bluuebunny/crossref_metadata_2025 huggingface dataset:
Situational Analysis of Maternal and Infant Mortality in Kazakhstan
Authors: Sabyrdilda Zhanar , Kosherbayeva Lyazzat , Qumar Ainur , Akhtayeva Nazgul , Abikulova Akmaral , Akhmetzhan Anuar
Published: March 2024

Background: Previous studies from Western countries showed an association between maternal and infant mortality with sociomedical problems. The social environment influencing the health status of mothers and infants is thus seen to be a function of the economic resources and forms of production of different regions. This is the first study that includes the study of preventable mortality from Pregnancy, childbirth and perinatal period and Congenital malformations in Kazakhstan in the context of regions. For 2015-2019 maternal mortality decreased by 16.5% in the Republic of Kazakhstan. However, since the start of the pandemic in 2020, the maternal mortality ratio has increased by 2.7 times.
This study aimed to provide the latest policy in maternal and infant mortality, and analyze their mortality ratios.
Methods: An appraisal was conducted of regulatory documents related to the maternal and child health last ten years in the Kazakhstan health system. To identify changes in avoidable mortality ratio trends for the period 2011-2021, join point regression was used to calculate the average annual percentage change for every age group by using the Join Point Regression Program, Version 4.9.1.0.
Results: Crude mortality associated with pregnancy and childbirth and the postpartum period were high in the 30-34 age group from 2015 to 2018. From 2019 to 2021, there has been an increase in mortality in the 35-39 age group from 0.48 (95% CI: - 0.06; 1.03) to 4.37 (95% CI: 2.83; 5.91) per 100,000 women. In general, in all age groups, there is a twofold increase in mortality in the period from 2018-2021.
Treatable mortality from pregnancy, childbirth and the puerperium fluctuated from 2015-2019 between 0.34 to 0.37 after which rose till 1.07 in 2021 per 100.000 population. The highest increase can be seen in Atyrau, South and East Kazakhstan, Karagandy and Almaty regions. The treatable mortality decreased in Kyzylorda, Akmola regions in the 2015-2021 period.
Conclusion: Several regions need to step up efforts to reduce maternal mortality, which remains high nationally compared to OECD countries.
This is the first study to examine the prevention of deaths from pregnancy, childbirth, and the perinatal period, as well as the development of birth defects in Kazakhstan by region, which helps physician decision-makers reconsider possible approaches to providing care at the primary health care level.
Experimental investigation on the physco-mechanical and protective properties of concrete incorporating Layered double hydroxide (LDH)
Authors: Shohide Mostafa A.
Published: March 2024

The main perspective of this paper is enhancing the physico-mechanical and protective characteristics of concrete. This was achieved by incorporation Layered double hydroxide (LDH) in mix design of concrete with different doses. The concrete specimens were prepared with LDH percentages (0.5, 1.0, 1.5, and 2) % by the cement weight. After the characterization of LDH, the prepared concrete specimens were investigated as follows: the workability and density of the fresh concrete, effect of the addition of LDH on the compressive strength of hardened concrete were determined. The protective performance of concrete was evaluated by determining water absorption, contact angle, and chloride permeability. The obtained results detected that the physico-mechanical and protective performance of concrete are enhanced gradually by the addition of LDH up to 1.5%. After this percent, LDH is agglomerate and therefore unable to disperse uniformly.
Comparison of esketamine and remifentanil in combination with propofol in patients with septic shock receiving invasive mechanical ventilation: a randomized controlled trial
Authors: Li Yuting , Li Hongxiang , Zhang Yuhan , Zhang Chaoyang , Gao Meng , Zhang Liying , Wang Youquan , Fu Yao , Zhang Dong
Published: March 2024

Background Analgesics and sedatives may affect the hemodynamics of patients with septic shock and produce adverse reactions. The purpose of this study was to compare the analgesic and sedative effect of esketamine and remifentanil in combination with propofol in patients with septic shock receiving invasive mechanical ventilation. Methods In this single-center, prospective, randomized, controlled pilot study, patients with septic shock in the intensive care unit (ICU) receiving invasive mechanical ventilation were randomized to receive esketamine or remifentanil in combination with propofol intravenously. The target Critical-Care Pain Observation Tool (CPOT) score was < 3 points and Richmond Agitation and Sedation Scale (RASS) score was − 2 ~ 0 points. The primary outcome was dosage of norepinephrine. Secondary outcomes included mechanical ventilation time, dosage of propofol, intestinal dysfunction rate, ICU length of stay, hospital length of stay, hospital mortality and 28-day survival rate. Adverse events during the interventional period were also recorded. Results A total of 120 patients were enrolled in the study. Sixty patients were assigned to each group. The median (IQR) dosage of norepinephrine of remifentanil group was 4.09(1.52,8.85) mg/kg while that of esketamine group was 1.72(1.01,3.97) mg/kg. The dosage of norepinephrine of esketamine group was less than that of remifentanil group(P = 0.007). There were no significant differences between two groups with respect to adverse event rate, intestinal dysfunction rate, dosage of propofol, mechanical ventilation time, ICU length of stay, hospital length of stay and hospital mortality(P > 0.05). Kaplan-Meier survival analysis showed that there was no significant difference in 28-day survival rate between two groups(P = 0.225). Conclusions Esketamine may decrease the dosage of norepinephrine in patients with septic shock receiving invasive mechanical ventilation. It is beneficial for stabilizing hemodynamics and appears to be an effective and safe agent for patients with septic shock requiring invasive mechanical ventilation. Further large scale studies are still required to confirm these results.
Non-uptake of COVID-19 vaccines and reasons for non-uptake among healthcare workers in Uganda: a cross-sectional study
Authors: Kyakuwa Nasimu , Abaasa Andrew , Mpooya Simon , Kalutte Hamza , Atuhairwe Christine , Perez Laurent , Kikaire Bernard
Published: March 2024

