bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Acute Anal Fissure at a Tertiary Care Hospital in West Bengal, India- A Longitudinal Study
Authors: Rahbar Farhan MD , Mohanta Pradip Kumar , Pal Sabuj
Published: April 2023

Introduction: Anal fissure is a tear in the lining of the anus and is a common problem throughout the world. It is one of the most common painful and benign conditions of the anal region, which leads to morbidity and decrease in quality of life. Aim: To prospectively observe the outcomes of management of acute anal fissure, both surgically and conservative modalities of treatment. Materials and Methods: This longitudinal study constituted patients clinically presenting with features of acute anal fissure such as pain, bleeding, constipation attending Out Patient Department (OPD) in College of Medicine and JNM Hospital, West Bengal, India, from January 2020 to June 2021. Patients were grouped according to modalities of treatment given (surgical/conservative), after that regular follow-up was done at regular intervals to find out outcome of treatment, with respect to relief of pain, bleeding, healing rate, fissure relapse and incontinence. Chi-square test was used to compare the proportions and independent t-test was used to compare means. The p-value of <0.05 was considered to be statistically significant. All the analysis was done in IBM Statistical Package for the Social Sciences (SPSS) version 22.0. Results: In the current study, 9 (8.8%) patients had anterior anal fissure and 93 (91.2%) patients had posterior anal fissure. Fifty one patients (50.0%) underwent medical management {(nifedipine 2% gel locally, diltiazem (2%) locally)} and 51 patients (50.0%) were treated with surgical management (lateral internal sphincterectomy). Significant difference was noted at 15th, and 30th and 45th days post-treatment when surgically managed patients were compared with medically managed patients p-value <0.05*. Four patients in the medically managed group, had bleeding during the entire period. Association of Bleeding at 15th day, 30th day, 45th day and 6th month with mode of management was statistically significant (p<0.05*) healing was achieved for 90 patients (88.2%) at the end of 6th month follow-up. In medical management, 9 (17.6%) patients had fissure relapse. In surgical management, 3 (5.9%) patients had fissure relapse p>0.05. Conclusion: In the present study, though patients in both surgical and medical groups had pain relief, those who underwent surgery had better result. Majority of the patients in the study achieved remission, at the end of sixth month follow-up, irrespective of the type of management. Relapse of the disease was slightly more in medically managed group, compared to those, who underwent surgical management.
Effect of Educational Video on Maternal Nutrition, Hygiene and Sanitation Among Maternal Age Group Women: A Prospective Interventional Study from Prayagraj, Uttar Pradesh, India
Authors: Verma Tripti , Gupta Alka
Published: April 2023

Introduction: Interventions that try to alter behaviour in order to promote health and disease management are typically time and resource-consuming. At the moment, boosting maternal and child nutrition is the main focus of nutrition programs in India. This paper discusses the most effective methods to change eating habits, hygiene, and sanitisation particularly the significance of contemporary Information Technology (IT) in health education. Aim: To determine the pre education knowledge level and create awareness regarding maternal nutrition, hygiene and sanitation through the developed education video on personal hygiene and sanitation among maternal-aged group women. Materials and Methods: The community-based prospective interventional study was conducted from October 2019 to April 2021 by using the prospective intervention study design. Based on the Socio-demographic profile, anthropometric measurement, and clinical assessment, specific questions regarding dietary knowledge and personal hygiene were recorded by using the questionnaire. By using the recorded data through a questionnaire, 100 respondents were selected through stratified random sampling and divided into the control group (n=50) and experimental group (n=50) involved in the intervention study. The experimental group which consisted of 50 respondents was grouped into two groups E1 (n=25) and E2 (n=25) and educated separately (due to COVID-19 restriction on mass gatherings) three times a month at 15 days intervals. The nutrition education intervention was given through an educational video in the Hindi language. The effects of the intervention were studied among the participants of the experimental group. The control group did not receive any nutritional awareness sessions. Knowledge level before and after the education intervention was recorded by using the self-structured questionnaire consisting of 15 multiple questions. The data was analysed by using Analysis of variance (ANOVA) technique. Results: Analysis was done for the complete data collected from 100 participants (15-35 years of age, 50 in each control and experimental group) included in the present study. The mean age of maternal age group women was 22 years. No significant difference was found between the knowledge of the control and experimental group at baseline (p-value >0.05). However, the post-intervention, there was significant gain in knowledge in the experimental group (p-value <0.001). Conclusion: It was found that providing the nutrition education through the developed information and communication technology proved effective by increasing knowledge level among the maternal aged group women.
Dengue Fever with Myositis- An Uncommon Complication of a Common Disease
Authors: Priyank Rastogi Priyank , Chetiwal Rajesh , Choudhary Sandeep
Published: April 2023

Dengue has a high prevalence in tropical countries including India. Although myalgias are a common musculoskeletal manifestation in dengue but myositis is unusual. The present case series describes three cases of female patients with dengue fever (35-yearold, 30-year-old and 37-year-old), who developed severe pain and tenderness in muscles and were diagnosed with myositis. The present case series emphasises the fact that, although the condition is usually self-limiting, but it has the potential to aggravate into life threatening conditions like acute respiratory and renal failure, if left unattended.
A Comprehensive Cross-sectional Analysis on the Diagnostic Predictors of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration
Authors: Pilakadan Shibini , Nivas Anand Madhava , Akkara Paulo Varghese , Thazhepurayil Rajagopal
Published: April 2023

