bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends in the Quality of Primary Care and Acute Care in Korea From 2008 to 2020: A Cross-sectional Study
Authors: Gwon Yeong Geun , Han Seung Jin , Kim Kyoung Hoon
Published: April 2023

Objectives: Measuring the quality of care is paramount to inform policies for healthcare services. Nevertheless, little is known about the quality of primary care and acute care provided in Korea. This study investigated trends in the quality of primary care and acute care.Methods: Case-fatality rates and avoidable hospitalization rates were used as performance indicators to assess the quality of primary care and acute care. Admission data for the period 2008 to 2020 were extracted from the National Health Insurance Claims Database. Case-fatality rates and avoidable hospitalization rates were standardized by age and sex to adjust for patients’ characteristics over time, and significant changes in the rates were identified by joinpoint regression.Results: The average annual percent change in age-/sex-standardized case-fatality rates for acute myocardial infarction was -2.3% (95% confidence interval, -4.6 to 0.0). For hemorrhagic and ischemic stroke, the age-/sex-standardized case-fatality rates were 21.8% and 5.9%, respectively in 2020; these rates decreased since 2008 (27.1 and 8.7%, respectively). The average annual percent change in age-/sex-standardized avoidable hospitalization rates ranged from -9.4% to -3.0%, with statistically significant changes between 2008 and 2020. In 2020, the avoidable hospitalization rates decreased considerably compared with the 2019 rate because of the coronavirus disease 2019 pandemic.Conclusions: The avoidable hospitalization rates and case-fatality rates decreased overall during the past decade, but they were relatively high compared with other countries. Strengthening primary care is an essential requirement to improve patient health outcomes in the rapidly aging Korean population.
Primeros registros de tres especies de Clytini (Coeloptera: Cerambycidae: Cerambycinae) para los estados mexicanos de Oaxaca y Chiapas
Authors: Guzmán-Vásquez Héctor Miguel
Published: April 2023

Se presentan nuevos registros de distribución para cuatro especies de Clytini en los estados mexicanos de Oaxaca y Chiapas. Se registra por primera vez la presencia de Dexithea klugii (Castelnau & Gory, 1841) y Placosternus crinicornis (Chevrolat, 1860) en Oaxaca, y Placosternus guttatus (Chevrolat, 1860) en Chiapas. Además, se proporcionan nuevos registros de localidades para Placosternus erythropus (Chevrolat, 1835) en Oaxaca. Se incluyen imágenes de los adultos y sus mapas de distribución.
Maurice Goldring : Pleasant His Scholar’s Life
Authors: Colantonio Laurent
Published: April 2023

Maurice Goldring a marqué de son empreinte la recherche française en études irlandaises entre les années 1970 et les années 2010. Il fut aussi un chercheur et un historien reconnu et respecté en Irlande. À partir de grilles d’analyses variées, il a mis en perspective, déconstruit, renversé parfois, des lectures trop simples du passé irlandais, nationalistes aussi bien qu’unionistes. Cette rétrospective intellectuelle propose une évaluation critique de sa contribution à l’historiographie irlandaise du dernier demi-siècle, dans le temps court de la production des textes, comme dans celui, plus étiré, de leur réception, à partir de trois axes thématiques qu’il n’a cessé de faire dialoguer : la nation et ses intellectuels, la tension entre émancipation et exclusion, le laboratoire socio-politique nord-irlandais.
Francis Stuart’s Black List, Section H (1971): An Irishman in Berlin, 1939-1945
Authors: Mikowski Sylvie
Published: April 2023

This paper summarises the fate of novelist Francis Stuart, who was initially close to the Celtic Revival, married Iseult Gonne and enrolled in the IRA in the Irish Civil War. After he reached some literary fame in the 1930s, in 1939 he was invited to give lectures in Germany and then to record radio programs meant to broadcast Nazi propaganda to neutral Ireland. Stuart related all these personal experiences in Black List, Section H, published in 1971. His activities in Germany during World War II were brought to broad daylight again in the 1980s and 1990s, causing fierce controversy in Ireland. This paper examines the reasons which may explain why a whole generation of Irish writers took sides with Stuart at the time, despite the evidence of his past involvement in the service of Nazi Germany, a commitment which transpires in Black List, Section H.
AHP-BP-Based Algorithms for Teaching Quality Evaluation of Flipped English Classrooms in the Context of New Media Communication
Authors: Wu Xiaofeng
Published: April 2023

Big data analytics constitutes a key component in the pursuit of enhancing educational efficiency. This study defines the concept of the flipped classroom in the context of new media communication, evaluates the state of audiovisual instruction in higher education, and advocates for the use of this methodology to enhance college students' English listening and speaking skills. Utilizing multiple linear regression and a conditional quantile model, this research quantifies the range of impact of flipped instruction on college students' acquisition of a foreign language. To address the deficiencies in the current evaluation process for flipped classroom teaching, it proposes a teaching quality evaluation model based on the AHP and BP neural network. The AHP constructs the teaching quality evaluation index system for the flipped classroom and ascertains the combined weights of the indices. The simulated experiment's results show that utilizing the proposed evaluation model to assess flipped classroom instruction enhances objectivity, efficiency, and precision in the evaluation process.
One-Factor Cancellable Fingerprint Template Protection Based on Index Self-Encoding
Authors: Feng Yalan , Wang Huabin , Zhang Dailei , Li Jiahao , Tao Liang
Published: April 2023

