bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of preoperative Tranexamic Acid in patients undergoing intertrochanteric hip fracture surgery: A randomized placebo controlled trial
Authors: Shah Faaiz Ali , Naeemullah  , Mian Amjad Ali  , Mian Javed Iqbal
Published: September 2023

Objective: To determine the efficacy of preoperative Tranexamic Acid (TXA) in reducing perioperative allogenic blood transfusion frequency in patients with intertrochanteric fractures treated with Dynamic Hip Screw (DHS).

Methods: We conducted this placebo controlled double-blinded randomized trial in Orthopaedics & Traumatolgy Division Lady Reading Hospital, Peshawar from 1st January 2020 to 25th December 2022. All patients with intertrochanteric hip fractures fulfilling the inclusion criteria were treated with Dynamic Hip Screw (DHS) and were randomly divided into two equal groups. One group was administered single dose IV Tranexamic Acid (TXA) in a dose of 15mg/kg body weight in 100ml of saline while the other group (Placebo) was given 100 ml normal saline preoperatively. Post-operative Hemoglobin was measured on first, second and third day. The frequency of allogenic blood transfusions in the perioperative period was determined in both groups based upon the transfusion trigger (Hemoglobin 9g/dl). Categorical variables were compared with Chi-square test and mean with Independent sample t-test. P value of <0.05 was considered significant.

Results: The total number of patients in our trial were 200 which were equally but randomly allocated into TXA group and Placebo group each containing 100 patients. The mean age of the patients in TXA group was 48.16±1.75 years and the age of patients in the Placebo group was 48.35±1.60. The baseline demographic and clinical variables of both groups were identical (p< 0.05). The average preoperative hemoglobin was 11.5±4.2 g/dl in TXA group and 11.3±2.4g/dl in the Placebo group (p>0.05). The frequency of allogenic blood transfusion was significantly lower (p<0.05) in TXA group (13%, n=13) than in the Placebo group (41%, n=41).

Conclusion: Tranexamic acid (TXA) significantly reduces the frequency of peri operative allogenic blood transfusion in patients undergoing Dynamic Hip Screw (DHS) for intertrochanteric fractures.

doi: https://doi.org/10.12669/pjms.39.6.7667

How to cite this: Shah FA, Naeemullah, Ali MA, Iqbal MJ. Efficacy of preoperative Tranexamic Acid in patients undergoing intertrochanteric hip fracture surgery: A randomized placebo controlled trial. Pak J Med Sci. 2023;39(6):---------. doi: https://doi.org/10.12669/pjms.39.6.7667

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.
Clinical effectiveness of suture anchor repair combined with open reduction and internal fixation in the treatment of deltoid ligament rupture in ankle fracture
Authors: Zhang Le , Kong Xiaochuan , Hong Gang , Zheng Yinfeng , Zang Lei
Published: September 2023

Objective: To explore the clinical effectiveness of suture anchor (SA) repair combined with open reduction and internal fixation (ORIF) in the treatment of deltoid ligament rupture (DLR) in ankle fractures.

Methods: This is a retrospective analysis of 210 patients with DLR in ankle fracture who were treated in Beijing Chaoyang Hospital from January 2020 to June 2022. According to the surgical records, 125 patients received SA repair combined with ORIF (Repair group) and 85 patients received ORIF only (Non-repair group). The curative effect, recovery of ankle joint function, pain, and bone metabolism of the two groups were observed.

Results: The clinical effectiveness (overall good) was higher in the Repair group (P<0.05). The American Orthopedic Foot and Ankle Society (AOFAS) score was higher three and six months post-operation in the Repair group, and the Visual Analogue Scale (VAS) score was lower than that of the Non-repair group (P<0.05). The Repair group had higher levels of bone-specific alkaline phosphatase (BALP) and bone gla protein (BGP) than the Non-repair group six months post-operation (P<0.05).

Conclusions: SA combined with ORIF has a good effect in the treatment of DLR in ankle fracture patients, which can promote the recovery of ankle function, relieve postoperative pain and improve bone metabolism.

doi: https://doi.org/10.12669/pjms.39.6.8070

How to cite this: Zhang L, Kong X, Hong G, Zheng Y, Zang L. Clinical effectiveness of suture anchor repair combined with open reduction and internal fixation in the treatment of deltoid ligament rupture in ankle fracture. Pak J Med Sci. 2023;39(6):---------.  doi: https://doi.org/10.12669/pjms.39.6.8070

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.
Opening new vista for rapid detection of antimicrobial resistant genes via film array multiplex PCR
Authors: Zafar Humaira , Mirza Irfan Ali
Published: September 2023

doi: https://doi.org/10.12669/pjms.39.6.8635

How to cite this: Zafar H, Mirza IA. Opening new vista for rapid detection of antimicrobial resistant genes via film array multiplex PCR. Pak J Med Sci. 2023;39(6):1555-1556. doi: https://doi.org/10.12669/pjms.39.6.8635

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.
Case Report: A rare presentation of wandering spleen with rare cardiac anomalies and hepatomegaly in a young woman
Authors: Sahai Isha , Ghosh Benumadhab , Agrawal Gajendra
Published: September 2023

