bluuebunny/crossref_metadata_2025 huggingface dataset:
Using drawing and situated learning to teach transitional care to post-graduate residents
Authors: Liaw Fang-Yih , Chang Yaw-Wen , Chang Yan-Di , Shih Li-Wen , Tsai Po-Fang
Published: September 2022

Background

The “draw-and-talk” technique has become popular in medical training, as it can help healthcare practitioners develop empathic understanding of patients and contribute to personal transformation. We adopted this method to make the teaching of transitional care planning more relevant to post-graduate residents undergoing their internal medicine training at a medical center in Taiwan.

Methods

Before the conventional lecture on discharge planning, trainees were invited to draw their “home” and “life as older adults” and share their drawings with others. Subsequently, they were guided to consider whether their home would be livable if they either had a disability or were old. The drawings and narratives were analyzed thematically, and feedback on the session was collected.

Results

Trainees were initially of the opinion that they did not have any role in discharge planning. However, the emphasis on the self-experience of drawing and the thematic use of “home” and “elderly life” led to reflective discussions about post-discharge care. The session provoked constructive self-reflection and meta-cognitive awareness and encouraged residents to actively participate in transition care plans. Response to the draw-and-talk session was overwhelmingly favorable.

Conclusions

Post-graduate residents in Taiwan conventionally do not have much interest or autonomy regarding their patients’ lives outside the hospital. The use of drawing and reflection is a simple and inexpensive method to contextualize discharge planning in participants’ real lives, engage them in actively visualizing the healthcare needs of older adults and patients with disability, and initiate thinking about the impact of discharge preparations, follow-up care, and barriers to care at home. Draw-and-talk might be helpful in improving residents’ knowledge and empathy toward patients preparing for discharge, which is crucial for the quality of transitional care.
Predicting the level of anemia among Ethiopian pregnant women using homogeneous ensemble machine learning algorithm
Authors: Dejene Belayneh Endalamaw , Abuhay Tesfamariam M. , Bogale Dawit Shibabaw
Published: September 2022

Background

More than 115,000 maternal deaths and 591,000 prenatal deaths occurred in the world per year with anemia, the reduction of red blood cells or hemoglobin in the blood. The world health organization divides anemia in pregnancy into mild anemia (Hb 10–10.9 g/dl), moderate anemia (Hb 7.0–9.9 g/dl), and severe anemia (Hb < 7 g/dl). This study aims to predict the level of anemia among pregnant women in the case of Ethiopia using homogeneous ensemble machine learning algorithms.

Methods

This study was conducted following a design science approach. The data were gathered from the Ethiopian demographic health survey and preprocessed to get quality data that are suitable for the machine learning algorithm to develop a model that predicts the levels of anemia among pregnant. Decision tree, random forest, cat boost, and extreme gradient boosting with class decomposition (one versus one and one versus rest) and without class decomposition were employed to build the predictive model. For constructing the proposed model, twelve experiments were conducted with a total of 29,104 instances with 23 features, and a training and testing dataset split ratio of 80/20.

Results

The overall accuracy of random forest, extreme gradient boosting, and cat boost without class decompositions is 91.34%, 94.26%, and 97.08.90%, respectively. The overall accuracy of random forest, extreme gradient boosting, and cat boost with one versus one is 94.4%, 95.21%, and 97.44%, respectively. The overall accuracy of random forest, extreme gradient boosting, and cat boost with one versus the rest are 94.4%, 94.54%, and 97.6%, respectively.

Conclusion

Finally, the researcher decided to use cat boost algorithms with one versus the rest for further use in the development of artifacts, model deployment, risk factor analysis, and generating rules because it has registered better performance with 97.6% accuracy. The most determinant risk factors of anemia among pregnant women were identified using feature importance. Some of them are the duration of the current pregnancy, age, source of drinking water, respondent’s (pregnant women) occupation, number of household members, wealth index, husband/partner's education level, and birth history.
Implementing Exercise = Medicine in routine clinical care; needs for an online tool and key decisions for implementation of Exercise = Medicine within two Dutch academic hospitals
Authors: Bouma Adrie , van Nassau Femke , Nauta Joske , Krops Leonie , van der Ploeg Hidde , Verhagen Evert , van der Woude Lucas , van Keeken Helco , Dekker Rienk ,   PIE = M consortium, van Mechelen Willem , de Groot Vincent , van der Leeden Marike , Zwerver Johannes , Fluit Martin , van den Akker-Scheek Inge , Stevens Martin , Diercks Ronald , Bossers Willem , Buffart Laurien , de Jong Johan , Kampshoff Caroline , Leutscher Hans , van Twillert Sacha
Published: September 2022

Background

There is much evidence to implement physical activity interventions for medical reasons in healthcare settings. However, the prescription of physical activity as a treatment, referring to as ‘Exercise is Medicine’ (E = M) is currently mostly absent in routine hospital care in The Netherlands. To support E = M prescription by clinicians in hospitals, this study aimed: (1) to develop an E = M-tool for physical activity advice and referrals to facilitate the E = M prescription in hospital settings; and (2) to provide an E = M decision guide on key decisions for implementation to prepare for E = M prescription in hospital care.

