bluuebunny/crossref_metadata_2025 huggingface dataset:
Birefringent coating to remove polarization aberrations
Authors: Miller Sawyer , Jiang Linan , Pau Stanley
Published: May 2022

Polarization aberrations are found in most optical components due to a materials-differing response to s- and p-polarizations. This differing response can manifest either as diattenuation, retardance, or both. Correction of polarization aberrations, such as these, are critical in many applications such as interferometry, polarimetry, display, and high contrast imaging, including astronomy. In this work, compensators based on liquid crystal polymer and anti-reflection thin-films are presented to correct polarization aberrations in both transmission and reflection configurations. Our method is versatile, allowing for good correction in transmission and reflection due to optical components possessing differing diattenuation and retardance dispersions. Through simulation and experimental validation we show two designs, one correcting the polarization aberrations of a dichroic spectral filter over a 170nm wavelength band, and the other correcting the polarization aberration of an aluminum-coated mirror over a 400nm wavelength band and a 55-degree cone of angles. The measured performance of the polarization aberration compensators shows good agreement with theory.
Foveated integral imaging system for near-eye 3D displays
Authors: Koo Gyohyun , Won Yong Hyub
Published: May 2022

Integral imaging displays have been presented as the most effective solution to reduce the visual discomfort in three-dimensional (3D) images caused by vergence-accommodation conflict (VAC). However, due to the resolution degradation, it is still challenging to adapt the integral imaging system to near-eye display (NED) devices. In this paper, we propose a resolution-enhanced integral imaging NED using foveated imaging system with two display panels and an optical combiner. We use a microdisplay combined with a lens array to provide the integral imaging 3D images with relatively high pixel density to the central foveal area. And the peripheral area is covered by an additional display panel which offers background images with wide field-of-view (FOV). Combining these two images with an optical combiner, the foveated integral imaging system results in highly resolution- enhanced integral imaging 3D images concentrated on the foveal area. The proposed NED system effectively provides integral imaging 3D images with approximately 4.5 times improved resolution in the foveal area through an optimally designed foveated imaging system.
3D-printed fiber-based zeroth- and high-order Bessel beam generator
Authors: Reddy Innem V. A. K. , Bertoncini Andrea , Liberale Carlo
Published: May 2022

Bessel beams (BBs) have gained prominence thanks to their diffraction-free propagation and self-healing properties. These beams are conventionally generated using different approaches, namely by transforming a narrow circular beam with a lens, using axicons or holographic beam-shaping techniques. These methods involve space-consuming optics. To overcome this limitation, in the past, efforts have been made to create BBs directly from optical fibers. However, these solutions have limited capability to generate BBs with on-demand optical parameters and only focused on creating zeroth-order BBs. Here, we propose a photonic structure that uses stacked miniaturized optical elements 3D printed in a single step on the fiber facet. Our design allows for the generation of both zeroth- and high-order BBs and fully controllable tailoring of the beams’ parameters, such as their diffraction-free propagation distance or the width of their central peak or node. Remarkably, we report for the first time, to the best of our knowledge, the generation of high-order BBs from optical fibers. We expect our approach to be useful in applications such as optical and quantum communications, fiber-based sensors, microscopy, spectroscopy, and optical trapping.
Organisationale Ambidextrie für Digitale Transformation gezielt entwickeln – Konzeption des „CDO-CIO Do-it Kit“ auf Basis eines Reifegradansatzes
Authors: Back Andrea , Bub Udo , Wagner David M.
Published: May 2022

Die Digitale Transformation betrifft Unternehmen aller Branchen. Diese können sich nicht auf die laufende Verbesserung ihres erfolgreichen Bestandsgeschäfts beschränken, sondern müssen gleichzeitig neue, digitale Geschäftsmodelle aufbauen, um allenfalls bereits wegbrechendes Geschäft zu kompensieren. Das Konzept der Organisationalen Ambidextrie bezeichnet die Fähigkeit von Unternehmen, bei neuartigen strategischen Vorhaben (Exploration) gleichzeitig auf Kernkompetenzen aus dem Bestandsgeschäft (Exploitation) als Wettbewerbsvorteil zu setzen. In diesem Beitrag wird ein Kriterienkatalog vorgestellt, der die Fähigkeit von Organisationen beschreibt, das Ambidextrie-Konzept speziell bei den strategischen Vorhaben zur Digitalen Transformation umzusetzen. Dieser Katalog dient als Managementinstrument für eine Standortbestimmung und Zielvorgaben und lässt sich zu einem Reifegradmodell weiterentwickeln. Sowohl das IT-Know-how als auch das Zusammenspiel der Chief-Information- (CIO) und der jüngeren Chief-Digital-Officer (CDO)-Rolle sind dabei von zentraler Bedeutung und begründen den Unterschied zur allgemeinen Organisationalen Ambidextrie.