The existing one-factor cancellable biometrics algorithms generally require random sequences to reorder the biometrics, which reduces the discrimination of the transformed biometrics. Some algorithms hide and transmit the random sequence by XORing the random sequence with original biometrics, which may cause the leakage of the original biometrics. Therefore, this paper proposes a one-factor cancellable fingerprint template protection based on index self-encoding. First, the integer sequence generated by the hash function is used as the index. The random sequence is automatically encoded directly by the index value, and the generated binary sequence retains the original biological characteristics to the greatest extent. Second, self-encoding binary sequence and random binary sequence are XORed to obtain the encoded key without directly storing binary factor sequences. Experiments are implemented on the fingerprint database of FVC2002 and FVC2004, the results show that the recognition rate is enhanced; meanwhile, it fits the design criteria of cancellable biometrics.
Improved Equilibrium Optimizer for Short-Term Traffic Flow Prediction
Authors: Pan Jeng-Shyang , Hu Pei , Pan Tien-Szu , Chu Shu-Chuan
Published: April 2023

Meta-heuristic algorithms have been widely used in deep learning. A hybrid algorithm EO-GWO is proposed to train the parameters of long short-term memory (LSTM), which greatly balances the abilities of exploration and exploitation. It utilizes the grey wolf optimizer (GWO) to further search the optimal solutions acquired by equilibrium optimizer (EO) and does not add extra evaluation of objective function. The short-term prediction of traffic flow has the characteristics of high non-linearity and uncertainty and has a strong correlation with time. This paper adopts the structure of LSTM and EO-GWO to implement the prediction, and the hyper parameters of the LSTM are optimized by EO-GWO to transcend the problems of backpropagation. Experiments show that the algorithm has achieved wonderful results in the accuracy and computation time of the three prediction models in the highway intersection.
Incorporating I Ching Knowledge Into Prediction Task via Data Mining
Authors: Liu Wenjie , Chen Sai , Huang Guoyao , Lu Lingfeng , Li Huakang , Sun Guozi
Published: April 2023

Many real-world applications require prediction that takes the most advantage of data. Classic data mining mechanisms tend to feed a prediction model pivotal data to achieve a promising result, which needs to be adjusted in different application scenarios. Recent studies have shown the potential of I Ching mechanism to improve prediction capacity. However, the I Ching prediction mechanism has several issues, including underutilized I Ching knowledge and incomplete data conversion. To address these issues, the authors designed a model to leverage I Ching knowledge and transform traditional I Ching prediction processing into data mining. The authors' investigation revealed promising results in the stock market compared to popular machine learning and deep learning algorithms such as support vector machine (SVM), extreme gradient boosting (XGBoost), and long short-term memory (LSTM).
Optimizing the water distribution network of community water supply using different computer simulation techniques
Authors: Sutharsan M. E.
Published: April 2023

The appropriate operation of a water distribution network (WDN) of any water supply scheme is vital to supply sufficient potable water to consumers at sufficient pressure. However, the performance of the WDN may vary from the original design in the long run. In this study, a WDN network model was built using WaterGEMS and WaterCAD computer simulators, and hydraulic analyses were conducted to obtain an optimal WDN for a community water supply scheme of a village in Sri Lanka. A series of steps such as; selection of models, network representation, simulation of network, problem identification, network configuration finalization, and results analysis were carried out in developing the WDN simulation model. The hydraulic parameters such as pressure, flow velocity, and flow rate were analyzed under extended period simulation. The result indicated that the nodal pressure head in the junctions (100%) is above the required pressure level of 10 meters H2O, which is adequate for the effective performance of the water distribution system (WDS) during peak and off-peak demand hours. The elevated water tower was optimized with a 10 m height to supply water at satisfactory pressure. Nodal pressure is negatively correlated with ground elevation. The flow velocity was observed within the range of 0.1-0.4 m/s in 67% of the pipe network, while 17% of the pipe network velocity was below 0.1 m/s. The low daily water demand of the small community could be the reason for the low-velocity scenario, which shall lead to silt deposition in the pipelines; hence frequent line washout to eliminate the silt deposition in the system is recommended. The WDN was designed for optimized pipe sizes with availability in the market.
Evaluation of the changes in physiochemical properties and fatty acid profile of industrially pasteurized coconut (Cocos nucifera) milk during storage
Authors: Jayanetti Madara , Thambiliyagodage Charitha , Usgodaarachchi Leshan , Jayadasa Sasanka , Ratnayake Rangana Nishani
Published: April 2023

The changes in the quality of coconut milk in industrial storage conditions have received scarce attention despite its widespread use. The study was carried out to evaluate the quality of industrially pasteurized coconut milk based on physicochemical parameters; pH, total solid content, acidity, total microbial count, and the changes in the fatty acid profile during storage. The study revealed that pH of the coconut milk samples varied in the range of 5.2-7.2 and acidity drastically increased during storage. The total microbial count increased with an increasing number of days in all samples. The highest total microbial count was observed on day 5 in 3 samples indicating the unfavourable microbial spoilage. Total solids in all samples were higher than 35% throughout the study. The ANOVA confirmed a significant increase (p>0.05) in the acidity and total microbial count from day 1 to 5, illustrating the crucial roles which these variables play in determining the quality of industrially pasteurized coconut milk during storage. The presence and changes of fatty acids in industrially pasteurized coconut milk were quantitatively analyzed by GC/MS and a total of 8 fatty acids were identified. The fatty acid contents changed significantly after industrial pasteurization and storage.
State-of-the-art Experimental Techniques for VTOL Structural Dynamics
Authors:   Siemens Digital Industries Software, Hallez Raphael , Lorenzo Emilio
Published: April 2023

