bluuebunny/crossref_metadata_2025 huggingface dataset:
The association between surgical fixation of hip fractures within 24 hours and mortality
Authors: Welford Paul , Jones Conor S. , Davies Gareth , Kunutsor Setor K. , Costa Matt L. , Sayers Adrian , Whitehouse Michael R.
Published: July 2021

Aims

The aim of this study was to assess the effect of time to surgical intervention from admission on mortality and morbidity for patients with hip fractures.

Methods

MEDLINE and Embase were searched from inception to June 2020. Reference lists were manually assessed to identify additional papers. Primary comparative research studies that recruited patients aged over 60 years, with non-pathological primary proximal femoral fractures that were treated surgically, were included. Studies that did not include a group operated on within 24 hours or which reported time to surgery in calendar days were excluded. Two investigators extracted data on study characteristics, methods, and outcomes. The pre-defined primary outcome was 30-day mortality. Secondary outcomes were complications and mortality at other time points. Relative risks (RRs) with 95% confidence intervals (CIs) were aggregated and were grouped by study-level characteristics.

Results

This review included 46 studies (January 1991 to June 2020), comprising 521,857 hip fractures with 64,047 postoperative deaths. No randomized controlled trials were eligible for inclusion. In a pooled analysis of 15 studies, RR of mortality at 30 days comparing time to surgery < 24 hours with > 24 hours was 0.86 (95% CI 0.82 to 0.91; I 2 = 69%; 95% CI 50% to 81%; p-value for heterogeneity < 0.001). The association was stronger in observational studies that did not adjust for confounders than in those that adjusted for multiple covariates. In a pooled analysis of six studies, the RR of mortality at 30 days comparing time to surgery < 24 hours with 24 to 36 hours was 0.87 (95% CI 0.81 to 0.93; I 2 = 65%; 95% CI 16% to 85%; p-value for heterogeneity = 0.014).

Conclusion

This meta-analysis indicates reduced mortality for patients operated within 24 hours compared with those operated on beyond 24 hours or within 24 to 36 hours. Where resources allow and there is no specific reversible contraindication to early surgery, we recommend that hip fractures should be surgically treated within 24 hours. Cite this article: Bone Joint J 2021;103-B(7):1176–1186.
Operative Production Controlling as Entrance into Controlling 4.0
Authors: Pfeifer Marcel Rolf
Published: July 2021

Purpose of the article: The paper focuses on the potentials and benefits controlling provides for companies in the transition period towards industry 4.0. Operative production controlling provides data that shall be used in the future to apply the concept of smart factories. This article proposes a controlling archtitecture based on computer-aided standardization.

Methodology/methods: The paper develops an architecture on operational production controlling based on an international literature review. Literature on controlling 4.0 are found mostly in publications in German language. While this literature has its focus on controlling as a whole or on strategic controlling, the paper has a look on operational controlling and its further usage and development towards smart factories.

Scientific aim: The aim of this article is to develop a model of an operational production controlling architecture that is able to suite the requirements of smart factories by using computer-aided standarization.

Findings: Research is working on concepts for industry 4.0 and its way towards real implementation. Competitive advantage in industry 4.0 is created through digitization and robotization. An architecture that fully complies to industry 4.0 is still waiting in real companies due to technical limitation in data storing, retrieval and processing as well as storage capacities.

Conclusions: The paper discussed the devlopment of a controlling architecture suitable for industry 4.0. Already today controlling is making use of data. Smart factories shall make use of production data. Production controlling together with the CAS, that is able to provide standardized data on all manufacturing, maintenance, and auxiliary processes, systems are able to make a step forward towards smart factories. The concept of production controlling combined with the strengths of a CAS may be seen as the basis from which to target smart factories and industry 4.0.
Treatment delay of cancer patients in Indonesia: a reflection from a national referral hospital
Authors: Gondhowiardjo Soehartati , Hartanto Sugandi , Wirawan Sigit , Jayalie Vito Filbert , Astiti Ida Ayu Putri , Panigoro Sonar Soni , Sekarutami Sri Mutya , Rachman Andhika , Bachtiar Adang
Published: July 2021

BACKGROUND Cancer is a complex disease requiring a multidisciplinary approach in establishing prompt diagnosis and treatment. Treatment in a timely manner is crucial for the outcomes. Hence, this study aimed to provide information on treatment delay including patient and provider delays and its associated factors. METHODS Cancer patients were recruited conveniently in the outpatient clinic of Department of Radiation Oncology, Cipto Mangunkusumo Hospital, Indonesia between May and August 2015. All patients were asked to fill a questionnaire and interviewed in this cross-sectional study. Treatment delay was explored and categorized into patient delay and provider delay. Patient delay could be happened before (patient-delay-1) or after (patient-delay-2) the patient was diagnosed with cancer. Provider delay could be due to physician, system-diagnosis, and system-treatment delays. RESULTS Among 294 patients, 86% patient had treatment delay. Patient delay was observed in 153 patients, and 43% of them had a history of alternative treatment. An older age (p = 0.047), lower educational level (p = 0.047), and history of alternative treatment (p<0.001) were associated with patient delay. Meanwhile, 214 patients had provider delay, and 9%, 36%, and 80% of them experienced physician, system-diagnosis, and system-treatment delays, respectively. All types of provider delay were associated with patient delay (p<0.001). CONCLUSIONS Most of the patient had treatment delay caused by either patient or provider.
Measuring Monsters, Academic Subjectivities, and Counting Practices
Authors: Cannon Susan O. , Flint Maureen A.
Published: July 2021