Introduction: Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) is a relatively new and minimally invasive procedure for sampling mediastinal and hilar lymph nodes. Various factors can influence the diagnostic yield of EBUS-TBNA and comprehensive studies evaluating them together are scarce. Aim: To evaluate the factors predicting the diagnostic yield of EBUS-TBNA in sampling mediastinal and hilar lymph nodes. Materials and Methods: A cross-sectional study was conducted for the period of one year from June 2019 to May 2020. The patients with enlarged mediastinal and hilar lymph nodes on Computed Tomography (CT) thorax underwent Fibre Optic Bronchoscopy (FOB) followed by EBUS-TBNA under conscious sedation. Patient and procedure related factors and ultrasonological features of lymph nodes were noted. Their relationships with EBUS-TBNA histopathological results were assessed. Statistical methods like Fisher’s exact test with significant p-value as <0.05 were used for analysis. Results: The mean age was 60.78±13.664 years with 59 (81%) males. Out of 73 lymph node stations sampled, 49.3% were subcarinal, followed by right lower paratracheal (30.1%), left hilar (8.2%), left upper paratracheal (6.9%) and left lower paratracheal (5.5%). EBUS-TBNA Histopathology Report (HPR) came as positive in 68.5% (50/73) cases with squamous cell carcinoma found in 34%, adenocarcinoma in 32%, poorly differentiated carcinoma in 16%, tuberculosis in 14%, and non specific inflammation in 4% cases. Significant association was found with factors like moderate sedation, duration of procedure taking >30 minutes, lymph node size >1 cm and absence of hilar sign, more number of passes per node and use of suction while sampling lymph nodes and diagnostic yield by EBUSTBNA (p-value <0.05). There was no significant association with lymph node stations, lymph node features like shape, margin, echogenicity, necrosis and Rapid On-Site Evaluation (ROSE) and diagnostic yield; so also is the case with patient related factors like age, sex, co-morbidities, FOB and CT findings. Conclusion: The duration of the procedure, type of sedation, lymph node size and absence of hilar sign, number of passes per node and use of suction while sampling the node are the main factors predicting the diagnostic yield of EBUS-TBNA in sampling mediastinal and hilar lymph nodes.
Profile of Skin Diseases among Patients Attending a Dermatology Outpatient Clinic: A Record-based Cross-sectional Study from a Tertiary Care Centre in Northern Kerala, India
Authors: Sanker Anita , George Sandhya , Bhaskaramenon Sindhu C , Sivaprasad R
Published: April 2023

Introduction: Epidemiological studies to determine the pattern of skin diseases among patients attending a hospital are important for proper healthcare planning and management. They give insight to the epidemiology of diseases. Similar studies have not been conducted in Northern Kerala recently. Aim: To identify the pattern of diseases among patients who attended the Outpatient (OP) section of the Department of Dermatology in our hospital. Materials and Methods: The present study was retrospective, record-based cross-sectional study in which OP registers of the Department of Dermatology from December 2018 to November 2019 were analysed retrospectively. Skin diseases were grouped into different groups and the frequency of cases in each group was studied. These were also categorised according to different age groups, gender and month of their OP visit. Descriptive statistics were used to analyse the data. Data analysis was performed using Microsoft Excel and R software (R version 3.6.1 (2019-07-05)). Results: Out of the 17,907 new patients, 42.7% were infections, of which fungal infections were the most common. Eczema (27.7%) was the common group. Significant difference in male: female ratio was seen in melasma (14:95), leprosy (13:2), drug reaction (1:28), connective tissue diseases (0:18) and Vesiculobullous (VB) (0:4). Monthly split-up of cases showed increased frequency of some groups of diseases during some months these include Sexually Transmitted Infections (STI) in February-9/20 (45%), leprosy in May-4/15 (26.7%), drug reaction in December- 9/29 (31%), connective tissue diseases in April- 6/18 (33.3%) and VB diseases in February 4/4 (100%). Conclusion: Infections and eczemas which could be managed in primary healthcare set-up contributed to majority of the OP attendance of our tertiary care centre. The peripheral institutions should be strengthened in manpower and the level of knowledge and skills. More focused and effective training of medical students, continuing medical education for general practitioners and the implementation of family physician system should gain more importance in our country. Increased frequency of some diseases was seen during some months these findings have to be confirmed by longer duration studies.
Prolactin-secreting Pituitary Macro-adenoma Presenting with Mass Effects, Hormonal Deficiencies, and Neurogenic Diabetes Insipidus: A Case Report and Review of Literature
Authors: Okikiade Adedeji , Browne-Caesar Twanna , Afolayan-Oloye Olayinka , Agboola Rasheed , Olojede Olubunmi , Oyewole Adijat
Published: April 2023

To report and review a case of prolactin-producing pituitary tumor presenting with mass effects, hormonal deficiency, and neurogenic diabetes insipidus in a nulliparous woman of Afro-Caribbean descent. The patient presented with dull-aching headaches associated with worsening vision, nausea, and vomiting. The patient also complained of polyuria, nocturia, thirst, polydipsia, and weight gain. Physical examination showed bilateral visual field defects, while investigations revealed hypernatremia and elevated plasma osmolality but decreased urine sodium concentration, osmolality, and specific gravity.