The presence of a wandering spleen with hepatomegaly causing acute abdominal symptoms is an extremely rare clinical entity. The combination of this condition with cardiac anomalies like ostium primum and VSD (ventricular septal defect) has been a cause for the severe growth abnormalities and clinical features like early satiety, blood in vomit and palpitations. Here we report the case of an early 20s woman who presented with decreased appetite, hematemesis, syncopal attacks, palpitations, irregular menstrual cycle, pallor, cyanosis and with a known case of ventricular septal defect. This report focuses on a rare association of wandering spleen with ostium primum and hepatomegaly and ovarian cyst. The significance of this case is heightened because if the patient had received an earlier diagnosis, it could have prevented the onset of these clinical conditions, leading to a better quality of life for the patient.
Potato seed production
Authors: Uskov Aleksandr , Oves Elena , Uskova Lyudmila , Buharova Al'mira , Mozhaev Evgeniy , Zakabunina Elena
Published: September 2023

The textbook describes the main elements of the potato seed production system in the Russian Federation, including classification, reproduction and reproduction of the original and original seed material, elite and reproductive potato seed production, features of seed growing technology and quality control of seed potatoes.
Meets the requirements of the federal state standards of higher education of the latest generation.
It is intended for students of higher educational institutions studying in the field of training 35.03.04 "Agronomy", as well as for agricultural specialists growing potatoes.
Altar barriers of temples of Central Russia of Modern times (on the example of the Prioksky region)
Authors: Lazareva Tat'yana
Published: September 2023

The monograph is the first attempt to study the previously unknown and mostly lost iconostases of Central Russia of Modern times, before the break in the history of the continuous evolution of the altar barrier. Based on the results of the art history analysis, the main trends in the stylistic and iconographic development of iconostases are revealed. The considered works of the XVIII — early XX century include monuments of the Oryol, Bryansk, Yelets, Ryazan, Nizhny Novgorod lands, unique ensembles of Arzamas and Murom. The lack of literature and sources is compensated by information from more than 50 archival documents introduced into scientific circulation, including pictorial material. The monograph continues the diverse works on the history of architecture, art and the Russian Church and supplements them with previously unknown facts and details. The results of the study are presented by a number of author's provisions, summary tables and diagrams — reconstructions of altar barriers.
The work is aimed at specialists and a wide range of readers interested in the history of church art.
Mutual insurance system in Tula province in the second half of the XIX - early XX century
Authors: Zubareva Elena
Published: September 2023

The monograph is devoted to the consideration of mutual insurance as an important tool of the socio-economic policy of the Russian Empire in the second half of the XIX — early XX century. Attention is focused on the study of the types of mutual insurance most common in pre—revolutionary Russia - zemstvo property insurance, mutual property insurance against fire in cities, as well as social insurance of workers in production that appeared at the beginning of the twentieth century. The development of the mutual insurance system in Tula Province reflected the processes and difficulties characteristic of the formation of the insurance system of the Russian Empire as a whole.
For researchers, students and postgraduates specializing in the history of Russia.
Biointerface. Conformal nanoenergy
Authors: Luchinin Viktor , Il'in Sergey
Published: September 2023

The monograph examines the current state, development prospects and innovative solutions of conformal IoP devices for generating and recovering electricity (solar cells, piezo generators, tribonogenerators, thermogenerators, rectenns), conformal IoP devices for storing electricity (lithium-ion batteries and supercapacitors), as well as hybrid energy devices based on them. Industrially produced elements and devices, as well as innovative developments are presented.
It is intended for engineers, researchers and teachers specializing in the field of flexible electronics and conformal nanoenergy, as well as for students of relevant specializations.
Onomastics of international relations
Authors: Ternovaya Lyudmila
Published: September 2023

The monograph introduces readers not just into a complex, but into an exceptionally complicated history of international communication through a very simple and understandable entrance, which is torn off by the science of onomastics, which studies proper names. This knowledge, concerning the names of those personalities who have left their mark in the history of international relations, becomes a kind of anthroponymic guide to international relations. Toponymy, which explains the names of geographical objects, is the part of geopolitics that will help to identify the edges of agreement and conflict. Since not only things, phenomena, processes have their own names, but also symbols, including those that permeate the space of international interaction, the state of the world, its stability and security may depend on the accuracy of the use of such names.
It is addressed to specialists in the field of geopolitics, history, sociology, and cultural studies. A narrative about the history and peculiarities of modern international relations, in which the main facts are taken from the world of proper names, will be interesting to a wide range of readers.
Managerial economics: analysis and diagnostics of the company's activities
Authors: Kukukina Irina , Makarova Anastasiya
Published: September 2023