Background
Vaccines play a crucial role in eradicating and containing disease outbreaks. Therefore, understanding the reasons behind vaccine refusal and associated factors is essential for improving vaccine acceptance rates. Our objective was to examine the determinants of COVID-19 vaccine non-uptake and explore the reasons for non-uptake among healthcare workers in Uganda.
Methods
Between July and August 2021, we conducted a cross-sectional study among healthcare workers in primary healthcare facilities in Entebbe Municipality, Uganda. Participants were recruited using convenience sampling, and consenting individuals received credentials to access an electronic database and complete a structured questionnaire. Survey questions were based on the '3Cs' model of vaccine hesitancy, focusing on confidence, convenience, and complacency factors. We employed counts, percentages, and simple logit models to summarize the reasons for non-uptakeof COVID-19 vaccines and to identify associated factors.
Results
The study recruited 360 healthcare workers, 61.7% of whom were female, with an average age of 31 years (SD=7.9). Among them, 124 (34.4%) healthcare workers did not receive any COVID-19 vaccine. Non-uptake of COVID-19 vaccines was independently associated with several factors, including age [35+ years adjusted odds ratio (aOR)=0.30, 95% CI: 0.13-0.66 compared with 18-24 years], facility ownership [government, aOR=0.22 (0.10-0.49) compared with private not-for-profit], previous testing for coronavirus [yes, aOR=0.35 (0.19-0.65)], and previous involvement in COVID-19 vaccine activities [yes, aOR=0.17 (0.10-0.29)].
The primary reasons cited for non-uptake of COVID-19 vaccines were related to a lack of confidence in the vaccines, such as concerns about side effects (79.8%) and the need for more time to understand the vaccines (89.5%), as well as the importance of weighing benefits and risks (84.7%) before being vaccinated. A smaller proportion, approximately 23%, cited reasons related to complacency and lack of convenience in accessing vaccination services.
Conclusion
The high proportion of non-uptake of COVID-19 vaccines among this population primarily stems from a lack of confidence and trust in the vaccines, coupled with insufficient time allowed for users to make informed decisions. This underscores the urgent need for ongoing monitoring and trend analysis of vaccine non-uptake to guide the development and implementation of strategies aimed at building and sustaining vaccine confidence.
WITHDRAWN: Developing an artificial intelligence framework to combat tax noncompliance in Botswana
Authors: Edmore Munjeyi
Published: March 2024

The full text of this preprint has been withdrawn by the authors in order to comply with an institutional policy on preprints. Therefore, the authors do not wish this work to be cited as a reference.
Predictors of prolonged length of stay in PICU of infants with severe bronchiolitis: are initial blood gases helpful?
Authors: Laruelle Baptiste , Rambaud Jerome , Léger Pierre-Louis , Bakayoko Awa , Essid Aben , Mbieleu Blaise , Tissiere Pierre , Bergounioux Jean , Zini Justine
Published: March 2024

Purpose
Every year between November and January, the epidemic of acute viral bronchiolitis causes massive admissions to pediatric intensive care units. One of the challenges is to identify infants who will require invasive ventilation or have a prolonged length of stay in intensive care units.
Methods
We conducted a multicenter retrospective study on three PICU wards in France to evaluate the different risk factors for prolonged hospitalization in pediatric intensive care and for invasive ventilation. We focused particularly on the blood gas parameters (pH, PCO2, and bicarbonate) before and after PICU admission.
Results
We included 268 patients between October 2018 and April 2019. Mean age was 62 days, 7% of infants had chronic conditions (bronchopulmonary dysplasia, congenital heart disease, etc.). The median length of stay in PICU was 4 days, 83% of infants required noninvasive ventilation and 6% required invasive ventilation. Variables associated with prolonged length of stay in PICU were an age less than 30 days, a severe comorbidity, onset of symptoms less than 3 days before admission, initial FiO2 above 30%, presence of apneas or bradycardia, hemodynamic failure, and presence of bacterial coinfection. The pH, PCO2 and bicarbonate after PICU admission were correlated with PICU length of stay whereas none of the blood gas parameters before admission.
Conclusion
Blood gas after PICU admission may be useful to predict the length of stay in PICU in patients whose clinical condition is difficult to evaluate.
Anopheles arabiensis larval habitats characterization and Anopheles species diversity in water bodies from Jozini, KwaZulu-Natal Province.
Authors: Marubini Elelwani Elliot , Musekiwa Alfred , Maposa Innocent , Mazarire Theresa , Sekgele Windy , Mabaso Nondumiso , Dlamini Dumsani , Md Hetani , Kuonza Lazarus , Munhenga Givemore
Published: March 2024