Results of the hormonal profile showed high plasma prolactin levels, a low plasma concentration of the antidiuretic hormone, and decreased levels of other anterior pituitary hormones. Imaging revealed a large, uncalcified, cystic pituitary mass extending into adjacent structures and compressing the optic chiasm and internal carotid artery. The outcome of the water deprivation and desmopressin administration tests were consistent with neurogenic diabetes insipidus, and a diagnosis of prolactin-producing pituitary macroadenoma with mass effects, hormonal deficiencies, and neurogenic diabetes insipidus was made. The patient was commenced on medical treatment and referred for histopathological diagnosis and definitive treatment. This report highlights the coexistence of neurogenic diabetes insipidus with a prolactin-producing pituitary macroadenoma presenting with mass effects.
Plant Growth Promoting- Rhizobacteria (PGPR): Their Potential as Biofertilizer and Biopesticide Agents: A Review
Authors: Purnima  , Singh Pooja
Published: April 2023

Currently, world is dealing with the curse of pollution in agricultural fields due to rampant use of chemical fertilizers and pesticides. These agrochemicals cause great harm to human health when consumed in food (e.g. cancer and thyroid) and also to environment (reduce fertility of soil etc) when released out there. Hence, there is an intense demand of such biological agents (e.g. microorganisms) which could partially or fully replace these agrochemicals. Plant growth promoting rhizobacteria could come to the rescue and would help to escalate growth and productivity of plants in an environment friendly way. Plant growth promoting rhizobacteria occurs in/around plant roots; enhance its growth and development, directly or indirectly by depleting or secreting several regulative chemical compounds. The direct method by which plant growth promoting rhizobacteria escalates plant growth is, by making easy availability of phosphorus, nitrogen and other essential minerals as well as by controlling quantity of plant hormones whereas indirect methods include, reducing impeding effects of pathogenic microbes (e.g. by siderophore production) which adversely affect development and growth of plants. There are several studies which registers that plant growth promoting rhizobacteria escalates health and yield of several plant species, both in normal and adverse situations. Therefore, plant growth promoting rhizobacteria could possibly lower the reliability of world on harmful agricultural chemicals which disturbs ecosystem. They can be used as a potent biofertilizers and biopesticides whose market demand is also hiking globally, currently as reported here.
Effects of Anchor Borrowers Programme on Rice Farming in Benue State, Nigeria
Authors: Soom A. , Sani M. H. , Danwanka H. A.
Published: April 2023

The study analyzed effects of Anchor Borrowers Programme on rice farming in Benue State, Nigeria. Multi-stage sampling technique was used to select 125 beneficiary rice farmers of the anchor borrowers’ programme. Data were collected using structured questionnaire and analyzed using descriptive statistics, multiple regression analysis and factor analysis. The results from the multiple regression analysis revealed that productivity of beneficiary rice farmers was positively and significantly determined by farm size at P≤ 0.01 but negatively influenced by seed and fertilizer at P≤0.01 and P≤ 0.05 levels. The R2 of 0.43 implies that 43% of the variability in rice productivity was accounted for by explanatory variables included in the model. The result of the amount of credit/inputs and mode of loan repayment revealed that beneficiary rice farmers in the study area had mostly from the programme received N50, 000.00 and paid back their loan mostly as part-payment in cash. Certain limited factors such as socio-economic factors, economic factors and institutional factors had constrained farmers’ access to credit and other inputs from the programme. It was concluded that rice production by the beneficiary rice farmers in the study area was not optimally productive. The study recommended that farmers should be advised to expand their farm lands to ensure efficient utilization of resources for increased productivity. Also, policies that will make credit accessible to farmers will go a long way in addressing their inefficiency problems.
Pediatric Drug Development Process: A Review
Authors: Sushir Chetan , Kilor Vaishali , Rewatkar Ashika
Published: April 2023

This review includes New Formulation approaches to improve Pediatric compliance such as Mini tablets, 3D printing, Orodispersible films, Chewable tablets. Various strategies to improve patient adherence such as ‘nipple shield’ delivery system, dry solid formulations to be converted to liquid at the point of administration, pill swallowing cups, Medicated dosing straw. It is important to formulate pediatric medicines that are tailored to a child’s age, size, physiological condition, and treatment requirements. Legislations for pediatric formulation to ensure that products to treat pediatric patients are appropriately authorized for use in the pediatric population, minimize the worst effect of Off-label medication and to improve the information available on the use of these products in the various pediatric populations. Also, the review consists of Information on legislative obligation and requirement, current State, challenges and effect of regulations. Recent progress has been made in the development of pediatric formulations due to new regulations, additional funding opportunities, and collaborative research initiatives.
Post-covid Henoch-schonlein Purpura: A Pediatric Case Report
Authors: Mebrouk Nadia , Halimi Boutaina , Attari Najlae El , Abdeljalil Youssra , Loubna Chtouki , Bentahila Abdelali
Published: April 2023