Increasing complexity in modern aircraft systems and structures makes it challenging for engineers to develop aircraft within time and budget constraints. This is particularly true in the context of new Vertical Take-off and Landing (VTOL) vehicle development where many disruptive aircraft configurations are being studied. Ground and flight testing help to validate aircraft structural dynamic performance and prove that the aircraft meets certification requirements. Several experimental techniques have been developed lately to help getting deeper insight into aircraft structural dynamics and are helpful to accelerate the verification and certification process of new VTOL vehicles. Some of these methods have been recently industrialized and are available in commercial hardware and software solutions. This includes techniques for contactless measurements based on digital image correlation as well as methods for accelerated modal testing and identification of non-linearities in aircraft structures. These methods are presented here and positioned in the context of accelerated VTOL aircraft development.
Comparative Flight Test Evaluation of Passive and Active External Slung Load Dynamics
Authors:   National Research Council of Canada, Alexander Marc ,   Université de Sherbrooke, Perron Etienne , Comeau Perry , Rancourt David
Published: April 2023

The National Research Council of Canada and Université de Sherbrooke performed flight testing of an Actively Stabilized Slung Load on the NRC Bell 206 Research Aircraft. Hover, Attitude Capture, NRC designed Lateral Precision Hover, and Frequency Sweep mission tasks were performed for Bare Airframe, Passive Water-Filled Barrel and Active Slung Load configurations. Load Mass Ratios of 0.12 with pendulum modes of 1.3 rad/sec were identified for both configurations. Time domain response indicated that both loads remained controllable under excitation by pilot gain, winds, and helicopter-load mode coalescence. Frequency domain analyses confirmed pilot comments indicating HQR-4 handling qualities ratings for bare airframe and stable load behaviors. This degraded to HQR-5 for task execution with load oscillation effects rated at pilot induced oscillation tendency of PIO/T-4. Barrel load HQR degradation related to load inertial and surface area drag effects versus active tether feedback and roll-pitch actuation disharmony of the Active load. Though not optimized, this load’s swing behavior (consistent period and rate) can aid in management of aircraft rate response and pilot compensation. Overall, comparable passive and active test results indicate potential for magneto-rheological actuation to improve slung load mission task performance.
Scaled Model Testing of Coaxial Rotor Hub Flows
Authors:   Pennsylvania State University, Tierney Charles , Jaffa Nicholas , Reich David , Schmitz Sven
Published: April 2023

Rotor hub parasite drag remains a primary obstacle to improving the forward-flight capabilities of helicopters. As part of a rotor hub flow physics project at the Vertical Lift Research Center of Excellence (VLRCOE) at Penn State, this investigation was designed to improve the understanding of the interactional aerodynamics and wake flow physics of counter-rotating coaxial rotor hubs and explore designs for reducing the rotor hub drag factor, Kfe. These experiments measured the time-averaged and time-varying drag on four rotor hub designs, each with unique blade stubs. The four shapes tested were the DBLN 526 airfoil, 3.25:1 Rectangle, 4:1 Ellipse, and the novel profile named the Optimized Cambered Shape (OCS). Load data was collected at four Reynolds numbers ranging from 3.77×105 to 1.51×106 and advance ratios ranging from .25 to .6. Additionally, stereoscopic particle-image velocimetry (SPIV) measured the three velocity components at two downstream locations in the wake of the DBLN 526 rotor hub at Re=1.13×106 and advance ratios of .25 and .6, providing insight into and visualizing the development of the wake. Presented here is the compiled load data and calculated Kfe from these experiments, as well as the flow fields at the near- and midwake locations, with discussion of new knowledge gained of the coaxial rotor hub wakes.
Streamlining Flight Safety Assurance Processes for Future Vertical Lift Development Programs through Government-Industry Collaboration
Authors:   Bell Textron Inc., Stroncek Chris ,   Avion Solutions, Stephan David ,   US Army DEVCOM AvMC, Benton Robert , Hiros Tricia , Cripps Dave , Martin Edwin
Published: April 2023

The U.S. Army's Future Vertical Lift (FVL) programs provide many opportunities and challenges for Vertical Flight Society members. The early stages of each FVL program are governed by principles that foster competition between companies, while requiring collaboration between the Army and each company. Down-selected companies competing for the Future Attack Reconnaissance Aircraft (FARA) Competitive Prototype (CP) possess unique capabilities and initiatives to help advance collaboration with the Army. Bell, with a long history of developing aircraft for commercial and military use, is one of five performers selected for Phase 1 of FARA CP, and one of two performers selected for phase 2. During phase 1, the Army began working with the Industry performers to exercise and adapt existing industry processes to collaborate with airworthiness representatives from the Army. The collaboration required for FARA CP also applies to another FVL Other Transaction Agreement (OTA). Concurrently, Bell was also selected as an OTA project agreement holder for the Future Long-Range Assault Aircraft (FLRAA) Competitive Demonstration and Risk Reduction (CD&RR) effort. The FARA CP and FLRAA CD&RR programs have introduced new types of agreements and new expectations in airworthiness paradigms that require greater collaboration between experienced industry and U.S. Army representatives.
Vitrimer Composites for Rotorcraft Components
Authors:   Rensselaer Polytechnic Institute, Kamble Mithil , Koratkar Nikhil , Picu Catalin
Published: April 2023