Der Katalog wurde in einem iterativen Design-Science-Research-Ansatz mit zwei Design- und Evaluationszyklen entwickelt und enthält für ein Erhebungsinstrument einsatzfertige Fragestellungen zu 46 Gestaltungsfaktoren in sieben Dimensionen mit insgesamt 99 Kriterien. Als konzeptionelle Grundlagen dienten insbesondere literaturbasiertes Wissen zu Rollenanforderungen für CIO und CDO, einschlägige Untermengen von Kriterien aus Reifegradmodellen und Assessments zu allgemeiner Digitaler Transformation, Intrapreneurship und Innovationskultur für digitale Lösungen. Die Bezeichnung CDO-CIO Do-it Kit ergibt sich aus den Anfangsbuchstaben der Dimensionen: CDO-CIO Zusammenarbeit, Digital-Transformation-Strategie, Organisation, Innovation, Transformationsmanagement, Kultur & Kompetenz sowie IT & IT-Kompetenz.
Unusual mammalian usage of TGA stop codons reveals that sequence conservation need not imply purifying selection
Authors: Ho Alexander Thomas , Hurst Laurence Daniel
Published: May 2022

The assumption that conservation of sequence implies the action of purifying selection is central to diverse methodologies to infer functional importance. GC-biased gene conversion (gBGC), a meiotic mismatch repair bias strongly favouring GC over AT, can in principle mimic the action of selection, this being thought to be especially important in mammals. As mutation is GC→AT biased, to demonstrate that gBGC does indeed cause false signals requires evidence that an AT-rich residue is selectively optimal compared to its more GC-rich allele, while showing also that the GC-rich alternative is conserved. We propose that mammalian stop codon evolution provides a robust test case. Although in most taxa TAA is the optimal stop codon, TGA is both abundant and conserved in mammalian genomes. We show that this mammalian exceptionalism is well explained by gBGC mimicking purifying selection and that TAA is the selectively optimal codon. Supportive of gBGC, we observe (i) TGA usage trends are consistent at the focal stop codon and elsewhere (in UTR sequences); (ii) that higher TGA usage and higher TAA→TGA substitution rates are predicted by a high recombination rate; and (iii) across species the difference in TAA <-> TGA substitution rates between GC-rich and GC-poor genes is largest in genomes that possess higher between-gene GC variation. TAA optimality is supported both by enrichment in highly expressed genes and trends associated with effective population size. High TGA usage and high TAA→TGA rates in mammals are thus consistent with gBGC’s predicted ability to “drive” deleterious mutations and supports the hypothesis that sequence conservation need not be indicative of purifying selection. A general trend for GC-rich trinucleotides to reside at frequencies far above their mutational equilibrium in high recombining domains supports the generality of these results.
RADA-dependent branch migration has a predominant role in plant mitochondria and its defect leads to mtDNA instability and cell cycle arrest
Authors: Chevigny Nicolas , Weber-Lotfi Frédérique , Le Blevenec Anaïs , Nadiras Cédric , Fertet Arnaud , Bichara Marc , Erhardt Mathieu , Dietrich André , Raynaud Cécile , Gualberto José M.
Published: May 2022

Mitochondria of flowering plants have large genomes whose structure and segregation are modulated by recombination activities. The post-synaptic late steps of mitochondrial DNA (mtDNA) recombination are still poorly characterized. Here we show that RADA, a plant ortholog of bacterial RadA/Sms, is an organellar protein that drives the major branch-migration pathway of plant mitochondria. While RadA/Sms is dispensable in bacteria, RADA-deficient Arabidopsis plants are severely impacted in their development and fertility, correlating with increased mtDNA recombination across intermediate-size repeats and accumulation of recombination-generated mitochondrial subgenomes. The radA mutation is epistatic to recG1 that affects the additional branch migration activity. In contrast, the double mutation radA recA3 is lethal, underlining the importance of an alternative RECA3-dependent pathway. The physical interaction of RADA with RECA2 but not with RECA3 further indicated that RADA is required for the processing of recombination intermediates in the RECA2-depedent recombination pathway of plant mitochondria. Although RADA is dually targeted to mitochondria and chloroplasts we found little to no effects of the radA mutation on the stability of the plastidial genome. Finally, we found that the deficient maintenance of the mtDNA in radA apparently triggers a retrograde signal that activates nuclear genes repressing cell cycle progression.
Female and male partner perspectives on placebo Multipurpose Prevention Technologies (MPTs) used by women in the TRIO study in South Africa and Kenya
Authors: Wagner Laura Danielle , Minnis Alexandra M. , Shea Jaclyn , Agot Kawango , Ahmed Khatija , van der Straten Ariane
Published: May 2022

Background

Male partner awareness and acceptance of microbicide and family planning product use has been shown to increase women’s own acceptance and adherence of a product. However, little is known about preferences regarding potential Multipurpose Prevention Technology (MPT) product delivery forms. As part of the TRIO study, men’s reactions to their female partner’s TRIO product use and comparisons of men’s and women’s views of TRIO product attributes and use acceptability were explored to better understand product preferences.

Methods

Women in TRIO used three placebo products that represented potential MPTs: daily oral tablets, monthly vaginal rings, and monthly dual injections. Male partners (N = 39) and women (N = 88) completed in-depth interviews on their own and their partner’s experiences with these products. Qualitative coding and analyses followed a conceptual model of HIV prevention product acceptability, and here, we explored themes of disclosure, trust and infidelity as they informed barriers and facilitators to product use.

