bluuebunny/crossref_metadata_2025 huggingface dataset:
Dramatic Impact of Centralization and a Multidisciplinary Bladder Cancer Program in Reducing Mortality: The CABEM Project
Authors: Korkes Fernando , Timóteo Frederico , Martins Suelen , Nascimento Matheus , Monteiro Camila , Santiago José H. , Baccaglini Willy , Silveira Marcel A. , Pedroso Eduardo F. , Gava Marcello M. , Patel Prashant , Spiess Phillipe E. , Glina Sidney
Published: November 2021

PURPOSE

Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a complex treatment. In Brazil, as in most developing countries, data are scarce, but mortality seems exceedingly high. We have created a centralization program involving a multidisciplinary clinic in a region comprising seven municipalities. The aim of this study is to evaluate the impact of a multidisciplinary clinic and a centralization-of-care program (CABEM program) on MIBC treatment in Brazil.

PATIENTS AND METHODS

A total of 116 consecutive patients were evaluated. In group 1, 58 patients treated for MIBC before establishing a bladder cancer program from 2011 to 2017 were retrospectively evaluated. Group 2 represented 58 patients treated for MIBC after the implementation of the CABEM centralization program. Age, sex, staging, comorbidity indexes, mortality rates, type of treatment, and perioperative outcomes were compared.

RESULTS

Patients from group 2 versus 1 were older (68 v 64.2 years, P = .02) with a higher body mass index (25.5 v 22.6 kg/m2, P = .017) and had more comorbidities according to both age-adjusted Charlson Comorbidity Index (4.2 v 2.8, P = .0007) and Isbarn index (60.6 v 43.9, P = .0027). Radical cystectomy (RC) was the only treatment modality for patients in group 1, whereas in group 2, there were 31 (53%) RC; three (5%) partial cystectomies; seven (12%) trimodal therapies; 13 (22%) palliative chemotherapies; and three (5%) exclusive transurethral resections of the bladder tumor. No patient in group 1 received neoadjuvant chemotherapy, whereas it was offered to 69% of patients treated with RC. Ninety-day mortality rates were 34.5% versus 5% for groups 1 versus 2 ( P < .002). One-year mortality was also lower in group 2.

CONCLUSION

Our data support that a centralization program, a structured bladder clinic associated with protocols, a multidisciplinary team, and inclusion of chemotherapy and radiotherapy treatments can pleasingly improve outcomes for patients with MIBC.
Multi-Institutional Validation of a Mammography-Based Breast Cancer Risk Model
Authors: Yala Adam , Mikhael Peter G. , Strand Fredrik , Lin Gigin , Satuluru Siddharth , Kim Thomas , Banerjee Imon , Gichoya Judy , Trivedi Hari , Lehman Constance D. , Hughes Kevin , Sheedy David J. , Matthis Lisa M. , Karunakaran Bipin , Hegarty Karen E. , Sabino Silvia , Silva Thiago B. , Evangelista Maria C. , Caron Renato F. , Souza Bruno , Mauad Edmundo C. , Patalon Tal , Handelman-Gotlib Sharon , Guindy Michal , Barzilay Regina
Published: November 2021

PURPOSE

Accurate risk assessment is essential for the success of population screening programs in breast cancer. Models with high sensitivity and specificity would enable programs to target more elaborate screening efforts to high-risk populations, while minimizing overtreatment for the rest. Artificial intelligence (AI)-based risk models have demonstrated a significant advance over risk models used today in clinical practice. However, the responsible deployment of novel AI requires careful validation across diverse populations. To this end, we validate our AI-based model, Mirai, across globally diverse screening populations.

METHODS

We collected screening mammograms and pathology-confirmed breast cancer outcomes from Massachusetts General Hospital, USA; Novant, USA; Emory, USA; Maccabi-Assuta, Israel; Karolinska, Sweden; Chang Gung Memorial Hospital, Taiwan; and Barretos, Brazil. We evaluated Uno's concordance index for Mirai in predicting risk of breast cancer at one to five years from the mammogram.

RESULTS

A total of 128,793 mammograms from 62,185 patients were collected across the seven sites, of which 3,815 were followed by a cancer diagnosis within 5 years. Mirai obtained concordance indices of 0.75 (95% CI, 0.72 to 0.78), 0.75 (95% CI, 0.70 to 0.80), 0.77 (95% CI, 0.75 to 0.79), 0.77 (95% CI, 0.73 to 0.81), 0.81 (95% CI, 0.79 to 0.82), 0.79 (95% CI, 0.76 to 0.83), and 0.84 (95% CI, 0.81 to 0.88) at Massachusetts General Hospital, Novant, Emory, Maccabi-Assuta, Karolinska, Chang Gung Memorial Hospital, and Barretos, respectively.

CONCLUSION

Mirai, a mammography-based risk model, maintained its accuracy across globally diverse test sets from seven hospitals across five countries. This is the broadest validation to date of an AI-based breast cancer model and suggests that the technology can offer broad and equitable improvements in care.
Impact of Behavioral Nudges on the Quality of Serious Illness Conversations Among Patients With Cancer: Secondary Analysis of a Randomized Controlled Trial
Authors: Li Eric H. , Ferrell William , Klaiman Tamar , Kumar Pallavi , O'Connor Nina , Schuchter Lynn M. , Chen Jinbo , Patel Mitesh S. , Manz Christopher R. , Parikh Ravi B.
Published: November 2021

PURPOSE:

Serious Illness Conversations (SICs) are structured conversations between clinicians and patients about prognosis, treatment goals, and end-of-life preferences. Although behavioral interventions may prompt earlier or more frequent SICs, their impact on the quality of SICs is unclear.