Introduction: The South African government is now implementing winter larviciding as a supplementary vector control tool. To achieve effective larviciding programme there is a need to understand the distribution of the larval habitats of vectors and their corresponding ecology. This study aimed to determine larval breeding habitats of anophelines and characterize the physicochemical properties of water that promote the proliferation of Anopheles arabiensisimmature stages of this species.
Methods: A desktop survey of water bodies was carried out followed by a physical search of potential Anophelesbreeding habitats. Anopheline larvae were sampled from water habitats in January and April 2021. At each positive habitat, physicochemical characteristics of the water including pH, electrical conductivity, total dissolved solids and salinity were measured. The collected Anopheles larvae were reared to adults and identified to genus and species level using morphological and molecular techniques. Factors associated with the presence of Anopheles arabiensislarvae in the breeding habitats were determined.
Results: Desktop survey identified 72 potential water bodies and only 38 were physically identified as potential anopheline larval habitats. Of these 84% (n=32/38) were positive for Anopheles larvae. A total of 598 Anopheles larvae collected, of which 59.4% (n=355/598) emerged into adults. Morphological identification of these adults, showed that the Anopheles gambiaecomplex accounted for 70% (n=250/355) of the collections. Polymerase chain reaction species of the Anopheles gambiaecomplex showed predominance of Anopheles merus 56% (n=83/147) in January, and predominance of Anopheles arabiensis in April, 91% (n=80/88). All physicochemical parameters differed significantly between the breeding sites (p<0.05 in all instances), except for electrical conductivity (p =0.07). The aquatic habitats surveyed showed that the impermanency of the breeding sites, neutral to alkaline pH, moderate salinity and low total dissolved solids were associated with the occurrence of Anopheles arabiensis larvae.
Conclusion: This study showed that Anopheles arabiensis primarily breed in small temporary water habitats characterized by neutral pH. Larviciding that targets Anopheles arabiensis should focus on temporary water bodies with neutral, moderate salinity and low total dissolved solids.
Identification of 4 Novel Variants in 19 Families with Congenital Cataracts
Authors: Sun Hai-Sen , Huang Teng , Xu Yi-Tong , Wang Ya-Qi , Zhang Shen-Rong , Xu Jia-Lin , Zhu Kai-Yi , Huang Wen-Kai , Huang Xiu-Feng , Li Jin
Published: March 2024

Background
Congenital cataracts (CC) are one of the leading causes of impaired vision or blindness in children, of which approximately 8.3–25% are inherited. More than 100 cataract-related genes have been identified globally.
Purpose
To identify the gene variants associated with congenital cataracts.
Methods
This study included a total of 58 patients from 19 pedigrees with congenital cataracts. All probands were initially screened by whole-exome sequencing(WES), and some pedigrees were validated by co-segregation analysis using Sanger sequencing.
Results
Pathogenic variants were detected in 10 families, with a positivity rate of 52.6%. Variants in various genes were identified, including GJA3, CRYGD, BFSP2, CRYAA, and CRYBA1. Importantly, this study identified novel variants in CRYBA4, IARS2, ARL2, and CRYBB3.
Conclusions
Our research findings have revealed multiple gene variant sites associated with cataracts in the 10 families studied, providing clinical guidance for better understanding and management of the disease.
Unstable Intertrochanteric Femur Fracture Fixation with PFNA2: Does Not Require Lateral Wall Fixation? A Study of 278 Patients
Authors: Shetty Vivek , Agashe Vikas , Shekhar Sajeev , Mishra Shaswat , Landge Suhas , Jorule Kailash
Published: March 2024

Lateral wall fracture is considered to be one of the major contributors to failure when such fractures are routinely treated with a sliding hip screw. Later, several publications stressed that the intramedullary device (IM) is the implant of choice in such cases. Hence, PFNA2 has become the implant of choice for unstable IT fractures in the Asian population since the last decade. However, with this background, we have assessed our results over the last 5 years, where PFNA2 was the only implant used for all IT fractures, irrespective of comminution and stability. Methods: This was a retrospective analysis of 309 patients with stable and unstable fractures in 3rd and 4th cranial nerves between June 2008 and June 2022 who were fixed with PFNA2 only, without additional fixation of the lateral wall. Results: All fractures united at an average of 14 weeks, without significant differences between the two groups (with and without lateral wall fracture). There was no statistically significant difference between the two groups with respect to TAD < 20 mm (p = 0.24) or neck-shaft valgus angle at the time of fixation (p = 0.31). There was no significant difference between the union rate, fracture collapse rate (p = 0.41), change in neck shaft angle (p = 0.11) or change in TAD (p = 0.44) between the surgery group and the union group. Two patients who presented with implant failure (one performed elsewhere) were revised and fixed with our technique with a PFNA2 without any lateral augmentation, and both went on to unite well. Conclusion: For a well-aligned anteromedial cortex, coupled with a valgus reduction in the neck shaft angle, a helical blade in the center-center region and a TAD of ˂20 mm, fixation of the lateral wall has no role in preventing fracture collapse or in the healing of unstable IT femur fractures.
Blunted synaptic plasticity in the vHPC-mPFC pathway involving the working memory deficits of mice with perinatal bisphenol-A exposure
Authors: Hu Fan , Li Zimu , Zhang Wentai , Tang Huiping , Chang Jingjing , Zhang Linke , Liang Weifeng , Liu Honglin , Wang Ming
Published: March 2024