Results

Men expressed a desire to know of their partner’s product use decisions and be informed and educated on the products to better support their partners, in some cases, expressing a high level of concern regarding maximizing the ease of product adherence for their partner. They also wanted to understand the effects of products on sexual encounters with their partner, but in some cases, wanted more knowledge in order to control their partner’s product use decisions. Similarly to women, men found long-acting, discreet products that have little to no effect on sexual encounters or libido the most acceptable for their female partners’ use. Product use was most acceptable to men if they were informed of use without inadvertent discovery.

Conclusions

Men’s product attribute preferences often aligned with women’s opinions of the same products. To support women’s correct use of MPTs, further research is needed to determine the best strategy for achieving male partner acceptance and support of product use, particularly for less familiar delivery forms, such as the vaginal ring.
Vaginal hormone-free moisturising cream is not inferior to an estriol cream for treating symptoms of vulvovaginal atrophy: Prospective, randomised study
Authors: Garcia de Arriba Susana , Grüntkemeier Lisa , Häuser Manuel , May Theodor W. , Masur Clarissa , Stute Petra
Published: May 2022

This prospective, open-label, multicentre, multinational, randomised trial investigated the non-inferiority of treatment with a vaginal hormone-free moisturising cream compared to a vaginal estriol (0.1%) cream in a panel of post-menopausal women suffering from symptoms of vulvovaginal dryness in a parallel group design. In total, 172 post-menopausal women were randomly allocated to either one of the two treatments, each administered for 43 days. The primary endpoint was the total severity score of subjective symptoms (dryness, itching, burning and pain unrelated to sexual intercourse) of the respective treatment period. Secondary endpoints were severity of single subjective symptoms (including dyspareunia if sexually active), impairment of daily life, Vaginal Health Index, as well as assessment of safety. In both groups, women treated with hormone-free moisturising cream and those treated with estriol cream, total severity score improved significantly compared to baseline by 5.0 (from 6.1 to 1.1) and by 5.4 (from 6.0 to 0.6), respectively, after 43 days of treatment (p < 0.0001). One-sided test of baseline differences (for a clinically relevant difference Δ = 1.5) confirmed the hormone-free moisturising cream to be non-inferior to the estriol cream. Severity of dyspareunia as well as impairment of daily life due to subjective symptoms, significantly improved for both treatment groups (p<0.0001). Subgroup analysis of women with mild or moderate impairment of daily life at baseline caused by “vaginal dryness” symptoms benefited from both creams, while women with severe impairment showed a significantly greater benefit from the estriol cream (p = 0.0032). Both treatments were well tolerated with no serious adverse events occurring. This study provides clinical evidence that a hormone-free vaginal moisturising cream cannot only improve vaginal dryness compared to an 0.1% estriol cream but also can relieve dyspareunia as well as improve woman’s impairment of daily life, justifying its use as a first choice for mild or moderate vulvovaginal dryness symptoms.
Intermolecular binding between bulk water and dissolved gases in earth’s magnetic field
Authors: Kohno Masahiro , Kamachi Toshiaki , Fukui Koji
Published: May 2022

Elucidation of the static states and dynamic behavior of oxygen and nitrogen dissolved in water is one of the most important issues in the life sciences. In the present study, experimental trials and theoretical calculations were performed based on the hypothesis that the dissolution of gas molecules in water is related to excitation by the Earth’s magnetic field. Using quantum theories such as those used to describe electro magnetic resonance and nuclear magnetic resonance, this study investigated the states of oxygen, nitrogen and hydrogen dissolved in water. The results indicate that the Earth’s magnetic field is involved in the bonding and dissociation of molecules at the gas-liquid interface. These calculations assessed the effect of a field strength of 1.0 x 10−4 T and reproduced the influences of temperature changes on dissolved gas concentrations. Molecular interactions caused by electromagnetic properties and the external geomagnetic field were found to affect intermolar bonding associated with water cluster structures. It is concluded that the binding between molecules typically attributed to Coulomb coupling by magnetic charge and van der Waals forces results from excitation in the Earth’s magnetic field.
Interventions to improve linkage along the HIV-tuberculosis care cascades in low- and middle-income countries: A systematic review and meta-analysis
Authors: Salomon Angela , Law Stephanie , Johnson Cheryl , Baddeley Annabel , Rangaraj Ajay , Singh Satvinder , Daftary Amrita
Published: May 2022

Introduction

In support of global targets to end HIV/AIDS and tuberculosis (TB) by 2030, we reviewed interventions aiming to improve TB case-detection and anti-TB treatment among people living with HIV (PLHIV) and HIV testing and antiretroviral treatment initiation among people with TB disease in low- and middle-income countries (LMICs).

Methods

We conducted a systematic review of comparative (quasi-)experimental interventional studies published in Medline or EMBASE between January 2003-July 2021. We performed random-effects effect meta-analyses (DerSimonian and Laird method) for interventions that were homogenous (based on intervention descriptions); for others we narratively synthesized the intervention effect. Studies were assessed using ROBINS-I, Cochrane Risk-of-Bias, and GRADE. (PROSPERO #CRD42018109629).