In this paper, we explore the online academic research platforms we are entangled with as tenure-track faculty members in the neoliberal university. We are so embedded in these systems that the assumptions and constructions inherent in practices of counting are often lost, wrapped in the coils of counting practices—a becoming with algorithm. Though academic platforms are intricately enmeshed in our research and lives, they have been operating as “onto-epistemological blind spots” (Sweet et al., 2020, p. 2). And yet, the numbers they produce and rely on (H-scores, impact factors, citation counts, and journal rankings) matter and are “promiscuous and inventive in [their] agential wanderings” (Barad, 2015, p. 487), offering possibilities for intimacy and response-ability to what we are and might become. In other words, attending to the monstrous qualities of counting practices offers an entry point for re-thinking the relational, ethical, and affective aspects of academic subjectivity. So, we attend tothese qualities to become with the neoliberal counting and control mechanisms in innovative ways. Through this paper, we open ourselves to the wild possibilities of academic algorithms, working within and thinking with counting practices to intimately understand the ontologies of number at work in these platforms and how they work on our subjectivities. As we consider how our futures are being modelled and pre-empted, we think the algorithms in relation to feminist new materialist philosophers, Rosi Braidotti and Karen Barad. We ask: ‘what if?’ we were to think ontologies of number with these theories and see what possibilities emerge. We entangle Braidotti and  Barad with Deleuzoguattarian philosophies to imagine different relational becomings; to construct new ways of attending to our monstrous potentials and possibilities.
La investigación biomédica y conductual en prisiones. Claves para un cambio de marco normativo
Authors: Urruela Mora Asier
Published: July 2021

La investigación biomédica y conductual si bien se erige en una actividad fundamental de cara al desarrollo científico en áreas básicas para el bienestar de la humanidad, constituye una temática que plantea cuestiones éticas de calado, en particular, cuando la misma se lleva a cabo en poblaciones vulnerables. El presente trabajo se configura como un estudio de naturaleza bioética y jurídica acerca de la investigación biomédica y conductual en el entorno penitenciario que, partiendo de la normativa actualmente vigente en España, se adentra en las concepciones sostenidas en las últimas décadas a nivel comparado en materia de investigación en el medio carcelario, con el fin de establecer una serie de pautas que coadyuven a sentar criterios sólidos en dicha esfera.
La patologización de la homosexualidad en los Manuales diagnósticos y clasificaciones psiquiátricas
Authors: Peidro Santiago
Published: July 2021

Investigaremos la relación entre el diagnóstico en la atención de la Salud Mental y la clasificación de la homosexualidad como enfermedad o trastorno mental con el fin de analizar que en lo que a las sexualidades no hegemónicas respecta, el diagnóstico no supone ser únicamente un conocimiento acabado del fenómeno que pretende investigar, sino que funciona como un procedimiento performativo que produce el mismo fenómeno que busca delimitar. Para ello, consideraremos los “Principios para la protección de los enfermos mentales” adoptados por la Asamblea General de las Naciones Unidas el 17/12/1991, así como los sistemas internacionalmente vigentes de Clasificación en Salud Mental. Nuestra hipótesis de trabajo descansa también en las ideas sobre la performatividad desarrolladas por Judith Butler.
Formación en Comunicación para Profesionales Sanitarios
Authors: Carreras Marcos Bernat , Esquerda Areste Montse , Ramos Pozón Sergio
Published: July 2021

Los profundos cambios vividos en el ámbito sanitario en general, y en concreto en el cambio de modelo relacional con el desarrollo del modelo centrado en la persona, requieren cambios en la formación de profesionales sanitarios, no tan solo con la incorporación de nuevos conocimientos sino también en la formación en habilidades comunicativas y relacionales. Este artículo presenta una propuesta de formación en comunicación de malas noticias para los profesionales sanitarios, atendiendo a las actitudes, habilidades y a los conocimientos necesarios para hacerlo. Se presenta un modelo de formación escalar y adaptable a diferentes contextos y especialidades sanitarias.
Iridium thin-film coatings for the BabyIAXO hybrid
X-ray optic
Authors: Henriksen Peter L. , Ferreira Desiree D. M. , Massahi Sonny , Civitani Marta C. , Basso Stefano , Vogel Julia , Armendariz Jaime R. , Knudsen Erik B. , Irastorza Igor G. , Christensen Finn E.
Published: July 2021

Reflective coatings are an essential feature of X-ray telescopes. Their
overall performance relies heavily on substrate compatibility and how
well they conform to the optics assembly processes. We use X-ray
reflectometry (XRR) to demonstrate the compatibility of shaping flat
substrates coated with iridium, and show that specular and nonspecular
reflectance before and after shaping is on par with traditional
hot-slumped coated substrates. From 1.487 and

8.048

k
e
V

measurements, we find that the
substrates have rms roughness of

0.38

n
m

and magnetron sputtered iridium
deposits with rms surface roughness of

0.27

−

0.35

n
m

. A hydrocarbon overlayer from
atmospheric contamination is present with a thickness of