METHODS:

This was a secondary analysis of a randomized clinical trial ( NCT03984773 ) among 78 clinicians and 14,607 patients with cancer testing the impact of an automated mortality prediction with behavioral nudges to clinicians to prompt more SICs. We analyzed 318 randomly selected SICs matched 1:1 by clinicians (159 control and 159 intervention) to compare the quality of intervention vs. control conversations using a validated codebook. Comprehensiveness of SIC documentation was used as a measure of quality, with higher integer numbers of documented conversation domains corresponding to higher quality conversations. A conversation was classified as high-quality if its score was ≥ 8 of a maximum of 10. Using a noninferiority design, mixed effects regression models with clinician-level random effects were used to assess SIC quality in intervention vs. control groups, concluding noninferiority if the adjusted odds ratio (aOR) was not significantly < 0.9.

RESULTS:

Baseline characteristics of the control and intervention groups were similar. Intervention SICs were noninferior to control conversations (aOR 0.99; 95% CI, 0.91 to 1.09). The intervention increased the likelihood of addressing patient-clinician relationship (aOR = 1.99; 95% CI, 1.23 to 3.27; P < .01) and decreased the likelihood of addressing family involvement (aOR = 0.56; 95% CI, 0.34 to 0.90; P < .05).

CONCLUSION:

A behavioral intervention that increased SIC frequency did not decrease their quality. Behavioral prompts may increase SIC frequency without sacrificing quality.
Revisiting berdache
Authors: Lo Vecchio Nicholas
Published: November 2021

The transformation of French bardache, ultimately a borrowing from Italian denoting the passive partner in sex between men, to English berdache, referring to Native American nonbinary gender identities or roles, involved a complex translinguistic dialogue in North America in the early nineteenth century. This history has never before been adequately explained. While berdache is now largely obsolete and considered offensive due to its exoticizing, colonialist, and ethnocentric origins, its multifaceted history encapsulates variation and change on phonetic, graphic, semantic, pragmatic, axiological, and ideological levels. In recent decades, Indigenous queer people have adopted Two-Spirit as a means of challenging this imposed categorization and asserting linguistic self-determination. With the aim of correcting previous accounts and omnipresent misconceptions about the history of the lexeme berdache, this article uses a qualitative philological method to describe the development of this internationalism from a linguistic perspective.
Differentiation of paediatric posterior fossa tumours by the multiregional and multiparametric MRI radiomics approach: a study on the selection of optimal multiple sequences and multiregions
Authors: Dong Jie , Li Suxiao , Li Lei , Liang Shengxiang , Zhang Bin , Meng Yun , Zhang Xiaofang , Zhang Yong , Zhao Shujun
Published: November 2021

Objective:

To evaluate the diagnostic performance of a radiomics model based on multiregional and multiparametric MRI to classify paediatric posterior fossa tumours (PPFTs), explore the contribution of different MR sequences and tumour subregions in tumour classification, and examine whether contrast-enhanced T  1 weighted (T1C) images have irreplaceable added value.

Methods:

This retrospective study of 136 PPFTs extracted 11,958 multiregional (enhanced, non-enhanced, and total tumour) features from multiparametric MRI (T  1- and T  2 weighted, T1C, fluid-attenuated inversion recovery, and diffusion-weighted images). These features were subjected to fast correlation-based feature selection and classified by a support vector machine based on different tasks. Diagnostic performances of multiregional and multiparametric MRI features, different sequences, and different tumoral regions were evaluated using multiclass and one-vs-rest strategies.

Results:

The established model achieved an overall area under the curve (AUC) of 0.977 in the validation cohort. The performance of PPFTs significantly improved after replacing T1C with apparent diffusion coefficient maps added into the plain scan sequences (AUC from 0.812 to 0.917). When oedema features were added to contrast-enhancing tumour volume, the performance did not significantly improve.

Conclusion:

The radiomics model built by multiregional and multiparametric MRI features allows for the excellent distinction of different PPFTs and provides valuable references for the rational adoption of MR sequences.

Advances in knowledge:

This study emphasized that T1C has limited added value in predicting PPFTs and should be cautiously adopted. Selecting optimal MR sequences may help guide clinicians to better allocate acquisition sequences and reduce medical costs.
Peritoneal disease: key imaging findings that help in the differential diagnosis
Authors: Campos Nuno M F , Almeida Vânia , Curvo Semedo Luís
Published: November 2021

The peritoneum is a unique serosal membrane, which can be the site of primary tumors and, more commonly, secondary pathologic processes. Peritoneal carcinomatosis is the most common malignant condition to affect the peritoneal cavity, and the radiologist plays an important role in making the diagnosis and assessing the extent of disease, especially in sites that may hinder surgery. In this review, we address the role of the radiologist in the setting of peritoneal pathology, focusing on peritoneal carcinomatosis as this is the predominant malignant process, followed by revising typical imaging findings that can guide the differential diagnosis.