Results

Of 21,516 retrieved studies, 23 were included, contributing 53 arms and 84,884 participants from 4 continents. Five interventions were analyzed: co-location of test and/or treatment services; patient education and counselling; dedicated personnel; peer support; and financial support. A majority were implemented in primary health facilities (n = 22) and reported on HIV outcomes in people with TB (n = 18). Service co-location had the most consistent positive effect on HIV testing and treatment initiation among people with TB, and TB case-detection among PLHIV. Other interventions were heterogenous, implemented concurrent with standard-of-care strategies and/or diverse facility-level improvements, and produced mixed effects. Operational system, human resource, and/or laboratory strengthening were common within successful interventions. Most studies had a moderate to serious risk of bias.

Conclusions

This review provides operational clarity on intervention models that can support early linkages between the TB and HIV care cascades. The findings have supported the World Health Organization 2020 HIV Service Delivery Guidelines update. Further research is needed to evaluate the distinct effect of education and counselling, financial support, and dedicated personnel interventions, and to explore the role of community-based, virtual, and differentiated service delivery models in addressing TB-HIV co-morbidity.
Genetic diversity analysis and marker-trait associations in Amaranthus species
Authors: Jamalluddin Norain , Massawe Festo J. , Mayes Sean , Ho Wai Kuan , Symonds Rachael C.
Published: May 2022

Amaranth (Amaranthus spp.) is a highly nutritious, underutilized vegetable and pseudo-cereal crop. It possesses diverse abiotic stress tolerance traits, is genetically diverse and highly phenotypically plastic, making it an ideal crop to thrive in a rapidly changing climate. Despite considerable genetic diversity there is a lack of detailed characterization of germplasm or population structures. The present study utilized the DArTSeq platform to determine the genetic relationships and population structure between 188 amaranth accessions from 18 agronomically important vegetable, grain, and weedy species. A total of 74, 303 SNP alleles were generated of which 63, 821 were physically mapped to the genome of the grain species A. hypochondriacus. Population structure was inferred in two steps. First, all 188 amaranth accessions comprised of 18 species and second, only 120 A. tricolor accessions. After SNP filtering, a total of 8,688 SNPs were generated on 181 amaranth accessions of 16 species and 9,789 SNPs generated on 118 A. tricolor accessions. Both SNP datasets produced three major sub-populations (K = 3) and generate consistent taxonomic classification of the amaranth sub-genera (Amaranthus Amaranthus, Amaranthus Acnida and Amaranthus albersia), although the accessions were poorly demarcated by geographical origin and morphological traits. A. tricolor accessions were well discriminated from other amaranth species. A genome-wide association study (GWAS) of 10 qualitative traits revealed an association between specific phenotypes and genetic variants within the genome and identified 22 marker trait associations (MTAs) and 100 MTAs (P≤0.01, P≤0.001) on 16 amaranth species and 118 A.tricolor datasets, respectively. The release of SNP markers from this panel has produced invaluable preliminary genetic information for phenotyping and cultivar improvement in amaranth species.
Comparison of triple-DMEK to pseudophakic-DMEK: A cohort study of 95 eyes
Authors: Semler-Collery Axelle , Bloch Florian , Hayek George , Goetz Christophe , Perone Jean Marc
Published: May 2022

Previous comparative studies show that triple Descemet membrane endothelial keratoplasty (DMEK) (i.e. phacoemulsification followed immediately by DMEK) has either equivalent or better visual outcomes than DMEK in pseudophakic patients. To resolve this discrepancy, a retrospective cohort study was conducted. All consecutive patients with Fuchs Endothelial Corneal Dystrophy who underwent triple or pseudophakic DMEK in 2015–2019 in a tertiary-care hospital (France) and were followed for >12 months were compared in terms of best spectacle-corrected visual acuity (BSCVA), final refractive outcomes, and endothelial-cell loss at 12 months as well as rebubbling rates. The triple-DMEK (40 eyes, 34 patients) and pseudophakic-DMEK (55 eyes, 43 patients) groups were similar in terms of age and other baseline variables. They also did not differ in final BSCVA (both 0.03 logMAR), final endothelial-cell loss (54% vs. 48%), or astigmatism (-1.25 vs. -1 D). At 12 months, triple-DMEK associated with significantly smaller residual hyperopia (0.75 vs. 1 D; p = 0.04) and spherical equivalence (0 vs. 0.5 D; p = 0.02). Triple-DMEK also tended to associate with more frequent rebubbling (40% vs. 24%, p = 0.09). In conclusion, while triple-DMEK and pseudophakic-DMEK achieved similar visual acuity improvement, triple-DMEK was superior in terms of final sphere and spherical refraction but also tended to have higher complication rates.
Predicting the target specialty of referral notes to estimate per-specialty wait times with machine learning
Authors: Abdalla Mohamed , Lu Hong , Pinzaru Bogdan , Rudzicz Frank , Jaakkimainen Liisa
Published: May 2022

Background

Currently, in Canada, existing health administrative data and hospital-inputted portal systems are used to measure the wait times to receiving a procedure or therapy after a specialist visit. However, due to missing and inconsistent labelling, estimating the wait time prior to seeing a specialist physician requires costly manual coding to label primary care referral notes.