1.4

–

1.6

n
m

and a density of

1.2

−

1.6

g

/

c
m

3

. Both the traditional hot slumped and
the flat substrates undergoing post-coating shaping have a similar
characteristic surface morphology and are equally well-suited for use
with X-ray optics. Finally, we demonstrate by simulation the improved
effective area achieved by using a low-Z overlayer, and illustrate the
performance of a hybrid optic coated with optimized bilayers for a
Primakoff axion spectrum emitted by the sun.
Optical hiding based on single-input multiple-output and binary amplitude-only holograms via the modified Gerchberg-Saxton algorithm
Authors: Zhou Lina , Xiao Yin , Pan Zilan , Cao Yonggui , Chen Wen
Published: July 2021

Optics has provided a promising means for the development of information hiding in recent years. However, conventional optical information hiding systems can only hide a limited number of images, and optical implementation complexity is usually high in conventional methods. In this paper, we propose a new scheme to implement optical information hiding based on single-input multiple-output (SIMO) and binary amplitude-only holograms (AOHs) using the modified Gerchberg-Saxton algorithm (MGSA). Different from conventional optical hiding methods with the limited multiplexing capacity, the proposed scheme can retrieve a large number of different secret images from one single host image during optical retrieval. In addition, it is also illustrated that optical implementation complexity is reduced in the proposed method. Simulations and optical experiments are conducted to verify feasibility, security and robustness of the proposed method. It is expected that the proposed method could open up a different research perspective for optical multiple-image hiding.
Light recycling in LED-pumped Ce:YAG luminescent concentrators
Authors: Nourry-Martin Maxime , Pichon Pierre , Druon Frederic , Darbon Stephane , Balembois François , Georges Patrick
Published: July 2021

We report the development of a high-brightness, high-power Ce:YAG luminescent concentrator pumped by 2240 blue LEDs in quasi-continuous wave operation (10 µs, 10  Hz). Using light confinement and recycling in the three space dimensions, the parallelepiped (1mm×14×mm×200mm) Ce:YAG emits a power of 145 W from a square output surface (1 × 1mm2) corresponding to a brightness of 4.6 kW/cm2/sr. This broadband yellow source has a unique combination of luminous flux (7.6 104 lm) and brightness (2.4 104 cd/mm2) and overcomes many other visible incoherent sources by one order of magnitude. This paper also proposes a deep understanding of the performance drop compared to a linear behavior when the pump power increases. Despite excited state absorption was unexpected for this low doped Ce:YAG pumped at a low irradiance level, we demonstrated that it affects the performance by tripling the losses in the concentrator. This effect is particularly important for small output surfaces corresponding to strong light recycling in the concentrator and to average travel distances inside the medium reaching meters.
Interleaved superposed-64QAM-constellation design for spatial multiplexing visible light communication systems
Authors: Guo Xinyue , Yuan Yuansha , Pan Chao , Xiao Jiangnan
Published: July 2021

Superposed constellation combined with spatial multiplexing multiple-input multiple-output (MIMO) techniques have been increasingly utilized in visible light communication (VLC) systems, as multiplexing gains can be achieved regardless of the correlation extent of the VLC channel. Herein, we propose a novel superposed 64-quadrature amplitude modulation (QAM) constellation scheme for 2 × 2 MIMO VLC systems. Considering the nonlinearity of light-emitting diodes (LEDs), two geometrically shaped 8QAM constellations are introduced to reduce the peak-to-average power ratio at the transmitter. Because the two 8QAM constellations are superposed in an interleaved manner, the required power ratio between two transmitted signals is 1, which further reduces the risk of nonlinear distortion and avoids signal-to-noise ratio deterioration induced by power competition. The proposed superposed 64QAM constellation scheme is experimentally investigated comprehensively, where the system performance is evaluated under different transmitted powers, direct current bias currents, and driving peak-to-peak voltages (Vpps). The experimental results show that the proposed scheme achieves better bit error rate (BER) performance than the traditional superposed 64QAM constellation schemes. Below the 7% pre-forward error correction BER threshold of 3.8 × 10−3, the dynamic range of the driving Vpps of the two LEDs improves from 0.06 to 0.4 V and 0.23 to 0.4 V when the optimal power ratio is achieved.
Experimental verification of group non-membership in optical circuits
Authors: Sun Kai , Zhang Zi-Jian , Meng Fei , Cheng Bin , Cao Zhu , Xu Jin-Shi , Yung Man-Hong , Li Chuan-Feng , Guo Guang-Can
Published: July 2021

The class quantum Merlin–Arthur (QMA), as the quantum analog of nondeterministic polynomial time, contains the decision problems whose YES instance can be verified efficiently with a quantum computer. The problem of deciding the group non-membership (GNM) of a group element is conjectured to be a member of QMA. Previous works on the verification of GNM, which still lacks experimental demonstration, required a quantum circuit with

O
(

n
5

)

group oracle calls. Here, we provide an efficient way to verify GNM problems, in which each quantum circuit only contains

O
(
1
)

group of oracle calls, and the number of qubits in each circuit is reduced by half. Based on this protocol, we then experimentally demonstrate the new verification process with a four-element group in an all-optical circuit. The new protocol is validated experimentally by observing a significant completeness-soundness gap between the probabilities of accepting elements in and outside the subgroup. This work efficiently simplifies the verification of GNM and is helpful in constructing more quantum protocols based on the near-term quantum devices.
Societal perceptions of caregivers linked to culture across 20 countries: Evidence from a 10-billion-word database
Authors: Ng Reuben , Indran Nicole
Published: July 2021