Working memory guides human decisions and actions by temporarily holding and manipulating information, yet it has been well-documented as impaired in children with bisphenol A (BPA) exposure. However, neither its underlying neural circuit mechanism nor synaptic basis has been rigorously examined. In the present study, mouse pups were exposed to BPA from dams with BPA exposure (0.735 mg/kg/day) during the gestation and lactation periods to simulate children exposure situation. We found that there was a significant decline in working memory during T maze and objective recognition testing. The in vivo electrophysiological results showed that there was a noticeable decline in theta (θ)/gamma (γ) oscillation power in the medial prefrontal cortex (mPFC) and θ-γ oscillation coupling in the ventral hippocampus (vHPC)-mPFC circuit during retrieval of spatial cues (choice phase) in the novelty-driven T maze task. This fail retrieval of spatial cues and network activity appears to be mediated by down-regulated synaptic plasticity within the vHPC-mPFC circuit. Further patch-clamp recording results revealed a pronounced decrease in the amplitude, rather than the frequency, of excitatory postsynaptic currents (EPSCs) in the mPFC of BPA-exposed mice. Importantly, the spine density of pyramidal neurons and the expression of excitatory receptors (GluA1) in the mPFC were significantly decreased after BPA exposure, providing the postsynaptic basis for BPA-induced synaptic plasticity impairment. Our findings in this study provide rigorous physiological and structural mechanism at circuit and synaptic level underlying working memory deficits resulting from BPA exposure during the critical developmental stage.
Barriers to providing long-term care insurance services by direct care workers: a qualitative study in Shandong Province, China
Authors: Gao Jing , Yin Jia , Sun Qiang
Published: March 2024

Background
China's long-term care insurance (LTCI) system plays a crucial role in addressing the challenges posed by an aging population, while simultaneously placing higher demands on the quantity and quality of long-term care (LTC) services. However, LTCI-designated facilities still face challenges in terms of recruiting and retaining care workers. There is limited knowledge regarding the barriers to service delivery for direct care workers in the context of LTCI.
Objectives
To analyze the barriers faced by direct care workers in providing LTC services from their perspectives and to explore possible reasons.
Methods
Based on Herzberg's two-factor theory, face-to-face semi-structured interviews were conducted with 31 direct care workers. Thematic framework analysis method was used to generate qualitative codes and identify themes.
Results
Direct care workers in designated LTCI facilities faced barriers to meeting motivation and hygiene factors. The motivation factors included three themes: intense and difficult work, tedious and boring work content, and difficulty in gaining recognition and fulfillment at work. Hygiene factors included four themes: difficulty communicating with patients or family members, depressing work environments, incomplete service processes, and inadequate safety measures for home care.
Conclusions
The conditions of people with disabilities or dementia covered by LTCI are complicated, which causes many difficulties and obstacles to the work of direct care workers. We recommend that in the development of the LTCI system, more emphasis should be placed on service providers as the mainstay of policy practice so that both the hygiene and motivation factors of direct care workers are met and put into effect together. Systems related to LTCI assessment and service provision should be optimized to alleviate the stress of direct care workers and eliminate barriers to their work.
Interference and Motor Memory Consolidation Effects of Sequential Gait Interventions: A randomized controlled trial
Authors: Hoque Adila , Kim Seok Hun , Reed Kyle B.
Published: March 2024

Background Sensorimotor adaptation and instructional adaptation have been found to be motor learning processes that exhibit additive characteristics when applied simultaneously. This study investigates the effects on acquisition and retention of gait outcomes when interventions corresponding to sensorimotor and instructional learning processes are applied sequentially, i.e., split-belt treadmill training (SBT) and (asymmetric) rhythmic auditory cueing (ARAC), respectively. Factors evaluated include order of sequential intervention, congruence between subsequent interventions, and the relative contribution(s) of each intervention in the acquisition and retention of gait (a)symmetry.Methods The repeated-measures study involved six randomized sessions; two controls included SBT and ARAC individually. Four sessions included sequential combinations of SBT and ARAC applied congruently and incongruently. Written informed consent was obtained from ten healthy, young subjects and all experiments were performed on the Computer Assisted Rehabilitation Environment (CAREN). Motion analysis was performed using infrared-reflective markers placed on the subjects’ lower limbs and ground reaction forces obtained from the force plates. Gait asymmetries were assessed for changes in step length, step time, and vertical reaction force and compared against baseline conditions. Between-trial comparisons were then performed using Friedman’s test and post-hoc analysis using Wilcoxon signed-rank test.Results Interference (during acquisition) to adaptation and memory consolidation (during retention) patterns exhibited different trends between opposite orders of intervention, and these characteristics were distinctive for step length and step time. Asymmetries during congruent trials were significantly greater than incongruent trials. SBT showed a greater influence (interference) on subsequent adaptation to ARAC than vice versa. Nonetheless, ARAC demonstrated a higher retention of after-effects than SBT – indicating its competitive potential for long-term learning.Conclusion The study shows that the order in which we learn to walk symmetrically can affect how well and how long we remember these skills. Based on the outcomes between different intervention order(s) on acquired asymmetries in step length and step time, future sequentially combined strategies can implement this sequence to balance minimizing interference between learning processes while maximizing consolidation of motor memories. This will help personalize future sequential interventions in terms of the targeted gait parameter and the costs acquired in other parameters to maximize the retained after-effects.
Electronic control of hand hygiene in intensive care unit and its correlation with healthcare-associated infections: a retrospective study
Authors: Gu Yue-Qin , Ye Hui-Ling , Tang Hui , Wang Min-Fang , Zhou Ye , Gu Bing
Published: March 2024