Methods

In this work, we represent the notes using word-count vectors and develop a logistic regression machine learning model to automatically label the target specialist physician from a primary care referral note. These labels are not available in the administrative system. We also study the effects of note length (measured in number of tokens) and dataset size (measured in number of notes per target specialty) on model performance to help other researchers determine if such an approach may be feasible for them. We then calculate the wait time by linking the specialist type from a primary care referral to a full consultation visit held in Ontario, Canada health administrative data.

Results

For many target specialties, we can reliably (F1Score ≥ 0.70) predict the target specialist type. Doing so enables the automated measurement of wait time from family physician referral to specialist physician visit. Of the six specialties with wait times estimated using both 2008 and 2015 data, two had a substantial increase (defined as a change such that the original value lay outside the 95% confidence interval) in both median and 75th percentile wait times, one had a substantial decrease in both median and 75th percentile wait times, and three has non-substantial increases.

Conclusions

Automating these wait time measurements, which had previously been too time consuming and costly to evaluate at a population level, can be useful for health policy researchers studying the effects of policy decisions on patient access to care.
Inference on P(X < Y) in Bivariate Lomax model based on progressive type II censoring
Authors: Helu Amal , Samawi Hani
Published: May 2022

This article considers the estimation of the stress-strength reliability parameter, θ = P(X < Y), when both the stress (X) and the strength (Y) are dependent random variables from a Bivariate Lomax distribution based on a progressive type II censored sample. The maximum likelihood, the method of moments and the Bayes estimators are all derived. Bayesian estimators are obtained for both symmetric and asymmetric loss functions, via squared error and Linex loss functions, respectively. Since there is no closed form for the Bayes estimators, Lindley’s approximation is utilized to derive the Bayes estimators under these loss functions. An extensive simulation study is conducted to gauge the performance of the proposed estimators based on three criteria, namely, relative bias, mean squared error, and Pitman nearness probability. A real data application is provided to illustrate the performance of our proposed estimators through bootstrap analysis.
Addition of digital VIA/VILI to conventional naked-eye examination for triage of HPV-positive women: A study conducted in a low-resource setting
Authors: Dufeil Eva , Kenfack Bruno , Tincho Evelyn , Fouogue Jovanny , Wisniak Ania , Sormani Jessica , Vassilakos Pierre , Petignat Patrick
Published: May 2022

Background

World Health Organization guidelines for cervical cancer screening recommend HPV testing followed by visual inspection with acetic acid (VIA) for triage if HPV positive. In order to improve visual assessment and identification of cervical intraepithelial neoplasia grade 2 and worse (CIN2+), providers may use visual aids such as digital cameras.

Objectives

To determine whether combined examination by naked-eye and digital VIA (D-VIA) and VILI (D-VILI) improves detection of CIN2+ as compared to the conventional evaluation.

Materials and methods

Women (30–49 years) living in Dschang (West Cameroon) were prospectively invited to a cervical cancer screening campaign. Primary HPV-based screening was followed by VIA/VILI and D-VIA/VILI if HPV-positive. Health care providers independently defined diagnosis (pathological or non-pathological) based on naked-eye VIA/VILI and D-VIA/VILI. Decision to treat was based on combined examination (VIA/VILI and D-VIA/VILI). Cervical biopsy and endocervical curettage were performed in all HPV-positive participants and considered as reference standard. Diagnostic performance of individual and combined naked-eye VIA/VILI and D-VIA/VILI was evaluated. A sample size of 1,500 women was calculated assuming a prevalence of 20% HPV positivity and 10% CIN2+ in HPV-positive women.

Results

Due to the COVID-19 pandemic, the study had to terminate prematurely. A total of 1,081 women with a median age of 40 (IQR 35.5–45) were recruited. HPV positivity was 17.4% (n = 188) and 26 (14.4%) had CIN2+. Naked-eye VIA and D-VIA sensitivities were 80.8% (95% CI 60.6–93.4) and 92.0% (95% CI 74.0–99.0), and specificities were 31.2% (95% CI 24–39.1) and 31.6% (95% CI 24.4–39.6), respectively. The combination of both methods yielded a sensitivity of 92.3% (95% CI 74.9–99.1) and specificity of 23.2% (95% CI 16.8–30.7). A trend towards improved sensitivity was observed, but did not reach statistical significance.