Caregivers play an indispensable role in society. In 2017, 41 million family caregivers in the United States provided approximately 34 billion hours of care to their aging parents, spouses, partners and friends. The estimated economic value of their unpaid contributions amounted to $470 billion. Despite their invaluable contributions, caregivers often operate in a reality of inadequate social support. Little is known about the factors linked to the societal perceptions of caregivers, and our study seeks to contribute by filling this gap. Importantly, whether society honors or stigmatizes caregivers is critical as it could impact caregiving decisions and either exacerbate or ameliorate caregiver burden. We leveraged an online media database of 10 billion words collated from over 28 million articles, across 20 countries, to analyze societal perceptions of caregivers. Of the 20 countries, 18 evidenced neutral to positive perceptions of caregivers. Bangladesh and Ghana had the most positive perceptions, while Sri Lanka and Tanzania had the most negative perceptions. Aging demographics and culture (individualism, masculinity and uncertainty avoidance) were significantly associated with perceptions of caregivers. Findings suggest that positive perceptions of caregivers can be better cultivated when caring is lauded as a virtuous act that aids in reducing the care deficit. This study is among the first to analyze the societal perceptions of caregivers globally, and lays the groundwork to design culturally sensitive interventions that increase society’s appreciation for caregivers.
Bayesian neural networks for stock price forecasting before and during COVID-19 pandemic
Authors: Chandra Rohitash , He Yixuan
Published: July 2021

Recently, there has been much attention in the use of machine learning methods, particularly deep learning for stock price prediction. A major limitation of conventional deep learning is uncertainty quantification in predictions which affect investor confidence. Bayesian neural networks feature Bayesian inference for providing inference (training) of model parameters that provides a rigorous methodology for uncertainty quantification in predictions. Markov Chain Monte Carlo (MCMC) sampling methods have been prominent in implementing inference of Bayesian neural networks; however certain limitations existed due to a large number of parameters and the need for better computational resources. Recently, there has been much progress in the area of Bayesian neural networks given the use of Langevin gradients with parallel tempering MCMC that can be implemented in a parallel computing environment. The COVID-19 pandemic had a drastic impact in the world economy and stock markets given different levels of lockdowns due to rise and fall of daily infections. It is important to investigate the performance of related forecasting models during the COVID-19 pandemic given the volatility in stock markets. In this paper, we use novel Bayesian neural networks for multi-step-ahead stock price forecasting before and during COVID-19. We also investigate if the pre-COVID-19 datasets are useful of modelling stock price forecasting during COVID-19. Our results indicate due to high volatility in the stock-price during COVID-19, it is more challenging to provide forecasting. However, we found that Bayesian neural networks could provide reasonable predictions with uncertainty quantification despite high market volatility during the first peak of the COVID-19 pandemic.
Utility of the Global Respiratory Severity Score for predicting the need for respiratory support in infants with respiratory syncytial virus infection
Authors: Kubota Jun , Hirano Daishi , Okabe Shiro , Yamauchi Kento , Kimura Rena , Numata Haruka , Suzuki Takayuki , Kakegawa Daisuke , Ito Akira
Published: July 2021

Background

Respiratory syncytial virus (RSV) is a common cause of acute respiratory infection in children. One of the most important strategies for treatment of an RSV infection is to decide whether the patient needs respiratory support. This study aimed to assess the validity and clinical benefit of the Global Respiratory Severity Score (GRSS) and the Wang bronchiolitis severity score (WBSS) for clinical decision-making regarding providing respiratory support (high-flow nasal cannula, nasal continuous positive airway pressure, or ventilator) in infants with an RSV infection.

Study design and methods

This retrospective cohort study enrolled 250 infants aged under 10 months who were admitted to Atsugi City Hospital with an RSV infection between January 2012 and December 2019. The utility of these scores was evaluated for assessing the need for respiratory support through decision curve analysis by calculating the optimal GRSS and WBSS cut-offs for predicting the need for respiratory support.

Results

Twenty-six infants (10.4%) received respiratory support. The optimal cut-offs for the GRSS and the WBSS were 4.52 and 7, respectively. Decision curve analysis suggested that the GRSS was a better predictive tool than the WBSS if the probability of needing respiratory support was 10–40%.

Conclusions

The GRSS was clinically useful in determining the need for respiratory support in infants aged under 10 months with an RSV infection.
The genetic association of the transcription factor NPAT with glycemic response to metformin involves regulation of fuel selection
Authors: Chen Changwei , Gallagher Jennifer R. , Tarlton Jamie , van Aalten Lidy , Bray Susan E. , Ashford Michael L. J. , McCrimmon Rory J. , Pearson Ewan R. , McNeilly Alison D. , Sutherland Calum
Published: July 2021

