bluuebunny/crossref_metadata_2025 huggingface dataset:
An international comparison of pool lifeguard requirements and qualifications
Authors: Demant D , Peden A , Lam W
Published: October 2020

Background

Drowning is one of the leading causes of the global burden of morbidity and injury-related deaths. In highly industrialised countries, death and injuries from drowning are commonly associated with recreational activities and disproportionately affect minors. In aquatic facilities, drowning is often the result of risky behaviours and management issues. Pool lifeguards are an important factor in lowering the drowning burden. However, research on lifeguard training and formal requirements is scarce.

Methods

The aim of this study was to review official and unofficial (training) requirements for pool lifeguards in 24 high-income countries. Information was extracted from (1) legislative databases, (2) publicly available information from governmental and non-governmental organisations as well as a (3) cross-sectional survey on training and employment practices sent out to specialist organisations and aquatic facilities.

Results

All jurisdictions had a minimum standard for physical fitness, swimming ability, eligible minimum age, and further training and qualification requirements. However, the depth and length of further training differed drastically between jurisdictions and many of these standards were 'de-facto' industry standards rather than legislated. Only some jurisdictions had regulations regarding visual and hearing impairments (n = 13) or infectious and chronic conditions (n = 13). Only three jurisdictions had a character requirement.

Conclusions

Pool lifeguards are an important factor in preventing injury and death from drowning and require a high-level of physical endurance, first aid and rescue knowledge as well as analytical skills to be effective. A stronger legislated regulation of pool lifeguard requirements may be effective in reducing risk of drowning.

Key messages

Pool lifeguards are an important factor in preventing injury and death from drowning and require high-level physical endurance, first aid/rescue knowledge as well as analytical skills to be effective. A stronger legislated regulation of pool lifeguard requirements may be effective in reducing risk of drowning.
Quality of health promotion programs is associated with built environment features in Jerusalem
Authors: Besor O , Manor O , Paltiel O , Dunchin M , Rauch O , Lahad A , Kaufman-Shriqui V
Published: October 2020

Background

Neighbourhood built environment and infrastructure influence health status. Greater walkability, green spaces and healthy food accessibility can enhance healthy lifestyles. While health promotion programs (HPPs) have been shown to improve population's health, little is known about the reciprocal influences between the built environment and quality and distribution of HPPs across a city.

Methods

HPPs operating in Jerusalem focusing on healthy diet and physical activities were located and evaluated for quality using the European Quality Instrument for Health Promotion (EQUIHP) in 2017. HPPs location, intervention type and characteristics of the target population were documented. Using Geographic Information System (GIS), we combined infrastructure data from the Jerusalem Municipality and socioeconomic score (1 lowest - 10 highest) from Israel's Central Bureau of Statistics. Associations between distribution and quality of HPPs and the built environment at the neighbourhood (n = 115) level and municipal planning area level (7 areas) were assessed.

Results

Overall 93 HPPs operating in 349 locations and serving 582,500 adult residents, were identified in Jerusalem. Higher HPP quality, at the municipal planning area, was associated with higher density of HPPs, longer bike or walking lanes and fewer food stores. Positive significant (p < 0.05) correlations, at a neighbourhood level, were found between neighbourhood EQUIHP median scores and HPPs targeting women (0.262), participants < 60 years old (0.324) and the Arab ethnicity (0.473). Linear regression showed a significant (p = 0.01) decrease of 0.015 in median EQUIHP score at a neighbourhood level for each increase in socioeconomic status score (p = 0.036).

Conclusions

A comprehensive evaluation of HPP quality, spatial and sociodemographic information demonstrates an association of HPP access and quality with the built environment. Fortunately, in Jerusalem high quality programs are designed for populations at need.

Key messages

In Jerusalem, the quality of health promotion programs measured by the EQUIHP score, was positively associated with infrastructure features promoting physical activity and lower neighbourhood SES. In Jerusalem, higher quality of health promotion programs focusing in nutrition and physical activity were designed for populations at need.
Students‘ attitudes towards the measures of healthy lifestyle promotion in Lithuania
Authors: Berzanskyte A , Drungelaite O
Published: October 2020

Background

To ensure more resistant community in the future of humanity, the early life prevention within aging societies becomes very important. The new generation clearly expresses their needs and indicates the ways that are the most attractive for positive changes of healthy behavior. The aim of the study was to reveal school children's attitudes to different measures of healthy lifestyle promotion in Lithuania.

Methods

The data were collected from 380 12-19 years students from two high schools of the regional city by self-administered anonymous questionnaires. The relative frequencies and prevalence ratios were compared in groups by different sociodemographic categories. Chi squared and Fisher's exact tests were conducted to establish statistical significance which was set at p < 0.05. Confidence intervals were used for prevalence statistics.