Carbon fiber reinforced composites (CFRP) are frequently used in rotorcraft components due to their high strength to weight ratio. Carbon fibers are the principal load carriers whereas polymer matrix provides structural integrity to the CFRP components. Fatigue failure originating in the matrix pose a design constraint on CFRP components. The fatigue failure originates in form of small scale sub-critical cracks which eventually grow into macroscopic cracks/shear localization resulting in eventual failure. Research efforts have been directed at improving fracture and fatigue performance of polymeric matrix by arresting incipient cracks. Thermoset polymers are widely used as matrix material as they posses superior strength due to high crosslinking density. However, since no self-healing mechanism operates in thermosets, damage is irreversibly accumulated over the life cycle of components. A new class of materials called vitrimers provide a novel approach to develop fatigue resistant CFRP. Vitrimers are associative covalent adaptive networks (CAN) which have reversible crosslinking reactions which can be activated by external energy stimulus like heat. As the crosslinked network is reversible, the incipient damage can be 'healed' by application of heat. In this work we explore the self-healing properties of vitrimer fabricated by the reaction of adipic acid and epoxy resin. The vitrimer is initially tested in static tests to probe mechanical properties, followed by fatigue experiments. The vitrimer is then used to make a vitrimeric CFRP (vCFRP) composite and is tested for its static and fatigue performance.
Reliability-Driven Analysis, Design and Characterization of Rotorcraft Structures: Decision-Making Framework
Authors:   Collins Aerospace, Gurvich Mark
Published: April 2023

The objective of this work is a definition of a decision-making framework for reliability-driven assessment and corresponding methods of solutions, considering uncertainty, structural/material imperfections, missed information, randomness of input data, etc. More specifically, such framework is proposed to integrate critical steps including design, analysis, and experimental characterization and is suggested for typical rotorcraft and aircraft structures. The paper highlights details of the framework, key questions to address and proposed decision-making checklist for the assessment. Demonstrations of the framework are shown on cases of analysis, representing real structures, and on design studies based on their system-level understanding. In addition, enhanced solutions are shown for experimental characterization, specifically focused on assessment of variability and imperfections.
A case report of Hailey-Hailey disease treated with fractional carbon dioxide laser
Authors: Gabdrafike Zivile , Blazeviciute Monika , Janonyte Ugne , Makstiene Jurgita , Valiukeviciene Skaidra
Published: April 2023

Hailey-Hailey disease (HHD) or familial benign pemphigus is a rare genetic condition, characterized by recurrent blisters and erosions, with a predilection for intertriginous areas. There is no specific treatment for HHD. Topical and systemic treatment tends to provide temporary remission. Alternative treatment (surgical interventions, such as dermabrasion, excision, and laser) has been shown to prolong remission. Considering the risk of complications associated with surgical modalities, laser is often preferred as an alternative for patients failing to respond to first-line therapies. We report a case of recalcitrant HHD successfully treated with a fractional ablative CO2 laser procedure (wavelength of 10600 nm, power of 7-10 W, 2-3 passes) on a 35-year-old female. The patient has a seven-year history of therapy-resistant HHD. A 2-month follow-up showed substantially resolved lesions, with mild erythema and post-inflammatory hyperpigmentation in treated areas.
Places Nigerians visited during COVID-19 government stay-home policy: evidence from secondary analysis of data collected during the lockdown
Authors: Olatunji David I. , Okusanya Babasola O. , Ebenso Bassey , Usuwa Sophia I. , Akeju David , Adejoh Samuel , Ochu Chinwe L. , Onoja Michael A. , Okediran James O. , Nwiyi Gloria O. , Yahya Disu , Eziechina Sunday , Igumbor Ehimario
Published: April 2023

Introduction: Compliance with the Government’s lockdown policy is required to curtail community transmission of Covid-19 infection. The objective of this research was to identify places Nigerians visited during the lockdown to help prepare for a response towards future infectious diseases of public health importance similar to Covid-19. Methods: This was a secondary analysis of unconventional data collected using Google Forms and online social media platforms during the COVID-19 lockdown between April and June 2020 in Nigeria. Two datasets from: i) partnership for evidence-based response to COVID-19 (PERC) wave-1 and ii) College of Medicine, University of Lagos perception of and compliance with physical distancing survey (PCSH) were used. Data on places that people visited during the lockdown were extracted and compared with the sociodemographic characteristics of the respondents. Descriptive statistics were calculated for all independent variables and focused on frequencies and percentages. Chi-squared test was used to determine the significance between sociodemographic variables and places visited during the lockdown. Statistical significance was determined by P0.05. All statistical analyses were carried out using SPSS version 22. Results: There were 1304 and 879 participants in the PERC wave-1 and PCSH datasets, respectively. The mean age of PERC wave-1 and PCSH survey respondents was 31.8 [standard deviation (SD)=8.5] and 33.1 (SD=8.3) years, respectively. In the PCSH survey, 55.9% and 44.1% of respondents lived in locations with partial and complete covid-19 lockdowns, respectively. Irrespective of the type of lockdown, the most common place visited during the lockdown was the market (shopping); reported by 73% of respondents in states with partial lockdown and by 68% of respondents in states with the complete lockdown. Visits to families and friends happened more in states with complete (16.1%) than in states with partial (8.4%) lockdowns.Conclusions: Markets (shopping) were the main places visited during the lockdown compared to visiting friends/family, places of worship, gyms, and workplaces. It is important in the future for the Government to plan how citizens can safely access markets and get other household items during lockdowns for better adherence to stay-at-home directives for future infectious disease epidemics.
The epidemiological profile associated with lifestyle risk factors and nutritional status for COVID-19 patients in the Iraqi population
Authors: Abed Sameeha Naser , Kassab Shandaway Al-Zamali Sarah , Mahdi Muslim Tareq
Published: April 2023