The biguanide, metformin, is the first-choice therapeutic agent for type-2 diabetes, although the mechanisms that underpin metformin clinical efficacy remain the subject of much debate, partly due to the considerable variation in patient response to metformin. Identification of poor responders by genotype could avoid unnecessary treatment and provide clues to the underlying mechanism of action. GWAS identified SNPs associated with metformin treatment success at a locus containing the NPAT (nuclear protein, ataxia-telangiectasia locus) and ATM (ataxia-telangiectasia mutated) genes. This implies that gene sequence dictates a subsequent biological function to influence metformin action. Hence, we modified expression of NPAT in immortalized cell lines, primary mouse hepatocytes and mouse tissues, and analysed the outcomes on metformin action using confocal microscopy, immunoblotting and immunocytochemistry. In addition, we characterised the metabolic phenotype of npat heterozygous knockout mice and established the metformin response following development of insulin resistance. NPAT protein was localised in the nucleus at discrete loci in several cell types, but over-expression or depletion of NPAT in immortalised cell models did not change cellular responses to biguanides. In contrast, metformin regulation of respiratory exchange ratio (RER) was completely lost in animals lacking one allele of npat. There was also a reduction in metformin correction of impaired glucose tolerance, however no other metabolic abnormalities, or response to metformin, were found in the npat heterozygous mice. In summary, we provide methodological advancements for the detection of NPAT, demonstrate that minor reductions in NPAT mRNA levels (20–40%) influence metformin regulation of RER, and propose that the association between NPAT SNPs and metformin response observed in GWAS, could be due to loss of metformin modification of cellular fuel usage.
Treatment seeking delay and associated factors among tuberculosis patients attending health facility in Ethiopia from 2000 to 2020: A systematic review and meta analysis
Authors: Obsa Mohammed Suleiman , Daga Wakgari Binu , Wosene Naol Gorde , Gebremedhin Tsegaye Demeke , Edosa Dinkisisa Chemeda , Dedecho Abdurahman Tune , Awoke Nefsu , Weji Bedilu Girma , Bekele Eyob Eshetu
Published: July 2021

Background

Treatment seeking delay is defined as the time interval between the onset of the major symptoms of tuberculosis (TB) and the first visit to the formal health care facility. The patient was said to be delayed if the patient visited the health-facility after 3 weeks onset of major symptoms. However, in low-income countries like Ethiopia, the delay in treatment-seeking among tuberculosis patients contributes to a widespread transmission and high prevalence of tuberculosis.

Methods

Studies were retrieved from PubMed, Cochrane Database, Cinahl, Scopus, Mednar, and Google Scholar by employing a combination of search terms with Boolean operators. Heterogeneity across studies was assessed using the Cochrane Q test. A funnel plot was used for visual assessment of publication bias. Subgroup analyses were performed to explore the possible causes of heterogeneity. Egger’s weighted regression test at a p-value < 0.05 was used to assess the presence of publication bias. Sensitivity analysis was performed to judge whether the pooled effect size was influenced by individual study. STATA software version 14 was used for all statistical analyses.

Result

A total of 12 studies with 5122 total sample size were included. The national pooled prevalence of treatment seeking delay was 44.29% (95% CI: 39.805, 48.771). The visual inspection of the funnel plot showed the asymmetrical distribution, and the Egger test showed insignificant (P = 0.348). Patients who did not seek formal health care providers on a first contact had about 7 times more likely to delay than patients who sought formal health care provider on a first contact (OR: 7.192 ((95% CI 5.587–9.257), P = 0.001, I2: 85%). The others independent predictors of delay were rural residence (OR: 3.459 ((95% CI 1.469–8.148), P ≤ 0.001), extra pulmonary TB (OR: 2.520 ((95% CI 1.761–3.605), 0.180), lower educational level (OR 11.720 ((95% CI 1.006–2.938), P <0.001), and distance more than 10km from health facility (OR: 1.631 ((95% CI (10.858–3.101), P = 0.001).

Conclusion

In this review, we identified a substantial treatment seeking delay among TB patients in Ethiopia. And, the independent predictors of delay were treatment sought before formal health care provider, residence of the patient, type of TB, educational level, and distance from a health facility. Thus, we recommend health extension workers, health professionals and other stakeholders to focus on patient education, and to continuously mobilize the whole communities on early treatment seeking with a special emphasis given to where treatment sought before formal health care provider, rural resident, extra pulmonary TB, and a patient living farther than 10km distance from health facility.
e-Learning for enhancement of medical student performance at the Objective Structured Clinical Examination (OSCE)
Authors: Kim Kyong-Jee , Lee Yeon Ji , Lee Mi Jin , Kim Young Hyo
Published: July 2021

This study aimed to investigate the impact of student e-learning on the development of clinical competencies. The study participants were 3rd year students (n = 43) at a private mid-sized medical school located in a South Korean suburb on a four-year medical program. Educational intervention was implemented to enhance student clinical performance. Students engaged in learning activities that intended to promote their self-directed learning abilities and clinical performances using e-learning resources. Intervention was conducted for the duration of six months during the 3rd year and its effectiveness was investigated by comparing student performances in OSCEs in a pre- and post- comparison format and also by comparing them with national scores. In addition, student perceptions of the impact of e-learning on their OSCE performances were assessed using a questionnaire, which included 36 items that elicited student perceptions of their experiences of e-learning and readiness for e-learning. Student OSCE scores improved significantly after educational intervention in all domains of clinical competencies assessed and for total scores (p < 0.001). Furthermore, students achieved higher OSCE scores than national average scores in the post-test, whereas they had performed lower than national average scores in the pre-test. Students showed neutral or slightly positive responses to the effectiveness of e-learning, and their perceptions of e-learning were not associated with their e-learning readiness scores. The study shows student OSCE performance improved significantly after educational intervention, which indicate the effectiveness of e-learning to support student learning of clinical performance. Despite significant improvements in student OSCE scores after e-learning, their perceptions of its effectiveness were neutral. Furthermore, student perceptions of e-learning were not associated with their readiness for it. Suggestions are made to help students use e-learning more effectively to enhance their clinical competencies.
Quantifying responses to changes in the jurisdiction of a congestion charge: A study of the London western extension
Authors: Ait Bihi Ouali Laila , Musuuga Davis , Graham Daniel J.
Published: July 2021