We report the case of a 28-month-old boy who displayed symptoms of Henoch-Schonlein purpura (HSP), a type of small-vessel vasculitis that affects multiple systems in childhood and is caused by IgA. The symptoms include dermatological, abdominal, articular, and renal manifestations. HSP can occur due to several factors, such as upper respiratory tract infections, medications, vaccinations, and malignancies. The patient had positive COVID-19 serology but no other trigger factor for HSP, indicating a possible correlation between the two. The boy received oral prednisolone, leading to a swift clinical improvement. Our findings align with other research that suggests a link between the SARS-CoV-2 coronavirus and infantile HSP.
Assessment of Land Use-Land Cover Changes in Samastipur District of Bihar (India) Using Geo-Informatics
Authors: Kumar Jitendra , Sahu Ram Kumar , Prasad Sudarshan
Published: April 2023

The assessment and analysis of Land Use/Land Cover (LULC) changes are required to identify the land use changes from year to year which plays a critical role in planning and implementation of developmental activities. The present study aims to assess LULC changes in Samastipur district of Bihar using Remote Sensing (RS) and Geographical Information System (GIS). The LULC maps were prepared using LANDSAT-5 and LANDSAT-8 images by adopting object based image classification technique. Assessments of LULC changes were done @ 5 years, @ 10 years and @ 20 years during 2000-2020. The results indicated that the agriculture land coverage increased at high rate during 2000-2005 and 2005-2010; and after that it is increasing at slow rate. The natural vegetation coverage is continuously decreasing during years 2000-2020 while settlement is continuously increasing during this period with notable increase during 2000-2005 and 2015-2020. In the time interval of 10 years (2000-2010), the agriculture land area increased by 22.17%; natural vegetation area decreased by 38.04%; the water-bodies decreased by 46.69%; sand and barren land decreased by 61.27% and settlement area increased by 15.62%. Over the next 10 years (2010-2020), area covered by agriculture land, settlement, water-bodies and sand and barren land increased by 8.05%, 38.30%, 26.27% and 44.65% respectively while area covered by natural vegetation decreased by 75.24%. During time interval of 20 years (2000-2020), agriculture land area and settlement area increased by 32% and 59.91% respectively while natural vegetation, sand and barren land and water-bodies decreased by 84.66%, 43.98% and 32.68% respectively. The analysis of the results indicates that the natural vegetation has decreased at fast rate in the recent years. Therefore, proper attention is required towards stopping of cutting of natural vegetation in the district to save the environment.
Response of Organic Fertilizers on Sorghum: Greengram Intercropping on Yield Attribute, Yield, and Economics at Varying Row Ratios under Rainfed Situations
Authors: Kumar Neeraj , Uttam S. K. , Kumar Pradeep , Verma Shikhar , Dheer Vineet , Gautam Susheel
Published: April 2023

India is the largest producer of Pulses, however productivity is stills very low, and need of millet is also increasing day by day in this concern to utilize the filed efficiently to get higher millet yield as well as pulses per unit area.  A field experiment was conducted during kharif season of 2017 at Soil Conservation and Water Management Farm of the Chandra Shekhar Azad University of Agriculture and Technology, Kanpur to find out effect of cropping systems of different row ratio and doses of farm yard manure (FYM) on, yield and economics of crops under rainfed condition. The treatments comprised of 4 cropping systems i.e. (i) sole sorghum, 45 cm apart (ii) sole greengram, 45 cm apart (iii) sorghum + greengram (2:1 row ratio ) (iv) sorghum + greengram (3:1 row ratio) and 3 doses of FYM i.e. (i) without FYM (ii) 10 t/ha (iii) 20 t/ha were tested in Factorial Randomized block design with 3 replications. Results obtained that the yield of sorghum and greengram were highest in their sole stands. The yield of sole and intercropped greengram in terms of sorghum equivalent grain yield showed significantly (p <0.05) variation, whereas sorghum + greengram (2:1 row ratio) brought out significantly (p <0.05) the highest production as compared to other cropping systems. Moreover, the land equivalent ratio, gross return and net return were also found to be the highest. Simultaneously Increasing rates of FYM brought out significant (p <0.05) improvement in vegetative growth, yield attributes and grain/stover yield, where a dose of 10 t FYM/ha gave best performance in respect of vegetative growth, yield attributes and grain/stover yield. In addition, net return was also noticed higher.
Influence of Nitrogen and Zinc on Growth, Yield and Economics of Sorghum (Sorghum bicolor L.)
Authors: Kumar Amit , Umesha C. , Indu Thakur
Published: April 2023

A field experiment was conducted during kharif 2022 at Crop Research Farm, Department of Agronomy, SHUATS, Prayagraj (U.P) to study the “Influence of Nitrogen and Zinc on Growth, Yield and Economics of Sorghum (Sorghum bicolor L.)”. To Study treatment consisting of three levels of Nitrogen viz. 60, 80 and 100 kg/ha and three levels of Zinc viz. 15, 20 and 25 kg/ha. There were 10 treatments, each of which was replicated three times and laid out in randomized block design. The results showed that treatment 9 [Nitrogen 100 kg/ha + Zinc 25 kg/ha] recorded significant higher plant height (238.83 cm), higher dry weight (122.37 g), higher length of ear head (27.51 cm), higher seed yield (4430.43 kg/ha), higher stover yield (7246.58 kg/ha), higher number of grains/head (981.34) and higher harvest index (38.75 %) was recorded in treatment 9 [Nitrogen 100 kg/ha + Zinc 25 kg/ha]. Similarly, maximum gross return (1,46,993.65 INR/ha), maximum net return (99,186.03 INR/ha) and highest benefit cost ratio (2.08) was also recorded in treatment 9 [Nitrogen 100 kg/ha + Zinc 25 kg/ha] as compared to other treatments.
Effect of Intercropping Sonchus oleraceous with Maize and Cowpea on Biomass and Soil Conservation for Growth and Yield
Authors: Diana Bade M. , Patterson Semenye P. , Simon Muti M. , James Mwololo K.
Published: April 2023