Methods

A mixed method design was used employing a questionnaire and face-to-face interviews with clinicians, lifestyle coaches and hospital managers, a patient panel and stakeholders to assess the needs regarding an E = M-tool and key decisions for implementation of E = M. Based on the needs assessment, a digital E = M-tool was developed. The key decisions informed the development of an E = M decision guide.

Results

An online supportive tool for E = M was developed for two academic hospitals. Based on the needs assessment, linked to the different patients’ electronic medical records and tailored to the two local settings (University Medical Center Groningen, Amsterdam University Medical Centers). The E = M-tool existed of a tool algorithm, including patient characteristics assessed with a digital questionnaire (age, gender, PA, BMI, medical diagnosis, motivation to change physical activity and preference to discuss physical activity with their doctor) set against norm values. The digital E = M-tool provided an individual E = M-prescription for patients and referral options to local PA interventions in- and outside the hospital. An E = M decision guide was developed to support the implementation of E = M prescription in hospital care.

Conclusions

This study provided insight into E = M-tool development and the E = M decision-making to support E = M prescription and facilitate tailoring towards local E = M treatment options, using strong stakeholder participation. Outcomes may serve as an example for other decision support guides and interventions aimed at E = M implementation.
Investigating the relationship between consultation length and quality of tele-dermatology E-consults in China: a cross-sectional standardized patient study
Authors: Gong Xue , Hou Mengchi , Guo Rui , Feng Xing Lin
Published: September 2022

Background

Consultation length, the time a health provider spend with the patient during a consultation, is a crucial aspect of patient-physician interaction. Prior studies that assessed the relationship between consultation length and quality of care were mainly based on offline visits. Research was lacking in E-consults settings, an emerging modality for primary health care. This study aims to examine the association between consultation length and the quality of E-consults services.

Methods

We defined as standardized patient script to present classic urticaria symptoms in asynchronous E-consults at tertiary public hospitals in Beijing and Hangzhou, China. We appraised consultation length using six indicators, time waiting for first response, time waiting for each response, time for consultation, total times of provider’s responses, total words of provider’s all responses, and average words of provider’s each response. We appraised E-consults services quality using five indicators building on China’s clinical guidelines (adherence to checklist; accurate diagnosis; appropriate prescription; providing lifestyle modification advice; and patient satisfaction). We performed ordinary least squares (OLS) regressions and logistic regressions to investigate the association between each indictor of consultation length and E-consults services quality.

Results

Providers who responded more quickly were more likely to provide lifestyle modification advice and achieve better patient satisfaction, without compromising process, diagnosis, and prescribing quality; Providers who spent more time with patients were likely to adhere to clinical checklists; Providers with more times and words of responses were significantly more likely to adhere to the clinical checklist, provide an accurate diagnosis, appropriate prescription, and lifestyle modification advice, which achieved better satisfaction rate from the patient as well.

Conclusions

The times and words that health providers provide in E-consult can serve as a proxy measure for quality of care. It is essential and urgent to establish rules to regulate the consultation length for Direct-to-consumer telemedicine to ensure adequate patient-provider interaction and improve service quality to promote digital health better.
Factors impacting—stillbirth and neonatal death audit in Malawi: a qualitative study
Authors: Gondwe Mtisunge Joshua , Joshua Emily , Kaliati Hendrina , Aminu Mamuda , Allen Stephen , Desmond Nicola
Published: September 2022

Background

Over one million babies are stillborn or die within the first 28 days of life each year due to preventable causes and poor-quality care in resource-constrained countries. Death audit may be a valuable tool for improving quality of care and decreasing mortality. However, challenges in implementing audit and their subsequent action plans have been reported, with few successfully implemented and sustained. This study aimed to identify factors that affect stillbirth and neonatal death audit at the facility level in the southern region of Malawi.

Methods

Thirty-eight semi-structured interviews and seven focus group discussions with death audit committee members were conducted. Thematic analysis was guided by a conceptual framework applied deductively, combined with inductive line-by-line coding to identify additional emerging themes.

Results

The factors that affected audit at individual, facility and national level were related to training, staff motivation, power dynamics and autonomy, audit organisation and data support. We found that factors were linked because they informed each other. Inadequate staff training was caused by a lack of financial allocation at the facility level and donor-driven approaches to training at the national level, with training taking place only with support from funders. Staff motivation was affected by the institutional norms of reliance on monetary incentives during meetings, gazetted at the national level so that audits happened only if such incentives were available. This overshadowed other benefits and non-monetary incentives which were not promoted at the facility level. Inadequate resources to support audit were informed by limited facility-level autonomy and decision-making powers which remained controlled at the national level despite decentralisation. Action plan implementation challenges after audit meetings resulted from inadequate support at the facility level and inadequate audit policy and guidelines at the national level. Poor documentation affected audit processes informed by inadequate supervision and promotion of data usage at both facility and national levels.