Conclusion

Addition of D-VIA/VILI to conventional naked-eye examination may be associated with improved CIN2+ identification. Further studies including a larger sample size are needed to confirm these results.
Bottleneck analysis of maternal and newborn health services in hard-to-reach areas of Bangladesh using ‘TANAHASHI’ framework’: An explanatory mixed-method study
Authors: Chowdhury Mohiuddin Ahsanul Kabir , Karim Farhana , Hasan Mohammad Mehedi , Ali Nazia Binte , Khan Abdullah Nurus Salam , Siraj Md. Shahjahan , Ahasan S. M. Monirul , Hoque Dewan Md. Emdadul
Published: May 2022

Maternal and Newborn Health (MNH) is of paramount importance in the realm of attaining sustainable development goals that also focuses on universal health coverage (UHC). The study aimed at identifying and exploring the bottlenecks in MNH services in Hard-to-reach (HtR) areas of Bangladesh using the Tanahashi framework exploring the possible remedial approaches. The study was conducted in four different types of HtR areas (hilly, coastal, lowlands, and river islands) by utilizing a sequential explanatory mixed-method design. Overall, we collected information from 20 health facilities and 2,989 households by interviewing 2,768 recently delivered women (RDW) with a structured questionnaire and qualitative interviews (n = 55) of facility managers, local stakeholders, RDWs, and health care providers (HCP). The quantitative data were analyzed principally for descriptive statistics and the qualitative data was analyzed by utilizing the thematic approach. Antenatal care, under-5 care, and family planning services were available in almost all the facilities. However, Normal vaginal deliveries were performed in 55.6% of the union-level facilities. Only 40% of sub-district level facilities had provision for C-sections. Blood transfusion services were available in only 20.1% of facilities, whereas laboratory services were obtainable in 51.7% of facilities. Overall, the bottlenecks were identified in cases of availability of drugs, human resources, transportation, lack of knowledge regarding different essential services and health components, out of pocket expenditure etc. There have been several remedial approaches suggested from both the demand and supply side that included incentives for care providers for staying in these areas, a coordinated transport/referral system, and health education campaigns. More research works are warranted in HtR areas, especially to test the proposed interventions. Meanwhile, the government should take the necessary steps to overcome the bottlenecks identified.
A novel 3-acyl isoquinolin-1(2H)-one induces G2 phase arrest, apoptosis and GSDME-dependent pyroptosis in breast cancer
Authors: Ma Lei , Bian Mengyao , Gao Hui , Zhou Zhi , Yi Wei
Published: May 2022

Breast cancer is the most common malignancy among women worldwide, accordingly, numerous chemotherapeutic drugs have been discovered thus far. However, the development and application of these drugs is severely constrained because of their unclear mechanism. To address this issue, our previous work has defined 3-acyl isoquinolin-1(2H)-one derivatives as potent anti-tumor agents, among which the compound4fpossessed relatively higher activityin vitro. In this study, we aim to further explore the anti-cancer effect and the underlying molecular mechanism of4fin breast cancer cells. Therefore, CCK8 assay was used to detect cell viability and flow cytometry was used to analyze cell cycle and apoptosis. Meanwhile, related proteins that regulate cell cycle and apoptosis were detected. The results showed that4finduced cell apoptosis and inhibited cell proliferation in breast cancer cells in a dose-depended manner without significant toxicity to human normal mammary epithelial cell. The cell cycle was arrested at G2 phase with the suppressed expression of the CDK1 protein. Additionally,4fwas confirmed to induce the cell apoptosis with the up-regulation of bax, down-regulation of bcl-2, activation of cleaved-caspase3/7/9 and cleaved-PARP, together with the inhibition of MEK/ERK and p38 MAPK pathway. Moreover, the GSDME-mediated pyroptosis was also induced by4fin breast cancer cells. Together, these results demonstrated that4fcould serve as a new and promising candidate for the treatment of breast cancer.
Obstetric shift-to-shift handover in Kerala, India: A cross-sectional mixed method study
Authors: Pilcher Lucy , Kurian Merina , MacArthur Christine , Singh Sanjeev , Manaseki-Holland Semira
Published: May 2022

Introduction

Beyond the provision of services, quality of care and patient safety measures such as optimal clinical handover at shift changes determine maternity outcomes. We aimed to establish the proportion of women handed over and the content of clinical handovers and communication between shifts within 3 diverse obstetrics units in Kerala, India, and to describe the handover environment.

Methods

A cross sectional study was conducted for six weeks during February and March 2015at three hospitals in Kerala, India, during nurses obstetric handover in one tertiary private, one tertiary government and one secondary government hospital. Nursing handovers in obstetric post-operative, in-patient and labour wards were sampled. An SBAR-based (situation, background, assessment and recommendation) data schedule was completed whilst observing handover at nursing shift changes. Since obstetricians had no scheduled handover, qualitative interviews were conducted with obstetricians in two hospitals to establish how they acquire information when beginning a shift.

Results

Data was obtained on 258 patients handed over, within 67 shift changes. The median percentage of women handed over was 100% in two of the hospitals and 27.6% in the other. The median number of information items included out of a possible 25 was 11, 5 and 4,and did not change significantly for women with high-risk status. Important items regarding assessment and recommendation for care were often missed, including high-risk status. The median number of environment items achieved was good at 7 out of 10 in all hospitals. Obstetricians sought information in various ways when required. All supported the development of structured tools, face-to-face and team handovers.