Objectives. To determine the prevalence of COVID-19 infection and to identify the lifestyle factors and nutritional status associated with the epidemiological profile of COVID-19 patients.Materials and Methods. This cross-sectional survey was carried out in the eighteen Iraqi governorates, from 1st August to 20th of October 2020. At the end of this study, 433 participants were recruited.Results. The prevalence of coronavirus infection was 37.18%. Smoking and active physical activity were relatively higher for COVID-19 patients who are male, and belonged to the under-45 age range were 91.3%. It notices that COVID-19 patients who smoked and had active physical activity were married, residents in urban, and worked. Likewise, COVID-19 patients who had equal or more than an institute/college level of education are smokers and had active physical activity. Obesity prevalence was higher for patients aged 45 (92.2%), and higher for females (51%). The proportion of obesity was generally higher for married and for those living in urban areas (92.2%). Obesity was significantly more common among those in worked (70.6%).Conclusions. Of note is the high prevalence of COVID-19 infection observed. A strong correlation between the prevalence of active physical activity among COVID-19 patients and gender, marital status, residence, education, and occupation. Unexpectedly, the prevalence rate of obesity among COVID-19 patients correlating with socio-demographic status did not yield a significant difference.
Tackling antimicrobial resistance: developing and implementing antimicrobial stewardship interventions in four African commonwealth countries through a health partnership model
Authors: Ashiru-Oredope Diane , Nabiryo Maxencia , Zengeni Lisa , Kamere Nduta , Makotose Alexia , Olaoye Omotayo , Townsend William , Waddingham Beatrice , Matuluko Ayodeji , Nambatya Winnie , Esseku Yvonne , Bartimeus Ama , Mahjoub Sara , D’Arcy Nikki , Tuck Chloe , Cavanagh Sarah , Geoola Josef , Muro Eva Prosper , Munkombwe Derick , Fraser Jessica , Skone-James Richard , Rutter Victoria
Published: April 2023

In recent years, health partnerships have shared infection prevention and control innovations between United Kingdom hospitals and Low-Middle-Income Countries. However, none had focused on antimicrobial stewardship (AMS), a core component of tackling antimicrobial resistance (AMR). This paper documents an effective approach to developing a program to increase AMS capacity in four African countries: Ghana, Tanzania, Uganda, and Zambia as part of the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) program. A systematic approach was applied to assess gaps in AMS interventions and inform the development of the CwPAMS program through deskbased assessments, including National Action Plans on AMR, online focus group meetings, and expert advisory group reviews. Twelve partnerships were selected for the CwPAMS program. AMS support tools were developed based on recommendations from the scoping, including an AMS checklist tool, a healthcare worker knowledge and attitudes questionnaire, and an antimicrobial prescribing app to support clinical decision-making. Training workshops on AMS were developed and delivered to volunteers in Africa and the UK using a train-the-trainer model. The tools and workshops facilitated capacity building for AMS through the generation and strengthening of knowledge, skills, commitment, structures, systems, and leadership among stakeholders in the UK and Africa. The overall average rating assigned to the program following independent evaluation using the Organisation for Economic Cooperation and Development Assistance Committee Evaluation Criteria was very good. The evaluation also highlighted that the majority of the HPs (75%) focused on AMS and/or improved prescribing practice; all HPs have developed and implemented AMS strategies, guidelines, and tools within their hospitals; and NHS staff were able to translate the knowledge and skills they had received early on in the program into clinical practice in response to COVID-19 challenges./p
No longer so common: findings of Calliopaea bellula d’Orbigny 1837 (Gastropoda: Sacoglossa) and Tayuva lilacina (A. Gould 1852) (Gastropoda: Nudibranchia) along the central-eastern coast of Sicily (Ionian Sea)
Authors: Lombardo Andrea , Marletta Giuliana
Published: April 2023

The present note documents the finding of two species of marine heterobranch seaslugs along the central-eastern coast of Sicily (Italy, central Mediterranean): the sacoglossan Calliopaea bellula and the nudibranch Tayuva lilacina. These two species show a wide geographical range (C. bellula is present from Norway to the Black Sea, while T. lilacina is a cosmopolitan species) and in the literature were considered common species. However, in the last years, the number of findings of these species is decreasing, at least in the Western Ionian Sea, an area where these species seem to be currently rare. As documented for other Mediterranean areas, the reason for this decline in the number of marine heterobranch species might be attributable to a change in the current regime or to an increase in anthropogenic impacts around the coastal areas.
Positron Emission Tomography - Computed Tomography for Staging of Mediastinal Lymph Nodes in Patients with Non-Small Cell Lung Cancer
Authors: Prisadov Georgi , Blume-Vulin Anja , Scharpenberg Martin , Welcker Katrin , Kesieme Emeka Blessius , Linder Albert
Published: April 2023

Background:

The tumor involvement of lymph nodes (LN) in N2 station is a very important factor for the further therapy decision and the prognosis of lung cancer patients. Today, integrated positron emission tomography-computed tomography (PET-CT) is considered to be the new standard in the staging of bronchial carcinoma. The aim of this study is to investigate the correctness of the clinical staging of the mediastinal LNs in operated patients and to investigate the sensitivity and specificity of the PET-CT examination for mediastinal LNs.

