bluuebunny/crossref_metadata_2025 huggingface dataset:
Generating floor plans with deep learning: A cross-validation assessment over different dataset sizes
Authors: Rodrigues Ricardo C , Duarte Rovenir B
Published: September 2022

The advent of deep learning has enabled a series of opportunities; one of them is the ability to tackle subjective factors on the floor plan design and make predictions though spatial semantic maps. Nonetheless, the amount available of data grows exponentially on a daily basis, in this sense, this research seeks to investigate deep generative methods of floor plan design and its relationship between data volume, with training time, quality and diversity in the outputs; in other words, what is the amount of data required to rapidly train models that return optimal results. In our research, we used a variation of the Conditional Generative Adversarial Network algorithm, that is, Pix2pix, and a dataset of approximately 80 thousand images to train 10 models and evaluate their performance through a series of computational metrics. The results show that the potential of this data-driven method depends not only on the diversity of the training set but also on the linearity of the distribution; therefore, high-dimensional datasets did not achieve good results. It is also concluded that models trained on small sets of data (800 images) may return excellent results if given the correct training instructions (Hyperparameters), but the best baseline to this generative task is in the mid-term, using around 20 to 30 thousand images with a linear distribution. Finally, it is presented standard guidelines for dataset design, and the impact of data curation along the entire process.
Does Cross-Regime Contact Change the Evaluation of Democracy? Evidence From Taiwanese Student Delegations Visiting Mainland China
Authors: Wang Chia-chou
Published: September 2022

Does visiting Mainland China alter Taiwanese students’ evaluation of Taiwan’s democracy? This question greatly concerns democratic supporters globally. Therefore, 477 Taiwanese young adults participating in Mainland China exchange programmes were recruited for this study. Social contact, social identity, political socialisation and rational choice theories were introduced to formulate four hypotheses. The results indicated that, among the three dimensions constituting the democracy evaluation following their exchange to Mainland China, the Taiwanese students showed increased positive evaluations in democratic support and degree of democratisation. Furthermore, positive evaluations for satisfaction with democracy decreased. The evaluation of Taiwan’s democracy, formed by aggregating these three dimensions, indicates that this index decreased in 27.54% of students, increased in 29.24% and remained unchanged in 43.22%. After visiting Mainland China, students exhibit a tendency towards ethnically identifying as Taiwanese, or have a worse impression of China, or have greater political trust towards Taiwanese officials, or show a lower preference for the strongman rule, leading to a more favourable evaluation of Taiwan’s democracy.
Transcranial Color-Coded Doppler Cerebral Hemodynamics Following Aerobic Exercise Training: Outcomes From a Pilot Randomized Clinical Trial
Authors: Mitchell Carol , Gaitán J. Max , Pewowaruk Ryan J. , Gepner Adam D. , Hess Timothy , Wilbrand Stephanie M. , Dempsey Robert J. , Dougherty Ryan J. , Cook Dane B. , Okonkwo Ozioma
Published: September 2022

Introduction:

An active lifestyle with regular exercise is thought to decrease or delay the onset of Alzheimer dementia through increasing blood flow to the brain. We examined the mean flow velocity (MFV) and pulsatility index (PI) in the middle cerebral arteries of individuals randomized into 2 groups—a usual physical activity (UPA) group and an enhanced physical activity (EPA) exercise intervention group—to determine whether exercise training is related to changes in cerebral blood flow.

Methods:

We examined 23 participants, randomized into a UPA group (n = 12) and an EPA group (n = 11), with transcranial color-coded Doppler (TCCD) and cardiorespiratory fitness (VO2peak) testing at baseline and following a 26-week intervention. Transcranial color-coded Doppler was used to measure MFV and PI. Participants in the EPA group completed supervised aerobic exercise training for 26 weeks. Kendall’s tau-b correlation was used to examine relationships between variables. The Wilcoxon rank-sum tests were used to examine changes between the UPA and EPA groups.

Results:

There was no significant change in MFV or PI in the UPA group or the EPA group ( P values >.05) between baseline and 26 weeks; the change between the UPA and EPA groups was also not significant ( P = .603). There was no evidence of an association between change in VO2peak and change in MFV or PI (all P values >.05). Participants in the EPA group significantly increased their VO2peak compared with the UPA group ( P = .027).

Conclusion:

This study did not demonstrate evidence of a significant change in the MFV in the middle cerebral arteries or evidence of a significant change in the PI between UPA and EPA groups. Future studies should be performed in larger cohorts and should consider use of personalized exercise programs to maximize understanding of how cerebrovascular hemodynamics change in structure and function with exercise for adults at risk of Alzheimer dementia.
Performance of concrete reinforced with jute fibers (natural fibers): A review
Authors: Ahmad Jawad , Arbili Mohamed Moafak , Majdi Ali , Althoey Fadi , Farouk Deifalla Ahmed , Rahmawati Cut
Published: September 2022