This paper quantifies behavioural responses to changes in the jurisdiction of a congestion charge, with a successive focus on (i) an extension and (ii) a reduction in the size of the charging zone. We exploit the unanticipated nature of both the implementation and removal of London’s Western Expansion Zone (WEZ) as quasi-natural experiments to test whether individual responses to policies are asymmetric. We use the UK Department of Transport Annual Average Daily Flow (AADF) data, which records traffic flows for seven transport modes (including cars, buses, bicycles, heavy and light goods vehicles). Using a difference-in-differences approach, we find that the introduction of the WEZ led to a 4.9% decline in road traffic flows in the new congestion charge area. These results are robust to different model specifications. HGVs traffic did not significantly change post-WEZ, which indicates that their road demand is price inelastic. The removal of the WEZ led to no significant variations in traffic. This result indicates asymmetry in behaviour with persistent changes in post-intervention traffic demand levels.
Accuracy of the Geriatric Depression Scale (GDS)-4 and GDS-5 for the screening of depression among older adults: A systematic review and meta-analysis
Authors: Brañez-Condorena Ana , Soriano-Moreno David R. , Navarro-Flores Alba , Solis-Chimoy Blanca , Diaz-Barrera Mario E. , Taype-Rondan Alvaro
Published: July 2021

Background

The Geriatric Depression Scale (GDS) is a widely used instrument to assess depression in older adults. The short GDS versions that have four (GDS-4) and five items (GDS-5) represent alternatives for depression screening in limited-resource settings. However, their accuracy remains uncertain.

Objective

To assess the accuracy of the GDS-4 and GDS-5 versions for depression screening in older adults.

Methods

Until May 2020, we systematically searched PubMed, PsycINFO, Scopus, and Google Scholar; for studies that have assessed the sensitivity and specificity of GDS-4 and GDS-5 for depression screening in older adults. We conducted meta-analyses of the sensitivity and specificity of those studies that used the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases-10 (ICD-10) as reference standard. Study quality was assessed with the QUADAS-2 tool. We performed bivariate random-effects meta-analyses to calculate the pooled sensitivity and specificity with their 95% confidence intervals (95% CI) at each reported common cut-off. For the overall meta-analyses, we evaluated each GDS-4 version or GDS-5 version separately by each cut-off, and for investigations of heterogeneity, we assessed altogether across similar GDS versions by each cut-off. Also, we assessed the certainty of evidence using the GRADE methodology.

Results

Twenty-three studies were included and meta-analyzed, assessing eleven different GDS versions. The number of participants included was 5048. When including all versions together, at a cut-off 2, GDS-4 had a pooled sensitivity of 0.77 (95% CI: 0.70–0.82) and a pooled specificity of 0.75 (0.68–0.81); while GDS-5 had a pooled sensitivity of 0.85 (0.80–0.90) and a pooled specificity of 0.75 (0.69–0.81). We found results for more than one GDS-4 version at cut-off points 1, 2, and 3; and for more than one GDS-5 version at cut-off points 1, 2, 3, and 4. Mostly, significant subgroup differences at different test thresholds across versions were found. The accuracy of the different GDS-4 and GDS-5 versions showed a high heterogeneity. There was high risk of bias in the index test domain. Also, the certainty of the evidence was low or very low for most of the GDS versions.

Conclusions

We found several GDS-4 and GDS-5 versions that showed great heterogeneity in estimates of sensitivity and specificity, mostly with a low or very low certainty of the evidence. Altogether, our results indicate the need for more well-designed studies that compare different GDS versions.
Stay-at-home orders and the willingness to stay home during the COVID-19 pandemic: A stated-preference discrete choice experiment
Authors: Li Liqing , Long Dede , Rouhi Rad Mani , Sloggy Matthew R.
Published: July 2021

The spread of COVID-19 in the Spring of 2020 prompted state and local governments to implement a variety of policies, including stay-at-home (SAH) orders and mandatory mask requirements, aimed at reducing the infection rate and the severity of the pandemic’s impact. We implement a discrete choice experiment survey in three major U.S. States—California, Georgia, and Illinois—to empirically quantify individuals’ willingness to stay (WTS) home, measured as the number of weeks of a potential new SAH order, to prevent the spread of the COVID-19 disease and explore factors leading to their heterogeneous WTS. Our results demonstrate broad support for statewide mask mandates. In addition, the estimate of WTS to lower new positive cases is quite large, approximately five and half weeks, even though staying home lowers utility. We also find that individuals recognize the trade-offs between case reduction and economic slowdown stemming from SAH orders when they decide to stay home or not. Finally, pandemic related factors such as age, ability to work from home, and unemployment status are the main drivers of the heterogeneity in individuals’ WTS.
PKCδ deficiency inhibits fetal development and is associated with heart elastic fiber hyperplasia and lung inflammation in adult PKCδ knockout mice
Authors: Niino Yuko S. , Kawashima Ikuo , Iguchi Yoshinobu , Kanda Hiroaki , Ogura Kiyoshi , Mita-Yoshida Kaoru , Ono Tomio , Yamazaki Maya , Sakimura Kenji , Yogosawa Satomi , Yoshida Kiyotsugu , Shioda Seiji , Gotoh Takaya
Published: July 2021

