bluuebunny/crossref_metadata_2025 huggingface dataset:
The incidence of gestational diabetes mellitus among women with polycystic ovary syndrome: a meta-analysis of longitudinal studies
Authors: Yan Qingzi , Qiu Dan , Liu Xiang , Xing Qichang , Liu Renzhu , Hu Yixiang
Published: April 2022

Background

Previous studies have shown that polycystic ovary syndrome is a predictor of gestational diabetes mellitus, but we do not know exactly how many polycystic ovary syndrome patients may develop gestational diabetes mellitus. Currently, the incidence of gestational diabetes mellitus among women with polycystic ovary syndrome varies greatly across studies, ranged from 4.12% to 59.50%. Besides, many factors have been found to be related to the incidence of gestational diabetes mellitus among women with polycystic ovary syndrome, but the results among different studies are not consistent. The possible causes of inconsistencies between the current estimates were unclear. This review aimed at exploring the pooled incidence of gestational diabetes mellitus among women with polycystic ovary syndrome, summarizing possible causes of the inconsistencies in the current estimates, try to provide a reference for prevention of gestational diabetes mellitus and polycystic ovary syndrome in the future.

Methods

Systematic searches of different databases (including EMBASE, Web of Science, MEDLINE, The Cochrane Library, CNKI and PubMed) were conducted for studies published until 31 May 2021. Statistical analyses were performed using R software, the pooled incidence of gestational diabetes mellitus among polycystic ovary syndrome patients was combined using random effects model. Cochrane’s “Tool to Assess Risk of Bias in Cohort Studies” was used for quality assessment.

Results

Twenty-two longitudinal studies were included. A total of 24,574 women with polycystic ovary syndrome were identified in the 22 articles, of which 4478 were reported with gestational diabetes mellitus. The pooled incidence of gestational diabetes mellitus among women with polycystic ovary syndrome was 20.64%, with a 95% CI of 14.64% to 28.30%. In the meta-regression model, several variables including age, area, quality score and sample size were suggested as significant sources of heterogeneity, accounted for 77.57% of the heterogeneity across studies.

Conclusions

Evidence in this review suggests that gestational diabetes mellitus were common among women with polycystic ovary syndrome. More research is needed to found effective interventions for preventing gestational diabetes mellitus among women with polycystic ovary syndrome.
Combined anteroposterior approaches in lateral position treatment of lumbosacral tuberculous in single-stage
Authors: Bai Jianqiang , Xia Qun , Miao Jun
Published: April 2022

Background

The local anatomy of the lumbosacral region of spine is complicated, with special biomechanical characteristics. For surgical management of tuberculous spondylitis reported in the literature, the methods would be two-stage anterior and posterior approaches or one-stage anterior and posterior approach with patient’s intraoperative position being changed. These types of surgery approaches would result in long operative duration and more intraoperative blood loss, and most important there is no coordination between anterior and posterior procedures.

Methods

The purpose of this study was to introduce a new procedure called in the lateral position single -stage combined anteriorposterior approaches for treatment of lumbosacral tuberculous spondylitis and to evaluate its preliminary surgical outcomes. Fifteen patients with lumbosacral tuberculous spondylitis who underwent single-stage anterior and posterior radical focal debridement and reconstruction in lateral position in our hospital from April 2005 to June 2012 were included in the study. There were 6 males and 9 females with the average age of 46.8 years. The tuberculous lesions involved the following regions: L3-4 in 5cases, L4-5 in 5 cases, L5-S1 in 2 cases, L4 in one case, and L5 in 2 cases. The assessment of surgical outcomes was conducted with clinical symptoms and radiological findings,including operative time, blood loss. deformity angle, Frankel grade and Kirkaldy-Willis evaluation.

Results

Operation posture: The right lateral position was used for 11 patients and the left lateral position was used for the remaining 4 patients. The average duration of operation for the 15 patients was 270 min. The average intraoperative blood loss was 1720 ml. The mean follow-up period was 4.2 years. There was no recurrence. The postoperative radiological findings showed that the interbody bone grafts were fixed without any dislodgment. There was significant difference between preoperative and postoperative lumbosacral lordotic angles. Kirkaldy-Willis classification rating for the 13 cases with satisfactory results.

Conclusion

Single-stage combined anterior and posterior surgical management of lumbosacral tuberculous spondylitis with patient in lateral position can achieve radical focal debridement, anterior and posterior procedure coordination and spinal reconstruction.
A comparative study of transperineal software-assisted magnetic resonance/ultrasound fusion biopsy and transrectal cognitive fusion biopsy of the prostate
Authors: Hsieh Po-Fan , Chang Tian-You , Lin Wei-Ching , Chang Han , Chang Chao-Hsiang , Huang Chi-Ping , Yang Chi-Rei , Chen Wen-Chi , Chang Yi-Huei , Wang Yu-De , Huang Wen-Chin , Wu Hsi-Chin
Published: April 2022

Background

The advantages and disadvantages of transperineal and transrectal biopsies remain controversial in the era of prostate targeted biopsy. In this study, we compared the cancer detection and complication rates of transperineal magnetic resonance/ultrasound (MR/US) fusion biopsy and transrectal cognitive fusion biopsy of the prostate.

Methods

This was a comparative study of two prospectively collected cohorts. Men with clinically suspected prostate cancer and prostate imaging reporting and data system (PI-RADS) score ≥ 3 lesions on multi-parametric magnetic resonance imaging (mpMRI) were enrolled. They underwent either transperineal software fusion biopsy or transrectal cognitive fusion biopsy and systematic biopsy. The detection rates of any prostate cancer and clinically significant prostate cancer (csPC, defined as Gleason score ≥ 3 + 4) and the complication rates between both groups were analysed.