Subjects and Methods:

In the years 2010–2014, 359 patients underwent surgery for bronchial carcinoma. The histological examination of all mediastinal and hilar LNs was used as a reference to the data from the PET-CT examinations. The correctness of the PET staging, overestimation, and underestimation for the N stage was analyzed. In addition, the “sensitivity,” “specificity,” and “overall accuracy” of the PET-CT examination with regard to the N2 LNs were calculated.

Results:

It was found that in 8.9% the staging of the mediastinal N2/N3 LN stations was rated too high by the PET and in 11.2% too low. The study showed a sensitivity of 47.37%, a specificity of 90.07%, and an accuracy of 81.01% for the mediastinal LNs.

Conclusion:

Our study confirms the limited ability of integrated PET-CT in staging the mediastinal LNs. We, therefore, recommend a histological examination of the LNs in patients with PET-positive N2 LNs to avoid false-positive results and to initiate correct therapy.
Changes in Opthalmic Artery Doppler Velocimetry in Women with Preeclampsia in Kano, Nigeria
Authors: Hikima Mustapha Shu’aibu , Adamu Mansur Yahuza , Lawal Yusuf , Isyaku Kabiru , Isma’il Anas
Published: April 2023

Background:

Hypertensive disorders in pregnancy are among the most serious complications of pregnancy and represent important contributors to maternal and neonatal morbidity and mortality worldwide. Preeclampsia (PE)–eclampsia syndrome is the most important hypertensive gestational condition. Maternal ophthalmic artery Doppler velocimetry enables the identification of pregnant women with increased cerebral blood flow who are at risk of developing severe PE and eclampsia. Hence the need to determine the changes in ophthalmic artery Doppler velocimetric indices in PE in Kano, Nigeria becomes paramount.

Materials and Methods:

Ninety-six patients with the clinical diagnosis of PE and 96 normotensive pregnant controls between 20 and 40 weeks’ gestational age were recruited for this study. Ophthalmic artery Doppler velocimetric indices of the two groups were measured and documented.

Results:

The mean velocimetric measurements in the control group were as follows: peak systolic velocity (PSV) = 38.04 ± 13.68 cm/s, End-diastolic volume (EDV) =9.14 ± 3.65 cm/s, resistivity index (RI) = 0.75 ± 0.091, pulsatility index (PI) =1.62 ± 0.55, peak mesodiastolic velocity (PMDV) = 21.02 ± 8.83 cm/s, peak ratio (PR) = 0.56 ± 0.14. The mean velocimetric indices in the PE group were PSV = 44.59 ± 11.54 cm/s, EDV = 12.23 ± 2.66 cm/s, RI = 0.71 ± 0.069, PI = 1.67 ± 0.42, PMDV = 32.27 ± 9.12 and PR = 0.72 ± 0.10.

Conclusion:

There is a significant difference in the ophthalmic artery Doppler velocimetric indices between women with PE and normal pregnant women. Ophthalmic artery Doppler ultrasound is a useful tool in monitoring the hemodynamic changes in cerebral circulation in PE.
Skin and Soft-Tissue Infections Due to Rapidly Growing Mycobacteria
Authors: Kumar Chanchal , Shrivastava Kamal , Singh Anupriya , Chauhan Varsha , Varma-Basil Mandira
Published: April 2023

Background:

Rapidly growing mycobacteria (RGM) are increasingly being recognized as potential pathogens. RGM, particularly Mycobacterium abscessus, Mycobacterium fortuitum, and Mycobacterium chelonae, have been observed in both pulmonary and extrapulmonary infections including cutaneous, soft-tissue, and wound infections. However, there are limited reports of these potential pathogens from skin and soft-tissue infections. Moreover, the drug susceptibility profile of RGM is largely unknown in several regions of the world.

Methods:

We analyzed reports on RGM isolated from skin and soft-tissue infections globally for details of RGM species and drug susceptibility profile. We also analyzed the drug susceptibility profile of four RGM isolates, obtained from skin and soft-tissue infections in our laboratory, by broth microdilution method.

Results:

In the reports reviewed, the most common RGM isolated from skin and soft-tissue infections were M. abscessus (184/475, 38.7%), M. fortuitum (150/475, 31.5%), M. chelonae (72/475, 15%), and M. chelonae–M. abscessus complex (46/475, 9.6%). However, drug susceptibility was tested only in 26/39 (66.6%) reports. In our own laboratory, we obtained three isolates of M. abscessus and one isolate of M. fortuitum from one case of breast abscess and three cases of postsurgical wound infections. Maximum susceptibility of M. abscessus was observed to clarithromycin, amikacin, and linezolid. The M. fortuitum isolate was susceptible to clarithromycin, amikacin, clofazimine, and linezolid.