Results

Internet was the main source for 63.2% of the sample. Healthy behavior promotion provided at the school was assessed positively by 76.8%. However, 50.3% of the students thought that there was no sufficient attention for nutrition, 36% - for drugs and alcohol prevention, 34.6% - for physical activity, 32.6% - for smoking prevention. They preferred more discussions on those topics during nature sciences lectures. The parents' key role in healthy habits was referred by 46.6% of respondents. That was more expressed if the child lived with both parents or if they were physically active, had no addictions. The tendency of healthy lifestyle promotion by famous people was evaluated critically, as more than half respondents considered them not having such competencies. The students had scarce awareness about the impact of the laws regulating the consumption of alcohol, smoking and drugs, although half of them supported stricter control.

Conclusions

The students emphasized internet, the school and the parents as the most important sources of information for promotion of healthy behavior.

Key messages

In era of technologies the internet is the most accessible and attractive source for information, particularly for new young generation. The children need relevant guidance from the schools and the parents to get the right information to manage their health properly and get resistance in future aging societies.
Health system performance assessment from the private health insured persons’ perspective in Germany
Authors: Achstetter K , Blümel M , Köppen J , Busse R
Published: October 2020

Background

About 11% of the German population has full private health insurance (PHI) and mainly consists of self-employed persons, civil servants or persons with an income above a certain threshold (in 2020: 62,550 €/year) who choose to opt out from statutory health insurance. It can be assumed that these persons represent a distinct population group in Germany. Therefore, the assessment of the German health system performance from the perspective of persons with PHI was subject to this research (project IPHA “Integrating the Population Perspective in Health System Performance Assessment”).

Methods

A paper/online survey was conducted in 2018 among 20,000 persons with PHI in Germany. The items for this survey were based on the intermediate (access, coverage, quality and safety) and final goals (improved health, responsiveness, improved efficiency, and social and financial risk protection) of the WHO Health Systems Framework.

Results

The survey was completed by 3,601 participants (18.0%). Participants (age 58.6 years ± 14.6; 64.6% male) assessed the German health system very differently, exemplarily shown for the intermediate goal “access” and final goal “responsiveness”: Whereas access to off-hour care was perceived as difficult by 54.1% of the respondents, 6.7% of the respondents reported unmet needs within the last 12 months due to waiting times. 51,5% of these persons with unmet needs due to waiting times were still (very) satisfied with the overall waiting time for physicians' appointments. 73,6% of persons with unmet needs who perceived discrimination in their care reported waiting times as the area of discrimination (vs. 53,4% of all participants who perceived discrimination).

Conclusions

Privately insured persons in Germany perceived the performance of the health system very differently and also partially inconsistent. Further analyses will complete the picture of the persons with PHI's perspective in health system performance assessment.

Key messages

Persons with private health insurance perceive the performance of the German health care system very differently and also partially inconsistent. Despite unmet needs due to waiting time in 6.7% of the respondents, 51,5% of these persons were still (very) satisfied with waiting times.
The management of NDM-β-lactamase-producing carbapenem-resistant Enterobacterales in Tuscany
Authors: Ninci A , Grazzini M , Paolini D , Niccolini F , Mechi M T , Righi L , Gemmi F , Pieralli F , Lorini C , Bonaccorsi G
Published: October 2020

Issue

An important outbreak of New Delhi metallo-β-beta-lactamase (NDM)-producing carbapenem-resistant Enterobacterales (CRE) has been reported from north-western of Tuscany since November 2018. NDM is a metallo-β-lactamase able to hydrolyze most β-lactames (including carbapenems) with limited treatment options.

Description of the Problem

From November 2018 to May 2019, 7 Tuscan hospitals notified a total of 350 infected or colonized cases. This outbreak was described in a risk assessment edited by the European Centre for Disease Prevention and Control (ECDC) in June 2019. The Ministry of Health and the Tuscany Region promptly adopted infection prevention control measures.

Results

Since July 2019, a regional task force, composed by experts in infectivology, microbiology and public health, coordinated the following actions: Publication of Regional Resolutions which have established practical guidelines for the outbreak management. These measures included:(I) the introduction of screening test for CRE by rectal swab for hospitalized patients; (II) the implementation of microbiological rapid molecular tests and genotyping of rectal swab; (III) the enhancement of standard and transmission-based precautions; (iv) the strengthening of handover between hospital setting and primary healthcare; (v) the implementation of a regional data-base for outbreak surveillance.Monthly regional meetings with the infection control teams of each hospital.Site visits (n. 44) performed by a group of experts in all healthcare facilities.

After the implementation of these measures, a trend for decrease in positive blood cultures of NDM was registered.

Lessons

The spread of NDM in Tuscany has been the opportunity to standardize and improve the approach to Multidrug-Resistant Organisms (MDROs) prevention and control.

Key messages

The spread of NDM in Tuscany has been the opportunity to standardize and improve the approach to Multidrug-Resistant Organisms (MDROs) prevention and control. The cooperation among stakeholders and the standardization of precaution measures and healthcare workers’ behavior allows to effectively face the MDROs diffusion.
Nurses' perception on social network of children with chronic illness: qualitative study, Brazil
Authors: Souza M H N , Santos T J , Vasconcellos R N , MM Costa  , Lira A S , Conceição N V M , Nobrega V M , Lima H S B , Collet N
Published: October 2020

Introduction

The high prevalence of chronic diseases in childhood is a serious public health problem in Brazil. The family life of children with chronic illness is marked by numerous determinant and conditioning factors, whether they are biological, psychological, cultural and social. Such factors are more relevant in the absence of a social support network for care. Therefore, the greater the support offered by health professionals, the greater the resources available for the family to face vulnerability.