Maize and cowpeas are important staple foods in Kilifi county and their productivity is highly constrained by increased incidences of pests, weeds and prolonged drought. These adversely affect maize yields and availability of cowpea leafy vegetables during the dry seasons. Sonchus oleraceaous, a common weed in most maize-cowpea cropping systems is widely used and most preferred in most households of the Kenyan coast as a leafy vegetable. However, its role as a vegetable and cover crop have not been exploited and or documented. This study was conceived to investigate the effects of Sonchus on maize-cowpea cropping systems, specifically as a cover crop. A randomized complete block design experiment replicated thrice was set at Pwani University Crop Science farm for two (2) cropping seasons in 2014 to 2016. Treatments included three (3) intercropping systems composed of maize, Sonchus and cowpeas, and the sole crops as a control with maize spacing of 90 by 60 and cowpea and Sonchus at 15cm by 60cm. Plant height, % ground cover, and biomass yields were determined for each treatment. High groundcover was observed in all the intercrops, and was highest where cowpea was part of the treatment. Biomass of Sonchus was highest in the sole crop, followed by the maize-Sonchus intercrop (>7.5tons/ha) and was lowest (2.5-2.78) in the Sonchus-cowpea intercrop (82-84% lower compared to the other treatments). The results showed that intercropping maize with Sonchus was feasible where in between space was sufficient. The implication is that Sonchus can be integrated in maize farming systems for crop diversification as a vegetable to maximize on land productivity and contribute to nutrition. Further research on spacing and density for maize and Sonchus intercrop should be carried out to develop an agronomic package that would ensure maximum returns for promotion to farmers.
The Compliance and Quality of Biological Examination Requests at the Douala General Hospital
Authors: Pierre Nda Mefo'o Jean , Arnauld Ondoua Jacques , Pierre Ngene Jean , Emmanuel Mbosso Teinkela Jean , Elodie Ngo Malabo , Clémence Olemba , Christian Ngoule Charles , Gisèle Etame Loe , Cécile Okalla Ebongue
Published: April 2023

Introduction: The prescription of biological examinations is the first step in guaranteeing the quality of the results of the biological analyzes given by the laboratory. Indeed, the irregularity of requests for biological examinations makes it difficult to carry out and interpret the results and also compromises the optimal and rational use of the diagnostic aid tool that is the clinical biology laboratory. The purpose of this study was to assess the compliance and quality of Biological Examinations Requests (BERs) at the Douala General Hospital (DGH)

Material and Methods: A descriptive cross-sectional study was conducted from January to June 2022 in the clinical biology laboratory department of the DGH. The information provided on each request for examinations was evaluated using a technical sheet containing the evaluation grids of the ISO 15189 standard.

Results: A total of 1765 BERs from 10 known clinical departments and 5.20% (n = 91) with no details on the department were analyzed. Prescriber qualification was absent in 13.31% (n=235), clinical information was notified in 23.79% (n=420), prescriber contact in 2.89% (n=51). The compliance assessment revealed that 49% (n=867) requests were non-compliant. Furthermore, a correlation was observed between non-compliant BERs and the internal medicine department (OR = 0.52 and P-value = 0.038) and medical specialists (OR = 0.576 and P-value = 0.048) with a significant association.

Conclusion: It was observed that the non-compliant BERs lacked information identifying the patient, the prescriber, as well as the examination/sample. The ISO standard recommends the accuracy of this information. Because their absence would make it impossible to carry out the examinations, waste of time searching for the service/prescriber for additional information or for the return of the results. These results suggest an improvement in practices in the prescription of medical biology analyzes at the DGH in particular and in Cameroon in general.
Modelling Uncertainty Effects in Decision Taking in Buyer-Supplier Relations
Authors: Kamann Dirk-Jan F.
Published: April 2023

Purpose: To develop a model that shows the different aspects that play a role in decision making in buyer-supplier relations when facing uncertainty.

Methodology: Process steps and relevant aspects were distilled from a broad literature review and evaluated in a Mini-Delphi style workshop.

Findings: An accumulative three-layered model shows (1) the assumed decision flow of the decision maker’s process under uncertainty; (2) the assumed behavioural aspects affecting this decision flow; (3) manifest variables and latent constructs related to the decision flow.

Relevance: The proposed model is designed to be used for surveys and gamification experiments, with relevant operationalised variables made explicit.
Application of Segmental Prefabrication Method in Railway Bridge Construction
Authors: Mengen Song
Published: April 2023

Segmental prefabrication construction method is a bridge construction technology that divides a span bridge into several segments along the axis direction, prefabricated in batch at the beam yard and transported to the construction site for assembly. This method has been gradually popularized for its advantages of rapid construction, green environment protection and strong adaptability. In this paper, the application status of this method at home and abroad, the key points of construction technology are summarized, and the technical characteristics, advantages and disadvantages are summarized, so as to provide a reference for the project using this method.
Evaluating Morning Reports by Emergency Medicine Residents
Authors: Alotaibi Majed Alawe , Alahmari Ali , Almujalli Yazeed Mousa
Published: April 2023

Background: Inpatient case-based teaching is used in morning report (MR). In light of the quick changes in medical practice, it's critical to gauge the residents' opinions of this teaching approach. In order to determine the viewpoint of emergency medicine residents on different parts of morning reports and to suggest a format based on our observations, our study used an observational cross-sectional methodology.