Conclusions

Given that the factors that facilitate or inhibit audits are interconnected, implementers, policymakers and managers need to be aware that addressing barriers is likely to require a whole health systems approach targeting all system levels. This will require behavioural and complex intervention approaches.
A method based on non-ionizing microwave radiation for ancillary diagnosis of osteoporosis: a pilot study
Authors: Albuquerque Gabriela , Cruz Agnaldo , Carvalho Dionísio , Mayrink Nadja , Pinheiro Bruno , Campos Antonio , Lima Josivan Gomes , Henriques Jorge , Valentim Ricardo
Published: September 2022

Background

Osteoporosis is a condition characterized by low bone mineral density, which typically leads to fractures and reduced quality of life. Currently, diagnostic devices used to assess this condition (e.g., dual-energy X-ray absorptiometry) are very costly, making it infeasible to meet the demand for testing in most countries. Therefore, we proposed a preclinical validation of a prototype called Osseus in an attempt to enhance osteoporosis screening tests and alleviate their costs. Osseus is a device developed to assist bone mineral density classification. It integrates a microcontroller into other peripheral devices to measure the attenuation at the middle phalanx of the middle finger, with two antennas operating at the 2.45 GHz frequency.

Results

We conducted tests with plaster, poultry, and porcine bones. A comparison of the measurements of the original and mechanically altered samples demonstrated that the device can handle the complexity of the tissues within the bone structure and characterize its microarchitecture.

Conclusions

Osseus is a device that has been preliminarily validated. Ionising radiation needed for DXA tests is replaced by non-ionising microwave electromagnetic radiation. Osseus enables early detection of osteoporosis, reduces costs, and optimizes high-complexity testing referrals. There is a lack of validation studies with the reference/gold standard that are currently under development.
The impact of different endometrial preparation protocols on obstetric and neonatal complications in frozen-thawed embryo transfer: a retrospective cohort study of 3,458 singleton deliveries
Authors: Xu Junting , Zhou Hong , Zhou Tianfan , Guo Yi , Liang Shanshan , Jia Yanping , Li Kunming , Teng Xiaoming
Published: September 2022

Background

Frozen-thawed embryo transfer (FET) is thought to be associated with obstetric and neonatal complications after in vitro fertilization/intracytoplasmic single sperm injection (IVF/ICSI) treatment. The study aimed to determine whether the endometrial preparation protocol is an influencing factor for these complications.

Methods

We conducted a retrospective cohort study of 3,458 women who had singleton deliveries after IVF/ICSI–FET treatment at the Centre for Reproductive Medicine of Shanghai First Maternity and Infant Hospital between July 2016 and April 2021. The women were divided into three groups according to the endometrial preparation protocols: 2,029 women with programmed cycles, 959 with natural cycles, and 470 with minimal ovarian stimulation cycles. The primary outcomes were the incidence rates of obstetric and neonatal complications, namely, hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), placenta previa, preterm rupture of membranes (PROM), preterm delivery, postpartum haemorrhage, large for gestational age (LGA), small for gestational age (SGA), and macrosomia.

Results

After adjustments for confounding variables by multivariate logistic regression analysis, the results showed that programmed cycles had an increased risk of HDP (aOR = 1.743; 95% CI, 1.110–2.735; P = 0.016) and LGA (aOR = 1.269; 95% CI, 1.011–1.592; P = 0.040) compared with natural cycles. Moreover, programmed cycles also increased the risk of LGA (aOR = 1.459; 95% CI, 1.083–1.965; P = 0.013) but reduced the risk of SGA (aOR = 0.529; 95% CI, 0.348–0.805; P = 0.003) compared with minimal ovarian stimulation cycles. There were no significant differences between natural cycles and minimal ovarian stimulation cycles.

Conclusions

During IVF/ICSI–FET treatment, the risk of HDP and LGA was increased in women with programmed cycles. Therefore, for patients with thin endometrium, irregular menstruation or no spontaneous ovulation, minimal ovarian stimulation cycles may be a relatively safer option than programmed cycles.
TOP2A deficit-induced abnormal decidualization leads to recurrent implantation failure via the NF-κB signaling pathway
Authors: Fu Huijia , Tan Wang , Chen Zhi , Ye Zi , Duan Yuhan , Huang Jiayu , Qi Hongbo , Liu Xiru
Published: September 2022

Background

Successful implantation is a complex process that is influenced by embryo quality, endometrial receptivity, immune factors, and the specific type of in vitro fertilization protocol used. DNA topoisomerase IIα (TOP2A) is a well-known protein involved in cell proliferation; however, its expression and effect on the endometrium in recurrent implantation failure (RIF) have not been fully elucidated.

Methods

The human endometrial tissues of healthy controls and patients with RIF were collected. A proteomic analysis was performed to evaluate the differentially expressed proteins between the RIF group and the fertile control group. The expression patterns of TOP2A in the human preimplantation endometrium of the patients with RIF were determined by immunohistochemical staining, Western blotting and qRT-PCR. TOP2A knockdown (sh-TOP2A) T-HESCs were generated using lentiviruses. The expression of TOP2A in T-HESCs was manipulated to investigate its role in decidualization. The TOP2A-related changes in decidualization were screened by mRNA sequencing in decidualized TOP2A knockdown and control T-HESCs and then confirmed by Western blotting and immunofluorescence staining. TOP2A-deficient mice were generated by injection of TOP2A-interfering adenovirus on GD2.5 and GD3.5.

Results

We performed a proteomic analysis of endometrial tissues to investigate the potential pathogenesis of RIF by comparing the patients with RIF and the matched controls and found that TOP2A might be a key protein in RIF. TOP2A is ubiquitously expressed in both stromal and glandular epithelial cells of the endometrium. The data indicate that TOP2A expression is significantly lower in the mid-secretory endometrium of women with RIF. TOP2A expression was downregulated under stimulation by 8-bromo-cAMP and MPA. Ablation of TOP2A resulted in upregulated expression of decidual biomarkers and morphological changes in the cells. Mechanistic analysis revealed that TOP2A regulates the NF-κB signaling pathway in decidualized T-HESCs. The TOP2A-deficient mice exhibited lower fetal weights.