Conclusion:

Paucity of information available on RGM isolated from skin and soft-tissue infections highlights the need to be aware of the pathogenic potential and the drug susceptibility profile of these organisms.
Quality of Life and Mental Health Status of Hansen Disease Patients, Attending a Designated Leprosy Care Center in South-India
Authors: Patil Avinash , Mayur S. S.
Published: April 2023

Background:

“Quality of life (QOL)” is relatively a new concept, which originates from the World Health Organization (WHO) “health” definition. The WHO defines “health” as a state of complete physical, mental, and social well-being and not merely an absence of disease or infirmity. It introduces a word, “well-being,” which has two components, one the objective component and the second subjective component. The objective component mainly includes all the material possession by an individual, whereas the subjective component includes the perception of health by an individual, i.e., “QoL.” It has been observed that most of the persons affected by Hansen's Disease (leprosy) have good economic conditions, but they continue to suffer from social, psychological, and physical problems which makes their life miserable. Hence, an attempt has been made to assess their QOL and factors determining them.

Method:

A convenient sampling technique was used and 114 persons affected with Hansen's disease were studied. The study was conducted for a period of 1 year from November 2012 to October 2013. QOL was assessed using the WHO QOL-BREF Questionnaire and mental health status by the Self-Reporting Questionnaire. The results were obtained using SPSS 17.0 software, statistical tests such as Chi-square test, ANOVA, and standard multiple logistic regression analysis were used.

Results:

Quality of leprosy patients was poor. The mean WHOQOL-BREF total score was below average (mean score <65). Physical QOL of leprosy was more affected in females (mean WHOQOL-BREF score = 20.80). Mental distress was more prevalent in males (74.6%) compared to females (25.4%). Presence of deformities, female sex of the patient, and advanced age of the patient showed the greatest association with adverse QOL.

Conclusion:

Presence of physical disabilities or deformities and advanced age of leprosy patients adversely affect QOL of leprosy patients, whereas low level of education and poor socioeconomic status do not have a significant effect on QOL.
Central versus Peripheral Lesion on Chest X-Ray
Authors: Nguyen-Ho Lam , Tran-Van Ngoc , Le-Thuong Vu
Published: April 2023

Background:

Clinical characteristics of endobronchial tuberculosis (EBTB) patients whose sputum smears were negative have not been elucidated yet.

Method:

EBTB patients with negative sputum smears were documented retrospectively at the outpatient pulmonary clinic from late 2015 to early 2019.

Results:

We described the characteristics of 31 EBTB patients with negative sputum smears. The median age was 36 years (range 18–81 years). The male-to-female ratio is 1:1.58. The “peripheral” lesion group included 16 cases with opacity/consolidation, 2 cases with atelectasis, 1 case with cavitary lesion, and 1 case with pleural effusion. The “central” lesion group included four cases with normal chest X-ray and seven cases with only unilateral hilar enlargement. EBTB patients with “central” lesion were more common the presence of cough, the positive rate of bronchial lavage acid-fast bacilli smear, and the rate of misdiagnosis as pharyngitis, bronchitis, or asthma than that with “peripheral” lesion.

Conclusions:

EBTB with negative sputum smears was found in adult patients at any age and predominant in females. The diagnosis of EBTB with “central” lesion was more difficult than that with “peripheral” lesion. The location of the lesion could play a role in inducing cough among EBTB patients.
Pulmonary Mycobacterium abscessus and Response to Treatment in an Outpatient Setting
Authors: Gopalaswamy Radha , Padmapriyadarsini Chandrasekaran , Sekar Krithikaa , Vijayaragavan Vaishnavee , Bhavani Perumal Kannabiran , Lokanathan Lakshana Malla , Anandakrishnan Sundararajaperumal , Sivaramakrishnan Gomathi
Published: April 2023

Pulmonary disease due to Mycobacterium abscessus (Mab) has become an increasing cause of health concern, particularly among individuals infected with nontuberculous mycobacteria. Since Mab is intrinsically resistant to many antibiotics, it is very challenging to treat patients with symptomatic disease. In this case series, we report four patients with symptomatic pulmonary Mab who had prior history of antituberculosis treatment intake and declared cured at the end of treatment. The current episode was confirmed to be due to Mab infection by molecular and clinical diagnosis and received species specific-antibiotics therapy. All were periodically monitored for the sputum smear and culture conversions throughout the treatment period. The clinical course was variable though all received similar antibiotic regimen and showed varied treatment outcomes. The time of diagnosis and the treatment outcome indicate that a better understanding of host-pathogen interactions is essential for the successful treatment of pulmonary Mab infection.
In Vitro Anti-Mycobacterium ulcerans and Cytotoxic Activities of Some Selected Medicinal Plants and an Indoloquinoline Alkaloid
Authors: Amponsah Isaac Kingsley , Atchoglo Philip Kobla , Ackah Raphael Yaw , Tsouh Fokou Patrick Valere , Aboagye Samuel Yaw , Yeboah-Manu Dorothy , Appiah-Opong Regina , Mensah Abraham Yeboah
Published: April 2023

Background:

Buruli ulcer (BU) is a neglected tropical disease caused by the Mycobacterium ulcerans. BU is an endemic disease in many communities in sub-Saharan Africa where population have long history of using medicinal plants for treatment. Indeed, several medicinal plants have been documented against BU and related conditions. The present study was undertaken to prove the efficacy of seven medicinal plants documented for the treatment of mycobacterial infections and related symptoms in Ghana.

Method:

Antimycobacterial activity of the stem bark extracts and reference control drugs were conducted using the resazurin microtiter assay (REMA) assay method in clear round bottom 96-well microtiter plates. The extracts that showed anti-mycobacterium ulcerans activity were assessed for cytotoxicity using the Alamar blue assay.