Results

Ninety-two and 85 patients underwent transperineal software fusion and transrectal cognitive fusion biopsies, respectively. The detection rate for any prostate cancer was similar between both groups (60.8% vs. 56.4%, p = 0.659). In terms of csPC detection, transperineal fusion biopsy outperformed transrectal fusion biopsy (52.2% vs. 36.5%, p = 0.036). In multivariate regression analysis, age, PI-RADS score > 3, and transperineal route were significant predictors of csPC. Meanwhile, transperineal biopsy resulted in a higher rate of urinary retention than transrectal biopsy (18.5% vs. 4.7%, p = 0.009). No serious infectious complications were noted, although a patient developed sepsis after transrectal biopsy.

Conclusions

Transperineal software fusion biopsy provided a higher csPC detection rate than transrectal cognitive fusion biopsy and carried minimal risk for infectious complications in patients with MRI-visible prostate lesions.
The impact of a digital joint school educational programme on post-operative outcomes following lower limb arthroplasty: a retrospective comparative cohort study
Authors: Gray Joanne , McCarthy Stephen , Carr Esther , Danjoux Gerard , Hackett Rhiannon , McCarthy Andrew , McMeekin Peter , Clark Natalie , Baker Paul
Published: April 2022

Background

As part of an ongoing service improvement project, a digital ‘joint school’ (DJS) was developed to provide education and support to patients undergoing total hip (THR) and total knee (TKR) replacement surgery. The DJS allowed patients to access personalised care plans and educational resources using web-enabled devices, from being listed for surgery until 12 months post-operation. The aim of this study was to compare a cohort of patients enrolled into the DJS with a cohort of patients from the same NHS trust who received a standard ‘non-digital’ package of education and support in terms of Health-Related Quality of Life (HRQoL), functional outcomes and hospital length of stay (LoS).

Methods

A retrospective comparative cohort study of all patients undergoing primary TKR/THR at a single NHS trust between 1st Jan 2018 and 31st Dec 2019 (n = 2406) was undertaken. The DJS was offered to all patients attending the clinics of early adopting surgeons and the remaining surgeons offered their patient’s standard written and verbal information. This allowed comparison between patients that received the DJS (n = 595) and those that received standard care (n = 1811). For each patient, demographic data, LoS and patient reported outcome measures (EQ-5D-3L, Oxford hip/knee scores (OKS/OHS)) were obtained. Polynomial regressions, adjusting for age, sex, Charlson Comorbidity Index (CCI) and pre-operative OKS/OHS or EQ-5D, were used to compare the outcomes for patients receiving DJS and those receiving standard care.

Findings

Patients that used the DJS had greater improvements in their EQ-5D, and OKS/OHS compared to patients receiving standard care for both TKR and THR (EQ-5D difference: TKR coefficient estimate (est) = 0.070 (95%CI 0.004 to 0.135); THR est = 0.114 (95%CI 0.061 to 0.166)) and OKS/OHS difference: TKR est = 5.016 (95%CI 2.211 to 7.820); THR est = 4.106 (95%CI 2.257 to 5.955)). The DJS had a statistically significant reduction on LoS for patients who underwent THR but not TKR.

Conclusion

The use of a DJS was associated with improved functional outcomes when compared to a standard ‘non-digital’ method. The improvements between pre-operative and post-operative outcomes in EQ-5D and OKS/OHS were higher for patients using the DJS. Furthermore, THR patients also had a shorter LoS.
Clinical heterogeneity of ocular Behçet’s syndrome versus intestinal Behçet’s syndrome: a cross-sectional study from Shanghai Behçet’s syndrome database
Authors: Hou Cheng-cheng , Luo Dan , Bao Hua-fang , Ye Jing-fen , Ma Hai-fen , Shen Yan , Zou Jun , Guan Jian-long
Published: April 2022

Background

Behçet’s syndrome (BS) is a rare variant vasculitis which can involve the eyes and gastrointestinal systems. However, ocular involvement rarely overlaps with intestinal lesions. This study aimed to compare the clinical characteristics and laboratory parameters of ocular BS and intestinal BS patients in China and analyze the differences between two key phenotypes to verify the heterogeneous conditions in BS patients.

Methods

A retrospective analysis was used to collect the demographic data, clinical characteristics, endoscopic findings, and laboratory parameters from 135 ocular BS and 174 intestinal BS patients. The Mann-Whitney U test and Pearson chi-square or continuity correction was used to analyze the differences between two groups.

Results

Among 916 BS patients enrolled in this study, ocular BS and intestinal BS accounted for 14.74% (135 cases) and 19.00% (174 cases), respectively. Ocular and intestinal involvements overlapped in only 7 cases (0.76%). Male gender (74.8% vs. 51.1%, P=0.00), erythema nodosum (45.9% vs. 32.2%, P=0.01), and vascular involvement (6.7% vs. 1.7%, P=0.03) were more frequent in the ocular BS group compared with the intestinal BS group. On the contrary, hematologic involvement (7.5% vs. 0.0%, P=0.00) and fever (17.8% vs. 4.4%, P=0.00) were more frequent in the intestinal BS group compared with the ocular BS group. Additionally, the inflammation markers including ESR [26.5 (16.0–41.5) vs. 9.0 (5.0–15.0) mm/H, P=0.00], CRP [14.8 (4.8–33.0) vs. 4.1 (1.6–8.3) mg/L, P=0.00], serum amyloid A [27.4 (10.8–92.3) vs. 11.3 (6.0–24.0) mg/L, P=0.00], and interleukin 6 [8.4 (1.7–18.7) vs. 1.7 (1.5–3.2) pg/mL, P=0.00] were higher in the intestinal BS group than those in the ocular BS group, respectively.