Conclusions

Our findings revealed that abnormal expression of TOP2A affects decidualization and changes the “window of implantation”, leading to RIF. TOP2A participates in the processes of decidualization and embryo implantation, functioning at least in part through the NF-κB pathway. Regulating the expression of TOP2A in the endometrium may become a new strategy for the prevention and treatment of RIF.
Why Turner patients with 45, X monosomy should not be excluded from fertility preservation services
Authors: Schleedoorn MJ , Fleischer K , Braat DDM , Oerlemans AJM , van der Velden AAEM , Peek R
Published: September 2022

In this case report, we highlight the practical dilemma, i.e. to perform ovarian tissue cryopreservation surgery in a 45, X Turner Syndrome patient or not, by reporting on the presence of follicles in a 13-year-old female diagnosed with 45, X monosomy and an unmeasurable anti-müllerian hormone serum level. We compare our results with previous research, highlight the challenges we faced in this case and provide recommendations for daily practice. Hereby, we demonstrate that excluding certain subgroups of Turner Syndrome patients (e.g. monosomy patients, and/or girls with an anti-müllerian hormone level below 2.0 ng/l) may be premature, especially based on the current state of published research data. This practical example of a challenging dilemma in the counselling of Turner Syndrome patients for fertility preservation is of interest for clinicians involved in fertility counselling and Turner Syndrome care.
Farmers' perceptions of grassland management in Magui Khola basin of Madi Chitwan, Nepal
Authors: Barsila Shanker Raj , Joshi Niraj Prakash , Poudel Tuk Narayan , Devkota Badrika , Devkota Naba Raj , Chalise Dev Raj
Published: September 2022

Management of grassland is one of the important factors in traditional livestock farming systems. A survey was conducted in Madi of Chitwan Nepal to understand the perceptions of the farmers/graziers about grassland and feed management. For that, a well-prepared pretested set of questionnaires was used to collect information related to feeds and grassland ecological knowledge of the farmers. The questionnaire consisted of a set of questions about the household, factors affecting grassland productivity and alternative feeding resources. The survey revealed variations in household livestock ownerships, mostly for cattle (1–3) and buffalo (1–5), whilst goat ownership was similar across the survey sites. Grazing duration in months was similar in the study sites (about 7 months per year). Likewise, there was no conflict for grazing livestock, whereas it is believed that goat and buffalo have the same level of detrimental effect on grassland. A significantly higher number of respondents reported that flooding had a negative impact (p = 0.032) on grassland productivity. The Imperata cylindrica (L.) P. Beauv. locally known as Siru was a dominant forage species followed by the mosaics of Saccharum spontaneum L. locally known as Kaans in Nepali and Jhaksi in Tharu language, Saccharum bengalense Retz. locally known as Baruwa in Nepali and Narkat in the Tharu language. The respondents also pointed out that at least 2 to 3 years were needed for the recovery of grasslands when hampered by flooding and riverbank cut-off. Similar species dominated in the recovered grasslands over time of flooding. The seasonal fodder plantation was a major area of grassland improvement issue across the survey sites. There were high dependencies of the graziers on natural herbages and crop residues for feeding livestock in summer and winter, though the herbage species and preferences remained different. This study provides the primary background of the biophysical factors of grassland management for sustainable uses that require institutional support. The study further provides an insight into the need for implementation of the demand-based grassland technology interventions, possibly at a higher rate of adoption than the current local scale. However, the social-ecological consequences of grassland systems, i.e. the impact of climate change, herd dynamics and nutrient flow in vegetation and soil, have to be monitored in a long run.
Factors affecting the physical activity of healthcare workers of Iran University of Medical Sciences: a qualitative study
Authors: Hoveidamanesh Soodabeh , Tayefi Batool , Rampisheh Zahra , Khalili Narjes , Ramezani Mozhdeh
Published: September 2022

Background

Low physical activity in adulthood is a major public health challenge. The majority of adults spend many hours each week at work, and workplace thus becomes a suitable location in which to promote health and implement physical activity programs. This qualitative study was conducted to identify the barriers and facilitators of worksite physical activity from the perspective of the employees of Iran University of Medical Sciences.

Methods

In this qualitative thematic analysis, five focus group discussions were held with the participation of 68 staff members of Iran University of Medical Sciences who had been selected by purposive sampling with maximum diversity.

Results

The analysis of the data led to the identification of three general themes, including challenges and barriers, strategies, and incentives (facilitators). The four main categories of challenges and barriers included policy-making and legislation, organizational factors, structural factors, and personal factors. Most barriers identified by the participants were placed in the personal factors and organizational factors categories. The strategies for increasing physical activity were identified in the following three categories: Policy-making and legislation, organizational factors, and environmental factors. The majority of the strategies proposed were placed in the organizational factors and policy-making and legislation categories.