The textbook reveals the features of the analysis and diagnostics of the company's activities in the conditions of the managerial economy. The economic analysis of factors affecting the final results of management and owners' activities, assessment and diagnostics of key performance indicators in conditions of uncertainty and the need for resource conservation based on innovations are aimed at increasing the competitiveness of Russian enterprises.
Meets the requirements of the federal state educational standards of higher education of the latest generation.
For students of educational institutions of higher education studying in the areas of training 38.04.01 "Economics" and 38.04.02 "Management", as well as for specialists in accounting, analysis and controlling, financial managers, teachers of economic specialties of universities.
Methods of childbirth induction – a review of current knowledge
Authors: Kuźma Jan , Łokczewska-Bojar Aleksandra , Kuziemkowska Daria , Łącka-Majcher Anna , Tarsa Grzegorz , Kępka Przemysław , Sudelska Katarzyna , Ben Rhaiem Rami , Sawińska Zuzanna , Skotalczyk Magdalena
Published: September 2023

Introduction: Pregnancy lasts 40 weeks from the first day of the last menstrual period, i. e. 280 days or 264 days from conception. It has been established that a child born between 37+0 and 41+6 weeks of gestation is a child born "on time". Unfortunately, in some cases it is necessary to terminate the pregnancy earlier, due to the condition of the pregnant woman, the baby or the approaching 42 weeks of pregnancy.
Aim of the study: The aim of our study is to summarize available options for induction of childbirth. Particular attention was paid to available pharmacology and mechanical methods. The methods were compared in terms of effectiveness, possible complications and side effects.
Materials and methods: A review of the current literature was made in the accessible PubMed and Google Scholar database, using the keywords: „birth induction”, „Cook’s catether”, „prostaglandin and oxitocine induction”, „amniotomy”, „membran stripping”.
Conclusions: There are several ways to induce childbirth, which are used depending on current state of pregnacy. The availability of both pharmacotherapy and mechanical methods, allows the initiation of labor and termination of pregnancy by natural forces, in most cases avoiding the need to terminate the pregnancy by caesarean section.
Andexanet alfa - what we know about this promising drug
Authors: Ilnicka Natalia , Zuziak Patrycja , Sadlik Maria , Matyja Daria , Abod Leila
Published: September 2023

Introduction and purpose. Andexanet alfa (AA) is a recombinant modified version of human activated factor X. It is used as an antidote for apixsaban and rivaroxaban when reversal of anticoagulation due to life-threatening or uncontrolled bleeding is necessary. The aim of this paper is to present AA’s characteristics, treatment costs, clinical trial outcomes, and its use in medicine.
Material and methods. A review of the available literature was performed by searching the PubMed and GoogleScholar databases using the following keywords: “andexanet alfa”, “factor Xa inhibitors”, “anticoagulant reversal”.
Literature analysis. AA sequesters factor Xa inhibitors, which reactivates the endogenous factor Xa and reverses the anticoagulant effect. It is well tolerated, with a rapid onset of action. Side effects such as pneumonia, urinary tract infections and augmented thromboembolic risk have been observed. There are two dosing regimens, dependant on the ingested anticoagulant dose. Single dose cost is as high as 30 or 60 thousand USD.
Conclusion. AA represents a therapeutic advancement and can prove life-saving in patients who experience an acute major bleeding while treated with direct oral anticoagulants. Single dose cost is high, therefore its availability for use may be restricted.
Monte Carlo Methods for Economic Capital
Authors: Li Yajuan , Kaplan Zachary T. , Nakayama Marvin K.
Published: September 2023

Economic capital (EC) is a risk measure used by financial firms to specify capital levels to protect (with high probability) against large unforeseen losses. Defined as the difference between an (extreme) quantile and the mean of the loss distribution, the EC is often estimated via Monte Carlo methods. Although simple random sampling (SRS) may be effective in estimating the mean, it can be inefficient for the extreme quantile in the EC. Applying importance sampling (IS) may lead to an efficient quantile estimator but can do poorly for the mean. Measure-specific IS (MSIS) instead uses IS to estimate only the quantile, and the mean is independently handled via SRS. We analyze large-sample properties of EC estimators obtained via SRS only, IS only, MSIS, IS using a defensive mixture, and a double estimator using both SRS and IS to estimate both the quantile and the mean, establishing Bahadur-type representations for the EC estimators and proving they obey central limit theorems. We provide asymptotic theory comparing the estimators when the loss is the sum of a large number of independent and identically distributed random variables. Numerical and simulation results, including for a large portfolio credit risk model with dependent obligors, complement the theory.

History: Accepted by Bruno Tuffin, Area Editor for Simulation.

Funding: This work was supported by the National Science Foundation [Grant CMMI-1537322].