Natural fibers are an excellent alternative since they are inexpensive and easily accessible in fibrous form. Several researchers claim that jute fiber (JTF) can be used in concrete to improve its strength and durability performance. This review describes the characteristics and potential uses of some jute fibers in concrete. The main theme of this review is to summarize the effect of JTF on fresh properties of concrete, strength parameters, and durability characteristics. It can be concluded that jute fibers improved strength and durability aspect but decreased the fluidity of concrete in a similar way to synthetic fibers. However, there is little research available on the durability of concrete reinforced with JTF. Furthermore, the optimum percentage of JTF in concrete is critical as the higher dose adversely affects strength and durability characteristics due to lack fluidity. The typical range of optimum dose of JTF varies from 1% to 2% depending on the length and diameter of jute fibers. The review also identifies the key for future researchers to further, enhance the properties of concrete reinforced with JTF.
Utilizing a Matrix Approach to Analyze Qualitative Longitudinal Research: A Case Example During the COVID-19 Pandemic
Authors: Terzis Lauren D. , Saltzman Leia Y. , Logan Dana A. , Blakey Joan M. , Hansel Tonya C.
Published: September 2022

Qualitative Longitudinal Research (QLR) is an evolving methodology used in understanding the rich and in-depth experiences of individuals over time. QLR is particularly conducive to pandemic or disaster-related studies, where unique and rapidly changing environments warrant fuller descriptions of the human condition. Despite QLR’s usefulness, there are a limited number of articles that detail the methodology and analysis, especially in the social sciences, and specifically social work literature. As researchers adjust their focus to incorporate the impact of the COVID-19 global pandemic, there is a growing need in understanding the progression and adaptation of the pandemic on individuals’ lives. This article provides a process and strategy for implementing QLR and analyzing data in online diary entries. In the provided case example, we explore a phenomenological QLR conducted with graduate level students during the COVID-19 pandemic ( Saltzman et al., 2021 ) , and outline a matrix framework for QLR analysis. This paper provides an innovative way in which to engage in qualitative data collection and analysis for social science research.
Electro-osmotic optimized flow of Prandtl nanofluid in vertical wavy channel with nonlinear thermal radiation and slip effects
Authors: Abbasi Aamar , Farooq Waseh , Al-Khaled Kamel , Khan Sami Ullah , Elamin Mawahib , Khan Muhammad Ijaz , Farooq Shahid , El-Shorbagy MA , Malik Muhammad Yousaf
Published: September 2022

The simulations have been performed for the nonlinear radiative flow of Prandtl nanofluid following the peristaltic pumping in a wavy channel. The applications of entropy generation for the electrokinetic pumping phenomenon are also focused as a novelty. The complex wavy channel induced the flow of Prandtl nanofluid. Moreover, the formulated problem is solved by using the convective thermal and concentration boundary conditions. The Keller Box numerical procedure is adopted as a tool for the simulation task. The results are also verified by implementing the built-in numerical technique bvp4c. The comparison tasked against obtained numerical measurement has been done with already reported results with excellent manner. The physical characteristics based on the flow parameters for velocity, heat transfer phenomenon, concentration field, and entropy generation pattern is visualized graphically. It has been observed that the presence of thermal slip and concentration enhanced the heat transfer rate and concentration profile, respectively. The skin friction coefficient declines with electro-osmotic force and slip parameter. The increasing variation in Nusselt number is observed for electro-osmotic parameter for both linear and non-linear radiative phenomenon.
Women decision-making autonomy on maternal health service and associated factors in low- and middle-income countries: Systematic review and meta-analysis
Authors: Gebeyehu Natnael Atnafu , Gelaw Kelemu Abebe , Lake Eyasu Alem , Adela Getachew Asmare , Tegegne Kirubel Dagnaw , Shewangashaw Nathan Estifanos
Published: September 2022

Objective:

This study was done to determine the overall estimate of decision-making autonomy on maternal health services and associated factors in low- and middle-income countries.

Method:

PubMed, Science Direct, Google Scholar, Scopus, and the Ethiopian University online library were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (version 14). Publication bias was checked by forest plot, Begg’s rank test, and Egger’s regression test. To look for heterogeneity, I2 was computed, and an overall estimated analysis was carried out. Subgroup analysis was done by country, year, and publication. Joanna Briggs Institute quality assessment tool was used to check the quality of each study. We carried out a leave-one-out sensitivity analysis.

Results:

Out of 1305 articles retrieved, 19 studies (with 104,871 study participants) met eligibility criteria and were included in this study. The pooled prevalence of women’s decision-making autonomy on maternal health services in low- and middle-income countries was 55.15% (95% confidence interval: 44.11–66.19; I2 = 98.6%, P < 0.001). Based on subgroup analysis, decision-making autonomy in maternal health services was the highest in Ethiopia at 61.36% (95% confidence interval: 50.58–72.15) and the lowest in Nigeria at 36.16% (95% confidence interval: 12.99–43.39). It was 32.16% (95% confidence interval: 32.72–39.60) and 60.18% (95% confidence interval: 47.92–72.44) before and after 2016, respectively. It was also 54.64% (95% confidence interval: 42.51–66.78) in published studies and 57.91% (95% confidence interval: 54.80–61.02) in unpublished studies. Age (adjusted odds ratio = 2.67; 95% confidence interval: (1.29–5.55), I2 = 90.1%), primary level of education (adjusted odds ratio = 1.75; 95% confidence interval: (1.39–2.21), I2 = 63.8%), secondary education level (adjusted odds ratio = 2.09; 95% confidence interval: (1.32–3.32), I2 = 87.8%), being urban resident (adjusted odds ratio = 1.80; 95% confidence interval: (1.22–2.66), I2 = 73%), and monthly income (adjusted odds ratio = 3.23; 95% confidence interval: (1.85–5.65), I2 = 97%) were positively associated with decision-making autonomy on maternal health service.