Conclusions

Increasing physical activity in the workplace as a strategy for the general promotion of physical activity in people requires interventions in different areas, especially with regard to organizational factors and policy-making and legislation.
Strain-level resolution and pneumococcal carriage dynamics by single-molecule real-time (SMRT) sequencing of the plyNCR marker: a longitudinal study in Swiss infants
Authors: Oyewole Oluwaseun Rume-Abiola , Latzin Philipp , Brugger Silvio D. , Hilty Markus
Published: September 2022

Background

Pneumococcal carriage has often been studied from a serotype perspective; however, little is known about the strain-specific carriage and inter-strain interactions. Here, we examined the strain-level carriage and co-colonization dynamics of Streptococcus pneumoniae in a Swiss birth cohort by PacBio single-molecule real-time (SMRT) sequencing of the plyNCR marker.

Methods

A total of 872 nasal swab (NS) samples were included from 47 healthy infants during the first year of life. Pneumococcal carriage was determined based on the quantitative real-time polymerase chain reaction (qPCR) targeting the lytA gene. The plyNCR marker was amplified from 214 samples having lytA-based carriage for pneumococcal strain resolution. Amplicons were sequenced using SMRT technology, and sequences were analyzed with the DADA2 pipeline. In addition, pneumococcal serotypes were determined using conventional, multiplex PCR (cPCR).

Results

PCR-based plyNCR amplification demonstrated a 94.2% sensitivity and 100% specificity for Streptococcus pneumoniae if compared to lytA qPCR. The overall carriage prevalence was 63.8%, and pneumococcal co-colonization (≥ 2 plyNCR amplicon sequence variants (ASVs)) was detected in 38/213 (17.8%) sequenced samples with the relative proportion of the least abundant strain(s) ranging from 1.1 to 48.8% (median, 17.2%; IQR, 5.8–33.4%). The median age to first acquisition was 147 days, and having ≥ 2 siblings increased the risk of acquisition.

Conclusion

The plyNCR amplicon sequencing is species-specific and enables pneumococcal strain resolution. We therefore recommend its application for longitudinal strain-level carriage studies of Streptococcus pneumoniae.
Immersive cultural heritage digital documentation and information service for historical figure metaverse: a case of Zhu Xi, Song Dynasty, China
Authors: Fan Zhanling , Chen Chongcheng , Huang Hongyu
Published: September 2022

Cultural heritage is closely linked with individual historical figures, who become a key focus for cultural tourism. Confucianism laid the foundation for much of Chinese civilization, and Confucius and Mencius have been studied extensively and have been influential in many parts of the world. Zhu Xi, the founder and master of Neo-Confucianism (an important part of the Mount Wuyi world cultural heritage), has received less research attention. With the big bang of the metaverse, research on the immersive cultural heritage digital documentation and information service for historical figures has become a new perspective. This paper presents a metaverse-based digital documentation framework for historical figures. This framework addresses the digitization of multimodal data for cultural heritage and adapts to the needs of metaverse presentations. For cultural research and cultural preservation, the paper has explored a combined contactless virtual and real cultural heritage experience system. For tourists, we intend to develop an immersive and holistic cultural tourism information service before, during and after the tour. In particular, we have also developed the Zhu Xi metaverse system. This is a step forward in the construction of a metaverse of historical figures.
Pro re nata versus fixed aflibercept regimen for neovascular age-related macular degeneration: a systematic review and meta-analysis
Authors: Victor Andi Arus , Putri Yan Martha
Published: September 2022

Background

Aflibercept is a relatively new anti-VEGF used to treat neovascular age-related macular degeneration (AMD). The purpose of this review is to evaluate the effect of pro re nata (PRN) and fixed regimen (bimonthly) of aflibercept injection for neovascular AMD on visual outcomes at 12 months of follow-up.

Methods

We conducted a systematic search in PubMed (MEDLINE), Embase, Scopus, and Web of Science, EBSCOHost, and ClinicalTrials.gov databases. Number of injections, number of hospital visit, mean change of best corrected visual acuity (BCVA), mean change of central macular thickness (CMT), and adverse effects of the included studies were evaluated. Meta-analysis were performed using Review Manager 5.4.

Results

Four studies were selected for meta-analyses synthesis (3 RCT, 1 retrospective study). A total of 197 eyes in PRN group and 241 eyes in the fixed group. All four studies favored fixed regimen with standardized mean difference of 0.56 (95% CI 0.36–0.75, I2 = 0%, p < 0.00001). There was no significant difference in CMT between both group with SMD of 0.17 (95% CI − 0.14–0.48, I2 = 26%, p = 0.28).

Conclusion

The present meta-analysis shows that bimonthly injection of aflibercept for neovascular AMD is superior compared to PRN injection, shown by better improvement in BCVA at 12 months follow-up. However, high risk of bias downgrade the certainty of evidence.
Arterial tortuosity syndrome (variants in SLC2A10 gene) in two pediatric patients in the same city of Spain: a case report
Authors: Palanca Arias Daniel , Ayerza Casas Ariadna , Clavero Adell Marcos , Gutiérrez Alonso Cristina , López Ramón Marta , Jiménez Montañés Lorenzo , Estaben Boldova Victoria , Izquierdo-Álvarez Silvia
Published: September 2022

Background

Arterial tortuosity syndrome (ATS) (OMIM #208050) is a very rare autosomal recessive connective tissue disease characterized by elongation, tortuosity, and predisposition of aneurysms formation in medium and large-caliber arteries, vascular dissection, and ischemic events. To date, approximately 100 patients have been reported carrying some of the fewer than 35 causal mutations in the SLC2A10 gene.