Purpose
To investigate the impact of an electronic monitoring system(EMS) on the adherence to hand hygiene༈HH༉ protocols among healthcare professionals in the intensive care unit༈ICU༉, and analyze the correlation between HH and healthcare-associated infections (HAIs) .
Methods
We implemented the EMS system to monitor the HH compliance and collected HH data throughout the year in 2020. Additionally, a retrospective analysis was conducted on the HH and infection-related indicators of medical staff in the ICU from 2016 to 2019.
Results
HH compliance rate monitored by the EMS system exhibited a noteworthy improvement at 89.44%, and the result of direct observation was 88.5%. Notably, both rates were significantly higher than those observed between 2016 and 2019 (53.0%, 60.1%, 61.11%, and 82.4%). With the enhancement of HH compliance, there was a notable reduction in HAIs’ rate in the ICU ward. Every 1% increasing results in a 5.2% decline of HAIs’ rate (Y = -5.200X + 347.2, r =-0.9991, P = 0.0186). However, HAIs did not exhibit any further decline beyond an 80% HH compliance rate. Over the past five years, no significant changes were observed in terms of average infection rates across three tubes or detection rates for four drug-resistant bacteria within the ICU ward.
Conclusion
The EMS’ efficiency is comparable to that of the direct observation method. The rate of HAIs showed a negative correlation with HH compliance until the compliance rate exceeded 80%.
Carboxymethyl kappa carrageenan derivatives synthesized from kappa carrageenan of the red alga Kappaphycus striatus cultivated in Vietnam: Characterization, structure and biological activity
Authors: Nguyen Hoang Thi Trang , Trung Dinh Thanh , Trang Vo Thi Dieu , Thinh Pham Duc , Thuy Thanh Thi Thu , Hung Le Dinh
Published: March 2024

Carboxymethyl kappa carrageenans (CMKCs) have been synthesized from kappa carrageenan extracted from the red alga Kappaphycus striatus with different molar ratios of monochloroacetic acid (MCA) in the presence of sodium hydroxide. The structural and physicochemical characteristic of products wase evaluated by FT-IR, 13 C and 1 H NMR spectra, degree of substitution, molecular weight, zeta potential and biological activity. Degree of substitution of carboxymethyl group in kappa carrageenan ranged from 0.24 to 1.12. FT-IR and 13 C NMR spectra proved the substitution of carboxymethyl group in kappa carrageenan disaccharide unit. Molecular weight of CMKCs increased slightly while their zeta potential was lower compared to the parent kappa carrageenan. CMKCs exhibited a slight difference in the lowest hemagglutination concentrations on native human blood group types and showed an increase in antioxidant activity. The results indicate that carboxymethyl kappa carrageenan derivatives from kappa carrageenan of the red alga K. striatus cultivated could promise be a good source of materials for application as carriers.
Navigating Uncertainties in Quantifying Water Availability Amidst the Nexus of Climate and Land Use Changes
Authors: Devkota Nirajan , Lamichhane Suraj , Bhattarai Pawan Kumar
Published: March 2024

The intricate interaction between climate and land use changes induces complexities in water balance dynamics amidst global environmental shifts. Substantive impacts are delineated via a case study conducted in the Narayani Basin situated within the Hindu Kush Himalaya region. Quantifying uncertainty for average water yield involves employing Monte Carlo simulation and the Kernel Density Function on SWAT hydrological model output, revealing alterations in water balance components characterized by a generally upward trend and increased variability. The water yield varies spatially and temporally, exhibiting higher uncertainty. Variations in uncertainty specific to each scenario are highlighted, emphasizing the interconnected effects of landscape transformation and climate change. Climate models are categorized into four scenarios, representing wet_cool, wet_warm, dry_cool, and dry_warm. In the Far Future, Wet_Cool scenario (SSP585) exhibits the highest uncertainty in annual water yield (CV: 0.18) with a substantial 167% increase, while minimal uncertainty is seen in the Near Future for SSP245 under Dry_Cool conditions (CV: 0.165) with a modest 9% increase. These results underscore the nexus impact of climate and land use alterations, providing valuable insights for informed decision-making in water resource planning. The study emphasizes considering spatial uncertainties for sustainable water management amid ongoing environmental changes.
Targeted next-generation sequencing of pathogens reveals the profile of secondary infections in COVID-19 patients
Authors: Ren Feng-qin , Ji Feng , Liu Zhao-qi , Yan Li-ru , Gao Zhi-wei , Liu Meng-zhen , Teng Xin-guang , Gao Guang-sheng
Published: March 2024