Methods: Residents of King Saud Medical City (KSMC), King Salman Hospital, Aliman General Hospital, and Imam Abdulrahman Alfaisal Hospital participated in an observational cross-sectional survey on morning reports. The residents were given a 22-item questionnaire that asked them about the objective, structure, and substance of the morning report as well as who would be the best choice to present and conduct it and how frequently it should be done. The statistical program "Statistical Package for Social Sciences" was used for the analyses (SPSS).

Results: 88.6% of residents agreed that the morning report should be presented by the post-call faculty. 53.3% of respondents said they preferred a general internist, while the chief resident who was conducting the report received a nearly identical response rate (54.6%). Discussion of particular intriguing instances was preferred by 34.6% of the residents since it would aid those 70% more in their post-graduate exams. The residents strongly agreed that management difficulties (86.6%) and diagnostic workup (90%) should be discussed in the morning report. Evidence-based medicine (66.6%) and disease processes (67.3% each) received equal ratings.

Conclusion: Morning reports are a valuable instructional tool and ought to be a requirement of all postgraduate residency programs, both domestically and abroad.
Weak Membrane Stabilizing Activity of Sydowinin B and Pitholide B
Authors: Alade G. O. , Ajibesin K. K.
Published: April 2023

Background: There is a dire need for anti-inflammatory agents presently to solve many health challenges. Extracts of endophytic fungi have been implicated a lot in this area. The aim of the study was to test isolated compounds from the extract of Pestalotiopsis clavispora residing in Phoenix reclinata.

Methods: Fungal isolation from Phoenix reclinata, cultivation, extraction isolation of compounds, characterisation and membrane stabilisation assay were carried out by standard methods.

Results and Discussion: From the extract of P. clavispora, was isolated three compounds which are 7,8-dihydroxanthenone-8-carboxylic acid methyl ester,sydowinin B and pitholide B. The fungus was from the mangrove plant Phoenix reclinata Jacq. (Arecaceae).

Sydowinin B and pitholide B exhibited a very weak membrane stabilizing activity of 4.5 and 2% respectively, at 100 µg/mL and 5% at 200 µg/mL for the two compounds.

Conclusion: The compounds have not been isolated before from this fungus and they exhibited a   very weak membrane stabilizing activity.
Quantitative Measurements of Macular and Optic Nerve Head Blood Flow Parameters Following Cataract Surgery in Eye Department, Red Cross Tertiary General Hospital, Athens, Greece
Authors: Kouroupaki A. I. , Pateras E. , Karabatsas K.
Published: April 2023

Objective: To evaluate the effect of uncomplicated cataract surgery on macular and optic nerve head blood flow with Optical Coherence Tomography Angiography (OCT-A). Retinal vascular changes and macular vessel remodeling following cataract surgery is an area of interest, as the effect, cause and duration of such changes remain debatable.

Setting: Eye Department, Red Cross Tertiary General Hospital, Athens, Greece.

Methods: In this study, we recruited cataract surgery candidates who had regular post operative visits and underwent longitudinal OCT-A examinations before and after surgery.

Results: Macular vessel density increased in the post operative visits both in the superficial (SCP) and deep capillary network (DCP) (P<0.001) and showed a persistent effect over 3 months follow-up. Macular thickness increased over the first postoperative month, but returned to preoperative values at 3 months. Foveal avascular zone (FAZ) measurements and vessel density at radial peripapillary capillaries (RPC) were unaffected.

Conclusions: OCT-A enables a quantitative analysis of blood flow by regular patient monitoring. In this study, we found that after cataract surgery, macular blood flow increased significantly. The reason for this could be attributed to post operative inflammatory process or vascular remodeling due to change in retinal metabolic demands.
Association of State-Level Tax Policy and Infant Mortality in the United States, 1996-2019
Authors: Junior Jean A. , Lee Lois K. , Fleegler Eric W. , Monuteaux Michael C. , Niescierenko Michelle L. , Stewart Amanda M.
Published: April 2023

Importance

Infant mortality in the United States is highest among peer nations; it is also inequitable, with the highest rates among Black infants. The association between tax policy and infant mortality is not well understood.

Objective

To examine the association between state-level tax policy and state-level infant mortality in the US.

Design, Setting, and Participants

This state-level, population-based cross-sectional study investigated the association between tax policy and infant mortality in the US from 1996 through 2019. All US infant births and deaths were included, with data obtained from the National Center for Health Statistics. Data were analyzed from November 28, 2021, to July 9, 2022.

Exposures

State-level tax policy was operationalized as tax revenue per capita and tax progressivity. The Suits index was used to measure tax progressivity, with higher progressivity indicating increased tax rates for wealthier individuals.

Main Outcomes and Measures

The association between tax policy and infant mortality rates was analyzed using a multivariable, negative binomial, generalized estimating equations model. Since 6 years of tax progressivity data were available (1995, 2002, 2009, 2012, 2014, and 2018), 300 state-years were included. Adjusted incidence rate ratios (aIRRs) were calculated controlling for year, state-level demographic variables, federal transfer revenue, and other revenue. Secondary analyses were conducted for racial and ethnic subgroups.