We review the most frequent primary and secondary peritoneal tumor and tumor-like lesions, proposing a systemic approach based on clinical history and morphological appearance, namely distinguishing predominantly cystic from solid lesions, both solitary and multiple.
Is jaw fractal dimension a reliable biomarker for osteoporosis screening? A systematic review and meta-analysis of diagnostic test accuracy studies
Authors: Cavalcante Davi de Sá , Silva Paulo Goberlânio de Barros , Carvalho Francisco Samuel Rodrigues , Quidute Ana Rosa Pinto , Kurita Lúcio Mitsuo , Cid Adília Mirela Pereira Lima , Ribeiro Thyciana Rodrigues , Gurgel Marcela Lima , Kurita Bianca Moreira , Costa Fábio Wildson Gurgel
Published: November 2021

Objectives:

To summarize the evidence on the feasibility of maxillomandibular imaging exams-related fractal dimension (FD) in screening patients with osteoporosis.

Methods:

This registered systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy statement. High sensitivity search strategies were developed for six primary databases and grey literature. Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) items evaluated the risk of bias, and the GRADE approach assessed the evidence certainty.

Results:

From 1034 records initially identified through database searching, four studies were included (total sample of 747 patients [osteoporosis, 136; control group, 611]). The meta-analysis showed that the overall sensitivity and specificity of the FD were 86.17 and 72.68%, respectively. In general, all studies showed low RoB and applicability concern. The certainty of the evidence was very low to moderate.

Conclusions:

This systematic review showed that the jaw-related FD presented sensitivity and specificity values higher than 70%, and its sensitivity in osteoporosis screening was a better parameter than specificity.
Comparison of choroidal thickness in eyes of diabetic patients with eyes of healthy individuals using optical coherence tomography in a tertiary care hospital
Authors: Hassan Hafsa , Cheema Alyscia , Tahir Muhammad Ali , Nawaz Hina Nasreen
Published: November 2021

Objectives: To compare the choroidal thickness in eyes of diabetic patients with eyes of age matched controls using optical coherence tomography in a tertiary care hospital.

Methods: This Cross sectional study was conducted at the Department of Ophthalmology, Jinnah Postgraduate Medical Centre Karachi, for six months from13thJanuary 2020 to13thJuly 2020. The study group comprised of 44 patients with 88 eyes. Patients who fulfill the inclusion criteria that is age ranging from 35 to 80years, either gender, known case of diabetes mellitus and having any type of diabetic retinopathy (HbA1c >7), non-diabetic healthy individuals (HbA1c <7) and those giving informed consent were included in the study. However, patients having active ocular infections, history of myocardial infarction, stroke, uveitis, any ocular surgery, lasers, intravitreal injections, poor fundus view and not giving consent were excluded. A pre-designed proforma was filled. A baseline ocular examination was performed and choroidal thickness was assessed from retinal pigment epithelium to choroid sclera junction in diabetic and healthy participants of the study group using high resolution Swept source OCT (DRI-OCT-2 Triton; Topcon).

Results: The average age of the patients was 39.41±15.95 years. According to our study mean central subfoveal choroidal thickness in diabetic eyes was 268.5 ± 66.22 (95% CI 240 – 297) and in non-diabetic healthy participants it was 339.3 ± 71.49 (95% CI 308 – 369) with a p-value of 0.001. However, average choroidal thickness was 261.8 ± 61.93 (95% CI 235 – 288) and 336.0 ± 74.35 (95% CI 304 – 367) in diabetic and non-diabetic healthy population with a p-value of 0.001. Choroidal thickness comparison between gender in diabetic and non-diabetic population also showed similar trend.

Conclusion: In this study, mean central choroidal thickness as well as average choroidal thickness was significantly reduced in eyes having diabetic retinopathy as compared to participants with non-diabetic healthy eyes. These findings indicate that changes in choroid may be a probable route in the pathogenesis of diabetic retinopathy.

doi: https://doi.org/10.12669/pjms.38.1.4443

How to cite this:Hassan H, Cheema A, Tahir MA, Nawaz HN. Comparison of choroidal thickness in eyes of diabetic patients with eyes of healthy individuals using optical coherence tomography in a tertiary care hospital. Pak J Med Sci. 2022;38(1):254-260.  doi: https://doi.org/10.12669/pjms.38.1.4443

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.
The effects of Covid-19 on Medical Education
Authors: Karim Zoya , Javed Afzal , Azeem Muhammad Waqar
Published: November 2021

Since the start of January 2019, COVID-19 has caused unparalleled disruption to all aspects of life globally, including the delivery of medical education. Each university and institution have a different approach on how medicine, as a course, is taught and delivered, however, generally there is a consensus that in the earlier years, more emphasis should be given to the acquisition of theoretical and scientific knowledge, including anatomy and physiology. In the later years, medical students are then expected to apply their theoretical knowledge in a practical setting by attending various placements and interacting with patients and other healthcare professionals. The duality of this approach results in doctors who are both competent in their knowledge of the basic sciences whilst being good clinicians with sound practical and inter-personal skills. Covid-19 causes an unprecedented interruption to all students, however with courses such as Medicine, whereby a practical element is crucial, the adaptation to deliver the course effectively is more of a challenge. Clinical rotations were cancelled during the start of the pandemic due to concerns about the students and their families contracting the virus and also for the protection of the vulnerable patients in hospitals. In this manuscript we have explored the adaptations made in order to deliver medical education and evaluate the effectiveness of these methods. We will also be discussing the implications and limitations of these methods.