Conclusions

Ocular BS was more prevalent in male patients and more likely to manifest with erythema nodosum and vascular involvement, while intestinal BS tends to have fever and hematologic disorders with higher inflammation markers. Ocular BS and intestinal BS are two distinct clinical phenotypes and very rarely overlapped.
The association between diabetes coexisting with low levels of high-density lipoprotein cholesterol and peritoneal dialysis-related peritonitis
Authors: Zhang Rui , Zhang Xing , Tang Xingming , Tang Liwen , Shang Sijia , Wang Xiaoyang , Wen Yueqiang , Feng Xiaoran , Zhou Qian , Su Ning , Huang Yajuan
Published: April 2022

Background

Low levels of high-density lipoprotein cholesterol (HDL-C) and diabetes are common in patients undergoing peritoneal dialysis (PD). The aim of this study was to investigate the association between the coexistence of diabetes with a low level of HDL-C and the first episode of peritoneal dialysis-related peritonitis (PDRP) in patients with PD.

Methods

We retrospectively investigated patients with PD from January 1, 2003, to May 31, 2020, in four PD centers. Patients with PD were divided into four groups: no comorbidities, low HDL-C only, diabetes only, and diabetes plus low HDL-C. The clinical and laboratory baseline data of the four groups were collected and compared. The association between diabetes coexisting with low HDL-C levels and the first episode of PDRP was analyzed by multivariate Cox regression analysis.

Results

A total of 1013 patients with PD were included in our study. The mean age was 49.94 ± 14.32 years, and 597 (58.99%) patients were males. A total of 301 (29.7%) patients had their first episodes of PDRP, and low HDL-C levels coexisted with diabetes in 72 patients with PD. After adjusting for confounding factors, a low level of HDL-C coexisting with diabetes was significantly associated with the first episode of PDRP in our study (hazard ratio: 2.81, 95% CI 1.32 ~ 4.73, p = 0.005). The associations among HDL-C, diabetes and PDRP were consistent in the following subgroups: sex, age, and pre-existing CVD (all P interaction > 0.05).

Conclusions

Patients with both diabetes and low HDL-C levels were at higher risk for PDRP in patients with PD.
Evaluation of patients with oral squamous cell carcinoma treated by radical irradiation with mold radiotherapy using a customized device: a retrospective clinical study
Authors: Noguchi Tadahide , Sugiura Yasushi , Dohi Akihiro , Yamada Manabu , Okada Naruo , Sasaguri Ken-ichi , Takahashi Satoru , Mori Yoshiyuki
Published: April 2022

Background

It is very important to determine the indication of mold radiotherapy for the radical treatment of oral cancer. We investigated eight patients with oral squamous cell carcinoma who were treated by radical irradiation with mold radiotherapy using a customized device.

Methods

The subject is a case of curable superficial oral cancer of a few millimeters, or cancer of a size that can be cured by the placement of the radiation source. Of the eight patients, six were male and two were female, aged 64–93 years (mean, 78.9 years; median, 73.5 years). The primary sites were the buccal mucosa in three cases, gingiva in two cases, and floor of the mouth, soft palate, and lower lip in one case each. Five cases were in the T1 stage, and the remaining three cases were in T2. With respect to thickness, seven cases were of the superficial type and could not be detected by magnetic resonance imaging or computed tomography, and the remaining case showed a tumor thickness of 7.5 mm. All cases were diagnosed as squamous cell carcinoma by biopsy. Radical irradiation using mold radiotherapy was planned for all eight patients. Irradiation was delivered in 9–10 sessions, with a total dose of 45–50 Gy.

Results

Complete response was attained in six of the eight patients and partial response was observed in two patients, requiring additional treatment.

Conclusion

Since all patients with complete response had superficial cancers, we hypothesized that superficial cancers of the oral cavity with thicknesses of few millimeters could be indicated for mold irradiation. This method can be applied in complicated cases and older patients in whom surgery or chemotherapy may not be feasible. We believe that the results of our clinical studies will be of great help in choosing this method.
Community drug retail outlet staff’s knowledge, attitudes and practices towards non-prescription antibiotics use and antibiotic resistance in the Amhara region, Ethiopia with a focus on non-urban towns
Authors: Belachew Sewunet Admasu , Hall Lisa , Selvey Linda A.
Published: April 2022

Introduction

Some evidence suggests that knowledge and attitudes towards rational antibiotic use influences dispensing practice in community drug retail outlets. However, there is limited evidence in resource limited countries, including Ethiopia. We aimed to assess the knowledge and attitudes surrounding antibiotic use or supply and antibiotic resistance, and the non-prescribed antibiotic dispensing practices in community drug retail outlets in non-urban Ethiopia.

Methods

We conducted a cross-sectional survey of community drug retail outlet staff in the Amhara region, Ethiopia with a focus on non-urban towns. An expert validated self-administered questionnaire was used. Following exploratory factor analysis and best items selection, we summarised our findings and assessed factors associated with non-prescribed antibiotic dispensing. The data were analysed using Stata Statistical Software version 17. P-values < 0.05 were considered significant.

Results

A total of 276 participants from 270 drug outlets completed the questionnaire. The participants median age was 30 (Interquartile range (IQR) = 25–35) years and 79.7% were pharmacy assistants. The majority demonstrated good levels of knowledge about antibiotic use or supply and antibiotic resistance (77.9% and 76% of the participants responded correctly to more than half of the items, respectively). We identified four attitude domains: the role of antibiotics in recovering from diseases regardless of their cause (median score = 2 (IQR = 2–4), beliefs inconsistent with good practice); professional competency to supply non-prescribed antibiotics, and the non-prescribed antibiotics supply (median score for each domain = 4 (IQR = 4–5), attitudes consistent with good practice); and positive attitudes towards actions to prevent antibiotic resistance and promote appropriate antibiotic use (median score = 4 (IQR = 4–5). Fifty eight percent of the participants reported that they had dispensed antibiotics without a prescription. Participants who did not perceive that they were competent to supply non-prescribed antibiotics (adjusted odds ratio = 0.86, 95% confidence interval = 0.78–0.93) were less likely to report non-prescribed antibiotics dispensing.