Objectives

describing primary care nurses' perception of the social network approach for children with chronic diseases.

Methods

Qualitative research conducted in October 2019 through an interview with ten nurses from family health units in the city of Rio de Janeiro, Brazil. The project was approved by the Ethics and Research Committees of the participating institutions. Thematic content analysis was used.

Results

For nurses, social network meant support from family members and from secondary and tertiary level services. In their practice, these professionals are often unaware of the health situation of children with chronic diseases, and they perceive lack of articulation in referral those children to other services of the Health Care Network.

Conclusions

There are gaps between knowledge and practice of these professionals on the social network approach. It is important to highlight frailties in comprehensive care of children with chronic illness and the service counter-referral to the family health unit. It is necessary to carry out training courses for professionals, helping them to belong to the social network of the family of the child with chronic disease. This strategy could implement effective approach of support, surveillance and health promotion of children.

Key messages

There is a gap in the knowledge of social network approach among primary care nurses. The social network approach of children with chronic diseases favors comprehensive care and implementation of effective strategies focused on supporting, monitoring and promoting child health.
Comparison of feeding behavior problems of hostel and non-hostel living children with ASD in Dhaka
Authors: Islam T , Islam N , Tasnim S
Published: October 2020

Backgrounds

The purpose of this study was to determine the distribution and differences of nutritional status and feeding behavior problems between the school going children with autism spectrum disorder (ASD) who are living either at school hostel or at home with parents of the urban lower-middle-class population in Dhaka city, Bangladesh.

Methods

This is a cross-sectional study where the children with ASD were randomly selected from 4 schools for children with special needs in Dhaka, Bangladesh. Written consent was taken from the parents of the children. Anthropometric and other nutrition referral data were taken directly from the children during school time. Demographic, parity and behavioral pediatrics feeding assessment scale (BPFAS) module have been interviewed through structured questionnaires from the parents. The referral scores have been applied to measure and compare the mean BPFAS scores.

Results

93 children have participated in this study (mean age 10.21 years). It was observed that BPFAS scores for >10 years of age are higher in overall both groups of children (p = <0.05). Parents from joint or bigger families reported higher feeding problems of their child living at home (p = <0.05). Significant difference found in BPFAS score according to the number of siblings in the homegroup (52.0 vs. 81.8; p = <0.01). Mean BPFAS score was higher in the hostel group if the children's parents were highly educated (p = <0.05). No association found in feeding assessment and socio-economic status as we found the SES were quite similar in both groups.

Conclusions

In this preliminary data, we found that feeding behavior problems reported by parents are less in the hostel living children and also lower in comparatively higher aged children. This study is important for researchers and policymakers as it opens windows to think and do more research about the importance and impact of hostel disciplines and in-home family bonding for the healthy growth of children with ASD.

Key messages

Higher aged children are have less feeding problem in general. Keeping children with ASD at home in touch of family members have positive impact on their feeding problems and overall nutrition.
Prevalence of Human Immunodeficiency Virus among pregnant women in Nigeria
Authors: Ozim C , Mahendran R , Amalan M , Puthussery S
Published: October 2020

Background

Human Immunodeficiency Virus (HIV) infection among pregnant women has been associated with a number of adverse maternal and infant outcomes. Nigeria accounts for about 10% of the HIV/AIDS burden worldwide and has the second highest incidence of new HIV infections among women globally. This study estimated the overall prevalence of HIV among pregnant women in Nigeria and examined variations across the geo-political zones of the country.

Methods

We conducted a systematic review and meta-analysis. A comprehensive search was conducted using eight electronic databases and grey sources for studies published from 1·1·2008 to 31·8·2019. Primary studies reporting prevalence estimates of HIV among pregnant women diagnosed using a diagnostic/ screening test were identified, screened and appraised using a two-stage process. A meta-analysis was conducted with the primary outcome measure as proportion (%) of pregnant women identified as having HIV infection.

Results

Twenty three eligible studies involving 72,728 pregnant women were included in the meta-analysis. The overall pooled prevalence of HIV among pregnant women was 7·22% (95% CI: 5·64, 9·21). A high degree of heterogeneity (I2=97·2%) and publication bias (p = 0.728) was reported. Prevalence rate for South-East geo-political zone (17·04%, 95% CI: 9·01, 29·86) was higher compared to the overall prevalence.

Conclusions

Findings imply that 7 out of every 100 pregnant women in Nigeria are likely to have HIV infection. The magnitude of the issue highlight the need for targeted efforts at local, national and international levels towards prevention, diagnosis and treatment.

