apropiadores utilizaron estrategias particulares y mixtas para sustraer el agua. Las acciones particulares fueron: abastecimiento vía la red pública, acarreo a pie, en burro y en camioneta, y suministro mediante compra de camión cisterna (pipa) y de garrafón. Las estrategias mixtas fueron diferentes en cada contexto. La población rural utilizó ocho, 30.7% recurrió a la combinación: red pública, acarreo a pie y compra de agua de garrafón; mientras que la población urbana empleó once, 34.1% adoptó la combinación: red pública, compra de camión cisterna y de garrafón. Se concluye, que en la zona urbana combinan más estrategias mixtas con relación a la rural.
Dificuldades no enfrentamento da morte e do morrer por profissionais de saúde
Authors: Niemeyer da Rocha Fátima , Ferreira Marinho Avellar Adriana Marley
Published: June 2020

As reações diante da morte e do morrer foram se modificando com o passar dos tempos. Essas modificações são acompanhadas pelo desenvolvimento tecnológico, cultural, religioso, científico e social. A morte que, no passado, era vista como um acontecimento social, comunitário, público e doméstico, agora se dá cada vez mais dentro dos hospitais. Ela ainda é vista como um tabu pela sociedade contemporânea, um tema proibido e, para os profissionais de saúde, pode ser interpretada como um fracasso, uma vez que a hospitalização da morte acarreta um maior envolvimento desses profissionais, uma consequência desse novo panorama. O estudo teve como objetivo investigar o preparo dos profissionais de saúde, atuantes em hospitais, para o enfrentamento da morte e do morrer, a partir de sua percepção individual das dificuldades que enfrentam diante da morte do paciente. Os resultados revelaram que, durante a formação acadêmica, grande parte dos profissionais não recebeu preparo para lidar com a morte e o morrer. A reflexão e a discussão sobre o tema pode ser um fator contribuinte para ajudar esses profissionais a trabalhar com situações onde a morte seja a protagonista.
O bordado Kalocsai: entre significados e ressignificações
Authors: Cabral Kosa Karolina , Pires Teixeira Débora , Morgado Pereira Carolina
Published: June 2020

Na presente pesquisa analisa-se a ressignificação de um símbolo cultural Húngaro em território brasileiro, o bordado Kalocsai e sua aplicação em artigos do vestuário.  Para tanto, foi utilizado como objeto de estudo uma toalha de mesa bordada à mão pela húngara Katalin Kosa, confeccionada no Rio de Janeiro, em 1972, que foi analisada em seus aspectos têxteis, técnicos e simbólicos. Conclui-se que, como um objeto da cultura material, o bordado Kalocsai realizado no Brasil apresenta aspectos têxteis e técnicos semelhantes aos produzidos em seu país de origem, no entanto foi ressignificado, funcionando como um elo cultural, a fim de perpetuar este aspecto que compõe a tradição húngara.
Serviços de Acolhimento Institucional infanto-juvenil: desafios históricos e possibilidades de atuação do psicólogo
Authors: Moreira Estevan Carine , Verciano Baltor Letícia , Barbosa da Silva Roberta
Published: June 2020

O presente artigo tem como objetivo problematizar a relação entre acolhimento institucional, pobreza e negligência familiar, além de realizar um apontamento dos desafios e contribuições da Psicologia nos serviços de acolhimento. Sendo assim, foi utilizada uma revisão da literatura especializada, abarcando o caráter plural da institucionalização infanto-juvenil no Brasil e sua construção histórica. Nesse sentido, indica-se a produção da família pobre como negligente e a ineficiência do Estado mediante às políticas públicas e sociais na garantia de direitos deste público. Discorre-se ainda, sobre as atuações possíveis do profissional de Psicologia diante do processo de institucionalização. Durante a produção do presente artigo, foi possível identificar o papel político do Psicólogo(a) frente à rede de atendimento e garantias de direito, além da sua atuação referente à ressignificação de histórias e sua função como facilitador do protagonismo infanto-juvenil.
Mucormicose rinocerebral associada a trombose de seio cavernoso: Relato de Caso
Authors: Feital Montezzi Nina , Batista Vogas Karen , Ferraz da Silva Veiga Carolina , Marques Rechuan Mariana , Barbosa Cardoso do Santos Bruno , Calmon Nogueira da Gama Pereira Ana Beatriz
Published: June 2020