Conclusion

While most of the participants had appropriate knowledge about and attitudes to antibiotic use and antibiotic resistance, basic knowledge and attitude gaps remain. Despite Ethiopia’s regulatory restrictions, the non-prescribed antibiotic provision continues to be a common practice. Our study highlights the need for multifaceted interventions that may include a strict regulatory system, staff training and public education.
Using meta-learning for automated algorithms selection and configuration: an experimental framework for industrial big data
Authors: Garouani Moncef , Ahmad Adeel , Bouneffa Mourad , Hamlich Mohamed , Bourguin Gregory , Lewandowski Arnaud
Published: April 2022

Advanced analytics are fundamental to transform large manufacturing data into resourceful knowledge for various purposes. In its very nature, such “industrial big data” can relay its usefulness to reach further utilitarian applications. In this context, Machine Learning (ML) is among the major predictive modeling approaches that can enable manufacturing researchers and practitioners to improve the product quality and achieve resource efficiency by exploiting large amounts of data (which is collected during manufacturing process). However, disposing ML algorithms is a challenging task for manufacturing industrial actors due to the prior specification of one or more algorithms hyperparameters (HPs) and their values. Moreover, manufacturing industrial actors often lack the technical expertise to apply advanced analytics. Consequently, it necessitates frequent consultations with data scientists; but such collaborations tends to cost the delays, which can generate the risks such as human-resource bottlenecks. As the complexity of these tasks increases, so does the demand for support solutions. In response, the field of automated ML (AutoML) is a data mining-based formalism that aims to reduce human effort and speedup the development cycle through automation. In this regard, existing approaches include evolutionary algorithms, Bayesian optimization, and reinforcement learning. These approaches mainly focus on providing the user assistance by automating the partial or entire data analysis process, but they provide very limited details concerning their impact on the analysis. The major goal of these conventional approaches has been generally focused on the performance factors, while the other important and even crucial aspects such as computational complexity are rather omitted. Therefore, in this paper, we present a novel meta-learning based approach to automate ML predictive models built over the industrial big data. The approach is leveraged with development of, AMLBID, an Automated ML tool for Big Industrial Data analyses. It attempts to support the manufacturing engineers and researchers who presumably have meager skills to carry out the advanced analytics. The empirical results show that AMLBID surpasses the state-of-the-art approaches and could retrieve the usefulness of large manufacturing data to prosper the research in manufacturing domain and improve the use of predictive models instead of precluding their outcomes.
Spontaneous rupture of an undifferentiated carcinoma with osteoclast-like giant cells of the pancreas presenting as intra-abdominal bleeding: a case report
Authors: Tomihara Hideo , Hashimoto Kazuhiko , Ishikawa Hajime , Terashita Daisuke , Gakuhara Atsushi , Fukuda Shuichi , Ohta Katsuya , Kitani Kotaro , Hida Jin-ichi , Wakasa Tomoko , Kimura Yutaka
Published: April 2022

Background

Undifferentiated carcinoma is a very rare histologic subtype, representing only 0.8% to 5.7% of all pancreatic exocrine neoplasms. Additionally, spontaneous abdominal hemorrhage is a particularly rare, life-threatening cause.

Case presentation

A 68-year-old man was taken by ambulance to our hospital because of sudden-onset abdominal pain. Contrast-enhanced abdominal computed tomography revealed a huge mass measuring 99 × 70 mm in the pancreatic tail with enhanced rim staining in the peripheral area. Imaging also showed extravasation and fluid collection beside the tumor. Hence, spontaneous rupture of the pancreatic tumor and intra-abdominal bleeding were diagnosed. Emergency laparotomy was performed because of acute abdominal pain with peritoneal signs. With an intraoperative diagnosis of rupture of the pancreatic tumor, distal pancreatectomy was successfully performed. Histologically, hematoxylin and eosin staining showed round to spindle-shaped, highly pleomorphic mononuclear cells and multinucleated giant cells as well as a component of ductal adenocarcinoma. Immunohistochemical staining showed that the tumor cells were negative for AE1/AE3, whereas the non-neoplastic osteoclast-like giant cells were positive for CD68. Taken together, these results led to a diagnosis of undifferentiated carcinoma with osteoclast-like giant cells. The patient’s postoperative course was uneventful.

Conclusion

We experienced an extremely rare case of spontaneous rupture of an undifferentiated carcinoma with osteoclast-like giant cells presenting as intra-abdominal bleeding. Obtaining a correct preoperative diagnosis is quite difficult at the first evaluation. Undifferentiated carcinoma should be considered as a differential diagnosis in the case with spontaneous rupture of a pancreatic tumor.
Antenatal couples’ counselling in Uganda (ACCU): study protocol for a randomised controlled feasibility trial
Authors: Mubangizi Vincent , McGrath Nuala , Kabakyenga Jerome Kahuma , Muller Ingrid , Stuart Beth L. , Raftery James P. , Natukunda Sylvia , Ngonzi Joseph , Goodhart Clare , Willcox Merlin Luke
Published: April 2022

Background

Common avoidable factors leading to maternal, perinatal and neonatal deaths include lack of birth planning (and delivery in an inappropriate place) and unmet need for contraception. Progress has been slow because routine antenatal care has focused only on women. Yet, in Uganda, many women first want the approval of their husbands. The World Health Organization recommends postpartum family planning (PPFP) as a critical component of health care. The aim of this trial is to test the feasibility of recruiting and retaining participants in a trial of a complex community-based intervention to provide counselling to antenatal couples in Uganda.