Key messages

HIV infection among pregnant women is a major public health issue in Nigeria. Targeted efforts are needed at local, national and international levels towards prevention, diagnosis and treatment.
Aging Influences the Metabolic and Inflammatory Phenotype in an Experimental Mouse Model of Acute Lung Injury
Authors: Gibbs Kevin W , Chuang Key Chia-Chi , Belfield Lanazha , Krall Jennifer , Purcell Lina , Liu Chun , Files D Clark
Published: October 2020

Increased age is a risk factor for poor outcomes from respiratory failure and acute respiratory distress syndrome (ARDS). In this study, we sought to define age-related differences in lung inflammation, muscle injury, and metabolism after intratracheal lipopolysaccharide (IT-LPS) acute lung injury (ALI) in adult (6 months) and aged (18–20 months) male C57BL/6 mice. We also investigated age-related changes in muscle fatty acid oxidation (FAO) and the consequences of systemic FAO inhibition with the drug etomoxir. Aged mice had a distinct lung injury course characterized by prolonged alveolar neutrophilia and lack of response to therapeutic exercise. To assess the metabolic consequences of ALI, aged and adult mice underwent whole body metabolic phenotyping before and after IT-LPS. Aged mice had prolonged anorexia and decreased respiratory exchange ratio, indicating increased reliance on FAO. Etomoxir increased mortality in aged but not adult ALI mice, confirming the importance of FAO on survival from acute severe stress and suggesting that adult mice have increased resilience to FAO inhibition. Skeletal muscles from aged ALI mice had increased transcription of key fatty acid metabolizing enzymes, CPT-1b, LCAD, MCAD, FATP1 and UCP3. Additionally, aged mice had increased protein levels of CPT-1b at baseline and after lung injury. Surprisingly, CPT-1b in isolated skeletal muscle mitochondria had decreased activity in aged mice compared to adults. The distinct phenotype of aged ALI mice has similar characteristics to the adverse age-related outcomes of ARDS. This model may be useful to examine and augment immunologic and metabolic abnormalities unique to the critically ill aged population.
The calm after the storm: re-starting ART treatments safely in the wake of the COVID-19 pandemic
Authors:   The ESHRE COVID-19 Working Group, Gianaroli Luca , Ata Baris , Lundin Kersti , Rautakallio-Hokkanen Satu , Tapanainen Juha S , Vermeulen Nathalie , Veiga Anna , Mocanu Edgar
Published: October 2020

The coronavirus disease 2019 (COVID-19) pandemic created a significant impact on medically assisted reproduction (MAR) services. ESHRE decided to mobilize resources in order to collect, analyse, monitor, prepare and disseminate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) knowledge specifically related to ART and early pregnancy. This article presents the impact of the SARS-CoV-2 pandemic focusing on reproductive healthcare. It details the rationale behind the guidance prepared to support MAR services in organizing and managing the re-start of treatments or in case of any future wave of COVID-19 disease. The guidance includes information on patient selection and informed consent, staff and patient triage and testing, adaptation of ART services, treatment planning and code of conduct. The initiatives detailed in this article are not necessarily COVID-specific and such action plans could be applied effectively to manage similar emergency situations in different areas of medicine, in the future.
Militarized masculinity and the paradox of restraint: mechanisms of social control under modern authoritarianism
Authors: Tapscott Rebecca
Published: October 2020

The twenty-first century is marked by the rise of new forms of authoritarianism, many of which are characterized by the ‘paradox of restraint’, in which reforms compliant with the rule of law are used to unshackle the ruler's arbitrary power. Despite a proliferation of scholarly studies on this topic, we still have limited understanding of how national-level authoritarian power reaches ordinary citizens in these contexts. This article identifies the performance of militarized masculinities as an understudied mechanism that does so. It offers two main contributions: first, it highlights how performances of militarized masculinities enact the paradox of restraint through gendered idioms, thereby magnifying the ambiguities of modern authoritarianism and diffusing them at a local level. Second, it recasts the conceptual utility of militarized masculinities, showing that the concept's inherent tensions between ordered discipline and unaccountable violence produce and project authoritarian power, giving militarized masculinities special potency as a mode of social discipline in these contexts. The article draws on feminist International Relations, employing grounded ethnographic research to illustrate how national-level power circulates locally. To do so, it first illustrates the relationship between the paradox of restraint and militarized masculinities using the cases of Putin's Russia and Duterte's Philippines. It then turns to an in-depth case study of a local dispute between soldiers and civilians in Museveni's Uganda to trace how gendered local encounters facilitate the transmission of national-level authoritarian power into the lives of ordinary people.
The 2020 oil price dive in a carbon-constrained era: strategies for energy exporters in central Asia
Authors: Skalamera Morena
Published: October 2020

The quick rise of commercially viable renewable energy worldwide presents encouraging opportunities for sustainable growth, but it also portends new risks. Hydrocarbon-producing nations of Eurasia have typically strongly relied on geographic proximity to their most lucrative export market: Europe. Yet the revolutionary nature of Europe's ‘Green Deal’ means that their position is under threat. While the demand-side ramifications of the global low-carbon transition are widely discussed, little consideration has been given to the inevitable implications for hydrocarbons producers, particularly in the less-studied central Asian region. This article draws attention to the interconnections between hydrocarbon rents, regime stability and new foreign policy strategies in Kazakhstan, Uzbekistan and Turkmenistan in the wake of the global shift away from oil to renewable energy. By so doing, it systematically examines what implications the energy transition has on crucial petrostates in central Asia, and what this, in turn, means for international stability.
Automatic fish measurement using a camera and a 3D sensor applied to a long-term experiment
Authors: Silva César Santos , Aires Ricardo , Rodrigues Flávio
Published: October 2020