Conclusion:

Decision-making autonomy on maternal health services in low- and middle-income countries was low. Sociodemographic factors also influenced it. Educational accessibility and income generation should have been recommended, enabling women to decide for themselves.
Interrogating Gender-Exploratory Therapy
Authors: Ashley Florence
Published: September 2022

Opposition to gender-affirmative approaches to care for transgender youths by some clinicians has recently begun to consolidate around “gender exploratory therapy” as a proposed alternative. Whereas gender-affirmative approaches follow the client’s lead when it comes to gender, gender-exploratory therapy discourages gender affirmation in favor of exploring through talk therapy the potential pathological roots of youths’ trans identities or gender dysphoria. Few detailed descriptions of the approach’s parameters have been offered. In this article, I invite clinicians to reflect on gender-exploratory therapy through a series of questions. The questions are followed by an exploration of the strong conceptual and narrative similarities between gender-exploratory therapy and conversion practices. Finally, the ethical dimensions of gender-exploratory therapy are discussed from the lenses of therapeutic neutrality, patient-centered care, loving attention, and therapeutic alliance, suggesting that the approach may be unethical.
Mesenteric abnormalities play an important role in grading intestinal fibrosis in patients with Crohn’s disease: a computed tomography and clinical marker-based nomogram
Authors: Meng Jixin , Mao Yitao , Zhou Jie , Chen Zhao , Huang Siyun , Wang Yangdi , Huang Li , Zhang Ruonan , Shen Xiaodi , Lv Wen , Xiao Juxiong , Ye Ziyin , Chen Zhihui , Mao Ren , Sun Canhui , Li Ziping , Feng Shi-Ting , Lin Shaochun , Li Xuehua
Published: September 2022

Background:

While the grading of intestinal fibrosis is closely related to the therapeutic strategy of patients with Crohn’s disease (CD), it has not yet been well resolved. Mesenteric abnormalities are inextricably linked to intestinal fibrosis.

Objectives:

We aimed to establish an optimal model for assessing intestinal fibrosis using computed tomography enterography (CTE) and clinical markers.

Design:

A total of 174 patients with CD between January 2014 and June 2020 were included in this retrospective multicentre study.

Methods:

All patients underwent CTE within 3 months prior to surgery. Intestinal fibrosis was pathologically scored as non-mild or moderate-to-severe. Selected imaging of the intestinal walls and mesentery and/or clinical factors were used to develop the diagnostic models. The area under the receiver operating characteristic curve (AUC) analysis was used to evaluate the discrimination performance of the models. A decision curve analysis was performed to evaluate the clinical usefulness of the models.

Results:

One-, two-, and three-variable models were identified as possible diagnostic models. Model 1 [mesenteric creeping fat index (MCFI)], Model 2 (mesenteric oedema and MCFI), and Model 3 (mesenteric oedema, MCFI, and disease duration) were established. The AUCs of Model 1 in training and test cohorts 1 and 2 were 0.799, 0.859, and 0.693, respectively; Model 2 was 0.851, 0.833, and 0.757, respectively; and Model 3 was 0.832, 0.821, and 0.850, respectively. We did not observe any significant difference in diagnostic performance between the training and total test cohorts in any model (all p > 0.05). The decision curves showed that Model 3 had the highest net clinical benefit in test cohort 2. The nomogram of this optimal model was constructed by considering the favourable and robust performance of Model 3.

Conclusion:

A nomogram integrating mesenteric abnormalities on CTE with a clinical marker was optimal for differentiating between non-mild and moderate-to-severe fibrosis in patients with CD.
MRI pattern in acute optic neuritis: Comparing multiple sclerosis, NMO and MOGAD
Authors: Darakdjian Maximiliano , Chaves Hernan , Hernandez Jairo , Cejas Claudia
Published: September 2022

Background

Several MRI findings of optic neuritis (ON) have been described and correlated with specific underlying etiologies. Specifically, optic nerve enhancement is considered an accurate biomarker of acute ON.

Objective

To identify differences in MRI patterns of optic nerve enhancement in certain demyelinating etiologies presenting with acute ON.

Methods

Retrospective analysis of enhancement patterns on fat-suppressed T1-weighted images from patients presenting clinical and radiological acute ON, treated at our institution between January 2014 and June 2022. Location and extension of enhancing optic nerve segments, as well as presence of perineural enhancement were evaluated in three predetermined demyelinating conditions. Fisher’s exact test and chi2 were calculated.

Results

Fifty-six subjects met eligibility criteria. Mean age was 31 years (range 6–79) and 70% were females. Thirty-four (61%) patients were diagnosed with multiple sclerosis (MS), 8 (14%) with neuromyelitis optica (NMO), and 14 (25%) with anti-myelin oligodendrocyte glycoprotein disease (MOGAD). Bilateral involvement was more frequent in MOGAD, compared to MS and NMO (43 vs 3% and 12.5% respectively, p = 0.002). MS patients showed shorter optic nerve involvement, whereas MOGAD showed more extensive lesions ( p = 0.006). Site of involvement was intraorbital in 63% MS, 89% NMO, 90% MOGAD ( p = 0.051) and canalicular in 43% MS, 33% NMO and 75% MOGAD ( p = 0.039). Intracranial or chiasmatic involvement and presence of perineural enhancement were not statistically different between entities.