Protein kinase C-delta (PKCδ) has a caspase-3 recognition sequence in its structure, suggesting its involvement in apoptosis. In addition, PKCδ was recently reported to function as an anti-cancer factor. The generation of a PKCδ knockout mouse model indicated that PKCδ plays a role in B cell homeostasis. However, the Pkcrd gene, which is regulated through complex transcription, produces multiple proteins via alternative splicing. Since gene mutations can result in the loss of function of molecular species required for each tissue, in the present study, conditional PKCδ knockout mice lacking PKCδI, II, IV, V, VI, and VII were generated to enable tissue-specific deletion of PKCδ using a suitable Cre mouse. We generated PKCδ-null mice that lacked whole-body expression of PKCδ. PKCδ+/- parental mice gave birth to only 3.4% PKCδ-/- offsprings that deviated significantly from the expected Mendelian ratio (χ2(2) = 101.7, P < 0.001). Examination of mice on embryonic day 11.5 (E11.5) showed the proportion of PKCδ-/- mice implanted in the uterus in accordance with Mendelian rules; however, approximately 70% of the fetuses did not survive at E11.5. PKCδ-/- mice that survived until adulthood showed enlarged spleens, with some having cardiac and pulmonary abnormalities. Our findings suggest that the lack of PKCδ may have harmful effects on fetal development, and heart and lung functions after birth. Furthermore, our study provides a reference for future studies on PKCδ deficient mice that would elucidate the effects of the multiple protein variants in mice and decipher the roles of PKCδ in various diseases.
Potency of commonly retailed antibiotics in pharmacies found in Adama, Oromia regional state, Ethiopia
Authors: Demissie Demelash , Geremew Teshome , Chernet Adinew Zewdu , Ali Musa Mohammed
Published: July 2021

Introduction

Antibiotics are commonly used for the treatment and prevention of bacterial infections. The potency of antibiotics can be affected by factors such as temperature, light, moisture, and storage conditions. Inappropriate storage and transportation of antibiotics may lead to loss of potency earlier than the expiry date. The aim of this study was to determine the potency and associated factors of commonly retailed antibiotics.

Method

Institution-based cross-sectional study was conducted on commonly retailed antibiotics in pharmacies that are available in Adama, Ethiopia from March 2018 to June 2018. This study focused on commonly ordered antibiotics such as amoxicillin, azithromycin, ciprofloxacin, and ceftriaxone. Antibiotics to be tested were selected by using a simple random sampling technique. Socio-demographic and related data were collected using a semi-structured questionnaire. Antibiotic susceptibility testing was performed using the disc diffusion method as described in the Clinical Laboratory Standard Institute guideline.

Results

Mean inhibition zones of amoxicillin, ciprofloxacin, azithromycin, and ceftriaxone were 14.2 ± 4 mm, 30.9 ± 4.2 mm, 17.47 ± 3.83 mm, and 32.7±1.8 respectively. Out of 164 antibiotics tested, 61% passed the potency test. The potency of antibiotics varies across different countries in which 53.7% and 54.6 of antibiotics from India and Ethiopia passed the potency test. All ceftriaxone tested in this study passed the potency test. Factors such as air condition of pharmacy (X2 = 4.27; p = 0.039), source of all antibiotics (X2 = 5.41; p = 0.02), and source of amoxicillin (X2 = 4.73; p = 0.03) were significantly associated with potency of antibiotics.

Conclusions

About 40% of antibiotics tested in the current study did not pass the potency test; this warrants further investigation to identify the magnitude of the problem and its causes at a large scale.
“We need our own clinics”: Adolescents’ living with HIV recommendations for a responsive health system
Authors: Woollett Nataly , Pahad Shenaaz , Black Vivian
Published: July 2021

Adolescents living with HIV comprise a significant patient population in sub Saharan Africa but are poorly retained in care with consequent increased mortality and morbidity. We conducted in-depth interviews with 25 adolescents living with HIV engaged in care from five clinics in Johannesburg regarding their recommendations for the healthcare system. Findings included advocating for adolescent clinics, recognizing the importance of clinic-based support groups, valuing the influence lay counselors have in providing healthcare to adolescents, improving widespread education of vertical HIV transmission and meaningfully linking clinics to the community. Our study offers guidance to the differentiated care model recommended for adolescent treatment highlighting that a positive youth development approach and use of lay and peer counselors may act as cornerstones of this model. Serving the mental health needs of adolescents living with HIV in a responsive manner may strengthen their use of the system and elevate it to a source of resilience.
Increasingly capable at the ripe old age? Cognitive abilities from 2004 to 2013 in Germany, Spain, and Sweden
Authors: Grasshoff Julia , Beller Johannes , Kuhlmann Beatrice G. , Geyer Siegfried
Published: July 2021

Background

Life expectancy is increasing in most high-income countries, but gains in life years are maximized if spent in good health and if cognitive abilities are maintained until old age. Age-related decline of cognitive abilities does nevertheless occur, but the pace of decline is decisive. This was the starting point for our study that aims to examine cohort effects of cognitive aging in women and men in Germany, Spain and Sweden by analyzing changes from 2004 to 2013 by estimating cohort effects within age groups starting from the age of 50 years.