doi: https://doi.org/10.12669/pjms.38.1.5269

How to cite this:Karim Z, Javed A, Azeem MW. The effects of Covid-19 on Medical Education. Pak J Med Sci. 2022;38(1):320-322. doi: https://doi.org/10.12669/pjms.38.1.5269

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.
HIV index testing services in urban Lusaka: a retrospective review of medical records
Authors: Katamba Cibangu
Published: November 2021

Background: As the proportions of people living with HIV (PLHIV) who do not know their HIV infection status decrease, reaching the remaining few who are asymptomatic and not in contact with the health care system becomes a critical challenge. Therefore, reaching the first 90 of the UNAIDS 90-90-90 targets will require effective and efficient HIV testing approaches. The number of PLHIV who know their HIV status and who receive antiretroviral therapy could increase by the expansion of index testing services.

Methods: This project was a retrospective study looking at medical records of HIV positive clients who were elicited for index testing between October and December 2019. It was conducted in three high volume health facilities in Matero Urban sub-district 3 in Lusaka, Zambia.

Results: The HIV test outcomes for index contacts were as follows: 452 index contacts (53.5%) tested HIV negative, 113 index contacts (13.4%) tested HIV positive, 108 index contacts (12.8%) were known HIV positive, and 172 index contacts (20.4%) were not yet tested for HIV. Of the 113 contacts who tested HIV positive, 90 index contacts started anti-retroviral therapy within 7 days (79.6%).

The total number of 845 contacts were elicited from 604 index clients, giving a low elicitation ratio of 1:1.4. There was not much difference between gender for elicited contacts (423 men and 422 women). A total number of 565 index contacts were eligible for HIV test. 113 of them tested HIV positive, representing a positivity yield of 20%. Pearson Chi-Square test value was 0.498 and the p value was 0.481. This result is not significant since p value (0.481) is greater than the designated alpha level (0.05).

Conclusions: HIV programs need to explore and address barriers to HIV partner testing services to avoid over-testing and maximize HIV case identification (thus, improving HIV testing positivity yield).
Scientific research and innovation response to the COVID-19 pandemic in Peru
Authors: Moya-Salazar Jeel , Gomez-Saenz Lucia , Cañari Betsy , Contreras-Pulache Hans
Published: November 2021

Background: COVID-19 has shaken countries at all levels, putting public health at risk. Global efforts have allocated funding for the development of research for the development of vaccines, digital tools, epidemiologic, social, and economic studies. Although these efforts have been developed worldwide, not all countries have prioritized the same topics and may have a different impact on solving problems and containing the spread of COVID-19.

Methods: A descriptive study was conducted with secondary data of "Special Projects COVID-19” in order to analyze the prioritization of proposals and projects to Peruvian needs in the face of pandemic. Two calls were made by the Peruvian research council (CONCyTec); the first with five areas and the second with seven. The global amounts financed by each call were 342,857 USD (1,200,000 soles) and 700,000 USD (1,750,000 soles), respectively.

Results: A total of 1,101 research projects were presented, 600 (54.5%) in the first call. In this call, 176 (29.3%) projects were from technological development and innovation and 29 were winners (with a global budget of 1,711,907.25 USD /6,077,270.75 soles). In the second call, 120 (23.9%) projects were from the area of Social and economic research and 21 were winners (global budget of 1,284,002.25 USD/558,208.55 soles) (p=0.043). The largest proportion of winning projects in both calls was 12 (41.4%) in Technological developments and innovation, then five (17.2%) each in telehealth and mobile health, and epidemiological and social studies. Across both calls, 214 (55.8%) and 160 (51.9%) projects were of private organizations and universities, respectively.

Conclusions: This research shows ~2% of rapid response "Special Projects COVID-19” were financed by the CONCyTec call with over a million dollars of funds. Although the main topics were technological innovation, detection systems, and vaccines, these priorities have not had a global impact on the epidemiological development of the pandemic in Peru.
Palliative care and good death in acute diseases: a scoping review protocol
Authors: Widyaningsih Vitri , Febrinasari Ratih Puspita , Suwandono Adji , Bhima Sigid Kirana Lintang , Padmawati Retna Siwi , Probandari Ari
Published: November 2021

Increasing cases of emerging and re-emerging infectious diseases, requires healthcare systems to provide essential palliative care for critically ill patients and their families. With the rapid onset and often accelerated deterioration in patients with acute conditions, palliative and supportive care for these patients have different characteristics compared to those for chronic diseases. Furthermore, providing end-of life services for critically ill patients with acute diseases and their families to ensure good death for the patients, will also have its own challenges. This scoping review aims to explore the concept of palliative care and good death for acute diseases.