Case presentation

Here we present the clinical and molecular characterization of two new Spanish pediatric ATS patients from two unrelated families in the same city in a short period of time. Due to the knowledge of the pathology through the first case this pathology was suspected from birth in the second case, requesting the directed genetic study.

Conclusion

In addition to arterial tortuosity and connective tissue features, sequencing analysis revealed the homozygous and heterozygous Frameshift Deletion. Confirm diagnosis in the first few years of life is the most critical for possible life-threatening events and to offer adequate genetic counseling.
Utilization Trends, Cost, and Payments for Adult Spinal Deformity Surgery in Commercial and Medicare-Insured Populations
Authors: Wadhwa Harsh , Leung Christopher , Sklar Matthew , Ames Christopher P. , Veeravagu Anand , Desai Atman , Ratliff John , Zygourakis Corinna C.
Published: September 2022

BACKGROUND:

Previous studies have characterized utilization rates and cost of adult spinal deformity (ASD) surgery, but the differences between these factors in commercially insured and Medicare populations are not well studied.

OBJECTIVE:

To identify predictors of increased payments for ASD surgery in commercially insured and Medicare populations.

METHODS:

We identified adult patients who underwent fusion for ASD, 2007 to 2015, in 20% Medicare inpatient file (n = 21 614) and MarketScan commercial insurance database (n = 38 789). Patient age, sex, race, insurance type, geographical region, Charlson Comorbidity Index, and length of stay were collected. Outcomes included predictors of increased payments, surgical utilization rates, total cost (calculated using Medicare charges and hospital-specific charge-to-cost ratios), and total Medicare and commercial payments for ASD.

RESULTS:

Rates of fusion increased from 9.0 to 8.4 per 10 000 in 2007 to 20.7 and 18.2 per 10 000 in 2015 in commercial and Medicare populations, respectively. The Medicare median total charges increased from $88 106 to $144 367 (compound annual growth rate, CAGR: 5.6%), and the median total cost increased from $31 846 to $39 852 (CAGR: 2.5%). Commercial median total payments increased from $58 164 in 2007 to $64 634 in 2015 (CAGR: 1.2%) while Medicare median total payments decreased from $31 415 in 2007 to $25 959 in 2015 (CAGR: −2.1%). The Northeast and Western regions were associated with higher payments in both populations, but there is substantial state-level variation.

CONCLUSION:

Rate of ASD surgery increased from 2007 to 2015 among commercial and Medicare beneficiaries. Despite increasing costs, Medicare payments decreased. Age, length of stay, and BMP usage were associated with increased payments for ASD surgery in both populations.
Sustained Sleep Restriction Reduces Resistance Exercise Quality and Quantity in Females
Authors: KNOWLES OLIVIA E. , DRINKWATER ERIC J. , ROBERTS SPENCER S. H. , ALEXANDER SARAH E. , ABBOTT GAVIN , GARNHAM ANDREW , LAMON SÉVERINE , AISBETT BRAD
Published: September 2022

Introduction

Female athletes sleep less and report more sleep problems than their male counterparts. Inadequate sleep reduces maximal strength in male athletes; however, little is known about the impact of sleep restriction (SR) on the quantity and quality of resistance exercise performed by female athletes. This study investigated the effect of nine nights of moderate SR on repeated resistance exercise performance, hormonal responses, and perceived fatigue in females.

Methods

Ten healthy, resistance-trained, eumenorrheic females age 18–35 yr underwent nine nights of SR (5-h time in bed) and normal sleep (NS; ≥7-h time in bed) in a randomized, crossover fashion with a minimum 6-wk washout. Participants completed four resistance exercise sessions per trial, with blood samples collected before and after exercise. Exercise performance was assessed using volume load, reactive strength index, and mean concentric velocity with rating of perceived exertion recorded after exercise. Participants completed awakening saliva sampling and the Multi-component Training Distress Scale daily.

Results

Volume load decreased trivially (<1%, P < 0.05) with SR. Mean concentric velocity per set was slower during SR for the lower-body (up to 15%, P < 0.05), but not the upper-body, compound lifts. Intraset velocity loss was up to 7% greater during SR for back squats (P < 0.05). SR increased salivary cortisol area under the curve (by 42%), total training distress (by 84%), and session perceived exertion (by 11%).

Conclusions

Sustained SR reduces markers of resistance exercise quality (bar velocity) more than quantity (volume load) and increases perceived effort at the same relative intensity in resistance-trained females. Markers of exercise quality and internal load may be more sensitive than volume load, to advise coaches to the decline in lifting performance for female athletes experiencing SR.
Myocardial Fibrosis and Coronary Calcifications Caused by Endurance Exercise? Insights from Former Professional Cyclists
Authors: MACEIRA ALICIA , VALENZUELA PEDRO L. , SANTOS-LOZANO ALEJANDRO , GARCÍA-GONZÁLEZ MARÍA P. , ORTEGA LAURA HIGUERAS , DÍAZ-GONZALEZ LEONEL , BORAITA ARACELI , BARRANCO-GIL DAVID , LUCIA ALEJANDRO
Published: September 2022

Purpose

This study aimed to compare the prevalence of myocardial fibrosis and coronary calcification in individuals who have performed very high levels of strenuous endurance exercise (SEE; former male professional cyclists) and sex/age-matched controls.