Supplemental Material: The software that supports the findings of this study is available within the paper and its Supplemental Information ( https://pubsonline.informs.org/doi/suppl/10.1287/ijoc.2021.0261 ) as well as from the IJOC GitHub software repository ( https://github.com/INFORMSJoC/2021.0261 ). The complete IJOC Software and Data Repository is available at https://informsjoc.github.io/ .
Patient safety in the NHS: now is the time for optimism
Authors: Tingle John
Published: September 2023

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, considers the need for optimism about NHS patient safety
A global approach to workforce issues
Authors: Foster Sam
Published: September 2023

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, considers how World Health Organization documents can point the way to improving nursing and midwifery education
A Study on Major Uninsured Korean Medicine Treatments Search Trends and Their Meanings in an Online Portal: Using Naver Data Lab
Authors: Kwon Chan-Young
Published: September 2023

Objectives: The purpose of this study was to examine search trends and their meanings for major uninsuired Korean medicine (KM) treatments through analysis of an online portal search results.Methods: Keywords searches were performed using Naver Datalab on 4 July 2023. From January 2016 to June 2023, monthly relative search volume (RSV) for keywords ‘pharmacopuncture’, ‘Chuna’, and ‘needle-embedding therapy’, and ‘herbal decoction’ were extracted with a score between 0 and 100. For the obtained RSVs, longitudinal changes over time, characteristics according to sex and age group, and correlations between them were investigated.Results: The ranking of RSV for each keyword has changed from ‘Chuna’, ‘herbal decoction’, ‘needle-embedding therapy’, and ‘pharmacopuncture’ to ‘Chuna’, ‘herbal decoction’, ‘pharmacopuncture’, and ‘needle-embedding therapy’ after 2019. Overall, the RSV of needle-embedding therapy continuously decreased, while that of pharmacopuncture continuously increased. In 2019, a rapid increase in the RSV of Chuna was observed, and in 2020, a rapid increase in the RSV of herbal decoction was observed. There was a difference in the longitudinal change pattern of RSV for the keywords by age group. Importantly, in the elderly, changes in RSV were observed in a favorable pattern to KM treatment.Conclusion: Our findings enable estimation of the public's interest and its changes for the four uninsuired KM treatment, and can be used as basic data to strengthen health insurance coverage in Korea. Specifically, changes in interest in KM treatments according to sex and age can be referred to.
A Literature Study on the Diagnostic Factors and Value as a Syndrome of Damjeok
Authors: Lim Yun-Seo , Rho Gi-Hwan , Choi Gyu-Ho , Lee Sang-Hyun , Choi Seo-Hyung
Published: September 2023

Objectives: The purpose of this study is to investigate the diagnostic factors of Damjeok in the literature.Methods: This study used the databases of five (Mediclassics, RISS, KMbase, OASIS, CNKI) to analyze diagnostic factors of Damjeok. Literatures published by May 2023 were assessed and we classified 91 literatures dealing with diagnostic factors by 5 categories, ‘characteristics’, ‘location’, ‘symptom’, ‘pulse wave & tongue feature’, and ‘eating habits & lifestyle’.Results: Damjeok is mainly formed at the stomach in the form of lump or hard seed, and it can be observed in other regions or even the whole body by its trait of floating. Damjeok mainly shows symptoms of the digestive system and also causes various symptoms associated with the respiratory system and infection, musculoskeletal system, urogenital system, neuropsychiatric system and cardiovascular system. Regarding pulse wave and tongue feature, a slippery wave and greasy coated tongue are typical features of Damjeok. Additionally, bad eating habits and a lack of exercise have been described as a factor that cause and aggravate Damjeok.Conclusions: The two most important factors in the diagnosis of Damjeok are abdominal stiffness by physical examination and digestive symptoms, and these correspond to the definition of a syndrome. Diagnostic factors based on literature evidence will provide clues to the clinical diagnosis of Damjeok syndrome.
Gwibi-tang for Renal Anemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Kim Mikyung , Han Chang-ho
Published: September 2023

Objectives: The purpose of this study was to evaluate the effect of Gwibi-tang (GBT) on renal anemia.Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to investigate changes in anemia levels before and after oral administration of GBT in patients with renal anemia. Relevant literature published up to May 25, 2023, was searched in 10 academic electronic databases.Results: Data from 489 patients from 7 RCTs were obtained and analyzed. All participants were receiving erythropoietin-stimulating agent treatment, and most of them were under hemodialysis. Additional administration of GBT to the participants significantly increased the hemoglobin concentration (10.55 g/L, 95% CI 6.99 to 14.11) compared to the control group. Hematocrit, red blood cell count, serum ferritin concentration, transferrin saturation, and the total effective rate for anemia was also significantly higher in the GBT-treated group than in the control group.Conclusions: This study suggests that GBT may be considered to be a promising option for the effective management of patients with renal anemia under conventional treatment. However, the limitations of this study, including the quantitative and qualitative weakness of the RCTs, the lack of safety-related evidence, and the absence of long-term follow-up data, should be taken into account when interpreting the results of this study.
No Stairs in the Bush? Disability and Australian Steampunk
Authors: Mills Catriona
Published: September 2023