The fish monitoring effort has been increasing over the past years, due to conservation and management requests demanding more accurate data and consequently raising costs. This is an important challenge especially for remote and disperse locations where fish sampling poses unbearable costs, leading to limited spatial sampling schemes, limited data on rare and occasional landed species, and erroneous and biased observations. In this article, we propose a new autonomous system that can be installed on monitoring spots or on board fishing vessels, which is able to remotely acquire all the landed or captured fish and measure it automatically without any physical interaction. The system uses (i) a camera and a 3D sensor to obtain a complete XYZ reading of the fish and (ii) a convolutional neural network, trained for a representative set of species to detect and measure the individuals visible in a box. The system was validated in real conditions, using continuous observations of the landed fish in three islands of the Azores Archipelago, for 2 years. The aim of this article is to provide an overview of the measuring system and an analysis of the sampled data, by comparing the results of the proposed method with the traditional sampling methodology for a given period.
Individual growth profiling improves growth modelling in the geoduck clam Panopea generosa
Authors: Hidalgo-de-la-Toba José Angel , Vadopalas Brent , Lluch-Cota Daniel Bernardo , Morales-Bojórquez Enrique , Bautista-Romero J Jesús , González-Peláez Sergio Scarry
Published: October 2020

Contemporary modelling of growth based on shell-length to terminal age (SLTA) in long-lived clams is subject to inaccuracies as a consequence of low representation of early age classes in population samplings. To increase early age representation and improve growth modelling, we implemented an approach that used individual growth profile (IGP) data recorded in shells of the Pacific geoduck (Panopea generosa). We compared IGP against SLTA and a combination of both IGP + SLTA data through a multi-model approach for the southernmost known P. generosa population. The most parsimonious model for both IGP and IGP + SLTA data sets was the Schnute model, with L∞ = 127.9 and 122.5 mm, respectively, with the asymptotic phase attained at ∼15 years. For SLTA data alone, the most parsimonious was the Johnson model, with L∞ = 161.6 mm reaching the asymptotic phase at >25 years. In terms of performance, the IGP and IGP + SLTA data sets informed individual growth models with stronger relationships (r2 > 0.9) and higher modelling efficiency (ME > 0.9) than those fitted to SLTA alone (r2 = 0.51; ME = 0.51). The results demonstrate that IGP yields reliable information from relatively few organisms, improves the biological knowledge of the population, and increases the accuracy of parameter estimates for better fishery management.
Inferior outcomes following cardiac surgery in patients with a functioning renal allograft
Authors: Fazmin Ibrahim T , Rafiq Muhammad U , Nashef Samer , Ali Jason M
Published: October 2020

OBJECTIVES

Renal transplantation is an effective treatment for end-stage renal failure. The aim of this study was to evaluate outcomes for these patients undergoing cardiac surgery.

METHODS

A retrospective analysis identified patients with a functioning renal allograft at the time of surgery. A 2:1 propensity matching was performed. Patients were matched on: age, sex, left ventricle function, body mass index, preoperative creatinine, operation priority, operation category and logistic EuroSCORE.

RESULTS

Thirty-eight patients undergoing surgery with a functioning renal allograft were identified. The mean age was 62.4 years and 66% were male. A total of 44.7% underwent coronary artery bypass grafting and 26.3% underwent a single valve procedure. The mean logistic EuroSCORE was 10.65. The control population of 76 patients was well matched. Patients undergoing surgery following renal transplantation had a prolonged length of intensive care unit (3.19 vs 1.02 days, P < 0.001) and hospital stay (10.3 vs 7.17 days, P = 0.05). There was a higher in-hospital mortality (15.8% vs 1.3%, P = 0.0027). Longer-term survival on Kaplan–Meier analysis was also inferior (P < 0.001). One-year survival was 78.9% vs 96.1% and 5-year survival was 63.2% vs 90.8%. A further subpopulation of 11 patients with a failed renal allograft was identified and excluded from the main analysis; we report demographic and outcome data for them.

CONCLUSIONS

Patients with a functioning renal allograft are at higher risk of perioperative mortality and inferior long-term survival following cardiac surgery. Patients in this population should be appropriately informed at the time of consent and should be managed cautiously in the perioperative period with the aim of reducing morbidity and mortality.
Adjuvant chemotherapy as a risk factor for chronic postoperative pain after video-assisted thoracoscopic surgery: a 10-year single-centre retrospective study
Authors: Yoon Susie , Hong Won-Pyo , Joo Hyundeok , Jang Dongyeon , Park Samina , Lee Ho-Jin
Published: October 2020

OBJECTIVES

The association between adjuvant chemotherapy (AC) and chronic postoperative pain (CPP) after video-assisted thoracoscopic surgery (VATS) for lung cancer resection has not yet been reported. We, therefore, investigated the association between AC and the long-term incidence of CPP after VATS.