Conclusions

Maternity unit handovers for doctors and nurses were inadequate. Ensuring handover of all women and including critical information, between shifts as well as between doctors, needs to be improved to increase patient safety.
Composite measures of quality of health care: Evidence mapping of methodology and reporting
Authors: Kara Pinar , Valentin Jan Brink , Mainz Jan , Johnsen Søren Paaske
Published: May 2022

Background

Quality indicators are used to quantify the quality of care. A large number of quality indicators makes assessment of overall quality difficult, time consuming and impractical. There is consequently an increasing interest for composite measures based on a combination of multiple indicators.

Objective

To examine the use of different approaches to construct composite measures of quality of care and to assess the use of methodological considerations and justifications.

Methods

We conducted a literature search on PubMed and EMBASE databases (latest update 1 December 2020). For each publication, we extracted information on the weighting and aggregation methodology that had been used to construct composite indicator(s).

Results

A total of 2711 publications were identified of which 145 were included after a screening process. Opportunity scoring with equal weights was the most used approach (86/145, 59%) followed by all-or-none scoring (48/145, 33%). Other approaches regarding aggregation or weighting of individual indicators were used in 32 publications (22%). The rationale for selecting a specific type of composite measure was reported in 36 publications (25%), whereas 22 papers (15%) addressed limitations regarding the composite measure.

Conclusion

Opportunity scoring and all-or-none scoring are the most frequently used approaches when constructing composite measures of quality of care. The attention towards the rationale and limitations of the composite measures appears low.

Discussion

Considering the widespread use and the potential implications for decision-making of composite measures, a high level of transparency regarding the construction process of the composite and the functionality of the measures is crucial.
The effects of vocal exertion on lung volume measurements and acoustics in speakers reporting high and low vocal fatigue
Authors: Fujiki Robert Brinton , Huber Jessica E. , Sivasankar M. Preeti
Published: May 2022

Purpose

Vocal exertion is common and often results in reduced respiratory and laryngeal efficiency. It is unknown, however, whether the respiratory kinematic and acoustic adjustments employed during vocal exertion differ between speakers reporting vocal fatigue and those who do not. This study compared respiratory kinematics and acoustic measures in individuals reporting low and high levels of vocal fatigue during a vocal exertion task.

Methods

Individuals reporting low (N = 20) and high (N = 10) vocal fatigue participated in a repeated measures design study over 2 days. On each day, participants completed a 10-minute vocal exertion task consisting of repeated, loud vowel productions at elevated F0 sustained for maximum phonation time. Respiratory kinematic and acoustic measures were analyzed on the 1st vowel production (T0), and the vowels produced 2 minutes (T2), 5 minutes (T5), 7 minutes (T7), and 10 minutes (T10) into the vocal exertion task. Vowel durations were also measured at each time point.

Results

No differences in respiratory kinematics were observed between low and high vocal fatigue groups at T0. As the vocal exertion task progressed (T2-T10), individuals reporting high vocal fatigue initiated phonation at lower lung volumes while individuals with low vocal fatigue initiated phonation at higher lung volumes. As the exertion task progressed, total lung volume excursion decreased in both groups. Differences in acoustic measures were observed, as individuals reporting high vocal fatigue produced softer, shorter vowels from T0 through T10.

Conclusions

Individuals reporting high vocal fatigue employed less efficient respiratory strategies during periods of increased vocal demand when compared with individuals reporting low vocal fatigue. Individuals reporting high vocal fatigue had shorter maximum phonation time on loud vowels. Further study should examine the potential screening value of loud maximum phonation time, as well as the clinical implications of the observed respiratory patterns for managing vocal fatigue.
Preclinical and clinical developments for combination treatment of influenza
Authors: Koszalka Paulina , Subbarao Kanta , Baz Mariana
Published: May 2022

Antiviral drugs are an important measure of control for influenza in the population, particularly for those that are severely ill or hospitalised. The neuraminidase inhibitor (NAI) class of drugs, including oseltamivir, have been the standard of care (SOC) for severe influenza illness for many years. The approval of drugs with novel mechanisms of action, such as baloxavir marboxil, is important and broadens potential treatment options for combination therapy. The use of antiviral treatments in combination for influenza is of interest; one potential benefit of this treatment strategy is that the combination of drugs with different mechanisms of action may lower the selection of resistance due to treatment. In addition, combination therapy may become an important treatment option to improve patient outcomes in those with severe illness due to influenza or those that are immunocompromised. Clinical trials increasingly evaluate drug combinations in a range of patient cohorts. Here, we summarise preclinical and clinical advances in combination therapy for the treatment of influenza with reference to immunocompromised animal models and clinical data in hospitalised patient cohorts where available. There is a wide array of drug categories in development that have also been tested in combination. Therefore, in this review, we have included polymerase inhibitors, monoclonal antibodies (mAbs), host-targeted therapies, and adjunctive therapies. Combination treatment regimens should be carefully evaluated to determine whether they provide an added benefit relative to effectiveness of monotherapy and in a variety of patient cohorts, particularly, if there is a greater chance of an adverse outcome. Safe and effective treatment of influenza is important not only for seasonal influenza infection, but also if a pandemic strain was to emerge.
A bias correction method for precipitation through recognizing mesoscale precipitation systems corresponding to weather conditions
Authors: Yoshikane Takao , Yoshimura Kei
Published: May 2022