Abstract: With a combination of fantastical and anachronistic technologies and neo-Victorian settings, steampunk emerged from a niche genre to a widespread phenomenon. But this, in turn, raised urgent questions about the "punk"-ness of steampunk and the extent to which it can critique, avoid, and repurpose the Victorian trappings that it adopts. This article examines one such query: whether steampunk can interrogate its ableist underpinnings and, particularly, whether Australian steampunk writers do so in a way that is distinctly Australian. Beginning with a brief overview of Australian steampunk and the genre's conflicted approach to disability aesthetics and roleplaying, the author examines three case studies: the invisibility of disability in late nineteenth- and early twentieth-century proto-steampunk stories, prosthetics as a vehicle for imperial trauma, and the recurrent motif of the clockwork heart. As Australian steampunk exists outside the genre's mainstream, so too is it able to speak to the marginal elements, such as underlying ableism, that the mainstream too often ignores.
Complicating Feature: Gender and Disability in Mad Max: Fury Road
Authors: Ellis Katie , Peaty Gwyneth , McRae Leanne
Published: September 2023

Abstract: While scholarly discussion of disability in Australian narrative has focused on disability as a representational device, used to reinforce a hypermasculine and able-national identity, this article draws on Ato Quayson's aesthetic nervousness to establish patterns of cultural critique throughout Mad Max: Fury Road , layered on and through capitalism and gender representation. Strong female protagonists have been a recurring character in action genres since the 1980s yet have often been absent in Australian national cinema. There is barely a scene in Fury Road that does not include a disabled body and/or a woman. Furiosa's counterpart is not Max but Immortan Joe. Both bodies are impaired and use prosthesis. However, the role of Joe's prosthesis is to hide his decaying body, while the role of Furiosa's seems only to exist in Joe's world. Throughout this article, the authors invoke critical disability studies to argue that disability and gender are central to the aesthetic of Fury Road and to conveying its sociopolitical messages. In an ensemble filled with women, Furiosa's distinguishing feature is no longer her gender but her disability.
Climate Fiction and Disability: Enabled Futures in James Bradley's Clade (2015)
Authors: Rodoreda Geoff
Published: September 2023

Abstract: James Bradley's futuristic novel Clade (2015) is not chiefly a story about human disability. It is a novel about climate crisis set across the course of the twenty-first century. But midway through the novel, we are introduced to a seven-year-old boy, Noah, who becomes a key character in the second half of the narrative. Noah is on the spectrum. Autistics decry their portrayal in fiction as aliens, as outsiders, as harbingers of disease and disorder, as beings without agency. As we get to know Noah as a boy, through his teenage years, and later on as an astronomer, his autism is neither denied nor made the defining characteristic of his personhood. Noah is given voice, perspective, and centrality as a rounded character, emerging as someone well suited to a future world reshaped by environmental crises and new social relations. He is not pathologized but socialized across the course of the novel into a world of family, friends, and work. Like his biblical namesake, Noah becomes a survivor in the new environmental and social spaces of the latter part of the twenty-first century.
Barriers to optimal AEFI surveillance and documentation in Nigeria: Findings from a qualitative survey
Authors: Omoleke Semeeh Akinwale , Bamidele Moyosola , de Kiev Laurent Cleenewerck
Published: September 2023

Effective spontaneous AEFI reporting is the first step to ensuring vaccine safety. Half of the global population lives in countries with weak vaccine safety monitoring systems, especially in the African, Eastern Mediterranean, and Western Pacific regions. Further, Immunisation services have been upscaled without commensurate effective AEFI surveillance systems. Hence, this study aims to comprehensively investigate the impediments to an effective AEFI surveillance system. Given the programmatic and regulatory implications, understanding these impediments would facilitate the development and implementation of policies and strategies to strengthen the AEFI surveillance system in Nigeria. A qualitative research design (using a grounded theory approach) was employed by conducting ten key informant interviews and two Focus Group Discussion sessions among the study population to identify the barriers impeding optimal AEFI surveillance and documentation in Nigeria. This study found that the AEFI surveillance system is in place in Nigeria. However, its functionality is sub-optimal, and the potential capacity is yet to be fully harnessed due to health systems and socio-ecological impediments. The identified impediments are human-resource-related issues- knowledge gaps; limited training; lack of designated officers for AEFI; excessive workload; poor supportive supervision and attitudinal issues; caregiver’s factor; governance and leadership- moribund AEFI committee; lack of quality supervisory visit and oversight and weak implementation of AEFI policy guidance. Others include funding and logistics issues- no dedicated budget provision and weak referral mechanism; insecurity; socio-economic and infrastructural deficits- poverty, geographical barriers, limited ICT skills, and infrastructure; and poor feedback and weak community engagement by the health workers. Findings from this study provide empirical evidence and serve as an advocacy tool for vaccine pharmacovigilance strengthening in Nigeria. Addressing the impediments requires health system strengthening and a whole-of-the-society approach to improve vaccine safety surveillance, restore public confidence and promote vaccine demand, strengthen PHC services, and contribute to attaining UHC and SDGs.
Maternal, fetal, and perinatal outcomes among pregnant women admitted to an Ebola treatment center in the Democratic Republic of Congo, 2018–2020
Authors: Philpott David , Rupani Neil , Gainey Monique , Mbong Eta N. , Musimwa Prince Imani , Perera Shiromi M. , Laghari Razia , Ververs Mija , Levine Adam C.
Published: September 2023

Objective

This study aims to investigate maternal, fetal, and perinatal outcomes during the 2018–2020 Ebola outbreak in Democratic Republic of Congo (DRC).