Results

There were 148 336 infant deaths in the US from 1996 through 2019, including 27 861 Hispanic infants, 1882 non-Hispanic American Indian or Alaska Native infants, 5792 non-Hispanic Asian or Pacific Islander infants, 41 560 non-Hispanic Black infants, and 68 666 non-Hispanic White infants. The overall infant mortality rate was 6.29 deaths per 1000 live births. Each $1000 increase in tax revenue per capita was associated with a 2.6% decrease in the infant mortality rate (aIRR, 0.97; 95% CI, 0.95-0.99). An increase of 0.10 in the Suits index (ie, increased tax progressivity) was associated with a 4.6% decrease in the infant mortality rate (aIRR, 0.95; 95% CI, 0.91-0.99). Increased tax progressivity was associated with decreased non-Hispanic White infant mortality (aIRR, 0.95; 95% CI, 0.91-0.99), and increased tax revenue was associated with increased non-Hispanic Black infant mortality (aIRR, 1.04; 95% CI, 1.01-1.08).

Conclusions and Relevance

In this cross-sectional study, an increase in tax revenue and the Suits index of tax progressivity were both associated with decreased infant mortality. These associations varied by race and ethnicity. Tax policy is an important, modifiable social determinant of health that may influence state-level infant mortality.
Characterization of scanning orientation and lateral response artifact for EBT4 Gafchromic film
Authors: Miura Hideharu , Ozawa Shuichi , Okazue Toshiya , Enosaki Tsubasa , Nagata Yasushi
Published: April 2023

The purpose of this study was to investigate the impact of scanning orientation and lateral response artifact (LRA) effects on the dose‐response of EBT4 films and compare it with that of EBT3 films. Dose‐response curves for EBT3 and EBT4 films in red‐green‐blue (RGB) color channels in portrait orientation were created for unexposed films and for films exposed to doses ranging from 0 to 1 000 cGy. Portrait and landscape orientations of the EBT3 and EBT4 films were scanned to investigate the scanning orientation effect in the red channel. EBT3 and EBT4 films were irradiated to assess the LRA in the red channel using a field size of 15 × 15 cm2 and delivered doses of 200, 400, and 600 cGy. Films were scanned at the edge of the scanner bed, and the measured doses were compared with the treatment planning system (TPS) calculated doses at a position 100 mm lateral to the scanner center. At a dose of 200 cGy, the differences in optical density (OD) in the red, green, and blue color channels between EBT3 and EBT4 films were 0.035 (24.8%), 0.042 (49.7%), and 0.022 (64.4%), respectively. The EBT4 film slightly improved the scanning orientation compared to the EBT3 film. The OD difference in the different scanning orientations for the EBT3 and EBT4 films was 0.015 (6.8%) and 0.007 (3.9%), respectively, at a dose of 200 cGy. This is equivalent to a 20 or 10 cGy variation at a dose of 200 cGy. Compared with the TPS calculation, the measurement doses for EBT3 and EBT4 films irradiated at 200 cGy were approximately 16% and 13% higher, respectively, at the 100 mm off‐centered position. The EBT4 film showed an improvement concerning the impact of LRA compared with the EBT3 film. This study demonstrated that the response of EBT4 film to a dose in the blue channel was less sensitive and showed an improvement in the scanning orientation and LRA effects.
Sensitivity and specificity of Varian Halcyon's portal dosimetry for plan‐specific pre‐treatment QA
Authors: Razinskas Gary , Schindhelm Robert , Sauer Otto A. , Wegener Sonja
Published: April 2023

Purpose

Developed as a plan‐specific pre‐treatment QA tool, Varian portal dosimetry promises a fast, high‐resolution, and integrated QA solution. In this study, the agreement between predicted fluence and measured cumulative portal dose was determined for the first 140 patient plans at our Halcyon linear accelerator. Furthermore, the capability of portal dosimetry to detect incorrect plan delivery was compared to that of a common QA phantom. Finally, tolerance criteria for verification of VMAT plan delivery with Varian portal dosimetry were derived.

Methods

All patient plans and the corresponding verification plans were generated within the Eclipse treatment planning system. Four representative plans of different treatment sites (prostate, prostate with lymphatic drainage, rectum, and head & neck) were intentionally altered to model incorrect plan delivery. Investigated errors included both systematic and random errors. Gamma analysis was conducted on both portal dose (criteria γ2%/2 mm, γ2%/1 mm, and γ1%/1 mm) and ArcCHECK measurements (criteria γ3%/3 mm, γ3%/2 mm, and γ2%/2 mm) with a 10% low‐dose threshold. Performance assessment of various acceptance criteria for plan‐specific treatment QA utilized receiver operating characteristic (ROC) analysis.

Results

Predicted and acquired portal dosimetry fluences demonstrated a high agreement evident by average gamma passing rates for the clinical patient plans of 99.90%, 96.64%, and 91.87% for γ2%/2 mm, γ2%/1 mm, and γ1%/1 mm, respectively. The ROC analysis demonstrated a very high capability of detecting erroneous plan delivery for portal dosimetry (area under curve (AUC) > 0.98) and in this regard outperforms QA with the ArcCHECK phantom (AUC ≈ 0.82). With the suggested optimum decision thresholds excellent sensitivity and specificity is simultaneously possible.