This scoping review will be conducted using the Arksey and O’Malley's framework for scoping reviews: identifying the research question, identifying relevant studies, study selection, charting the data, collating, summarizing, reporting results, and conducting consultation. All original research with a focus on palliative care and good death due to acute diseases will be included. This review will include all original research designs published between the period of 2000–2021 that describe a measure of palliative care management for and good death due to acute diseases. Quantitative, qualitative and mixed-method studies will be included in order to consider different aspects of healthcare services. This review will also include guidelines and gray literature on palliative care and good deaths. The search will be conducted through PubMed, Scopus Database, and ScienceDirect using the key terms related to acute disease palliative care and the concept of good death due to acute diseases. Two authors will screen the titles and abstracts of the studies. Two authors will review the full text of selected studies independently and extract the data. All selected studies will be synthesized qualitatively, and the results will be consulted with experts through discussion and depict the current concept of palliative care and good death in acute diseases.
Financing conditions of renewable energy projects – results from an EU wide survey
Authors: Brückmann Robert , Roth Agustin , Jimeno Moïra , Banasiak Jörn , Đukan Mak , Kitzing Lena , Anatolitis Vasilios
Published: November 2021

This data note aims to present a dataset with values for financing conditions for renewable energy projects in Europe. This includes weighted average cost of capital, cost of debt, cost of equity, debt share, debt service coverage ratio and loan tenors. The dataset was elaborated in the framework of the "Auctions for Renewable Energy Support II" project (AURES II). The main goal of the AURES II project is to provide policy support to the Member States of the European Union in order to improve the effectiveness and cost-efficiency of auctions for renewable energy support. As part of the AURES II project, an extensive survey (structured interviews) was conducted between September 2019 and April 2020 with different stakeholders involved in the renewable energy industry, such as banks, project developing companies, and investment funds, among others. The technologies covered were solar photovoltaics (PV), wind onshore, and wind offshore. Interviewees were asked to provide values for financing conditions for specific projects (for certain cases, country estimates or ranges of values were provided). Spain, Portugal, Greece, Germany, and Denmark were selected as focus countries, for which the interviews also included qualitative questions to discuss the observed quantitative data in these countries. The presented data has been used as the main input to elaborate an AURES II report on renewable energy financing conditions in Europe.
Azithromycin and cefixime combination versus azithromycin alone for the out-patient treatment of clinically suspected or confirmed uncomplicated typhoid fever in South Asia: a randomised controlled trial protocol
Authors: Giri Abhishek , Karkey Abhilasha , Dongol Sabina , Arjyal Amit , Maharjan Archana , Veeraraghavan Balaji , Paudyal Buddhi , Dolecek Christiane , Gajurel Damodar , Phuong Dung Nguyen Thi , Thanh Duy Pham , Qamar Farah , Kang Gagandeep , Hien Ho Van , John Jacob , Lawson Katrina , Wolbers Marcel , Hossain Md. Shabab , Sharifuzzaman M , Luangasanatip Nantasit , Maharjan Nhukesh , Olliaro Piero , Rupali Priscilla , Shakya Ronas , Shakoor Sadia , Rijal Samita , Qureshi Sonia , Baker Stephen , Joshi Subi , Ahmed Tahmeed , Darton Thomas , Bao Tran Nguyen , Lubell Yoel , Kestelyn Evelyne , Thwaites Guy , Parry Christopher M. , Basnyat Buddha
Published: November 2021

Background: Typhoid and paratyphoid fever (enteric fever) is a common cause of non-specific febrile infection in adults and children presenting to health care facilities in low resource settings such as the South Asia.  A 7-day course of a single oral antimicrobial such as ciprofloxacin, cefixime, or azithromycin is commonly used for its treatment. Increasing antimicrobial resistance threatens the effectiveness of these treatment choices. We hypothesize that combined treatment with azithromycin (active mainly intracellularly) and cefixime (active mainly extracellularly) will be a better option for the treatment of clinically suspected and culture-confirmed typhoid fever in South Asia.

Methods: This is a phase IV, international multi-center, multi-country, comparative participant-and observer-blind, 1:1 randomised clinical trial. Patients with suspected uncomplicated typhoid fever will be randomized to one of the two interventions: Arm A: azithromycin 20mg/kg/day oral dose once daily (maximum 1gm/day) and cefixime 20mg/kg/day oral dose in two divided doses (maximum 400mg bd) for 7 days, Arm B: azithromycin 20mg/kg/day oral dose once daily (max 1gm/day) for 7 days AND cefixime-matched placebo for 7 days. We will recruit 1500 patients across sites in Bangladesh, India, Nepal, and Pakistan. We will assess whether treatment outcomes are better with the combination after one week of treatment and at one- and three-months follow-up.

Discussion: Combined treatment may limit the emergence of resistance if one of the components is active against resistant sub-populations not covered by the other antimicrobial activity. If the combined treatment is better than the single antimicrobial treatment, this will be an important result for patients across South Asia and other typhoid endemic areas.