Conclusion

In the setting of acute ON, patients presenting MOGAD were more likely to show bilateral, longitudinally extended and anterior (intraorbital and canalicular) optic nerve involvement compared to patients with MS or NMO.
Drug-related problems and determinants among elective surgical patients: A prospective observational study
Authors: Mohammed Mesud , Bayissa Bodena , Getachew Mestawet , Adem Fuad
Published: September 2022

Objectives:

The aim of this study was to assess drug-related problems and determinants among elective surgical patients admitted to Jimma University Medical Center.

Methods:

A hospital-based prospective observational study was conducted at Jimma University Medical Center, from April 10 to July 10, 2018. Data were collected through patients’ interview and physicians’ medication orders and charts review using pre-tested questionnaire and data abstraction formats. Drug-related problems were assessed for each patient using drug-related problem classification tool. Data were analyzed using Statistical Package for Social Science for windows; version 21.0. The predictors of drug-related problems were determined by multivariable logistic regression analysis. A p-value of less than or equal to 0.05 was considered to be statistically significant.

Results:

Of the total 141 participants, 98 (69.5%) of them had at least one drug-related problem during their hospital stay. A total of 152 drug-related problems were identified among 141 elective surgical patients. The most common identified drug-related problems were indication-related problems (39%) followed by effectiveness-related problems (21%) and safety-related problems (21%). The presence of complication (adjusted odds ratio = 2.90, 95% confidence interval (1.302, 3.460)), American Society of Anesthesiologists Physical Status ⩾ 2 (adjusted odds ratio = 6.01, 95% confidence interval (1.0011, 9.500)), and postoperative antibiotics (adjusted odds ratio = 6.027, 95% confidence interval (1.594, 22.792)) were independent predictors of drug-related problems.

Conclusion:

The prevalence of drug-related problems is high among elective surgical patients. The indication-related problems were the most common category of drug-related problem identified among elective surgical patients. The presence of complication, American Society of Anesthesiologists Physical Status ⩾ 2, and postoperative antibiotics were the independent predictors of drug-related problems.
Treatment of Recurrent Vulvovaginal Candidiasis With Ibrexafungerp
Authors: Grant Leah M. , Orenstein Robert
Published: September 2022

Recurrent vulvovaginal candidiasis is a common disorder which causes significant morbidity among women worldwide, and treatment options are limited. Ibrexafungerp is a novel antifungal agent which was approved in 2021 for treatment of vulvovaginal candidiasis. We present a case of recurrent vulvovaginal candidiasis successfully treated with ibrexafungerp.
School Nurses’ Experiences in Dealing with Adolescents Having Mental Health Problems
Authors: Moen Øyfrid Larsen , Jacobsen Inger Christine Roth
Published: September 2022

Introduction

An increased number of adolescents experience mental health problems. School nurses have described spending more than 50% of their time working with mental health in students. The lack of knowledge and necessary training to meet students’ mental health needs has been described previously. School nurses have a responsibility to find and guide those who need help with mental health problems.

Objectives

The aim of this study was, therefore, to explore school nurses’ experiences with mental health and how they in this work identify, talk, and intervene with adolescents having mental health problems.

Methods

A qualitative study was conducted with 21 school nurses using focus group interviews which were analyzed by means of content analysis.

Results

Three descriptive categories emerged: Health-promoting or preventive approaches, Enabling students to talk about feelings, and Collaborating partners.

Conclusion

School nurses highlight their mandate to work with health promotion and prevention but also draw attention to their difficulties in identifying those who need help. School nurses use their creativity, intuition, and knowledge but have difficulty identifying those students who need help with mental health problems. They also highlight collaboration with other professionals both in schools and in the health system.
Predicting housing deprivation from space in the slums of Dhaka
Authors: Patel Amit , Borja-Vega Christian , Mimmi Luisa M , Soukup Tomas , Kolomaznik Jan , Bhan Tanushree , Mundt Marcia D , Lee Hyunjung
Published: September 2022

Cities in developing countries have been struggling to deal with the pressures of urbanization on infrastructure, basic services, land, and housing that often manifest as poor living conditions found in slums and informal settlements. One of the key challenges to effectively target policy interventions and meet Sustainable Development Goals (SDGs) for improving lives of people living in slums is the lack of data on their housing condition. Furthermore, the slum/non-slum dichotomy is inadequate in identifying specific deprivations that prevents effective policymaking and implementation. To this end, we propose a methodological framework to predict multidimensional housing deprivation with slums of Dhaka, Bangladesh as our case study. Our framework predicts multidimensional housing deprivation using geospatial and remote sensing variables. Several indicators, including distance to the central business district, arterial roads, major road junctions, railroads, average dwelling size, and street type within slums were related to increased risk of overall deprivation whereas proximity to heavy industry and shoreline, building density, informal street pattern, the low-level connectivity and proximity to social amenities were related to lower risk of housing deprivation. The results from the statistical models indicate their potential to predict the extent and type of housing deprivation, which could in turn support planning and policy interventions for achieving SDGs for the most vulnerable populations in slums of developing countries.
Police preparedness to respond to cybercrime in Australia: An analysis of individual and organizational capabilities
Authors: Wilson Michael , Cross Cassandra , Holt Thomas , Powell Anastasia
Published: September 2022