Mucormicose rinocerebral é uma infecção fúngica rara e invasiva da cavidade nasal e seios da face, podendo evoluir para áreas de necroses, fístulas, acometimento orbital e cerebral. Acomete principalmente indivíduos imunodeprimidos e cetoacidose diabética, com letalidade de aproximadamente 50% dos casos. É considerada uma emergência médica. Uma possível complicação intracraniana é a trombose do seio cavernoso, com prognóstico limitado. É relatado um paciente imunocompetente, 62 anos, diabético, com mucormicose, quadro de rinossinusite fúngica, além da trombose de seio cavernoso com paralisia facial e dos nervos oculomotor, troclear e abducente. Foi tratado com Anfotericina B, Vancomicina, Cefepime, Enoxaparina, com posterior desbridamento cirúrgico e evoluiu com reversão dos sintomas neurológicos. Esse caso requer diagnóstico complexo e tratamento imediato devido a sua alta letalidade (50%). É essencial considerar essa hipótese diagnóstica em pacientes diabéticos e que apresentam mau controle glicêmico ou em cetoacidose diabética com sinusite crônica ou não responsiva ao tratamento padrão.
Restoring the Order of Information Packets Based on Hash Sequence Analysis
Authors: Tanygin M. O.
Published: June 2020

Purpose of research. Currently, various technologies and methods are used to control the integrity and authenticity of data transmitted through open communication channels. One of them is the technology for transmitting sequences of information packets connected to each other in chains using certain cryptographic algorithms. Similar approaches are used in the well-known blockchain technology and are focused on large volumes of transmitted and protected information and large sizes of additional service information fields. The purpose of this article is to study the characteristics of systems, transmission of small information packets in comparison with traditional size frames of TCP/IP stack, in which the broken packet sequence order is restored using the chain method, by analyzing hash sequences available in each of such packets.

Methods. In this article, simulation modeling, system analysis method, method of systematization and ranking of the obtained results are used.

Results. It is shown that increasing the size of the additional field with the hash of the previous message from 4 to 6 bits has a significant effect on reducing the probability of erroneous restore of the order of information packets. Further increasing the length of the hash field reduces the probability of error by only 2 to 5 % for each additional bit of the hash field for any length of the chain being restored. It is shown that the coefficient of the usage of the communication channel (the ratio of useful chain of packets to the volume of information transmitted through the communication channel) is maximum when the length of the hash field is 6 in the whole range of sizes of the field information part of the data packet.

Conclusion. The paper shows that the chain method is applicable for restoring the original sequence of information packets transmitted from the source to the receiver in systems where the preservation of the sequence of packets is not guaranteed. The obtained values of the transmission system parameters allow us to ensure acceptable reliability of data transmission with a minimum amount of additional service information, and achieve information redundancy less than that in similar ones by 10-15.
Admissions to a Low-Resource Neonatal Unit in Malawi Using a Mobile App: Digital Perinatal Outcome Audit
Authors: Crehan Caroline , Kesler Erin , Chikomoni Indira Angela , Sun Kristi , Dube Queen , Lakhanpaul Monica , Heys Michelle
Published: June 2020

Background

Mobile health (mHealth) is showing increasing potential to address health outcomes in underresourced settings as smartphone coverage increases. The NeoTree is an mHealth app codeveloped in Malawi to improve the quality of newborn care at the point of admission to neonatal units. When collecting vital demographic and clinical data, this interactive platform provides clinical decision support and training for the end users (health care professionals [HCPs]), according to evidence-based national and international guidelines.

Objective

This study aims to examine 1 month’s data collected using NeoTree in an outcome audit of babies admitted to a district-level neonatal nursery in Malawi and to demonstrate proof of concept of digital outcome audit data in this setting.

Methods

Using a phased approach over 1 month (November 21-December 19, 2016), frontline HCPs were trained and supported to use NeoTree to admit newborns. Discharge data were collected by the research team using a discharge form within NeoTree, called NeoDischarge. We conducted a descriptive analysis of the exported pseudoanonymized data and presented it to the newborn care department as a digital outcome audit.

Results

Of 191 total admissions, 134 (70.2%) admissions were completed using NeoTree, and 129 (67.5%) were exported and analyzed. Of 121 patients for whom outcome data were available, 102 (84.3%) were discharged alive. The overall case fatality rate was 93 per 1000 admitted babies. Prematurity with respiratory distress syndrome, birth asphyxia, and neonatal sepsis contributed to 25% (3/12), 58% (7/12), and 8% (1/12) of deaths, respectively. Data were more than 90% complete for all fields. Deaths may have been underreported because of phased implementation and some families of babies with imminent deaths self-discharging home. Detailed characterization of the data enabled departmental discussion of modifiable factors for quality improvement, for example, improved thermoregulation of infants.