Results:

Overall, The Cryptolepis sanguinolenta root aqueous extract exhibited the highest antimycobacterial activity (MIC=64 μg/mL) followed by Cleistopholis patens (MIC=256 μg/mL). Based on the marked activity of the Cryptolepis sanguinolenta extracts, pure cryptolepine, its major metabolite recorded a MIC value of 32 μg/mL. These extracts with considerable antimycobacterial activity showed 50% cytotoxic concentration (CC50) ranging from 94 to 384 μg/mL.

Conclusions:

Thus, Cleistopholis patens and Cryptolepis sanguinolenta are primed for further studies and could afford novel drugs for the mitigation of buruli ulcer disease.
Validation and Comparative Analysis of Kogene Mycobacterial Interspersed Repetitive Unit-Variable Number of Tandem Repeat Typing Kit and Its Application on Clinically Isolated Mycobacterium tuberculosis Samples from National Tuberculosis Hospital, Republic of Korea
Authors: Jung Jihee , Kang Taeuk , Hwang Yoohyun , Ryoo Sungweon
Published: April 2023

Background:

Tuberculosis (TB) remains a serious public health burden in Korea. Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeat (MIRU-VNTR) is preferred for epidemiological TB investigation. Until recently, the difficulty lies in epidemiological TB investigation due to the absence of commercialized MIRU-VNTR in Korea. Here, we have evaluated the newly designed MIRU-VNTR kit by Kogenebiotech, Korea.

Materials and Methods:

A total of 200 samples, where 100 are Mycobacrerium tuberculosis (M. tuberculosis), and the other 100 are non-M. tuberculosis, were used. Initially, the Kogenebiotech MIRU-VNTR typing kit (KoMIRU) was compared with Multilocus Variable Number Tandem Repeat Genotyping of M. tuberculosis typing kit (MVNTR) by Philip Supply for validation purpose. Then, Limit of Detection for DNA copies was optimized. Finally, KoMIRU and Genoscreen MIRU-VNTR typing kit (GeMIRU) were tested and comparatively analyzed for its specificity and sensitivity.

Results:

The study showed that the KoMIRU has slightly higher discriminatory power over MVNTR, 100% versus 97.5%. In comparative analysis, the KoMIRU has shown comparable capability as GeMIRU, showing 100% for sensitivity and specificity with a 95% CI value of 96.38 to 100.00%. Also, no discrepancies were observed on discriminated lineage strains between KoMIRU and GeMIRU. Out of 100, 84 were identified as Beijing strains, and remains were identified as NEW-1 (n = 8), Uganda (n = 6), East African Indian (EAI) (n = 6), Turkey (n = 2), and Haarlem (n = 1).

Conclusion:

In this study, KoMIRU has shown a comparable capability to GeMIRU. Furthermore, previous researches had suggested an association between lineage strains and drug resistance; hence, the implementation of KoMIRU can help in TB control and prevention.
Nonbacterial Thrombotic Endocarditis with Atypical Presentation as Overt Congestive Heart Failure
Authors: Restelli Davide , Trio Olimpia , Poleggi Cristina , Piccione Maurizio Cusmà , Manganaro Roberta , Certo Giuseppe , Zito Concetta , Andò Giuseppe
Published: April 2023

Nonbacterial thrombotic endocarditis (NBTE) is a form of endocarditis associated with malignancy or autoimmune disorders. Diagnosis remains a challenge as patients are often asymptomatic up to embolic events or rarely, valve dysfunction. We report a case of NBTE with uncommon clinical presentation and identified with multimodal echocardiography. An 82-year-old man presented to our outpatient clinic reporting dyspnea. Past medical history included hypertension, diabetes, kidney disease, and unprovoked deep-vein thrombosis. On physical examination, he was apyretic, mildly hypotensive, and hypoxemic, had a systolic murmur and lower limbs edema. Transthoracic echocardiography revealed severe mitral regurgitation due to verrucous thickening of the free margin of both leaflets, increased pulmonary pressure, and dilated inferior vena cava. Multiple blood cultures were negative. Transesophageal echocardiography confirmed “thrombotic” thickening of mitral leaflets. Nuclear investigations were highly suggestive of multi-metastatic pulmonary cancer. We did not further proceed with the diagnostic workup and prescribed palliative care. Lesions seen on echocardiography were suggestive of NBTE: they involved both sides of mitral leaflets, close to the edges, had irregular shape and echo density, a broad base, and no independent motion. Criteria for infective endocarditis were not met and the final diagnosis was paraneoplastic NBTE due to underlying lung cancer. We remark the lack of definitive recommendations about the treatment of NBTE and the only role of anticoagulation to prevent systemic embolism. We have reported a case of NBTE presenting with atypical symptoms and likely related to the prothrombotic state induced by underlying lung cancer. Provided the unconclusive microbiological tests, multimodal imaging has played a crucial role in the final diagnosis.
Percutaneous creation of new bilioenteric anastomosis in a patient with accidentally failed hepaticojejunostomy
Authors: Park Suyoung , Kim Jeong Ho , Hwang Jung Han , Yu Sung Hyun , Choi Sang Tae
Published: April 2023

If the cause of the bile leakage after hepaticojejunostomy is accidental non-anastomosis of one bile duct, it is unlikely that the leakage will resolve spontaneously, and reoperation may be necessary. However, if the patient has contraindications to surgery, other treatments should be considered. In this case report, we describe a new percutaneous tract creation between the isolated right bile duct and Roux-en-Y afferent jejunal loop in a patient who underwent hepaticojejunostomy, and the right bile duct was accidentally not anastomosed with the jejunal loop.