The rapid growth in the availability of information and communications technologies has also expanded opportunities to commit cybercrime. Law enforcement officers are often the first responders to such incidents. Internationally, research has revealed how police preparedness to respond to cybercrime is mediated by organizational policies and procedures, as well as characteristics such as education, gender, and previous training for cybercrime investigations. However, there has been limited research in an Australian context examining police preparedness to respond to cybercrime. As such, this article examines the preparedness of Australian police personnel to respond to cybercrime incidents drawing on surveys with two state-wide police agencies ( n = 422). Here, we examine the prevalence of cybercrime training across both agencies, levels of individual and organizational confidence about responding to cybercrime incidents, and their views about enhancing responses to cybercrime. The results suggest only half of the surveyed personnel have received some cybercrime-related training, with significantly less reporting specific instruction about how to receive and direct incident reports and manage digital crime scenes. Further, while personnel are modestly confident in their individual capabilities to respond to cybercrime incidents, they lack comparative confidence in their organizations and yearn for more resourcing and professional development. Implications for police resourcing, training, and practices are discussed.
Long term evaluation of a multidisciplinary trigeminal neuralgia service
Authors: Singhota Sanjeet , Tchantchaleishvili Nana , Wu Jianhua , Zrinzo Ludvic , Thorne Lewis , Akram Harith , Zakrzewska Joanna M.
Published: September 2022

Background

Trigeminal neuralgia is an episodic severe neuralgic pain and can be managed both medically and surgically. If possible, this should be directed by a Multidisciplinary Team (MDT) of specialised surgeons, physicians, dentists, psychologists and specialist nurses with access to all treatment modalities, which enables patients to make an informed decision about their future management.

Objective

The aim of this study was to review the outcomes of patients managed by an MDT clinic, in a single institute over an eleven-year period.

Methods

A prospective database was used to identify patients with trigeminal neuralgia or its variants who had attended a joint MDT clinic. The electronic notes were examined for demographics, onset and duration of trigeminal neuralgia, medications history, pain scores and details of surgical procedures if any by two independent assessors.

Results

Three hundred thirty-four patients attended the MDT between 2008–2019. Forty-nine of them had surgery before being referred to the service and were included but analysed as a subgroup. Of the remaining patients, 54% opted to have surgery following the MDT either immediately or at a later date. At the last reported visit 55% of patients who opted to have surgery were pain free and off medications, compared to 15.5% of medically managed patients. Surgical complications were mostly attributable to numbness and in the majority of cases this was temporary. All patients who were not pain free, had complications after surgery or opted to remain on medical therapy were followed up in a facial pain clinic which has access to pain physicians, clinical nurse specialists and a tailored pain management program. Regular patient related outcome measures are collected to evaluate outcomes.

Conclusion

An MDT clinic offers an opportunity for shared decision making with patients deciding on their personal care pathway which is valued by patients. Not all patients opt for surgery, and some continue to attend a multidisciplinary follow up program. Providing a full range of services including psychological support, improves outcomes.
Multi-level Cells and Quantized Conductance Characteristics of Al2O3-Based RRAM Device for Neuromorphic System
Authors: Lee Yunseok , Park Jongmin , Chung Daewon , Lee Kisong , Kim Sungjun
Published: September 2022

Recently, various resistance-based memory devices are being studied to replace charge-based memory devices to satisfy high-performance memory requirements. Resistance random access memory (RRAM) shows superior performances such as fast switching speed, structural scalability, and long retention. This work presented the different filament control by the DC voltages and verified its characteristics as a synaptic device by pulse measurement. Firstly, two current–voltage (I–V) curves are characterized by controlling a range of DC voltages. The retention and endurance for each different I–V curve were measured to prove the reliability of the RRAM device. The detailed voltage manipulation confirmed the characteristics of multi-level cell (MLC) and conductance quantization. Lastly, synaptic functions such as potentiation and depression, paired-pulse depression, excitatory post-synaptic current, and spike-timing-dependent plasticity were verified. Collectively, we concluded that Pt/Al2O3/TaN is appropriate for the neuromorphic device.
How do interventions to improve the efficiency of acute stroke care affect prehospital times? A systematic review and narrative synthesis
Authors: McClelland Graham , Hepburn Sarah , Finch Tracy , Price Christopher I.
Published: September 2022

Background

Emergency medical services (EMS) are the first point of contact for most acute stroke patients. EMS call to hospital times have increased in recent years for stroke patients in the UK which is undesirable due to the relationship between time and effectiveness of reperfusion treatment. This review aimed to identify and describe interventions devised to improve the efficiency of acute stroke care which reported an impact on ground-based EMS call to hospital times.

Methods

A systematic review of published literature identified from five databases (Medline, EMBASE, CINAHL, the Cochrane library and the Database of Research in Stroke (DORIS)) from January 2000 to December 2020 with narrative synthesis was conducted. Inclusion criteria were primary studies of ground-based EMS, focused on stroke and aiming to improve EMS times. Papers published before 2000, focussing on mobile stroke units or in languages other than English were excluded. Two reviewers independently screened prospective titles. Cochrane ROB2 and ROBINS-I tools were used to assess for risk of bias. This review was funded by a Stroke Association fellowship.