Methods

This is a two-group, non-blinded cluster-randomised controlled feasibility trial of a complex intervention. Primary health centres in Uganda will be randomised to receive the intervention or usual care provided by the Ministry of Health. The intervention consists of training village health teams to provide basic counselling to couples at home, encouraging men to accompany their wives to an antenatal clinic, and secondly of training health workers to provide information and counselling to couples at antenatal clinics, to facilitate shared decision-making on the most appropriate place of delivery, and postpartum contraception. We aim to recruit 2 health centres in each arm, each with 10 village health teams, each of whom will aim to recruit 35 pregnant women (a total of 700 women per arm). The village health teams will follow up and collect data on pregnant women in the community up to 12 months after delivery and will directly enter the data using the COSMOS software on a smartphone.

Discussion

This intervention addresses two key avoidable factors in maternal, perinatal and neonatal deaths (lack of family planning and inappropriate place of delivery). Determining the acceptability and feasibility of antenatal couples’ counselling in this study will inform the design of a fully randomised controlled clinical trial. If this trial demonstrates the feasibility of recruitment and delivery, we will seek funding to conduct a fully powered trial of the complex intervention for improving uptake of birth planning and postpartum family planning in Uganda.

Trial registration

Pan African Clinical Trials RegistryPACTR202102794681952. Approved on 10 February 2021. ISRCTN Registry ISRCTN97229911. Registered on 23 September 2021
Feasibility of video recording interpersonal interactions between patients and hospital staff during usual care
Authors: Todd Angela L. , Roberts Lynette , Foster Kirsty
Published: April 2022

Background

Video-reflexive ethnography (VRE) has been used to record aspects of patient care which are then shared with staff to drive self-identified improvements. Interpersonal interactions between patients and hospital staff are key to high-quality, patient-centred care and mostly occur randomly throughout a patient’s hospital stay. One of the most common types of hospital admission is for women giving birth.

Aims

To assess the feasibility of adapting the VRE methodology to capture naturally occurring interactions between patients and health staff over an extended period during hospital admission, and to assess whether the approach would yield useful interaction data.

Participants

Twelve women, who had a planned caesarean section at 37+ weeks, were considered low risk (no known medical or obstetric complication) and were admitted to a postnatal unit after giving birth, and the staff who attended them.

Methods

This study took place in a large hospital in Sydney, Australia, where approximately 2200 women give birth each year. Continuous unattended video recordings were made during each woman’s hospital stay to capture interactions with hospital staff. The recordings were reviewed to determine what kinds of interaction data could be obtained.

Results

In order to recruit 12 eligible women, we needed to invite 45 to participate. The estimated recruitment period of 3–4 months had to be extended to 8 months. A fixed video camera was successfully installed in the hospital room of each woman and a remote control provided. A total of 246.5 h of video recordings was obtained, of which 38 h (15.5%) involved interpersonal interactions with staff. Two women reported negative responses from staff about being video recorded. Both quantitative and qualitative data could be obtained from the recordings.

Conclusion

Video recordings of interpersonal interactions between patients and staff in an in patient hospital care setting can be obtained and can provide unique insights into the complexity of healthcare delivery. However, significant contextual barriers can exist to engaging staff in quality improvement initiatives that are not part of their usual healthcare activities.
Suubi4Stigma study protocol: a pilot cluster randomized controlled trial to address HIV-associated stigma among adolescents living with HIV in Uganda
Authors: Nabunya Proscovia , Ssewamala Fred M. , Bahar Ozge Sensoy , Michalopoulos Lynn T. M. , Mugisha James , Neilands Torsten B. , Trani Jean-Francois , McKay Mary M.
Published: April 2022

Background

Sub-Saharan Africa (SSA) is heavily burdened by HIV, with 85% of the global new infections among adolescents happening in the region. With advances in medication and national policies promoting antiretroviral therapy (ART), children < 15 years living with HIV (CLWH) continue to grow with a chronic, highly stigmatized disease. Unfortunately, the stigma they experience results in much lower quality of life, including poor mental health and treatment outcomes. Family members also experience stigma and shame by virtue of their association with an HIV-infected family member. Yet, stigma-reduction interventions targeting CLWH and their families are very limited. The goal of this study is to address HIV-associated stigma among CLWH and their caregivers in Uganda.

Methods

This three-arm cluster randomized control trial, known as Suubi4Stigma, will evaluate the feasibility, acceptability, and preliminary impact of two evidence-based interventions: (1) group cognitive behavioral therapy (G-CBT) focused on cognitive restructuring and strengthening coping skills at the individual level and (2) a multiple family group (MFG) intervention that strengthens family relationships to address stigma among CLWH (N = 90, 10–14 years) and their families (dyads) in Uganda. Nine clinics will be randomized to one of three study arms (n = 3 clinics, 30 child-caregiver dyads each): (1) usual care; (2) G-CBT + usual care; and (3) MFG + usual care. Both treatment and control conditions  will be delivered over a 3-month period. Data will be collected at baseline (pre-intervention) and at 3 months and 6 months post-intervention initiation.

Conclusion

The primary aim of the proposed project is to address the urgent need for theoretically and empirically informed interventions that seek to reduce HIV-associated stigma and its negative impact on adolescent health and psychosocial well-being. As several countries in SSA grapple with care and support for CLWH, this study will lay the foundation for a larger intervention study investigating how HIV-associated stigma can be reduced to foster healthy child development—especially for CLWH as they transition through adolescence.