Clinicaltrials.gov registration: NCT04349826 (16/04/2020)
Star-Cursed Lovers: Role of Popularity Information in Online Dating
Authors: Bojd Behnaz , Yoganarasimhan Hema
Published: November 2021

This paper examines the effect of user’s popularity information on his or her demand in a mobile dating platform.
A Continuous Model for Designing Corridor Systems with Modular Autonomous Vehicles Enabling Station-wise Docking
Authors: Chen Zhiwei , Li Xiaopeng , Qu Xiaobo
Published: November 2021

The “asymmetry” between spatiotemporally varying passenger demand and fixed-capacity transportation supply has been a long-standing problem in urban mass transportation (UMT) systems around the world. The emerging modular autonomous vehicle (MAV) technology offers us an opportunity to close the substantial gap between passenger demand and vehicle capacity through station-wise docking and undocking operations. However, there still lacks an appropriate approach that can solve the operational design problem for UMT corridor systems with MAVs efficiently. To bridge this methodological gap, this paper proposes a continuum approximation (CA) model that can offer near-optimal solutions to the operational design for MAV-based transit corridors very efficiently. We investigate the theoretical properties of the optimal solutions to the investigated problem in a certain (yet not uncommon) case. These theoretical properties allow us to estimate the seat demand of each time neighborhood with the arrival demand curves, which recover the “local impact” property of the investigated problem. With the property, a CA model is properly formulated to decompose the original problem into a finite number of subproblems that can be analytically solved. A discretization heuristic is then proposed to convert the analytical solution from the CA model to feasible solutions to the original problem. With two sets of numerical experiments, we show that the proposed CA model can achieve near-optimal solutions (with gaps less than 4% for most cases) to the investigated problem in almost no time (less than 10 ms) for large-scale instances with a wide range of parameter settings (a commercial solver may even not obtain a feasible solution in several hours). The theoretical properties are verified, and managerial insights regarding how input parameters affect system performance are provided through these numerical results. Additionally, results also reveal that, although the CA model does not incorporate vehicle repositioning decisions, the timetabling decisions obtained by solving the CA model can be easily applied to obtain near-optimal repositioning decisions (with gaps less than 5% in most instances) very efficiently (within 10 ms). Thus, the proposed CA model provides a foundation for developing solution approaches for other problems (e.g., MAV repositioning) with more complex system operation constraints whose exact optimal solution can hardly be found with discrete modeling methods.
Shaping and delivering services in primary care: benzodiazepine and opiate withdrawal service
Authors: Fernandez Jeff
Published: November 2021

This article looks at the development of the benzodiazepine and opiate withdrawal service (BOWS) based in addiction services in London. The service was created to implement a manageable and sustainable model that would treat patients with benzodiazepine and codeine-based dependencies. It was envisaged the service would effectively treat patients in GP practices in two boroughs in London. The article outlines what is possible in terms of treatment for patients with issues of opioid dependency, by examining two in-depth case studies. It also illustrates what is possible for nurses in the modern NHS and can be used as a resource to shape and deliver services with positive patient outcomes. Nurses should be seen as shaping and delivering care in the NHS. This is a role that should be promoted to a greater degree, wherever possible.
Abomasal ulcers in cattle
Authors: Turner Andrea
Published: November 2021

Abomasal ulcers in cattle often present with non-specific clinical signs meaning that it is one of several differentials that may be relevant for a wide range of clinical presentations. This, combined with a lack of accurate diagnostic tests, makes the condition hard for the clinician to diagnose with confidence. The management and prognosis for cattle differ significantly depending on the severity and chronicity of an abomasal ulcer. It is important that clinicians are aware of the possibilities for diagnosis, treatment, and prognosis of the varying forms of this condition so they can offer the most appropriate management plans for the individual animal in every case.
A brief overview of acute poisoning in sheep
Authors: Bates Nicola
Published: November 2021

Acute poisoning in sheep can occur following ingestion of toxic plants, including plants that they may eat normally such as ivy (Hedera spp.) and plants they avoid unless other forage is unavailable. Poisoning with plants containing grayanotoxins (Pieris and Rhododendron spp.) is very common in sheep, particularly when the weather is poor and they are hungry. Oak (Quercus spp.) poisoning is also relatively common in sheep, particular in years with a heavy acorn crop. Numerous plants contain cardiac glycosides and are a potential risk to sheep. Sudden death is frequently the first signs of plant toxicosis in livestock. Bites from adders (Vipera berus berus) may also occur in sheep but are likely to be underreported as the actual biting event is not witnessed. Envenomation may result in swelling and haematological, renal, hepatic and cardiac effects. Overdosage of drugs with a narrow therapeutic index may also be a risk. One such example is closantel which can result in blindness. Management of acute poisoning in sheep is supportive including removal from exposure, and providing analgesia, rehydration and potentially a rumenotomy for plant exposure in valuable animals.
Ogden Type I to III Tibial Tubercle Fractures in Skeletally Immature Patients: Is Routine Anterior Compartment Fasciotomy of the Leg Indicated?
Authors: Brown Corey , Kelly Brian A. , Brouillet Kirsten , Luhmann Scott J.
Published: November 2021

Purpose

Determine the frequency of compartment syndrome of the leg after displaced, operatively treated modified Ogden I to III tibial tubercle fractures (TTFxs), evaluate the preoperative assessment and use of advanced imaging, and need for prophylactic fasciotomies.