Methods

We used a retrospective cohort study design, where cases were former finishers of ≥1 Grand Tour (Tour de France, Giro d’ Italia or Vuelta a España) and controls were untrained individuals free of cardiovascular risk. All participants underwent cardiac magnetic resonance and cardiac computer tomography in the same center during years 2020–2021 to detect myocardial fibrosis (late gadolinium enhancement) and to quantify coronary calcium, respectively.

Results

Twenty-three cases (age, 46 ± 6 yr) and 59 controls (47 ± 7 yr) were studied. Fibrotic patches were evidenced only in the left ventricle, with a higher prevalence in cases (23% vs 2% in controls, P = 0.006). However, fibrotic tissue was nonischemic and of low extension (0.6% ± 0.4% of left ventricle mass), and no significant differences were found between cases and controls for native T1 or T2 values. No between-group differences were found for coronary calcium indicators, including Agatston or density scores. Subanalyses revealed no differences attending to whether cases were still performing regular SEE (n = 8) or not (n = 15) after professional retirement.

Conclusions

Although former professional cyclists seemed to show a greater prevalence of myocardial fibrosis, the extension of fibrotic tissue was minimal and no alterations were found in coronary calcification indicators. While keeping in mind the low sample size of the cases’ group, our results do not support evidence for major cardiac maladaptations with long-term exposure to SEE, at least in middle-age adults.
Spectrum of hemoglobinopathies with hematological and biochemical profile: A five year experience from a tertiary care hospital
Authors: Mansoor Neelum , Meraj Fatima , Shaikh Ameerah , Jabbar Naeem
Published: September 2022

Background & Objective: Determination of hemoglobinopathies is significant for epidemiological studies. There is a need to identify burden of hemoglobinopathies at national level to lay down the foundation of appropriate screening and prevention programs. The present study aimed to evaluate the spectrum of hemoglobinopathies along with hematological and biochemical parameters in a tertiary care hospital.

Methods: This retrospective study included results of high performance liquid chromatography (HPLC) test from July 2015 - May 2020 in the department of Hematology, Indus Hospital and Health Network, Karachi, Pakistan. Data of all patients collected for red blood cell (RBC) indices, serum iron profile, and vitamin B12 and red cell folate levels. Diagnosis of hemoglobinopathies was done by an automatic analyzer ADAMS A1C Model No. HA-8180T Arkray/Japan.

Results: Among 2422 participants, hemoglobinopathy observed in 14.5% (n=352). Beta thalassemia trait is observed as the most common hemoglobinopathy (6.4%). Severe anemia (Hb=5.1-5.5 g/dl) found in beta thalassemia major (BTM) and HbE disease. Red cell parameters showed significant association with different types of hemoglobinopathies. Mean ferritin level was high in E-beta thalassemia (687.8±591.9) followed by sickle cell disease (615.7±543.5).

Conclusion: Apparently, overall frequency is static however, results of this study are not applicable to general population due to sample bias. Moreover, true figures are difficult to identify due to high incidence of iron deficiency anemia that masks the diagnosis by conventional techniques. Molecular characterization by DNA analysis is the most reliable tool of diagnosis. However, this method is not widely available in our country due to lack of expertise and cost issues.

doi: https://doi.org/10.12669/pjms.38.8.5935

How to cite this:Mansoor N, Meraj F, Shaikh A, Jabbar N. Spectrum of hemoglobinopathies with hematological and biochemical profile: A five year experience from a tertiary care hospital. Pak J Med Sci. 2022;38(8):---------. doi: https://doi.org/10.12669/pjms.38.8.5935

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
INTERCULTURALIDADE E INCLUSÃO NA EDUCAÇÃO NO BRASIL E NO QUEBEC: diferentes concepções, semelhantes desafios
Authors: Russo Kelly , Borri-Anadon Corina
Published: September 2022

Este artigo procura discutir as concepções de interculturalidade adotadas no Brasil e no Quebec, estabelecendo paralelos e contrapontos. Apresenta informações sobre a origem e o desenvolvimento do conceito na América Latina, no Brasil e no Quebec, analisa sua incidência nas políticas educativas dos diferentes contextos e discute a interface entre tendências globais e locais na configuração da perspectiva intercultural em ambas as sociedades. O artigo também apresenta reflexões sobre como o debate da inclusão tem ocupado maior centralidade nos discursos e nas políticas educativas em detrimento do debate intercultural nos últimos anos. Acreditamos que a análise comparada sobre o desenvolvimento de políticas públicas educacionais interculturais favorece um maior aprofundamento para a discussão sobre avanços e atuais desafios do reconhecimento das diferenças na educação.
GAMIFICAÇÃO NO ENSINO DE MATEMÁTICA: UMA PROPOSTA PARA O USO DE JOGOS DIGITAIS NAS AULAS COMO MOTIVADORES DA APRENDIZAGEM
Authors: Alves Dieime Machado , Carneiro Raylson Dos Santos , Carneiro Rogerio Dos Santos
Published: September 2022