Methods

Mortality between pregnant and non-pregnant women of reproductive age admitted to DRC’s Mangina Ebola treatment center (ETC) were compared using propensity score matching. Propensity scores were calculated using age, initial Ebola viral load, Ebola vaccination status, and investigational therapeutic. Additionally, fetal and perinatal outcomes of pregnancies were also described.

Results

Twenty-seven pregnant women were admitted to the Mangina ETC during December 2018—January 2020 among 162 women of childbearing age. We found no evidence of increase mortality among pregnant women compared to non-pregnant women (relative risk:1.0, 95%CI: 0.58–1.72). Among surviving mothers, pregnancy outcomes were poor with at least 58% (11/19) experiencing loss of pregnancy while 16% (3/19) were discharged with viable pregnancy. Two mothers with viable pregnancies were vaccinated, and all received investigational therapeutics. Two live births occurred, with one infant surviving after the infant and mother received an investigational post-exposure prophylaxis and Ebola therapeutic respectively.

Conclusions

Pregnancy was not associated with increased mortality among women with EVD in the Mangina ETC. Fetal and perinatal outcomes remained poor in pregnancies complicated by EVD, though novel therapeutics may have potential for improving these outcomes.
An immunoinformatics and extended molecular dynamics approach for designing a polyvalent vaccine against multiple strains of Human T-lymphotropic virus (HTLV)
Authors: Moin Abu Tayab , Rani Nurul Amin , Ullah Md. Asad , Patil Rajesh B. , Robin Tanjin Barketullah , Nawal Nafisa , Zubair Talha , Mahamud Syed Iftakhar , Sakib Mohammad Najmul , Islam Nafisa Nawal , Khaleque Md. Abdul , Absar Nurul , Shohael Abdullah Mohammad
Published: September 2023

Human T-lymphotropic virus (HTLV), a group of retroviruses belonging to the oncovirus family, has long been associated with various inflammatory and immunosuppressive disorders. At present, there is no approved vaccine capable of effectively combating all the highly pathogenic strains of HTLV that makes this group of viruses a potential threat to human health. To combat the devastating impact of any potential future outbreak caused by this virus group, our study employed a reverse vaccinology approach to design a novel polyvalent vaccine targeting the highly virulent subtypes of HTLV. Moreover, we comprehensively analyzed the molecular interactions between the designed vaccine and corresponding Toll-like receptors (TLRs), providing valuable insights for future research on preventing and managing HTLV-related diseases and any possible outbreaks. The vaccine was designed by focusing on the envelope glycoprotein gp62, a crucial protein involved in the infectious process and immune mechanisms of HTLV inside the human body. Epitope mapping identified T cell and B cell epitopes with low binding energies, ensuring their immunogenicity and safety. Linkers and adjuvants were incorporated to enhance the vaccine’s stability, antigenicity, and immunogenicity. Initially, two vaccine constructs were formulated, and among them, vaccine construct-2 exhibited superior solubility and structural stability. Molecular docking analyses also revealed strong binding affinity between the vaccine construct-2 and both targeted TLR2 and TLR4. Molecular dynamics simulations demonstrated enhanced stability, compactness, and consistent hydrogen bonding within TLR-vaccine complexes, suggesting a strong binding affinity. The stability of the complexes was further corroborated by contact, free energy, structure, and MM-PBSA analyses. Consequently, our research proposes a vaccine targeting multiple HTLV subtypes, offering valuable insights into the molecular interactions between the vaccine and TLRs. These findings should contribute to developing effective preventive and treatment approaches against HTLV-related diseases and preventing possible outbreaks. However, future research should focus on in-depth validation through experimental studies to confirm the interactions identifiedin silicoand to evaluate the vaccine’s efficacy in relevant animal models and, eventually, in clinical trials.
Reducing antimicrobial use in chicken production in Vietnam: Exploring the systemic dimension of change
Authors: Bâtie Chloé , Tran Minh Hang , Thi Vu Van Anh , Thuy Luong Duong , Thi Pham Trang , Fortané Nicolas , Pham Duc Phuc , Goutard Flavie Luce
Published: September 2023

Antibiotic use in livestock production is one of the drivers of antibiotic resistance and a shift towards better and reduced antibiotic usage is urgently required. In Vietnam, where there are frequent reports of the misuse and overuse of antibiotics, little attention has been paid to farmers who have successfully changed their practices. This qualitative study aims to understand the transition process of Vietnamese chicken farmers toward reduced antibiotic usage. We conducted semi-structured interviews with 18 chicken farmers, 13 drug sellers, and 5 traders using participatory tools and a socio-anthropological approach. We explored the farmers’ histories, current and past antibiotic usage, methods used to reduce antibiotic use, and motivations and barriers to changing practices. Through the thematic analysis of the farmers’ transcripts, we identified technical, economic, and social factors that influence change. Out of eighteen farmers, we identified ten farmers who had already reduced antibiotic usage. The main motivations included producing quality chickens (tasty and safe) while reducing farm expenditures. Barriers were related to poor biosecurity in the area, market failures, and the farmers’ lack of knowledge. Innovation led to overcome these obstacles included the local development of handmade probiotics and the organization of farmer cooperatives to overcome economic difficulties and guarantee product outlets. Knowledge was increased by workshops organized at the communal level and the influence of competent veterinarians in the area. We showed that the transition process was influenced by several components of the system rather than by any individual alone. Our study demonstrated that local initiatives to reduce antibiotic use in Vietnamese chicken production do exist. As changes depend on the system in which stakeholders are embedded, systemic lock-ins must be removed to allow practices to change. The promotion of locally-developed solutions should be further encouraged.
Extending the Omega model with momentum and reversal strategies to intraday trading
Authors: Yu Jing-Rung , Wei Chieh-Hui , Lai Chi-Ju , Lee Wen-Yi
Published: September 2023