Methods

Retrospective analysis of operatively treated, displaced modified Ogden I to III TTFxs, at our level 1 paediatric trauma centre between 2007 and 2019. Modified Ogden Type IV and V fracture patterns were excluded. Fracture patterns were determined by plain radiographs.

Results

There were 49 modified Ogden I to III TTFxs in 48 patients. None had signs nor symptoms of vascular compromise, compartment syndromes or impending compartment syndromes preoperatively. In all, 13 of the 49 fractures underwent anterior compartment fasciotomy at surgery; eight of the 13 had traumatic fascial disruptions, which were extended surgically. All incisions were primarily closed. There were no instances of postoperative compartment syndromes, growth arrest, leg-length discrepancy or recurvatum deformity postoperatively. All patients achieved radiographic union and achieved full range of movement.

Conclusion

The potentially devastating complications of compartment syndrome or vascular compromise following TTFx did not occur in this consecutive series of patients over 12 years. The presence of an intact posterior proximal tibial physis and posterior metaphyseal cortex (Modified Ogden TTFx Type I to III) may mitigate the occurrence of vascular injury and compartment syndrome. Plain radiographs appear appropriate as the primary method of imaging TTFxs, with use of advanced imaging as the clinical scenario dictates. Routine, prophylactic fasciotomies do not appear necessary in Ogden I to III TTFxs, but should be performed for signs and symptoms of compartment syndrome.

Level of evidence

Level IV
Physician wellness in orthopaedic surgery
Authors: Mir Hassan , Downes Katheryne , Chen Antonia F. , Grewal Ruby , Kelly Derek M. , Lee Michael J. , Leucht Philipp , Dulai Sukhdeep K.
Published: November 2021

Aims

Physician burnout and its consequences have been recognized as increasingly prevalent and important issues for both organizations and individuals involved in healthcare delivery. The purpose of this study was to describe and compare the patterns of self-reported wellness in orthopaedic surgeons and trainees from multiple nations with varying health systems.

Methods

A cross-sectional survey of 774 orthopaedic surgeons and trainees in five countries (Australia, Canada, New Zealand, UK, and USA) was conducted in 2019. Respondents were asked to complete the Mayo Clinic Well-Being Index and the Stanford Professional Fulfillment Index in addition to 31 personal/demographic questions and 27 employment-related questions via an anonymous online survey.

Results

A total of 684 participants from five countries (Australia (n = 74), Canada (n = 90), New Zealand (n = 69), UK (n = 105), and USA (n = 346)) completed both of the risk assessment questionnaires (Mayo and Stanford). Of these, 42.8% (n = 293) were trainees and 57.2% (n = 391) were attending surgeons. On the Mayo Clinic Well-Being Index, 58.6% of the overall sample reported feeling burned out (n = 401). Significant differences were found between nations with regards to the proportion categorized as being at risk for poor outcomes (27.5% for New Zealand (19/69) vs 54.4% for Canada (49/90) ; p = 0.001). On the Stanford Professional Fulfillment Index, 38.9% of the respondents were classified as being burned out (266/684). Prevalence of burnout ranged from 27% for Australia (20/74 up to 47.8% for Canadian respondents (43/90; p = 0.010). Younger age groups (20 to 29: RR 2.52 (95% confidence interval (CI) 1.39 to 4.58; p = 0.002); 30 to 39: RR 2.40 (95% CI 1.36 to 4.24; p = 0.003); 40 to 49: RR 2.30 (95% CI 1.35 to 3.9; p = 0.002)) and trainee status (RR 1.53 (95% CI 1.15 to 2.03 p = 0.004)) were independently associated with increased relative risk of having a ‘at-risk’ or ‘burnout’ score.

Conclusions

The rate of self-reported burnout and risk for poor outcomes among orthopaedic surgeons and trainees varies between countries but remains unacceptably high throughout. Both individual and health system characteristics contribute to physician wellness and should be considered in the development of strategies to improve surgeon wellbeing. Level of Evidence: III Cite this article: Bone Jt Open 2021;2(11):932–939.
State transfer with separable optical beams and variational quantum algorithms with classical light
Authors: Asthana Sooryansh , Ravishankar V.
Published: November 2021

Classical electromagnetic fields and quantum mechanics obey the principle of superposition alike. This opens up many avenues for simulation of a large variety of phenomena and algorithms, which have hitherto been considered quantum mechanical. In this paper, we propose two such applications. In the first, we introduce a new, to the best of our knowledge, class of beams, called “equivalent optical beams,” in parallel with equivalent states introduced in Phys. Rev. A 89, 062110 (2014)PLRAAN1050-294710.1103/PhysRevA.89.062110. These beams have the same information content for all practical purposes. Employing them, we show how to transfer information from one degree of freedom of classical light to another, without need for classically entangled beams. Next, we show that quantum machine learning can be performed with OAM beams through the implementation of a quantum classifier circuit. We provide explicit protocols and explore the possibility of their experimental realization.
Differential Hadamard ghost imaging via single-round detection
Authors: Yu Zhuo , Wang Xiao-Qian , Gao Chao , Li Zhe , Zhao Huan , Yao ZhiHai
Published: November 2021