Results

From 3767 initial records, 11 studies were included in the review. Included studies were categorised into three groups: studies targeting EMS dispatch and EMS clinicians (n = 4); studies targeting EMS clinicians only (n = 4); and studies targeting whole system change (n = 3). Suspected stroke patients were the primary population studied and most (n = 10) interventions involved clinician education. Only one study (9%) reported a significant decrease in call to hospital time in one subgroup whereas two studies (18%) reported a significant increase in call to hospital time and all other studies (73%) reported no significant change.

Conclusions

Based on the included studies, interventions intended to improve the efficiency of the acute stroke pathway rarely improved EMS call to hospital times. Included studies were heterogenous and rarely focussed on the review topic which limits the usability of the findings. Further research is needed to explore the trade-off between changes to EMS stroke care and call to hospital times and subsequent impacts on in-hospital care and patient outcomes.
Factors associated with internet use and health information technology use among older people with multi-morbidity in the United States: findings from the National Health Interview Survey 2018
Authors: He Wenbo , Cao Liujiao , Liu Rui , Wu Yi , Zhang Wei
Published: September 2022

Background

The number of older adults with physical multi-morbidity is increasing. As Internet-based eHealth and mHealth increasingly require patients to use technology, it is important to examine the use of Internet/health information technology (HIT) among older adults with physical multi-morbidity. Here we examine the distribution of physical multi-morbidity, Internet use, and HIT use, and further explored the factors associated with Internet use and HIT use among older adults with physical multi-morbidity.

Methods

One wave of data from the 2018 US National Health Interview Survey (NHIS) was analysed. We included respondents aged 65 years and older. We used 13 physical non-communicable diseases to measure physical multi-morbidity. Descriptive statistics and logistic regression models, with sociodemographic factors, health status, health insurance, health care service use, and satisfaction with health care as covariates, were used to examine the research questions.

Results

Of 72,746 respondents in NHIS, 7060 were eligible for our analysis. 5380 (76.2%) eligible respondents had physical multi-morbidity in this study. Overall, 60% of older adults reported using the Internet, with 38.9% using eHealth services (defined as looking up health information online, filling a prescription, scheduling an appointment with a health care provider, or communicating with a health care provider via email). Gender, age, marital status, region, race, education, and family income were significant factors associated with the Internet and HIT use among people with multi-morbidity. The study also showed that after adjusting for confounders, good health status, having Medicare, receiving home care from a health professional, and low satisfaction with health care were positive predictors of the Internet and HIT use.

Conclusions

In summary, our study found that Internet and HIT use among older patients with chronic diseases is far from the Healthy People 2030 target. Internet and HIT use vary depending on a number of sociodemographic factors. Relevant influencing factors should be fully considered in health education interventions promoted.
A modified Sequential Organ Failure Assessment score for dengue: development, evaluation and proposal for use in clinical trials
Authors: McBride Angela , Vuong Nguyen Lam , Van Hao Nguyen , Huy Nguyen Quang , Chanh Ho Quang , Chau Nguyen Thi Xuan , Nguyet Nguyen Minh , Ming Damien K. , Ngoc Nguyen Thanh , Nhat Phung Tran Huy , Phong Nguyen Thanh , Tai Luong Thi Hue , Tho Phan Vinh , Trung Dinh The , Tam Dong Thi Hoai , Trieu Huynh Trung , Geskus Ronald Bertus , Llewelyn Martin J. , Thwaites C. Louise , Yacoub Sophie
Published: September 2022

Background

Dengue is a neglected tropical disease, for which no therapeutic agents have shown clinical efficacy to date. Clinical trials have used strikingly variable clinical endpoints, which hampers reproducibility and comparability of findings. We investigated a delta modified Sequential Organ Failure Assessment (delta mSOFA) score as a uniform composite clinical endpoint for use in clinical trials investigating therapeutics for moderate and severe dengue.

Methods

We developed a modified SOFA score for dengue, measured and evaluated its performance at baseline and 48 h after enrolment in a prospective observational cohort of 124 adults admitted to a tertiary referral hospital in Vietnam with dengue shock. The modified SOFA score included pulse pressure in the cardiovascular component. Binary logistic regression, cox proportional hazard and linear regression models were used to estimate association between mSOFA, delta mSOFA and clinical outcomes.

Results

The analysis included 124 adults with dengue shock. 29 (23.4%) patients required ICU admission for organ support or due to persistent haemodynamic instability: 9/124 (7.3%) required mechanical ventilation, 8/124 (6.5%) required vasopressors, 6/124 (4.8%) required haemofiltration and 5/124 (4.0%) patients died. In univariate analyses, higher baseline and delta (48 h) mSOFA score for dengue were associated with admission to ICU, requirement for organ support and mortality, duration of ICU and hospital admission and IV fluid use.