Trial registration

ClinicalTrials.gov: NCT04528732; Registered August 27, 2020
Tunable narrow-band single-channel add-drop integrated optical filter with ultrawide FSR
Authors: Sun Chunlei , Yin Yuexin , Chen Zequn , Ye Yuting , Luo Ye , Ma Hui , Wang Lichun , Wei Maoliang , Jian Jialing , Tang Renjie , Dai Hao , Wu Jianghong , Li Junying , Zhang Daming , Lin Hongtao , Li Lan
Published: April 2022

Free-spectral-range (FSR)-free optical filters have always been a critical challenge for photonic integrated circuits. A high-performance FSR-free filter is highly desired for communication, spectroscopy, and sensing applications. Despite significant progress in integrated optical filters, the FSR-free filter with a tunable narrow-band, high out-of-band rejection, and large fabrication tolerance has rarely been demonstrated. In this paper, we propose an exact and robust design method for add-drop filters (ADFs) with an FSR-free operation capability, a sub-nanometer optical bandwidth, and a high out-of-band rejection (OBR) ratio. The achieved filter has a 3-dB bandwidth of < 0.5 nm and an OBR ratio of 21.5 dB within a large waveband of 220 nm, which to the best of our knowledge, is the largest-FSR ADF demonstrated on a silicon photonic platform. The filter exhibits large tunability of 12.3 nm with a heating efficiency of 97 pm/mW and maintains the FSR-free feature in the whole tuning process. In addition, we fabricated a series of ADFs with different periods, which all showed reliable and excellent performances.
Using Technology to Enhance Cancer Clinical Trial Participation
Authors: Haynes Rudene Mercer , Sirintrapun S. Joseph , Gao Jennifer , McKenzie Andrew J.
Published: April 2022

The COVID-19 pandemic presented many challenges to health care systems, including oncology clinical research programs. There were substantial negative effects on oncology clinical trial screening, enrollment, and study activities that forced institutions and regulatory bodies to develop innovative solutions to maintain robust and equitable participation in these trials. Digital pathology innovations at Memorial Sloan Kettering Cancer Center have streamlined the diagnostic life cycle for patients with cancer, and the seamless integration of digital pathology services with next-generation sequencing and other molecular pathology services have accelerated the time to diagnosis and receipt of molecular results. Timely access to these results, coupled with Memorial Sloan Kettering Cancer Center’s knowledge engine OncoKB, enhances patient clinical trial coordination precisely and efficiently. At the Sarah Cannon Research Institute, centralized remote clinical trial matching and screening, virtual molecular tumor boards, and centralized molecular interpretation support services have empowered clinic staff to identify more efficiently potential participants in clinical research, despite the COVID-19 pandemic. In addition, the U.S. Food and Drug Administration Oncology Center of Excellence has been involved in several efforts to address challenges for patients with cancer during the COVID-19 pandemic, including writing guidance documents and participating in efforts to modernize clinical trials. The enclosed personal experience of a patient with cancer currently participating in an oncology clinical trial emphasizes the need for continued decreasing of barriers to study participation. Clinical trial advances that were accelerated by the pandemic will ultimately help patients with cancer and the greater oncology health care community.
Minimum-Wage Increases and Low-Wage Employment: Evidence from Seattle
Authors: Jardim Ekaterina , Long Mark C. , Plotnick Robert , van Inwegen Emma , Vigdor Jacob , Wething Hilary
Published: April 2022

Seattle raised its minimum wage to as much as $11 in 2015 and as much as $13 in 2016. We use Washington State administrative data to conduct two complementary analyses of its impact. Relative to outlying regions of the state identified by the synthetic control method, aggregate employment at wages less than twice the original minimum—measured by total hours worked—declined. A portion of this reduction reflects jobs transitioning to wages above the threshold; the aggregate analysis likely overstates employment effects. Longitudinal analysis of individual Seattle workers matched to counterparts in outlying regions reveals no change in the probability of continued employment but significant reductions in hours, particularly for less experienced workers. Job turnover declined, as did hiring of new workers into low-wage jobs. Analyses suggest aggregate employment elasticities in the range of —0.2 to —2.0, concentrated on the intensive margin in the short run and largest among inexperienced workers. (JEL J22, J23, J24, J31, J38, R23)
Raising the Bar: Minimum Wages and Employers’ Hiring Standards
Authors: Butschek Sebastian
Published: April 2022

Many scholars have studied the employment effects of minimum wages, but little is known about effects on the composition of hires. I investigate whether Germany’s minimum wage introduction raised hiring standards, using worker fixed effects as a proxy for worker productivity. For the least productive workers hired, the minimum wage led to a 4 percentile point shift in the productivity distribution. This increase is missed using standard observable measures of worker productivity. The effects are larger with greater pre-reform screening intensity—indicating an employer response. This more selective hiring compensates about two-thirds of higher wage costs for the least productive hires. (JEL J23, J24, J31, J38, M51)
Engaging Teachers with Technology Increased Achievement, Bypassing Teachers Did Not
Authors: Beg Sabrin , Halim Waqas , Lucas Adrienne M. , Saif Umar
Published: April 2022

Using two RCTs in middle schools in Pakistan, we show that brief, expert-led, curriculum-based videos integrated into the classroom experience improved teaching effectiveness: student test scores in math and science increased by 0.3 standard deviations, 60 percent more than the control group, after 4 months of exposure. Students and teachers increased their attendance, and students were more likely to pass the high-stakes government exams. By contrast, providing similar content to students on personal tablets decreased student scores by 0.4 SD. The contrast between the two effects shows the importance of engaging teachers and the potential for technology to do so. (JEL I21, I28, J45, O15, O30)
Association of high Body Mass Index and postdates pregnancy
Authors: Qazi Qudsia , Liaqat Nazia , Hussain Shehzadi Saima , Syed Wajeeha
Published: April 2022

Background and Objective: Obesity with its growing prevalence is a major public health problem influencing gestational age at delivery. Raised Body Mass Index (BMI) has been shown to be associated with significantly increased risk of prolonged pregnancy; which is an important contributor to perinatal morbidity and mortality. Obesity needs modified antenatal, intrapartum and postpartum care by obstetrician. Limited data is found regarding association of obesity with prolonged pregnancy and the same fact led us to search for this association.