This study develops the Omega model integrated with momentum and reversal strategies using high-frequency data on the component stocks of the S&P 500 Index and the NASDAQ 100. The Omega model based on the momentum strategy (M_Omega), the reversal strategy (R_Omega), and both strategies (M_R_Omega) are designed to simulate trading over three periods. The portfolio is rebalanced every transaction day to optimize asset allocation by incorporating intraday winners or losers’ information and trading cost. The study finds that the proposed models generate positive returns (net of trading costs), in spite of fact that intraday trading frequently erodes profits. The M_Omega and R_Omega models produce a higher return than that of the S&P 500 index or NASDAQ 100 index, considering the intraday trading cost. The performance of the Omega model integrated with the momentum or reversal strategy is more profitable in a volatile market or period. The M_Omega and R_Omega reach the highest final market value from 2020 to 2021, when COVID 19 pandemic emerged. The rebalancing of the momentum or reversal strategy is suitable for the short term but not recommended in the long term for intraday trading as the trading costs become increasingly significant over time.
Relationship between spatial pattern and function of urban land use in Changchun, China
Authors: Shen Qingxi , Tan Xue , Li Xipeng
Published: September 2023

The urban spatial structure in this study refers to the combination of different categories of land use, and the purpose of the study is to reveal the intrinsic correlation characteristics between urban land use structural combination forms and urban functions. Through the integration of land and population maps and other multi-source data, with the help of exploratory spatial data analysis and other models, this research deals with the land use spatial structure characteristics of Changchun city and its coordination relationship with urban functions. Main conclusions of the study are as follows. The overall density of the land use in the central urban area of Changchun shows patterns of the core being higher than the periphery, the large-scale agglomeration being significant and the small-scale relatively scattered, and the pattern of the mixed land use function index has obvious differentiation characteristics. The study shows that, in the context of the spatial pattern, the overall coupling coordination degree of the land use structure index and the urban function index shows a trend of a gradual decrease, from the core to the periphery. In the context of category differences, the coupling coordination of the land use structure with the population distribution and the Baidu thermal distribution is relatively high, and the coupling coordination with various service facilities is relatively low. Finally, in the context of scale differences, all types of coupling coordination degrees have significant sensitivity to the spatial scales. A large scale significantly reflects the overall decrease in the coupling coordination degrees from the core to the periphery, while a small scale shows the polycentric pattern characteristics of the urban spatial structure.
Effectiveness of the aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in healthy community-dwelling older adults: A systematic review and meta-analysis
Authors: Melo Renato S. , Cardeira Caroline Stefany Ferreira , Rezende Damaris Scarleth A. , Guimarães-do-Carmo Vinícius J. , Lemos Andrea , de Moura-Filho Alberto Galvão
Published: September 2023

Background

Opting to use aquatic or land-based physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in community-dwelling older adults (CDOAs) is still a questionable clinical decision for physiotherapists.

Objective

Assess the quality of evidence from randomized or quasi-randomized controlled trials that used aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in CDOAs.

Methods

Articles were surveyed in the following databases: MEDLINE/PubMed, EMBASE, SCOPUS, LILACS, Web of Science, CENTRAL (Cochrane Central Register of Controlled Trials), PEDro, CINAHL, SciELO and Google Scholar, published in any language, up to July 31, 2023. Two independent reviewers extracted the data and assessed evidence quality. The risk of bias of the trials was evaluated by the Cochrane tool and evidence quality by GRADE approach. Review Manager software was used to conduct the meta-analyses.

Results

3007 articles were identified in the searches, remaining 33 studies to be read in full, with 11 trials being eligible for this systematic review. The trials included presented low evidence quality for the balance, gait, quality of life and fear of falling. Land-based and aquatic physical therapy exercises improved the outcomes analyzed; however, aquatic physical therapy exercises were more effective in improving balance, gait, quality of life and reducing fear of falling in CDOAs. The meta-analysis showed that engaging in aquatic physical therapy exercises increases the functional reach, through of the anterior displacement of the center of pressure of CDOAs by 6.36cm, compared to land-based physical therapy exercises, assessed by the Functional Reach test: [CI:5.22 to 7.50], (p<0.00001), presenting low quality evidence.