PURPOSE: To use targeted next-generation sequencing (tNGS) of pathogens for analysing the etiological distribution of secondary infections in patients with severe and critical novel coronavirus pneumonia (COVID-19), to obtain microbial epidemiological data on secondary infections in patients with COVID-19, and to provide a reference for early empirical antibiotic treatment of such patients.
METHODS: Patients with infections secondary to severe and critical COVID-19 and hospitalised at the First Affiliated Hospital of Shandong First Medical University between 1 December 2022 and 30 June 2023 were included in the study. The characteristics and etiological distribution of secondary infections in these patients were analysed using tNGS.
RESULTS: A total of 95 patients with COVID-19 secondary infections were included in the study, of whom 87.37% had one or more underlying diseases. Forty-eight pathogens were detected, the most common being HSV-4, Candida albicans, Klebsiella pneumoniae, Enterococcus faecium, HSV-1, Staphylococcus aureus, Aspergillus fumigatus, Acinetobacter baumannii, HSV-5, and Stenotrophomonas maltophilia, with Pneumocystis jirovecii being detected in 14.29% of cases. The majority (76.84%) of COVID-19 secondary infections were mixed infections, with mixed viral-bacterial-fungal infections being the most common (28.42%).
CONCLUSION: Most secondary infections in severe and critical COVID-19 patients are mixed, with high rates of viral and fungal infections. In clinical settings, monitoring for reactivation or secondary infections by Herpesviridae viruses is crucial; additionally, these patients have a significantly higher rate of P. jirovecii infection. tNGS testing on bronchoalveolar lavage fluid can help determine the aetiology of secondary infections early in COVID-19 patients and assist in choosing appropriate antibiotics.
Dural arteriovenous fistulas in the falx cerebri: case series and literature review
Authors: Su Xin , Song Zihao , YE Ming , Sun Liyong , Hong Tao , Ma Yongjie , Zhang Hongqi , Zhang Peng
Published: March 2024

Background
Dural arteriovenous fistulas (DAVFs) in the falx cerebri are seldomly reported. They may be associated with the falcine sinus/venous plexus. The falcine sinus/venous plexus is often considered a normal venous structure that manifests in a pathological state, different from the persistent fetal falcine sinus.
Methods
We performed a retrospective analysis at a single center, focusing on identifying all DAVFs in the falx cerebri between 2002 and 2022. Our study included the collection and analysis of data on demographics, fistula characteristics, treatment approaches, clinical outcomes, and fistula closure. In addition, we reviewed the literature on DAVFs in this area.
Results
Ten cases in our center and 13 cases of DAVFs in the falx cerevri reported in the literature were identified. At our center, the average age of the patients was 49.4 ± 8.1 years, and 90% were men. Trans-arterial embolization (TAE) alone resulted in immediate complete occlusion in eight cases. In two cases, conservative treatment was performed. There were no treatment-related complications or fistula recurrences found. According to the literature, seven patients underwent direct surgery, three underwent TAE, and one underwent both direct surgery and radiosurgery to completely close the fistula. There were no reported fistula recurrences or treatment complications.
Conclusions
Dural arteriovenous fistulas in the falx cerebri are rare, and there is limited literature available on this topic. Most of them are aggressive lesions. Curative treatment can be achieved by TAE or direct surgery. Further confirmation is needed to determine the involvement of the falcine sinus/venous plexus in falx cerebri DAVFs.
Biofilm on total joint replacement materials can be reduced through electromagnetic induction heating using a portable device
Authors: Cordero-GG Enrique , Medel-Plaza Marina , Correa John Jairo Aguilera , Sarnago Héctor , Acero Jesús , Burdío José M , Lucía Óscar , Esteban Jaime , Gomez-Barrena Enrique
Published: March 2024

Background:
Periprosthetic joint infection is a serious complication following joint replacement. The development of bacterial biofilms bestows antibiotic resistance and restricts treatment via implant retention surgery. Electromagnetic induction heating is a novel technique for antibacterial treatment of metallic surfaces that has demonstrated in-vitro efficacy. Previous studies have always employed stationary, non-portable devices. This study aims to assess the in-vitro efficacy of induction-heating disinfection of metallic surfaces using a new Portable Disinfection System based on Induction Heating.
Methods:
Mature biofilms of three bacterial species: S. epidermidis ATCC 35984, S. aureus ATCC 25923, E. coli ATCC 25922, were grown on 18x2mm cylindrical coupons of Titanium-Aluminium-Vanadium (Ti6Al4V) or Cobalt-chromium-molybdenum (CoCrMo) alloys. Study intervention was induction-heating of the coupon surface up to 70ºC for 210s, performed using the Portable Disinfection System (PDSIH). Temperature was monitored using thermographic imaging. For each bacterial strain and each metallic alloy, experiments and controls were conducted in triplicate. Bacterial load was quantified through scraping and drop plate techniques. Data were evaluated using non-parametric unilateral Wilcoxon test for 2 group comparison. Statistical significance was fixed at p ≤ 0.05.
Results:
All bacterial strains showed a statistically significant reduction of CFU per surface area in both materials. Bacterial load reduction amounted to 0.507 and 0.602 Log10 CFU/mL for S. aureus on Ti6Al4V and CoCrMo respectively, 5.937 and 3.500 Log10 CFU/mL for E. coli, and 1.222 and 0.372 Log10 CFU/mL for S. epidermidis.
Conclusions:
Electromagnetic induction heating using PDSIH is efficacious to reduce mature biofilms of S aureus, E coli and S epidermidis growing on metallic surfaces of Ti6Al4V and CoCrMo alloys.
Early Impressions and Adoption of the AtriAmp for Managing Arrhythmias Following Congenital Heart Surgery
Authors: Leopold Scott M. , Brown Diane H. , Zhang Xiao , Nguyen Xuan T. , Al-Subu Awni M. , Olson Krisjon R.
Published: March 2024