Conclusions

This digital outcome audit demonstrates that data can be captured digitally at the bedside by HCPs in underresourced newborn facilities, and these data can contribute to a meaningful review of the quality of care, outcomes, and potential modifiable factors. Coverage may be improved during future implementation by streamlining the admission process to be solely via digital format. Our results present a new methodology for newborn audits in low-resource settings and are a proof of concept for a novel newborn data system in these settings.
Understanding Medical Students’ Attitudes Toward Learning eHealth: Questionnaire Study
Authors: Vossen Kjeld , Rethans Jan-Joost , van Kuijk Sander M J , van der Vleuten Cees P , Kubben Pieter L
Published: June 2020

Background

Several publications on research into eHealth demonstrate promising results. Prior researchers indicated that the current generation of doctors is not trained to take advantage of eHealth in clinical practice. Therefore, training and education for everyone using eHealth are key factors to its successful implementation. We set out to review whether medical students feel prepared to take advantage of eHealth innovations in medicine.

Objective

Our objective was to evaluate whether medical students desire a dedicated eHealth curriculum during their medical studies.

Methods

A questionnaire assessing current education, the need for education about eHealth topics, and the didactical forms for teaching these topics was developed. Questionnaire items were scored on a scale from 1 (fully disagree with a topic) to 10 (fully agree with a topic). This questionnaire was distributed among 1468 medical students of Maastricht University in the Netherlands. R version 3.5.0 (The R Foundation) was used for all statistical procedures.

Results

A total of 303 students out of 1468, representing a response rate of 20.64%, replied to our questionnaire. The aggregate statement “I feel prepared to take advantage of the technological developments within the medical field” was scored at a mean value of 4.8 out of 10. Mean scores regarding the need for education about eHealth topics ranged from 6.4 to 7.3. Medical students did not favor creating their own health apps or mobile apps; the mean score was 4.9 for this topic. The most popular didactical option, with a mean score 7.2, was to remotely follow a real-life patient under the supervision of a doctor.

Conclusions

To the best of our knowledge, this is the largest evaluation of students’ opinions on eHealth training in a medical undergraduate curriculum. We found that medical students have positives attitudes toward incorporating eHealth into the medical curriculum.
Patients’ Experiences of Using Smartphone Apps to Support Self-Management and Improve Medication Adherence in Hypertension: Qualitative Study
Authors: McBride Ciara M , Morrissey Eimear C , Molloy Gerard J
Published: June 2020

Background

Worldwide, hypertension control rates remain suboptimal despite clinically effective antihypertensive drug therapy. Patient failure to take medication as prescribed (ie, nonadherence) is the most important factor contributing to poor control. Smartphone apps can facilitate the delivery of evidence-based behavior change techniques to improve adherence and may provide a scalable, usable, and feasible method to deliver self-management support.

Objective

The aim of this study is to explore patients’ experiences of the usability and feasibility of smartphone apps to support self-management and improve medication adherence in hypertension.

Methods

A qualitative descriptive study was conducted. A total of 11 people living with hypertension from the West of Ireland were sampled purposively and interviewed about their experience of using a self-management app for a 4-week period, which included two key functionalities: self-monitoring of blood pressure (BP) and medication reminders. Thematic analysis was carried out on the semistructured interview data.

Results

Participants’ age ranged from 43 to 74 years (mean 62 years, SD 9.13). Three themes were identified: digital empowerment of self-management, human versus digital systems, and digital sustainability. Although patients’ experience of using the technology to self-monitor BP was one of empowerment, characterized by an enhanced insight and understanding into their condition, control, and personal responsibility, the reminder function was only feasible for patients who reported unintentional nonadherence to treatment. Patients experienced the app as a sustainable tool to support self-management and found it easy to use, including those with limited technological competence.

Conclusions

The study’s findings provide new insights into the experience of using apps to support medication adherence in hypertension. Overall, the data support apps as a usable and feasible method to aid self-management of hypertension and highlight the need for personalized functionality, particularly with regard to medication adherence reminder strategies. The study’s findings challenge the perspective that the use of these technologies to support self-management can inevitably add to the burden of treatment experienced by patients.
Exchanges in a Virtual Environment for Diabetes Self-Management Education and Support: Social Network Analysis (Preprint)
Authors: Pérez-Aldana Carlos A , Lewinski Allison A , Johnson Constance M , Vorderstrasse Allison A , Myneni Sahiti
Published: June 2020

BACKGROUND

Diabetes remains a major health problem in the United States, affecting an estimated 10.5% of the population. Diabetes self-management interventions improve diabetes knowledge, self-management behaviors, and clinical outcomes. Widespread internet connectivity facilitates the use of eHealth interventions, which positively impacts knowledge, social support, and clinical and behavioral outcomes. In particular, diabetes interventions based on virtual environments have the potential to improve diabetes self-efficacy and support, while being highly feasible and usable. However, little is known about the patterns of social interactions and support taking place within type 2 diabetes–specific virtual communities.

OBJECTIVE

The objective of this study was to examine social support exchanges from a type 2 diabetes self-management education and support intervention that was delivered via a virtual environment.