METHODS

We retrospectively reviewed 3015 consecutive patients who underwent VATS for lung cancer between 2007 and 2016. The patients were divided into 2 groups: those who received (AC group) and those who did not receive (non-AC group) AC within 3 months after VATS. Propensity score analysis was performed to adjust for baseline differences between the 2 groups. The cumulative incidence of CPP at the intervals of 3 months, over 36 months, was compared before and after matching. A Cox proportional hazards regression analysis was used to investigate the predictors of CPP after VATS.

RESULTS

We included and assessed 2222 patients in this study. Of these, 320 patients (14.4%) received AC within 3 months post-VATS. The cumulative incidence of CPP during 36 months post-surgery was significantly higher in the AC group than in the non-AC group, before and after matching (log-rank test; P = 0.002 and 0.027, respectively). Cox proportional hazards regression analysis also showed that AC was a significant risk factor for CPP (hazard ratio 1.62, 95% confidence interval 1.16–2.28; P = 0.005).

CONCLUSIONS

Our results indicate that AC is an important risk factor for CPP after VATS. Further understanding of the risk factors for CPP may facilitate its prediction and treatment.
Mid-term outcomes of coronary endarterectomy combined with coronary artery bypass grafting
Authors: Tiemuerniyazi Xieraili , Yan Hua , Song Yangwu , Nan Yifeng , Xu Fei , Feng Wei
Published: October 2020

OBJECTIVES

The aim of this study was to evaluate the mid-term outcome of coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) and explore the potential risk factors for adverse events.

METHODS

A total of 208 consecutive patients underwent CE between 2008 and 2018 in our centre, of which 198 were included in this retrospective cohort study. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCEs). Kaplan–Meier analysis was performed to evaluate event-free survival, whereas subgroup analysis and Cox regression were used to explore risk factors for the outcomes.

RESULTS

The median follow-up time was 34.7 months. CE + CABG was performed mainly on the left anterior descending artery (42.3%) or right coronary artery (42.3%). Both operative mortality and incidence of perioperative myocardial infarction were 1.5%. The overall survival at 3 and 5 years was 98.0% and 95.9%, whereas the MACCE-free survival was 93.7% and 89.4%, respectively. No significant difference in the incidence of MACCE was observed between on-pump and off-pump CE (P = 0.256) or between left anterior descending artery and non-left anterior descending artery endarterectomy (P = 0.540). Advanced age (>65 years) was associated with a higher risk of MACCE both in univariate [hazard ratio (HR) 3.62, 95% confidence interval (CI) 1.37–9.62; P = 0.010] and multivariate analysis (HR 3.59, 95% CI 1.32–9.77; P = 0.013).

CONCLUSIONS

When performed by experienced surgeons, CE + CABG could be an acceptable approach to achieve complete revascularization of diffusely diseased coronary arteries with satisfactory outcomes, although advanced age might increase the risk of MACCE.
Reimbursement policy in a healthcare system with priorities: fee for priority versus bundled priority
Authors: Wang Zhongbin , Wang Jinting
Published: October 2020

This paper studies a healthcare system under two priority charging schemes. The first is a fee-for-priority (FFP) scheme under which the patients can choose to buy the priorities or not at their admission or readmission to the healthcare provider (HCP). The second is a bundled priority (BP) scheme under which the HCP receives a lump sum priority payment from patients for the entire episode of priority visits (regardless of the number of readmissions). Under both schemes, a certain proportion of revenue of the HCP (the reimbursement) is used to improve the service quality for patients. A two-stage Stackelberg game is established that captures the non-cooperative interactions between the HCP and patients, where the HCP is the leader who sets a price of priority and patients are the followers who decide whether to buy the priorities or not. We first characterize the Pareto-dominant equilibrium strategy of patients under the FFP and BP schemes, and we find that the total cost (including delay disutility and priority fee) of patients can be reduced if the patient pool is large. Although patients' minimum cost, including waiting cost and priority payment, is obtained under both the FFP and BP schemes, the prices are more flexible under the former than the latter. Finally, we demonstrate that implementing the FFP scheme can induce higher social welfare than the BP scheme.
Reducing the near boundary errors of nonhomogeneous heat equations by boundary consistent methods
Authors: Liu Chein-Shan , Chang Chih-Wen
Published: October 2020

In the paper, we point out a drawback of the Fourier sine series method to represent a given odd function, where the boundary Gibbs phenomena would occur when the boundary values of the function are non-zero. We modify the Fourier sine series method by considering the consistent conditions on the boundaries, which can improve the accuracy near the boundaries. The modifications are extended to the Fourier cosine series and the Fourier series. Then, novel boundary consistent methods are developed to solve the 1D and 2D heat equations. Numerical examples confirm the accuracy of the boundary consistent methods, accounting for the non-zeros of the source terms and considering the consistency of heat equations on the boundaries, which can not only overcome the near boundary errors but also improve the accuracy of solution about four orders in the entire domain, upon comparing to the conventional Fourier sine series method and Duhamel’s principle.
On the Optimal Volume Upper Bound for Kähler Manifolds with Positive Ricci Curvature (with an Appendix by Yuchen Liu)
Authors: Zhang Kewei
Published: October 2020