Na busca por engajamento dos estudantes, a gamificação tem sido uma estratégia de ensino que tem gerado resultados. Gamificar as aulas é uma forma de diversificar as metodologias de ensino, reduzindo o uso excessivo do método tradicional, e optar por aumentar, nos estudantes, o interesse em participar das aulas de Matemática. O objetivamos discutir sobre o uso dos jogos em formato digital para o ensino de Matemática e deste modo busca-se provocar uma reflexão para que os professores percebam que é possível realizar a inovação das aulas. Neste trabalho versou-se sobre a importância dos jogos para o desenvolvimento da aprendizagem dos estudantes, discutiu-se sobre como o uso dos jogos em formato digital pode atrair a atenção dos alunos e trazer inovação das aulas para os professores. Abordou-se sobre a dificuldade dos estudantes do sexto ano em resolver cálculos e problemas envolvendo as quatro operações básicas: adição, subtração, divisão e multiplicação. Por fim, apresenta-se uma proposta de sequência didática para o sexto ano com o jogo Tabuada do Alien, objetivando proporcionar aos estudantes uma inovação na forma de aprender.
Assessment of Digital Technology Adoption and Access Barriers Among Agricultural Service Providers and Agricultural Extension Professionals
Authors: Drewry Jessica L. , Shutske John M. , Trechter David , Luck Brian D.
Published: September 2022

Highlights

Agricultural service providers and Extension professionals were surveyed on technology use and barriers.

Data privacy and security and hiring qualified IT staff are barriers in the industry.

Surveys point to major opportunities for digital agriculture professional development and education.

Abstract. As agriculture becomes an increasingly data-driven sector, it is important to understand the technology use and barriers by the service providers who work closely with producers. This is especially important as these individuals can serve as drivers for technology adoption by farmers and ranchers. Although many surveys have looked at technology adoption by producers, little data on agricultural industry service providers exists. Surveys of Extension Professionals (EP) in Iowa, Michigan, North Dakota, Ohio, and Wisconsin, and several categories of Agricultural Service Providers (ASP) in Wisconsin were administered in 2018 to determine satisfaction with internet service and to learn more about information and technology usage and potential barriers to its adoption within the industry. In addition, follow-up informational telephone interviews were conducted with 13 Wisconsin EP. A paper survey was administered to ASP, which had a response rate of 35% (N=462). A similar online survey was administered to EP having an estimated 23% response rate (N=223). The frequency of transmission of data, information, and recommendations was high but specialized for both groups with more frequent use in crop production versus livestock (including dairy). The most commonly-cited barriers associated with the adoption of digital technologies by ASP were related to attracting and hiring well-qualified IT employees, training for both employees and clients, and data security. While data security was a commonly cited barrier, 16% of ASP worked for companies that did not have written policies on data privacy. ASP and EP consider their clients to be adept at using text messages, images, maps, and smartphones. They do not consider their clients to be skilled in their use of digitally accessed and used financial statements, spreadsheets, or laboratory analysis reports. Additional training should be better focused on these areas for ASP and EP which would allow them to be more effective in educating producers and to better realize the value associated with more thoughtful and widespread digital technology adoption. Keywords: Agricultural data, Agricultural service provider, Extension professional, Internet access, Technology adoption, Technology barriers.
Management of Partial Heel Pad Avulsion using Multiple Kirschner wire Anchorage Technique – Case Report
Authors: Kantharaju H , Gupta Devanshu , Kandan Veena , Rai Abhishek , Bandebuche Ajinkya Ramesh
Published: September 2022

Introduction: Isolated Partial Heel pad injuries are very rare and management of heel pad injury is always a challenge to a surgeon because of its complex structure and precious blood supply. The goal of management is to preserve a viable heel pad for weight-bearing during normal gait. Case Report: A 46-year-old male sustained a right heel pad avulsion following motorcycle bike ac-cident. Examination showed contaminated wound, viable heel pad, and no bony injury. Within 6 h of trauma, we reattached partial heel pad avulsion using multiple Kirschner wires without wound closure and daily dressings. Full weight bearing started on 12th post-operative week. Conclusion: A partial heel pad avulsion can be managed using multiple Kirschner wire which is cost-effective and simple method. Partial-thickness avulsion injury has a better prognosis as com-pared to full-thickness heel pad avulsion injury, due to preserved periosteal blood supply.
Efficient Lidar in Foggy Environment
Authors: Massoud Ali , Jiang Zhiping , Gao Hongbiao , Li Zeng
Published: September 2022

A novel method mitigating the Lidar performance in fog is presented. It employs a median filter to extract the laser pulses buried in the backscattering returns. Simulation results demonstrate the efficiency of the presented method.
Real-Time Reconstruction of 3D Compressive Samples with Deep Learning
Authors: Kravets Vladislav , Stern Adrian
Published: September 2022

We present a real-time 3D compressive samples reconstruction by using a deep learning network for variable density Hadamard samples. Our method is able to successfully recover 3D examples from as few as 10 samples.
Versatile Experimental Setup for Quantifying Key Metrics of 3D Light Field Displays
Authors: Rabia Sédick , Wong Herman M. K. , Zhuang Zhenfeng , Thibault Simon
Published: September 2022

We developed a versatile experimental setup able to characterize the optical performance of different 3D display designs based on far-field (spot size, lateral color) and near-field (contrast, spatial resolution, MTF) measurements.