Conclusions

The baseline and delta mSOFA scores for dengue performed well to discriminate patients with dengue shock by clinical outcomes, including duration of ICU and hospital admission, requirement for organ support and death. We plan to use delta mSOFA as the primary endpoint in an upcoming host-directed therapeutic trial and investigate the performance of this score in other phenotypes of severe dengue in adults and children.
Comparison of the amount of artifacts induced by zirconium and titanium implants in cone-beam computed tomography images
Authors: Shokri Abbas , Vafaee Fariborz , Haghighat Leila , Shahabi Shiva , Farhadian Maryam , Jamalpour Mohammad Reza
Published: September 2022

Background

This study aimed to compare the amount of artifacts induced by the titanium and zirconium implants on cone-beam computed tomography (CBCT) and assess the effect of different exposure settings on the image quality for both materials.

Methods

In this experimental study, 30 zirconium and 30 titanium implants were placed in bovine rib bone blocks. CBCT images were taken in two different fields of view (FOV: 4 × 6 cm2 and 6 × 8 cm2) and at two resolutions (133 µ and 200 µ voxel size). Subsequently, two observers assessed the images and detected the amount of artifacts around the implants through gray values. Data were analyzed by paired t test and independent t test using SPSS 21 and the 0.05 significance level.

Results

The results showed that titanium implants caused lower amounts of artifacts than zirconium implants, which was statistically significant (P < 0.001). The larger FOV (6 × 8 cm2) resulted in a lower amount of artifacts in both groups, although the results were only statistically significant in the zirconium group (P < 0.001). The amount of artifacts was increased when using the 133 µ voxel size in both groups, which was only significant in the zirconium group (P < 0.001).

Conclusion

Our results suggest that zirconium implants induce higher amounts of artifacts than titanium ones. We also concluded that the artifacts could be minimized using the larger FOV and voxel size.
Development and Validation of a Kidney-Transplant Specific Measure of Treatment Burden
Authors: Lorenz Elizabeth C. , Petterson Tanya M. , Zaniletti Isabella , Lackore Kandace A. , Johnson Bradley K. , Mai Martin L. , Nair Sumi S. , Bentall Andrew J. , Yost Kathleen J. , Eton David T.
Published: September 2022

Background

Treatment burden refers to the work involved in managing one’s health and its impact on well-being and has been associated with nonadherence in patients with chronic illnesses. No kidney transplant (KT)-specific measure of treatment burden exists. The aim of this study was to develop a KT-specific supplement to the Patient Experience with Treatment and Self-Management (PETS), a general measure of treatment burden.

Methods

After drafting and pretesting KT-specific survey items, we conducted a cross-sectional survey study involving KT recipients from Mayo Clinic in Minnesota, Arizona, and Florida. Exploratory factor analysis (EFA) was used to identify domains for scaling the KT-specific supplement. Construct and known-groups validity were determined.

Results

Survey respondents (n = 167) had a mean age of 61 years (range 22–86) and received a KT on average 4.0 years ago. Three KT-specific scales were identified (transplant function, self-management, adverse effects). Higher scores on the KT-specific scales were correlated with higher PETS treatment burden, worse physical and mental health, and lower self-efficacy (p < 0.0001). Patients taking more medications reported higher transplant self-management burden.

Conclusions

We developed a KT-specific supplement to the PETS general measure of treatment burden. Scores may help providers identify recipients at risk for nonadherence.
Predictive nomogram for soft robotic hand rehabilitation of patients with intracerebral hemorrhage
Authors: Jin Peng , Jiang Wei , Bao Qing , Wei Wenfeng , Jiang Wenqing
Published: September 2022

Background

Few studies focused on the risk factors for hand rehabilitation of intracerebral hemorrhage (ICH) using of soft robotic hand therapy (SRHT). The aim of this study was to establish a predictive nomogram for soft robotic hand rehabilitation in patients with ICH.

Methods

According to the Brunnstrom motor recovery (BMR) stage, the patients were grouped into poor and good motor function groups. The data of patient demographic information and serum level of C-terminal Agrin Fragment (CAF), S100B and neurofilament light (NfL) were collected. The logistic regression was used to analyze the risk factors for poor hand function.

Results

Finally, we enrolled 102 and 103 patients in the control and SRHT groups. For the SRHT group, there were 17 and 86 cases with poor and good motor function at 6-months follow-up respectively. In the good motor function group, the Fugl-Meyer Assessment-Wrist and Hand (FMA-WH score) and BMR score at admission were all better than that in the poor motor function group respectively (p < 0.001). The mean serum level of CAF, S100B and NfL in the good motor function group were 2.5 ± 0.82 ng/mL, 286.6 ± 236.4 ng/L and 12.1 ± 10.4 pg/mL respectively, which were lower than that in the poor motor function group (p < 0.001, Table 3). The multivariate logistic regression showed that hematoma volume (OR = 1.47, p = 0.007), FMA-WH score admission (OR = 0.78, p = 0.02), S100B (OR = 1.32, p = 0.04), and NfL (OR = 1.24, p = 0.003) were all significant predictors of poor motor function.

Conclusions

We found that Soft robotic hands therapy benefited in hand function in patients with ICH and hematoma volume, FMA-WH score admission, S100B, and NfL were all significant predictors for poor motor function of patients with ICH.
Safety and efficacy of double-balloon catheter for cervical ripening: a Bayesian network meta-analysis of randomized controlled trials
Authors: Zhao Ge , Song Guang , Liu Jing
Published: September 2022

Background

Various methods are used for cervical ripening during the induction of labor. Mechanical and pharmacological methods are commonly used for cervical ripening. A double-balloon catheter was specifically developed to ripen the cervix and induce labor; however, the efficacy of the double-balloon catheter in cervical ripening compared to other methods is unknown.