Methods: This cohort study was carried out in Gynecology and Obstetrics department, MTI Lady Reading Hospital Peshawar from March 2020 to April 2021. Patients were enrolled in third trimester at 37 weeks of gestation with primary exposures of interest being either self-reported pre-pregnancy weight or obtained from first trimester antenatal record. Patients were divided into two classes based on BMI i.e., one with BMI <25 and other with BMI ≥ 25. Patients in both classes were followed till their delivery to determine outcome of gestational age at delivery.

Results: Statistically significant difference between the two groups was seen at lower age range of 18-21 years(p-0.04) and higher age range of 39-42 years (p-0.0001). Statistically significant association was found between high pre pregnancy BMI and postdates pregnancy (OR:4.93 ;95%CI:1.98-12.26, p-0.001). Association of induction of labor with high pre pregnancy BMI was not significant. (OR 0.56, 95%CI:0.21-1.48, P < 0.001). Higher rates of Instrumental deliveries(p-0.0005) and cesarean sections (p-0.0001) were seen in higher BMI group.

Conclusion: Higher pre-pregnancy BMI is associated with increased risk of postdates pregnancy.

doi: https://doi.org/10.12669/pjms.38.5.4815

How to cite this:Qazi Q, Liaqat N, Hussain SS, Syed W. Association of high Body Mass Index and postdates pregnancy. Pak J Med Sci. 2022;38(5):---------. doi: https://doi.org/10.12669/pjms.38.5.4815

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Efficacy and Safety of N-Butyl 2 Cyanoacrylate Injection for Treatment of Gastric Varices: A five year experience from a tertiary care hospital in Karachi, Pakistan
Authors: Butt Nazish , Haleem Farhan , Khan Muhammad Ali , Abbasi Amanullah
Published: April 2022

Objectives: To evaluate the efficacy and safety of N-Butyl 2 Cyanoacrylate injection for treatment of gastric varices.

Methods: This was a retrospective observational cohort conducted at Medical Unit IV, Department of Gastroenterology, JPMC, Karachi from January 2014 to December 2018 (five years). All patients irrespective of age and gender that presented to the emergency department with complain of hematemesis or stigmata of UGIB were potential candidates. Once they were resuscitated and endoscopic evidence of gastric varices requiring intervention was found, the patients were inducted into the study. N-Butyl 2 Cyanoacrylate injection was performed until hemostasis and obliteration of gastric varices was achieved. Response to therapy was analyzed at three weeks with repeat endoscopy. Mortality was analyzed at six weeks. Major and minor complications recorded as well.

Results: A total of 159 patients were inducted into the study. Isolated gastric varices Type-I was mostly encountered. A singular session was sufficient to achieve obliteration and hemostasis in over three quarter of the patients. Complications affected 11.30% of the patients. Six weeks mortality was exceptionally low at 1.20%.

Conclusions: N-Butyl 2 Cyanoacrylate is safe and effective for treatment of gastric varices. There were few complications seen with this procedure in this study. It significantly reduces mortality at six weeks.

doi: https://doi.org/10.12669/pjms.38.5.4999

How to cite this:Butt N, Haleem F, Khan MA, Abbasi A. Efficacy and Safety of N-Butyl 2 Cyanoacrylate Injection for Treatment of Gastric Varices: A five year experience from a tertiary care hospital in Karachi, Pakistan. Pak J Med Sci. 2022;38(5):---------.  doi: https://doi.org/10.12669/pjms.38.5.4999

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Λογισμός κόστους στη γαλακτοπαραγωγό βοοτροφία και κοστολόγηση τυπικής μονάδας μεταποίησης γάλακτος αγελάδων με τη μέθοδο της κατά δραστηριότητα κοστολόγησης (Activity-based costing)
Authors: Κουτουζίδου Γεωργία
Published: April 2022