Using $\delta $-invariants and Newton–Okounkov bodies, we derive the optimal volume upper bound for Kähler manifolds with positive Ricci curvature, from which we get a new characterization of the complex projective space.
An explainable machine learning platform for pyrazinamide resistance prediction and genetic feature identification of Mycobacterium tuberculosis
Authors: Zhang Andrew , Teng Ling , Alterovitz Gil
Published: October 2020

Objective

Tuberculosis is the leading cause of death from a single infectious agent. The emergence of antimicrobial resistant Mycobacterium tuberculosis strains makes the problem more severe. Pyrazinamide (PZA) is an important component for short-course treatment regimens and first- and second-line treatment regimens. This research aims for fast diagnosis of M. tuberculosis resistance to PZA and identification of genetic features causing resistance.

Materials and Methods

We use clinically collected genomic data of M. tuberculosis that are resistant or susceptible to PZA. A machine learning platform is built to diagnose PZA resistance using the whole genome sequence data, and to identify resistance genes and mutations. The platform consists of a deep convolutional neural network (DCNN) model for resistance diagnosis and a support vector machine (SVM) model as a surrogate to identify resistance genes and mutations.

Results

The DCNN model achieves a PZA resistance diagnosis accuracy of 93%. Each prediction takes less than a second. The SVM has revealed 2 novel genes, embB and gyrA, besides the well-known pncA gene, and 9 mutations that harbor PZA resistance.

Discussion

The DCNN and SVM machine learning platform, if used together with the real-time genome sequencing machines, could allow for rapid PZA diagnosis, allowing for critical time to ensure good patient outcomes, and preventing outbreaks of deadly infections. Furthermore, identifying pertinent resistance genes and mutations will help researchers better understand the biological mechanisms behind resistance.

Conclusions

Machine learning can be used to achieve high-accuracy resistance prediction, and identify genes and mutations causing the resistance.
Large Differences in Urinary Benzene Metabolite S-Phenylmercapturic Acid Quantitation: A Comparison of Five LC–MS-MS Methods
Authors: Tevis Denise S , Willmore Andrew , Bhandari Deepak , Bowman Brett , Biren Chloe , Kenwood Brandon M , Jacob Peyton , Liu Jia , Bello Kristina , Hecht Stephen S , Carmella Steven G , Chen Menglan , Gaudreau Eric , Bienvenu Jean-François , Blount Benjamin C , De Jesús Víctor R
Published: October 2020

Benzene is a known genotoxic carcinogen linked to many hematological abnormalities. S-phenylmercapturic acid (PHMA, N-acetyl-S-(phenyl)-L-cysteine, CAS# 4775-80-8) is a urinary metabolite of benzene and is used as a biomarker to assess benzene exposure. Pre-S-phenylmercapturic acid (pre-PHMA) is a PHMA precursor that dehydrates to PHMA at acidic pH. Published analytical methods that measure urinary PHMA adjust urine samples to a wide range of pH values using several types of acid, potentially leading to highly variable results depending on the concentration of pre-PHMA in a sample. Information is lacking on the variation in sample preparation among laboratories regularly measuring PHMA and the effect of those differences on PHMA quantitation in human urine samples. To investigate the differences in PHMA quantitation, we conducted an inter-laboratory comparison that included the analysis of 50 anonymous human urine samples (25 self-identified smokers and 25 self-identified non-smokers), quality control samples and commercially available reference samples in five laboratories using different analytical methods. Observed urinary PHMA concentrations were proportionally higher at lower pH, and results for anonymous urine samples varied widely among the methods. The method with the neutral preparation pH yielded results about 60% lower than the method using the most acidic conditions. Samples spiked with PHMA showed little variation, suggesting that the variability in results in human urine samples across methods is driven by the acid-mediated conversion of pre-PHMA to PHMA.
Declining Use of Corticosteroids for Crohn’s Disease Has Implications for Study Recruitment: Results of a Pilot Randomized Controlled Trial
Authors: Balart M T , Russell L , Narula N , Bajaj G , Chauhan U , Khan K J , Marwaha A N , Ching E , Biro J , Halder S , Tse F , Marshall J K , Collins S M , Moayyedi P , Bercik P , Verdu E F , Leontiadis G I , Armstrong D , Pinto-Sanchez M I
Published: October 2020

Background

Corticosteroids (CS) have been used extensively to induce remission in Crohn’s disease (CD); however, they are associated with severe side effects. We hypothesized that the administration of an exclusive enteral nutrition (EEN) formula to CS would lead to increased CD remission rates and to decreased CS-related adverse events. We proposed to undertake a pilot study comparing EEN and CS therapy to CS alone to assess decrease symptoms and inflammatory markers over 6 weeks.