Methods

We searched five databases and performed a Bayesian network meta-analysis. Six interventions (double-balloon catheter, Foley catheter, oral misoprostol, vaginal misoprostol, dinoprostone, and double-balloon catheter combined with oral misoprostol) were included in the search. The primary outcomes were cesarean delivery rate and time from intervention-to-birth. The secondary outcomes were as follows: Bishop score increment; achieving a vaginal delivery within 24 h; uterine hyperstimulation with fetal heart rate changes; need for oxytocin augmentation; instrumental delivery; meconium staining; chorioamnionitis; postpartum hemorrhage; low Apgar score; neonatal intensive care unit admission; and arterial pH.

Results

Forty-eight randomized controlled trials involving 11,482 pregnant women were identified. The cesarean delivery rates of the cervical ripening with a double-balloon catheter and oral misoprostol, oral misoprostol, and vaginal misoprostol were significantly lower than cervical ripening with a Foley catheter (OR = 0.48, 95% CI: 0.23–0.96; OR = 0.74, 95% CI: 0.58–0.93; and OR = 0.79, 95% CI: 0.64–0.97, respectively; all P < 0.05). The time from intervention-to-birth of vaginal misoprostol was significantly shorter than the other five cervical ripening methods. Vaginal misoprostol and oral misoprostol increased the risk of uterine hyperstimulation with fetal heart rate changes compared to a Foley catheter. A double-balloon catheter with or without oral misoprostol had similar outcomes, including uterine hyperstimulation with fetal heart rate changes compared to a Foley catheter.

Conclusion

Double-balloon catheter did not show superiority when compared with other single method in primary and secondary outcomes of labor induction. The combination of double-balloon catheter with oral misoprostol was significantly reduced the rate of cesarean section compared to Foley catheter without increased risk of uterine hyperstimulation with fetal heart rate changes, which was shown in oral or vaginal misoprostol.
Molar pregnancy with a coexisting living fetus: a case series
Authors: Hemida Reda , Khashaba Eman , Zalata Khaled
Published: September 2022

Background

Coexistence of molar pregnancy with living fetus represents a challenge in diagnosis and treatment. The objective of this study to present the outcome of molar pregnancy with a coexisting living fetus who were managed in our University Hospital in the last 5 years.

Methods

We performed a retrospective analysis of patients who presented with molar pregnancy with a coexisting living fetus to our Gestational Trophoblastic Clinic, Mansoura University, Egypt from September, 2015 to August, 2020. Clinical characteristics of the patients, maternal complications as well as fetal outcome were recorded. The patients and their living babies were also followed up at least 6 months after delivery.

Results

Twelve pregnancies were analyzed. The mean maternal age was 26.0 (SD 4.1) years and the median parity was 1.0 (range 0–3). Duration of the pregnancies ranged from 14 to 36 weeks. The median serum hCG was 165,210.0 U/L (range 7662–1,200,000). Three fetuses survived outside the uterus (25%), one of them died after 5 months because of congenital malformations. Histologic diagnosis was available for 10 of 12 cases and revealed complete mole associated with a normal placenta in 6 cases (60%) and partial mole in 4 cases (40%). Maternal complications occurred in 6 cases (50%) with the most common was severe vaginal bleeding in 4 cases (33.3%). There was no significant association between B-hCG levels and maternal complications (P = 0.3).

Conclusion

Maternal and fetal outcomes of molar pregnancy with a living fetus are poor. Counseling the patients for termination of pregnancy may be required.

Trial registration

The study was approved by Institutional Research Board (IRB), Faculty of Medicine, Mansoura University (number: R.21.10.1492).
Outcomes and risk factors for failed trial of labor after cesarean delivery (TOLAC) in women with one previous cesarean section: a Chinese population-based study
Authors: He Xiaobo , Dai Qiaona , Wu Xiaoli , Zhou Junjun , Li Jie
Published: September 2022

Objective

To evaluate the outcomes and risk factors for trial of labor after cesarean delivery (TOLAC) failure in patients in China.

Methods

Consecutive patients who had a previous cesarean delivery (CD) and attempted TOLAC were included from 2014 to 2020. Patients who successfully delivered were classified into the TOLAC success group. Patients who attempted TOLAC but had a repeat CD due to medical issues were classified into the TOLAC failure group. Multiple logistic regression analyses were performed to examine the risk factors for TOLAC failure.

Results

In total, 720 women who had a previous CD and attempted TOLAC were identified and included. The success rate of TOLAC was 84.2%(606/720). Seven patients were diagnosed with uterine rupture, none of whom underwent hysterectomy. Multiple logistic regression analysis showed that the induction of labor (OR = 2.843, 95% CI: 1.571–5.145, P < 0.001) was positively associated with TOLAC failure, but the thickness of the lower uterine segment (LUS) (OR = 0.215, 95% CI: 0.103–0.448, P < 0.001) was negatively associated with TOLAC failure.

Conclusions

This study suggested that TOLAC was effective in decreasing CD rates in the Chinese population. The induction of labor was positively associated with TOLAC failure, but the thickness of the LUS was negatively associated with TOLAC failure. Our findings need to be confirmed in larger samples with patients of different ethnicities.