Accurate estimations of local precipitation are necessary for assessing water resources and water-related disaster risks. Numerical models are typically used to estimate precipitation, but biases can result from insufficient resolution and incomplete physical processes. To correct these biases, various bias correction methods have been developed. Recently, bias correction methods using machine learning have been developed for improved performance. However, estimating local hourly precipitation characteristics remains difficult due to the nonlinearity of precipitation. Here, we focused on precipitation systems that could be reproduced by numerical models, and estimated the spatial distribution of local precipitation by recognizing the relationship between simulated and observed precipitation with a resolution of 0.06 degrees using a machine learning method. We subsequently applied a quantile mapping method to modify the precipitation amounts. Validation showed that our method could significantly reduce bias in numerical simulations, especially the spatial distribution of hourly precipitation frequency. However, the bias in the temporal distribution of hourly precipitation did not improve. Spatial autocorrelation analysis showed that this method can predict precipitation systems with spatial scales of 2500 to 40000 km2, which are associated with large-scale disturbances (e.g., cold fronts, warm fronts, and low-pressure systems). The high accuracy of these estimates indicates that the spatial distribution of hourly precipitation frequency is strongly dependent on precipitation systems with these spatial scales. Accordingly, our method shows that the relationship between the spatial distribution of precipitation systems and local precipitation is strong, and by recognizing this relationship, the spatial distribution of local hourly precipitation can be accurately estimated.
Analysis of the Incidence and Risk Factors of Postoperative Delirium in Patients With Degenerative Cervical Myelopathy
Authors: Kim Namhoo , Kim Tae-Hwan , Oh Jae Keun , Lim Jeongsup , Lee Kang Uk , Kim Seok Woo
Published: May 2022

Objective: The purpose of this study is to analyze various risk factors that can cause postoperative delirium (POD) in degenerative cervical myelopathy (DCM) patients, which may affect normal recovery and outcomes after surgery, and to help deal with them in advance and to take a medical approach.Methods: A total of 148 patients aged 60 years or older who underwent laminoplasty or anterior cervical discectomy and fusion (ACDF) for DCM from 2008 to 2015 were included in this study. Incidence and multiple risk factors for development of POD were analyzed.Results: POD occurred in 24 patients (16.2%). Among the 148 patients, 78 received laminoplasty, of whom 19 patients (24%) experienced delirium; the other 70 patients underwent ACDF, of whom 5 patients (7.1%) experienced delirium. History of Parkinson disease (odds ratio [OR], 178.242; p = 0.015), potassium level (OR, 3.764; p = 0.031), and surgical approach of laminoplasty over ACDF (OR, 8.538; p = 0.008) were found to be significant risk factors in a multivariate analysis. Age (OR, 1.056; p = 0.04) and potassium level (OR, 3.217; p = 0.04) were significant risk factors in the laminoplasty group.Conclusion: The findings of this study suggest that the incidence and risk factors for POD may vary in patients with DCM. It is necessary to understand multiple factors that affect the development of POD.
Cost-Utility Analysis Compared Between Radiotherapy Alone and Combined Surgery and Radiotherapy for Symptomatic Spinal Metastases in Thailand
Authors: Taechalertpaisarn Pasawat , Wilartratsami Sirichai , Phisalprapa Pochamana , Kositamongkol Chayanis , Teyateeti Achiraya , Luksanapruksa Panya
Published: May 2022

Objective: To investigate the patient quality of life and cost-utility compared between radiotherapy alone and combined surgery and radiotherapy for spinal metastasis (SM) in Thailand.Methods: Patients with SM with an indication for surgery during 2018–2020 were prospectively recruited. Patients were assigned to either the combination surgery and radiotherapy group or the radiotherapy alone group. Quality of life was assessed by EuroQol-5D-5L (EQ-5D-5L) questionnaire, and relevant healthcare costs were collected pretreatment, and at 3-month and 6-month posttreatment. Total lifetime cost and quality-adjusted life-years (QALYs) were estimated for each group.Results: Twenty-four SM patients (18 females, 6 males) were included. Of those, 12 patients underwent combination treatment, and 12 underwent radiotherapy alone. At 6-month posttreatment, 10 patients in the surgery group, and 11 patients in the nonsurgery group remained alive for a survival rate of 83.3% and 91.7%, retrospectively. At 6-month posttreatment, the mean utility in the combination treatment group was significantly better than in the radiotherapy alone group (0.804 ± 0.264 vs. 0.518 ± 0.282, respectively; p = 0.011). Total lifetime costs were 59,863.14 United States dollar (USD) in the combination treatment group and 24,526.97 USD in the radiation-only group. The incremental cost-effectiveness ratio using 6-month follow-up data was 57,074.01 USD per QALY gained.Conclusion: Surgical treatment combined with radiotherapy to treat SM significantly improved patient quality of life compared to radiotherapy alone during the 6-month posttreatment period. However, combination treatment was found not to be cost-effective compared to radiotherapy alone for SM at the Thailand willingness-to-pay threshold of 5,113 USD/QALY.