The experimental implementation of computational ghost imaging based on orthogonalized patterns usually consists of two steps, corresponding to the illumination of the positive and negative elements. Here, we put forward a novel technique which avoids "negative illumination" and involves a single round of measurements. Our method is based on the properties of the second-order correlation function in Hadamard-based computational ghost imaging. Experimental results show that object information may be effectively recovered with half of the measurements compared to the conventional differential scheme. As a matter of fact, the application of our scheme is not limited to the Hadamard pattern, but it may be applied also to other orthogonal matrices. As such, it may be relevant for the general development of computational ghost imaging.
Connecting tolerancing of freeform surface deformation in illumination optics with the Laplacian magic mirror
Authors: Kim Wooyoun , Cassarly William J. , Rolland Jannick P.
Published: November 2021

This paper presents a methodology for illumination optics tolerancing. Specifically, we investigate tolerancing deformation of a single freeform surface under a point source illumination. Through investigation, we recognized and report here three surface-deformation characteristics that build tolerancing intuitions. First, we show that positive and negative irradiance changes occur together as a consequence of flux conservation. Then, we demonstrate a linear relationship between the steepness of the surface perturbation and the magnitude of the irradiance change. Lastly, we show that the Laplacian magic mirror concept (M. V. Berry [Eur. J. Phys. 27, 109 (2006)10.1088/0143-0807/27/1/012]) can be expanded to surface deformation tolerancing. Utilizing these surface deformation characteristics, we propose a fast and predictable tolerancing method for a sequential illumination optic.
Indirect momentum excitation of graphene using high transversal modes of light in hyperbolic media
Authors: Ahn Kwang Jun
Published: November 2021

Electrons in indirect semiconductors can optically transit between the valance and conduction band edges only when the momentum conservation is satisfied with help of a third quasi-particle, such as a phonon. In this report, we theoretically demonstrate that indirect interband transition of graphene electrons can be optically enabled only by light with highly enhanced transversal modes, which can be generated by scattering of point dipole radiation with periodic metal slits fabricated in a natural hyperbolic material. The light-matter interaction for graphene electrons is reformulated by using indirect transition matrix elements, and interband polarizations of graphene are obtained by solving quantum kinetic equations of motion in the semi-classical regime. The interband optical current density of graphene as a function of the polarization angle of the incident field shows clear hexagonal response to the high transversal modes of light, which results from the low dependence on dephasing rate and dominance of the indirect polarizations over the direct interband contributions.
Adjustable and continuous eyebox replication for a holographic Maxwellian near-eye display
Authors: Zhang Shijie , Zhang Zhiqi , Liu Juan
Published: November 2021

A Maxwellian display presents always-focused images to the viewer, alleviating the vergence-accommodation conflict (VAC) in near-eye displays (NEDs). Recently, many methods of improving its limited eyebox have been proposed, among which viewpoint replication has attracted a lot of attention. However, double-image, blind-area, and image-shift effects always happen in typical eyebox-replication Maxwellian NEDs when the eye moves between the replicated viewpoints, which prevents these NEDs from being applied more widely. In this Letter, we propose a method for designing a holographic Maxwellian NED system with continuous eyebox replication as well as flexible interval adjustment by changing the projection angles of the reconstructed images. Thus, holograms corresponding to the positions of different viewpoints are calculated to match the interval of the replicated viewpoints with the human pupil diameter, making it possible to eliminate or alleviate double-image or blind-area effects. Also, seamless viewpoint conversion in the eyebox is achieved by aligning the images of adjacent viewpoints on the retina via hologram pre-processing independently. These effects are verified successfully in optical experiments and have the potential to be applied in near-eye three-dimensional displays without VAC.
Expanding the range of the resolvable strain from distributed fiber optic sensors using a local adaptive reference approach
Authors: Sweeney Daniel C. , Petrie Christian M.
Published: November 2021

Optical frequency domain reflectometry (OFDR) is a spectral measurement technique in which shifts in the local Rayleigh backscatter spectra can be used to perform distributed temperature or strain measurements relative to a reference measurement using ordinary single-mode optical fibers. This work demonstrates a data processing methodology for improving the resolvable range of temperature and strain by adaptively varying the reference measurement position by position, based on the time evolution of the local optical intensities and the correlation between the reference and active measurements. These methods nearly double the resolvable range of temperature and strain compared with that achieved using the traditional static reference approach.
Frequency-stabilized Brillouin random fiber laser enabled by self-inscribed transient population grating
Authors: Zhang Liang , Qiu Zenghuan , Xiao Zhelan , Zhang Jilin , Pang Fufei , Wang Tingyun , Bao Xiaoyi
Published: November 2021

A frequency-stabilized Brillouin random fiber laser (BRFL) realized by a self-inscribed transient population grating (TPG) is proposed and demonstrated for the first time, to the best of our knowledge. The TPG is formed via the redistribution of the population in erbium-doped fibers (EDFs) by bidirectionally injected phonon-controlled random laser beams. Long-lifetime metastable ion states in EDFs basically prolonged the time dynamics of a stimulated Brillouin scattering (SBS) laser up to milliseconds. Consequently, significant random modes are suppressed with low relative intensity noise, owing to reduced mode hopping in a Stokes random laser, hence one dominating lasing mode at milliseconds of lifetime is established from the competition of numerous random modes, which is proved theoretically and experimentally via TPG.