METHODS

Data comprised virtual environment–mediated synchronous interactions among participants and between participants and providers from an intervention for type 2 diabetes self-management education and support. Network data derived from such social interactions were used to create networks to analyze patterns of social support exchange with the lens of social network analysis. Additionally, network correlations were used to explore associations between social support networks.

RESULTS

The findings revealed structural differences between support networks, as well as key network characteristics of supportive interactions facilitated by the intervention. Emotional and appraisal support networks are the larger, most centralized, and most active networks, suggesting that virtual communities can be good sources for these types of support. In addition, appraisal and instrumental support networks are more connected, suggesting that members of virtual communities are more likely to engage in larger group interactions where these types of support can be exchanged. Lastly, network correlations suggest that participants who exchange emotional support are likely to exchange appraisal or instrumental support, and participants who exchange appraisal support are likely to exchange instrumental support.

CONCLUSIONS

Social interaction patterns from disease-specific virtual environments can be studied using a social network analysis approach to better understand the exchange of social support. Network data can provide valuable insights into the design of novel and effective eHealth interventions given the unique opportunity virtual environments have facilitating realistic environments that are effective and sustainable, where social interactions can be leveraged to achieve diverse health goals.
Pupillary Responses for Cognitive Load Measurement to Classify Difficulty Levels in an Educational Video Game: Empirical Study (Preprint)
Authors: Mitre-Hernandez Hugo , Covarrubias Carrillo Roberto , Lara-Alvarez Carlos
Published: June 2020

BACKGROUND

A learning task recurrently perceived as easy (or hard) may cause poor learning results. Gamer data such as errors, attempts, or time to finish a challenge are widely used to estimate the perceived difficulty level. In other contexts, pupillometry is widely used to measure cognitive load (mental effort); hence, this may describe the perceived task difficulty.

OBJECTIVE

This study aims to assess the use of task-evoked pupillary responses to measure the cognitive load measure for describing the difficulty levels in a video game. In addition, it proposes an image filter to better estimate baseline pupil size and to reduce the screen luminescence effect.

METHODS

We conducted an experiment that compares the baseline estimated from our filter against that estimated from common approaches. Then, a classifier with different pupil features was used to classify the difficulty of a data set containing information from students playing a video game for practicing math fractions.

RESULTS

We observed that the proposed filter better estimates a baseline. Mauchly’s test of sphericity indicated that the assumption of sphericity had been violated (χ214=0.05; P=.001); therefore, a Greenhouse-Geisser correction was used (ε=0.47). There was a significant difference in mean pupil diameter change (MPDC) estimated from different baseline images with the scramble filter (F5,78=30.965; P<.001). Moreover, according to the Wilcoxon signed rank test, pupillary response features that better describe the difficulty level were MPDC (z=−2.15; P=.03) and peak dilation (z=−3.58; P<.001). A random forest classifier for easy and hard levels of difficulty showed an accuracy of 75% when the gamer data were used, but the accuracy increased to 87.5% when pupillary measurements were included.

CONCLUSIONS

The screen luminescence effect on pupil size is reduced with a scrambled filter on the background video game image. Finally, pupillary response data can improve classifier accuracy for the perceived difficulty of levels in educational video games.
A Computer-Interpretable Guideline for COVID-19: Rapid Development and Dissemination (Preprint)
Authors: Nan Shan , Tang Tianhua , Feng Hongshuo , Wang Yijie , Li Mengyang , Lu Xudong , Duan Huilong
Published: June 2020

BACKGROUND

COVID-19 is a global pandemic that is affecting more than 200 countries worldwide. Efficient diagnosis and treatment are crucial to combat the disease. Computer-interpretable guidelines (CIGs) can aid the broad global adoption of evidence-based diagnosis and treatment knowledge. However, currently, no internationally shareable CIG exists.

OBJECTIVE

The aim of this study was to establish a rapid CIG development and dissemination approach and apply it to develop a shareable CIG for COVID-19.

METHODS

A 6-step rapid CIG development and dissemination approach was designed and applied. Processes, roles, and deliverable artifacts were specified in this approach to eliminate ambiguities during development of the CIG. The Guideline Definition Language (GDL) was used to capture the clinical rules. A CIG for COVID-19 was developed by translating, interpreting, annotating, extracting, and formalizing the Chinese COVID-19 diagnosis and treatment guideline. A prototype application was implemented to validate the CIG.

RESULTS

We used 27 archetypes for the COVID-19 guideline. We developed 18 GDL rules to cover the diagnosis and treatment suggestion algorithms in the narrative guideline. The CIG was further translated to object data model and Drools rules to facilitate its use by people who do not employ the non-openEHR archetype. The prototype application validated the correctness of the CIG with a public data set. Both the GDL rules and Drools rules have been disseminated on GitHub.

CONCLUSIONS

Our rapid CIG development and dissemination approach accelerated the pace of COVID-19 CIG development. A validated COVID-19 CIG is now available to the public.