Objective: AtriAmp is a new medical device that displays a continuous real-time atrial electrogram on telemetry using temporary atrial pacing leads. Our objective was to evaluate early adoption of this device into patient care, understand how it affected clinical workflow, and identify unforeseen benefits or limitations.
Design: Qualitative study using inductive analysis of semi-structured interviews to identify dominant themes
Setting: Single center, tertiary, academic 21-bed mixed pediatric intensive care unit (PICU)
Subjects: PICU multidisciplinary team members (Pediatric Intensivists, PICU Nurse Practitioners, PICU nurses and Pediatric Cardiologists) who were early adopters of the AtriAmp (n=14)
Results: Three prominent themes emerged from qualitative analysis of the early adopters’ experiences. (1) Accelerated time from arrhythmia event to diagnosis, treatment, and determination of treatment effectiveness; (2) Increased confidence and security in the accuracy of providers’ arrhythmia diagnosis; and (3) Improvement in the ability to educate providers about post-operative arrythmias where reliance on time consuming consultation is a default. Providers also noted some learning curves with the device; none of which compromised medical care or clinical workflow.
Conclusions: Insights from early adopters of AtriAmp signal the need for simplicity and fidelity in new technologies within the PICU. Further research in the qualitative and observational sphere is needed to understand how technologies, such as AtriAmp, find expanded use in the PICU environment. Our research suggests that such technologies can be pivotal to the support and growth of multi-disciplinary teams, even among those who do not participate in early implementation.
Magnetic Resonance Elastography and Computational Modeling Identify Heterogeneous Lung Biomechanical Properties during Cystic Fibrosis
Authors: Cho Youjin , Fakhouri Faisal , Ballinger Megan N. , Englert Joshua A. , Hayes Don , Kolipaka Arunark , Ghadiali Samir N.
Published: March 2024

The lung is a dynamic mechanical organ and several pulmonary disorders are characterized by heterogeneous changes in the lung’s local mechanical properties (i.e. stiffness). These alterations lead to abnormal lung tissue deformation (i.e. strain) which have been shown to promote disease progression. Although heterogenous mechanical properties may be important biomarkers of disease, there is currently no non-invasive way to measure these properties for clinical diagnostic purposes. In this study, we use a magnetic resonance elastography technique to measure heterogenous distributions of the lung’s shear stiffness in healthy adults and in people with Cystic Fibrosis. Additionally, computational finite element models which directly incorporate the measured heterogenous mechanical properties were developed to assess the effects on lung tissue deformation. Results indicate that consolidated lung regions in people with Cystic Fibrosis exhibited increased shear stiffness and reduced spatial heterogeneity compared to surrounding non-consolidated regions. Accounting for heterogenous lung stiffness in healthy adults did not change the globally averaged strain magnitude obtained in computational models. However, computational models that used heterogenous stiffness measurements predicted significantly more variability in local strain and higher spatial strain gradients. Finally, computational models predicted lower strain variability and spatial strain gradients in consolidated lung regions compared to non-consolidated regions. These results indicate that spatial variability in shear stiffness alters local strain and strain gradient magnitudes in people with Cystic Fibrosis. This imaged-based modeling technique therefore represents a clinically viable way to non-invasively assess lung mechanics during both health and disease.
Development and validation of a nomogram for predicting pulmonary complications in elderly patients after thoracic surgery
Authors: Liu Jingjing , Xue Dinghao , Wang Long , Li Yanxiang , Liu Luyu , Liao Guosong , Cao Jiangbei , Liu Yanhong , Lou Jingsheng , Li Hao , Yang Yongbin , Mi Weidong , Fu Qiang
Published: March 2024

Background
Postoperative pulmonary complications (PPCs) remain a prevalent concern among elderly surgical patients, with a notably higher incidence observed in the elderly undergoing thoracic surgery. This study aimed to construct a nomogram to predict the risk of PPCs in this population.
Methods
A total of 2963 elderly patients who underwent thoracic surgery were randomly enrolled and divided into a training cohort (80%, n = 2369) and a validation cohort (20%, n = 593). Univariate and multivariate logistic regression analyses were conducted to identify risk factors for PPCs, and a nomogram was developed based on the findings from the training cohort. The validation cohort was used to validate the model. The predictive accuracy of the model was evaluated by receiver operating characteristic curve (ROC), area under ROC (AUC), calibration curve and decision curve analysis (DCA).
Results
A total of 918 (31.0%) patients reported PPCs. Nine independent risk factors for PPCs were identified: preoperative presence of chronic obstructive pulmonary disease (COPD), elevated leukocyte count, higher partial pressure of arterial carbon dioxide (PaCO2) levels, location of surgery, thoracotomy, intraoperative hypotension, blood loss > 100 mL, surgery duration > 180 min and malignant tumor. The AUC value for the training cohort was 0.739 (95% CI: 0.719–0.762), and that for the validation cohort was 0.703 (95% CI: 0.657–0.749). The P values for the Hosmer-Lemeshow test were 0.633 and 0.144 for the training and validation cohorts, respectively, indicating good calibration curve fit. The DCA curve showed that the nomogram could be applied clinically if the risk threshold was between 12% and 84%, which was found to be between 8% and 82% in the validation cohort.
Conclusions
This study underscores the pressing need for early detection of PPCs in elderly patients undergoing thoracic surgery. The nomogram exhibited promising predictive efficacy for PPCs in elderly individuals undergoing thoracic surgery, enabling the identification of high-risk patients and consequently aiding in the implementation of preventive interventions.
Constructing Small Sample Datasets with Game Mixed Sampling and Improved Genetic Algorithm
Authors: Zhu Bailin , Wang Hongliang , Fan Mi
Published: March 2024