Conclusions

Owing to the high achievable spatial resolution, portal dosimetry at the Halcyon can reliably be deployed as plan‐specific pre‐treatment QA tool to screen for errors. It is recommended to support the fluence integrated portal dosimetry QA by independent phantom‐based measurements of a random sample survey of treatment plans.
Microwave‐Assisted Fabrication of Superamphiphobic Surfaces on Aluminum Substrates
Authors: Rangel Thomaz Cabral , Backes Cláudio César Weber , Michels Alexandre Fassini , Weibel Daniel Eduardo
Published: April 2023

The field of superamphiphobic surface fabrication has evolved rapidly in the last decade; however, research on important issues such as sustainability and green chemistry procedures is still scarce. Herein, a simple method of microwave irradiation (MW) to minimize energy consumption during the preparation of superamphiphobic aluminum (Al) surfaces is reported. Al substrates are first etched in diluted HCl solutions to generate a microstructure and then irradiated in a commercial microwave unit for several time intervals, temperatures, and pressures. The surfaces are then coated with different compounds, and the wettability is tested with high and very‐low surface tension liquids. Optical profilometry and scanning electron microscopy images show that the density of hierarchical micro‐nanostructures increases with MW time, temperature, and pressure. At 170 °C and 7.9 bar, the surfaces present a high density of structures and re‐entrant topographies. The obtained coatings display excellent repellence to liquids with surface tensions as low as 27.5 mN m−1. X‐ray photoelectron spectroscopy data show the importance of efficient surface functionalization for the production of superamphiphobicity in Al substrates. The results show that MW irradiation of Al substrates can be a green and efficient method for fabricating superamphiphobic surfaces.
Dynamic Supramolecular Polymer Electrolyte to Boost Ion Transport Kinetics and Interfacial Stability for Solid‐State Batteries
Authors: Zhao Long , Du Yunfei , Zhao Erqing , Li Changgong , Sun Zixu , Li Yutao , Li Hao
Published: April 2023

The key hurdle to the practical application of polymeric electrolytes in high‐energy‐density solid lithium‐metal batteries is the sluggish Li+ mobility and inferior electrode/electrolyte interfacial stability. Herein, a dynamic supramolecular polymer electrolyte (SH‐SPE) with loosely coordinating structure is synthesized based on poly(hexafluoroisopropyl methacrylate‐co‐N‐methylmethacrylamide) (PHFNMA) and single‐ion lithiated polyvinyl formal. The weak anti‐cooperative H‐bonds between the two polymers endow SH‐SPE with a self‐healing ability and improved toughness. Meanwhile, the good flexibility and widened energy gap of PHFNMA enable SH‐SPE with efficient ion transport and superior interfacial stability in high‐voltage battery systems. As a result, the as‐prepared SH‐SPE exhibits an ionic conductivity of 2.30 × 10−4 S cm−1, lithium‐ion transference number of 0.74, electrochemical stability window beyond 4.8 V, and tensile strength up to 11.9 MPa as well as excellent adaptability with volume change of the electrodes. In addition, no major electrolyte decomposition inside batteries made from SH‐SPE and LiNi0.8Mn0.1Co0.1O2 cathode can be observed in the in situ differential electrochemical mass spectrometry test. This study provides a new methodology for the macromolecular design of polymer electrolytes to address the interfacial issues in high‐voltage solid batteries.
Toward Forty Thousand‐Cycle Aqueous Zinc‐Iodine Battery: Simultaneously Inhibiting Polyiodides Shuttle and Stabilizing Zinc Anode through a Suspension Electrolyte
Authors: Chen Guanhong , Kang Yuanhong , Yang Huiya , Zhang Minghao , Yang Jin , Lv Zeheng , Wu Qilong , Lin Pengxiang , Yang Yang , Zhao Jinbao
Published: April 2023

Aqueous zinc‐iodine (Zn‐I2) batteries are promising candidates for grid‐scale energy storage due to their safety and cost‐effectiveness. However, the shuttle effect of polyiodides, Zn corrosion, and accumulation of by‐products restrict their applications. Herein, a simple vermiculite nanosheets (VS) suspension electrolyte is designed for simultaneous confinement of polyiodides and stabilization of Zn anode. It is found that the generation of I5− as dominant intermediate and the precipitation reaction between I5− and alkaline by‐products should cause irreversible iodine species loss. Benefiting from the high binding energy between polyiodides and silica‐oxygen bonds of VS, dissolved polyiodides are effectively anchored on the surface of VS suspended in the bulk electrolyte to suppress the shuttle effect, which is confirmed by in situ Raman, Ultraviolet‐visible characterizations and theoretical calculations. Furthermore, the self‐assembly VS interfacial layer on the surface of Zn anode hinders side reactions induced by polyiodides. Meanwhile, the interlayer and surface excess negative charges of VS tend to be compensated by Zn2+ from diffuse layer, which serves as ion accelerators for transferring Zn2+ at the interface immediately, rendering dendrite‐free Zn plating/stripping behavior. Consequently, the Zn‐I2 battery with VS electrolyte achieves an ultra‐long lifespan of 40000 cycles with a negligible capacity decay at 20 C.