Η αλυσίδα εφοδιασμού γαλακτοκομικών προϊόντων βοοτροφίας στην Ελλάδα έχει βιώσει σημαντικές αλλαγές από το 2000. Δημιουργήθηκαν μεγάλου μεγέθους εκμεταλλεύσεις επιχειρηματικής μορφής, οι οποίες αποφάσισαν να εντατικοποιήσουν το σύστημα παραγωγής οδηγώντας έτσι, στην αύξηση του κόστους παραγωγής του γάλακτος. Αυτές οι εκμεταλλεύσεις υποστηρίζονται άμεσα από τη βιομηχανία μεταποίησης του αγελαδινού γάλακτος, οι οποίες έχουν εκσυγχρονιστεί προσαρμοζόμενες στις έντονα ανταγωνιστικές συνθήκες της αγοράς. Η βιωσιμότητα και η ανταγωνιστικότητα των παραγωγικών μονάδων, τόσο σε επίπεδο πρωτογενούς, όσο και σε επίπεδο δευτερογενούς παραγωγής, συνδέεται άμεσα με την αποτελεσματική λειτουργία της αλυσίδας εφοδιασμού, την ορθολογική διαχείριση των διαθέσιμων πόρων και τη λήψη ορθών διοικητικών και επιχειρηματικών αποφάσεων. Η αλυσίδα εφοδιασμού της γαλακτοπαραγωγού βοοτροφίας διερευνάται ολιστικά με την εκτίμησητων οικονομικών αποτελεσμάτων των βοοτροφικών εκμεταλλεύσεων και την κοστολόγηση του γάλακτος, με την περιγραφή της αλυσίδας αξίας των γαλακτοκομικών προϊόντων και την παρουσίαση των μηχανισμών μετακύλισης και μεταβολής των τιμών κατά μήκος αυτής της αλυσίδας, και την κοστολόγηση των γαλακτοκομικών προϊόντων με την εφαρμογή της κλασικής μεθόδου κοστολόγησης και της κατά δραστηριότητα κοστολόγησης μεθόδου. Παράλληλα, πραγματοποιείται μια συγκριτική ερμηνεία των αποτελεσμάτων των δύο μεθόδων κοστολόγησης. Από τα κύρια αποτελέσματα προκύπτει ότι το κόστος παραγωγής γάλακτος στην πρωτογενή παραγωγή είναι ιδιαίτερα υψηλό, γεγονός που προκύπτει από την εντατικοποίηση και την εκμηχάνιση των εκμεταλλεύσεων. Υποδεικνύονται οι αδυναμίες που υπάρχουν στην οργάνωση κυρίως του κεφαλαίου, ενώ προκύπτει βελτίωση της οικονομικότητας των μονάδων με την αύξηση των αποδόσεων σε γάλα. Η εφαρμογή της ανάλυσης SWOT και της Stakeholder ανάλυσης αναδεικνύουν τα υφιστάμενα προβλήματα σε ολόκληρη την αλυσίδα γαλακτοκομικών προϊόντων βοοτροφίας στην Ελλάδα και υποδεικνύουν ότι οι Αθέμιτες Εμπορικές Πρακτικές δεν έχουν έντονη παρουσία στη συγκεκριμένη αλυσίδα εφοδιασμού. Τα αποτελέσματα επίσης υπέδειξαν απόκλιση στην εκτίμηση του κόστους παραγωγής των προϊόντων μεταξύ των δύο μεθόδων κοστολόγησης και ειδικότερα υποεκτίμηση του κόστους παραγωγής των προϊόντων για την παραγωγή των οποίων απασχολούνται αρκετά τμήματα παραγωγής της επιχείρησης με την παραδοσιακή μέθοδο κοστολόγησης.
Το 'Υπόμνημα' του Σιμπλικίου στο 'Εγχειρίδιον' του Επικτήτου ως πρόταση τρόπου ζωής στην Ύστερη Αρχαιότητα
Authors: Παπαγεωργίου Φώτιος
Published: April 2022

Αντικείμενο της εργασίας αυτης είναι η νεοπλατωνική Εξήγησις (το Υπόμνημα) του Σιμπλίκιου στο Εγχειρίδιο του Επίκτητου και στόχο της αποτελει η ανάδειξη της πολιτικης σημασίας του νεοπλατωνικού έργου μέσω της ερμηνείας ενός ηθικού κειμένου της Υστερης Στοάς. Στη συγκεκριμένη ερμηνευτική χειρονομία του Σιμπλίκιου διακρίνουμε νεωτερικά χαρακτηριστικά, τα οποία προκύπτουν από τη σχέση του Υπομνήματος με τη βυζαντινή πραγματικότητα μετά τη Στάση του Νίκα το 532. Η εξάρτηση της ερμηνευτικής του Σιμπλίκιου από το ιστορικό παρόν χαρίζει στο Εγχειρίδιο του Επίκτητου την πολιτική διάσταση που καταστατικά το στωικό αυτό έργο αγνοεί, καθιστώντας το έτσι ικανό να καλύψει τις πνευματικές ανάγκες, ηθικές και πολιτικές, του φιλομαθούς Βυζαντινού τον έκτο αιώνα. Πρόκειται ουσιαστικά για την κατασκευή από τον Σιμπλίκιο ενός modus vivendi σε επίπεδο καθημερινότητας, ώστε να αντιμετωπιστεί το συναίσθημα του φόβου που προκαλεί σε Εθνικούς και Χριστιανούς η εφαρμοσμένη πολιτική του Ιουστινιανού. Κατά τη νεοπλατωνική ηθική και πολιτική θεωρία σύμφωνα με τον Σιμπλίκιο, η έλλογη ψυχή δεν αποσύρεται στά ενδότερα της υπάρξεώς της από αδιαφορία για όσα εκτός της συμβαίνουν, όπως θα ήθελε η ηθική φιλοσοφία του Επίκτητου, αλλά, αφού μετεωριστεί τραγικά μέσα της, φρονίμως και μετριοπαθώς δρα ελεύθερα εντός του κόσμου, ώστε να αλλάξει ή να επηρεάσει τη φορά των πραγμάτων. Με τον τρόπο αυτό γίνεται κατανοητό ότι η επιστροφή της ψυχής στό πεδίο των νοητών για τον Σιμπλίκιο διέρχεται του πρακτικού λόγου, την έκφραση του οποίου προκαλεί και διαμορφώνει η επιμέλεια του έλλογου στοιχείου του ανθρώπου. Η ιστορική πορεία της ψυχής φαίνεται να συμβάλλει καθοριστικά κατά τον νεοπλατωνικό στοχαστή στη συνειδητοποίηση της θεϊκής καταγωγής της και της υποχρεώσεώς της να μιμηθεί την πρόνοια των θεών για τον κόσμο μέσω της πραγματώσεως των καθηκόντων της προς τον εαυτό, τον άλλο και τον θεό. Η διαλεκτική δηλαδή της ιστορικότητας και της αυτοσυνειδήσεως αποτυπώνεται στις πράξεις καθήκοντος του έλλογου όντος στο πλαίσιο της κοινωνικής και πολιτικης ζωής με τελικό στόχο την κατάλληλη προετοιμασία της ψυχής του για τον κόσμο των νοητῶν