Conclusions

Aquatic physical therapy exercises are more effective than their land-based counterparts in enhancing balance, gait, quality of life and reducing the fear of falling in CDOAs. However, due to methodological limitations of the trials, this clinical decision remains inconclusive. It is suggested that new trials be conducted with greater methodological rigor, in order to provide high-quality evidence on the use of the aquatic physical therapy exercises to improve the outcomes analyzed in CDOAs.
Research on risk contagion mechanism of big fintech based on the SIRS model
Authors: Li Yutong , Tan Zhongming , Huang Chenyu
Published: September 2023

In recent years, while the relationship between the new financial institutions, represented by financial technology companies, and the traditional financial institutions(banks, securities, insurance, etc.) has been steadily enhanced, a New Relational Network has silently emerged. Along with the rapid expansion of big fintech companies, the possibility of financial risk breeding and spreading in the New Relational Network is also rising. This article analyzes and simulates the risk contagion mechanism of big fintech risks based on the SIRS epidemic model. The study’s findings imply that: when the number of big fintech companies infected with risk exceeds the risk threshold, the big fintech risk will spread in the New Relational Network. At this time, the number of big fintech companies infected with risk can be reduced below the threshold by enhancing the risk warning, risk management, risk buffering and blocking capabilities, and timely improving risk prevention and control measures in the post-infection phase. It means that the big fintech risk is controlled. For big fintech risks, proactive interventions are more effective than post-incident response measures. This paper makes the following recommendations for preventing big fintech risks: creating a risk monitoring and early warning system to raise the Big Fintech companies’ direct immunization rates; strengthening the big fintech companies’ risk management and risk mitigation capabilities; enhancing the internal and external supervision to achieve sustainable development of big fintech companies.
Mortality and prognostic factors for spontaneous pneumothorax in older adults
Authors: Nishizawa Saori , Tobino Kazunori , Murakami Yousuke , Uchida Kazuki , Kawabata Takafumi , Ota Hiroyuki , Hiramatsu Yuri , Sueyasu Takuto , Tsuruno Kosuke
Published: September 2023

Spontaneous pneumothorax occurs predominantly in young males and older adults, often as a secondary condition, and can be refractory and fatal. This study aimed to investigate the mortality and prognostic factors for pneumothorax in older patients. We retrospectively cohort studied patients with pneumothorax aged ≥65 years who visited our department from October 2012 to January 2019. Data on sex, age, medical history, smoking history, underlying lung disease, treatment, and prognosis were extracted from medical records. Cox proportional hazards regression analysis was used to investigate pneumothorax mortality and prognostic factors. In total, 239 patients were included. Among them, 36 (15%) died during hospitalization. Respiratory disease was the direct cause of death in 30 patients (83.3%), and 211 (88.3%) patients had underlying lung disease. The incidence of pneumonia in our hospital was 22.6% (54 cases). On admission, the mortality rate was 33% (18/54) in patients with concomitant pneumonia; univariate analysis showed significant differences in the Charlson Comorbidity Index (CCI), activities of daily living (ADL), and concomitant pneumonia. In the Cox proportional hazards analysis of ADL (p = 0.09), CCI (p = 0.05), and concomitant pneumonia on admission (p = 0.02), concomitant pneumonia on admission was found to be an independent predictor of in-hospital mortality. This study suggests that concomitant pneumonia at admission may be a mortality risk factor for pneumothorax.
Knowledge & attitudes toward fertility preservation (Medical and social freezing) among Lebanese women between the ages of 18 and 39 years
Authors: Ghazeeri Ghina , Beyrouthy Christine , El-taha Lina , Abiad May , Fahs Duaa
Published: September 2023

Egg freezing is a relatively new and controversial procedure in the Arab region, challenging traditional perceptions of fertility and motherhood. This study aims to assess Lebanese women’s awareness and acceptance of egg freezing and how these attitudes differ according to vary with age, socio-demographic characteristics, and educational level. We conducted a cross-sectional survey targeting Lebanese females aged between 18 and 39, involving 402 Lebanese women from six different institutions representing diverse cultural backgrounds. 65% of the respondents had heard of egg freezing. Younger women (18–30 years old) were 2.09 times more likely to consider egg freezing than those aged 31–39. Single women were 4.31 times more likely to consider egg freezing than women in relationships, while childless women were 5.00 times more likely compared to women who already had children. Overall, medical egg freezing was more widely accepted than social egg freezing. The most supported indication for social egg freezing was to enable women who struggled to find the right partner during their peak fertile years to have children in the future (41.5%). The most common concern that affected women’s decision to undergo egg freezing was whether the procedure would be proven safe for their future children and whether it would affect their future fertility. Interestingly, in a relatively conservative country, concerns about hymenal disruption were the least prevalent, (19%). The most common concern by far was limited information on the procedure (62%). In conclusion, the study reveals that awareness and acceptance of social egg freezing among Lebanese women were higher than expected. Limited information on the procedure’s details was the main impediment to higher acceptance rates, highlighting the importance of physicians and primary healthcare providers in providing reproductive-aged women with the necessary information to safeguard their reproductive potential.