Aim

The overall aim was to assess study feasibility based on recruitment rates and acceptability of treatment in arms involving EEN

Methods

The pilot study intended to recruit 100 adult patients with active CD who had been prescribed CS to induce remission as part of their care. The patients were randomized to one of three arms: (i) standard-dose CS; (ii) standard-dose CS plus EEN (Modulen 1.5 kcal); or (iii) short-course CS plus EEN.

Results

A total of 2009 CD patients attending gastroenterology clinics were screened from October 2018 to November 2019. Prednisone was prescribed to only 6.8% (27/399) of patients with active CD attending outpatient clinics. Of the remaining 372 patients with active CD, 34.8% (139/399) started or escalated immunosuppressant or biologics, 49.6% (198/399) underwent further investigation and 8.8% (35/399) were offered an alternative treatment (e.g., antibiotics, surgery or investigational agents in clinical trials). Only three patients were enrolled in the study (recruitment rate 11%; 3/27), and the study was terminated for poor recruitment.

Conclusion

The apparent decline in use of CS for treatment of CD has implications for CS use as an entry criterion for clinical trials.
Colonial legacies: Shaping African cities
Authors: Baruah Neeraj G , Henderson J Vernon , Peng Cong
Published: October 2020

Institutions persisting from colonial rule affect the spatial structure and conditions under which 100s of millions of people live in Sub-saharan African cities. In a sample of 318 cities, Francophone cities have more compact development than Anglophone, overall, in older colonial sections, and at clear extensive margins long after the colonial era. Compactness covers intensity of land use, gridiron road structures and leapfrogging of new developments. Why the difference? Under British indirect and dual mandate rule, colonial and native sections developed without coordination. In contrast, integrated city planning and land allocation were featured in French direct rule. These differences in planning traditions persist.1
Evaluation of depth of dislocation visibility in SEM electron channeling contrast imaging in Ti-6Al-4V alloy using serial sectioning method
Authors: Yamasaki Shigeto , Deguchi Misaki , Mitsuhara Masatoshi , Nakashima Hideharu , Ota Yutaro , Kubushiro Keiji
Published: October 2020

In this study, we conducted a quantitative evaluation of dislocation density by scanning electron microscopy electron channeling contrast imaging for α grains of a Ti-6Al-4V alloy deformed at room temperature. The depth of visibility of dislocations is experimentally measured as 140 to 160 nm by a serial sectioning observation. This result is compared with the theoretical value and applied to evaluate dislocation density. These factors confirm that the theoretically calculated value of the depth of visibility, at 5 to 6 times the extinction distance, is valid for the hexagonal close-packed Ti alloy.
Presentation of an iatrogenically displaced third molar into the maxillary sinus in a 14-year-old patient successfully removed with an endoscopic approach: a case report and a review of the literature
Authors: Allen David Z , Sethia Rishabh , Hamersley Erin , Elmaraghy Charles A
Published: October 2020

Oral surgeons remove third molars (wisdom teeth) to prevent impaction. Given the close anatomical relationship to the maxillary sinus, perforation and displacement of third molars into the maxillary sinus is a well-known phenomenon that is typically removed with a buccal mucoperiosteal flap or through a Caldwell–Luc approach. However, a less invasive route of endoscopic removal has been utilized to success in one report. A literature review shows few reports of displaced molars into the maxillary sinus and no reported patient below the age of 18. A 14-year-old patient presented with a displaced third molar into her maxillary sinus following third molar extraction with her oral surgeon. The tooth was removed successfully, utilizing endoscopic sinus surgery (ESS) with a transition to transoral retrieval to prevent nasal trauma. This is the first reported case of displaced third molar into the right maxillary sinus in a pediatric patient that was removed via ESS.
Differences in Proxy-Reported and Self-Reported Disability in the Demographic and Health Surveys
Authors: Elkasabi Mahmoud
Published: October 2020

This article examines the presence, direction, and magnitude of differences between proxy reports and self-reports of disability among adults aged fifteen to fifty-nine years and elderly individuals aged sixty years and older in Demographic and Health Surveys conducted in Uganda, South Africa, and Mali. We use the propensity score weighted multivariate logistic regression to balance the weighted distributions of the covariates between self-reports and proxy reports. Disabilities that have an immediate effect on the communication with others or that require one-to-one help are likely to be over-reported by proxies or under-reported if proxies are not used, especially among the elderly aged sixty years and older. Disabilities that are not observable might be under-reported by proxies.
Osteoporosis in the oldest old
Authors: Rizzoli René
Published: October 2020

Osteoporosis and frailty greatly increase the risk of fracture. Hip fractures are the most serious osteoporotic fractures, with increased risk of mortality. In most countries, the majority are over 80 years old. Large rises on hip and other fragility fracture rates are predicted for much of South America and Asia in the coming decades. The survivors have a high risk of sustaining another major fracture and face deterioration in their quality of life and high risk of dependency. Optimal protein and calcium intakes, and vitamin D supplies, together with regular weight-bearing and balance-improving physical exercise are the cornerstones of fracture prevention. Evidence for antifracture efficacy of pharmacological interventions relies on randomized controlled trials in postmenopausal women between the ages of 50 and 80 years and the evidence of antiosteoporotic efficacy in the oldest old has come primarily from subgroup analyses.