Methods

A cohort study was conducted that was based on data of the surveys 2004 (N = 6,081) and 2013 (N = 8,650) from the Survey of Health, Ageing and Retirement in Europe (SHARE). The analyses were based on data of female and male respondents aged 50 years and older. Age-specific means of verbal fluency and delayed recall from the German, Spanish and Swedish samples were the cognitive domains considered in the study.

Results

In both domains of cognitive ability the achievements in the later surveys were higher than in the earlier ones. This was found in all countries, abut achievement levels increased markedly in the German and the Spanish samples, while the scores of the Swedish samples were not significantly different.

While the highest scores were found for Sweden, Germany ranked in the middle and the lowest scores were found in the Spanish samples. Over time, the scores of the German samples approached those of Sweden.

Conclusions

From the first to the second survey, improvements of older adults’ cognitive abilities were found for all countries considered. This may indicate improvements of the underlying educational systems, but also increasingly stimulating general living conditions.
Use and experiences of galactagogues while breastfeeding among Australian women
Authors: McBride Grace M. , Stevenson Robyn , Zizzo Gabriella , Rumbold Alice R. , Amir Lisa H. , Keir Amy K. , Grzeskowiak Luke E.
Published: July 2021

Background

Galactagogues are substances thought to increase breast milk production, however evidence to support their efficacy and safety remain limited. We undertook a survey among Australian women to examine patterns of use of galactagogues and perceptions regarding their safety and effectiveness.

Methods

An online, cross-sectional survey was distributed between September and December 2019 via national breastfeeding and preterm birth support organisations, and networks of several research institutions in Australia. Women were eligible to participate if they lived in Australia and were currently/previously breastfeeding. The survey included questions about galactagogue use (including duration and timing), side effects and perceived effectiveness (on a scale of 1 [Not at all effective] to 5 [Extremely effective]).

Results

Among 1876 respondents, 1120 (60%) reported using one or more galactagogues. Women were 31.5 ± 4.8 years (mean ± standard deviation) at their most recent birth. Sixty-five percent of women were currently breastfeeding at the time of the survey. The most commonly reported galactagogues included lactation cookies (47%), brewer’s yeast (32%), fenugreek (22%) and domperidone (19%). The mean duration of use for each galactagogue ranged from 2 to 20 weeks. Approximately 1 in 6 women reported commencing galactagogues within the first week postpartum. Most women reported receiving recommendations to use herbal/dietary galactagogues from the internet (38%) or friends (25%), whereas pharmaceutical galactagogues were most commonly prescribed by General Practitioners (72%). The perceived effectiveness varied greatly across galactagogues. Perceived effectiveness was highest for domperidone (mean rating of 3.3 compared with 2.0 to 3.0 among other galactagogues). Over 23% of domperidone users reported experiencing multiple side effects, compared to an average of 3% of women taking herbal galactagogues.

Conclusions

This survey demonstrates that galactagogues use is common in Australia. Further research is needed to generate robust evidence about galactagogues’ efficacy and safety to support evidence-based strategies and improve breastfeeding outcomes.
Benchmarking of eight recurrent neural network variants for breath phase and adventitious sound detection on a self-developed open-access lung sound database—HF_Lung_V1
Authors: Hsu Fu-Shun , Huang Shang-Ran , Huang Chien-Wen , Huang Chao-Jung , Cheng Yuan-Ren , Chen Chun-Chieh , Hsiao Jack , Chen Chung-Wei , Chen Li-Chin , Lai Yen-Chun , Hsu Bi-Fang , Lin Nian-Jhen , Tsai Wan-Ling , Wu Yi-Lin , Tseng Tzu-Ling , Tseng Ching-Ting , Chen Yi-Tsun , Lai Feipei
Published: July 2021

A reliable, remote, and continuous real-time respiratory sound monitor with automated respiratory sound analysis ability is urgently required in many clinical scenarios—such as in monitoring disease progression of coronavirus disease 2019—to replace conventional auscultation with a handheld stethoscope. However, a robust computerized respiratory sound analysis algorithm for breath phase detection and adventitious sound detection at the recording level has not yet been validated in practical applications. In this study, we developed a lung sound database (HF_Lung_V1) comprising 9,765 audio files of lung sounds (duration of 15 s each), 34,095 inhalation labels, 18,349 exhalation labels, 13,883 continuous adventitious sound (CAS) labels (comprising 8,457 wheeze labels, 686 stridor labels, and 4,740 rhonchus labels), and 15,606 discontinuous adventitious sound labels (all crackles). We conducted benchmark tests using long short-term memory (LSTM), gated recurrent unit (GRU), bidirectional LSTM (BiLSTM), bidirectional GRU (BiGRU), convolutional neural network (CNN)-LSTM, CNN-GRU, CNN-BiLSTM, and CNN-BiGRU models for breath phase detection and adventitious sound detection. We also conducted a performance comparison between the LSTM-based and GRU-based models, between unidirectional and bidirectional models, and between models with and without a CNN. The results revealed that these models exhibited adequate performance in lung sound analysis. The GRU-based models outperformed, in terms ofF1scores and areas under the receiver operating characteristic curves, the LSTM-based models in most of the defined tasks. Furthermore, all bidirectional models outperformed their unidirectional counterparts. Finally, the addition of a CNN improved the accuracy of lung sound analysis, especially in the CAS detection tasks.