In domains dealing with unbalanced data categorization, the dataset is expected to be balanced by adding a few more classes of data, which results in more data and low data quality. Therefore, The paper proposes an innovative hybrid method that combines game-based mixed sampling and an improved genetic algorithm to solve imbalanced data classification with a small dataset. Initially, the framework utilizes game theory to establish balanced sampling methods and ratios to address data imbalances. Subsequently, it employs the SelectKBest technique to optimize feature selection. Finally, the improved genetic algorithm will refine the sampling size and sample selection. In the feature encoding stage of the genetic algorithm, an ensemble learning method is adopted, using K-nearest neighbor (KNN), decision tree (DT), support vector machine (SVM), random forest (RF), and Adaboost, combined with precision, F1 score, and MCC performance evaluation indicators to measure, preventing premature convergence and optimizing the entire solution space, thus enhancing data sampling quality. Determination of the minimum stable population size employs a sliding standard deviation approach. Empirical findings corroborate the efficacy of this approach in tackling challenges associated with imbalanced data classification, refining the sample space, and improving sample quality. This methodology demonstrates significant practical utility in augmenting classifier performance when dealing with imbalanced datasets.
Factors that influence the uptake of virtual care solutions in Australian primary care practice: a systematic scoping review
Authors: Delaforce Alana , Maddock Emma , Wheeler Pamela , Jayasena Rajiv , Parkinson Joy
Published: March 2024

Background
The use of virtual care solutions in primary care settings has increased exponentially. Current evidence suggests high patient satisfaction with virtual care, but it is not without limitations. Research is needed to understand what factors influence the implementation of virtual care so that it can be delivered to the right patient, in the right clinical context at the right time as business-as-usual healthcare. Implementation science offers theories and models to assist with this, but none yet comprehensively address virtual care solution delivery.
Methods
A systematic scoping review was undertaken to identify empirical research studies that reported factors influencing the uptake of virtual care solutions within the Australian primary care setting. Searches were undertaken in Embase, PubMed, Scopus and Web of Science. The Consolidated Framework for Implementation Research (CFIR) was used to code factors influencing the implementation of virtual care solutions.
Results
14 studies were identified as eligible for inclusion. A cluster of five common influencing factors were identified. Three were from the existing CFIR framework, and two were newly developed constructs. CFIR constructs included: innovation relative advantage, capability and information technology infrastructure. New constructs included accessibility and suitability. A further six new constructs were identified (trust, privacy, governance, unintended consequences, preference and choice) but they were not prominently mentioned.
Conclusions
There are common influencing factors among primary care settings that implemented virtual care. The CFIR assisted in conceptualising these but was not sufficient for capturing factors unique to virtual care. Newly developed constructs are noted to be of importance in the literature, but further primary research is needed to understand if they are applicable in multiple contexts.
Factores asociados al nivel de ciudadanía digital de estudiantes de escuelas primarias en la ciudad de Mérida
Authors: Bastarrachea Rodríguez Paola , Domínguez Castillo José Gabriel
Published: March 2024

El estudio de la ciudadanía digital (CD) ha adquirido mayor relevancia en la actualidad, sin embargo, pese a contar con una amplia literatura especializada, esta se ha concentrado en la medición del constructo; por lo que la información que se tiene sobre los factores asociados y predictores de la CD es incipiente. Por ello, el presente estudio busca identificar cuáles son los factores que se asocian a la ciudadanía digital en la educación primaria, población poco estudiada en el tema. Se diseñó un estudio no experimental con alcance correlacional, en el que participaron 644 estudiantes de 4to, 5to y 6to de primaria de instituciones públicas de la ciudad de Mérida, Yucatán. Se identifica que los estudiantes cuentan con un nivel bajo de CD, y a través del análisis de la regresión lineal múltiple, se concluye que las variables que se asocian a este son, en orden de importancia relativa, la edad, el nivel de competencia digital, hablar lengua maya y el grado escolar. Los resultados obtenidos sugieren continuar con el estudio de la CD en niveles básicos, ya que su dinámica es diferente a la observada en otros niveles; destacando la necesidad de la formación en CD desde edades tempranas.
Intervención virtual para disminuir la agresión de los adolescentes durante la pandemia de COVID
Authors: Mesurado Belén , Oñate María Emilia , Resett Santiago Alejandro
Published: March 2024

Durante las medidas de confinamiento por la pandemia de COVID aumentaron los niveles de problemas externalizantes entre los adolescentes. Héroe es un programa virtual que busca estimular variables socioemocionales positivas en los adolescentes y se implementó durante el confinamiento por dicha pandemia en Argentina. El propósito de este estudio fue evaluar la efectividad de este programa para inhibir el comportamiento agresivo de los adolescentes durante la pandemia. Se trata de un estudio experimental, de campo y longitudinal, se utilizó un diseño de pretest y postest con una evaluación de seguimiento a los tres meses de finalizada la intervención con un grupo experimental y uno de control. Ochenta y ocho adolescentes participaron en el grupo de intervención (51% mujeres, M edad = 13.52, DE = 1.04) y 102 adolescentes en el grupo control en lista de espera (58% mujeres, M edad = 13.59, DE = .91). Los resultados indican que el comportamiento agresivo disminuyó en el grupo de intervención, mientras que aumentó en el grupo de control. Estos hallazgos proporcionan evidencia sobre el papel que desempeñaron las intervenciones virtuales en la disminución de comportamientos disruptivos de los adolescentes durante el confinamiento por la pandemia de COVID-19 y su efectividad en el trabajo con adolescentes.