bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Presentation and Characteristics of the Upper Extremity in Patients with Musculocontractural Ehlers–Danlos Syndrome
Authors: Isobe Fumihiro , Hayashi Masanori , Kobayashi Rena , Nakamura Manami , Kosho Tomoki , Takahashi Jun
Published: October 2022

Musculocontractural Ehlers–Danlos syndrome (mcEDS) is a subtype of EDS caused by defective dermatan sulfate biosynthesis, characterized by multiple malformations (craniofacial features, ocular and visceral malformations) and progressive cutaneous, skeletal, vascular, and visceral fragility-related manifestations. Repeated dislocations and deformities of the joints due to joint relaxation are observed, causing serious damage to the musculoskeletal system of the whole body; however, the motor function of the upper limbs and the morphology of the bone joints have not been systematically investigated. In this study, we present a detailed and comprehensive report on upper limb lesions of 13 patients with a mean age at the first visit of 21 years. Twelve patients (92.3%) had a history of dislocation. Eleven patients (84.6%) had shoulder dislocations, and two patients (15.4%) had elbow dislocations. Four patients (30.8%) had elbow osteoarthritis, and three patients (23.1%) had distal radioulnar joint (DRUJ) osteoarthritis. The phalanges and metacarpals are thin, and the ratio of medullary cavity of the metacarpal bone decreases with age. As bone and joint deformity progresses, patients with mcEDS should be recommended to receive regular follow-up, including radiology. The present findings suggest an important role for dermatan sulfate in the maintenance of the skeletal system.
Bi-EB: Empirical Bayesian Biclustering for Multi-Omics Data Integration Pattern Identification among Species
Authors: Yazdanparast Aida , Li Lang , Zhang Chi , Cheng Lijun
Published: October 2022

Although several biclustering algorithms have been studied, few are used for cross-pattern identification across species using multi-omics data mining. A fast empirical Bayesian biclustering (Bi-EB) algorithm is developed to detect the patterns shared from both integrated omics data and between species. The Bi-EB algorithm addresses the clinical critical translational question using the bioinformatics strategy, which addresses how modules of genotype variation associated with phenotype from cancer cell screening data can be identified and how these findings can be directly translated to a cancer patient subpopulation. Empirical Bayesian probabilistic interpretation and ratio strategy are proposed in Bi-EB for the first time to detect the pairwise regulation patterns among species and variations in multiple omics on a gene level, such as proteins and mRNA. An expectation–maximization (EM) optimal algorithm is used to extract the foreground co-current variations out of its background noise data by adjusting parameters with bicluster membership probability threshold Ac; and the bicluster average probability p. Three simulation experiments and two real biology mRNA and protein data analyses conducted on the well-known Cancer Genomics Atlas (TCGA) and The Cancer Cell Line Encyclopedia (CCLE) verify that the proposed Bi-EB algorithm can significantly improve the clustering recovery and relevance accuracy, outperforming the other seven biclustering methods—Cheng and Church (CC), xMOTIFs, BiMax, Plaid, Spectral, FABIA, and QUBIC—with a recovery score of 0.98 and a relevance score of 0.99. At the same time, the Bi-EB algorithm is used to determine shared the causality patterns of mRNA to the protein between patients and cancer cells in TCGA and CCLE breast cancer. The clinically well-known treatment target protein module estrogen receptor (ER), ER (p118), AR, BCL2, cyclin E1, and IGFBP2 are identified in accordance with their mRNA expression variations in the luminal-like subtype. Ten genes, including CCNB1, CDH1, KDR, RAB25, PRKCA, etc., found which can maintain the high accordance of mRNA–protein for both breast cancer patients and cell lines in basal-like subtypes for the first time. Bi-EB provides a useful biclustering analysis tool to discover the cross patterns hidden both in multiple data matrixes (omics) and species. The implementation of the Bi-EB method in the clinical setting will have a direct impact on administrating translational research based on the cancer cell screening guidance.
DeepNup: Prediction of Nucleosome Positioning from DNA Sequences Using Deep Neural Network
Authors: Zhou Yiting , Wu Tingfang , Jiang Yelu , Li Yan , Li Kailong , Quan Lijun , Lyu Qiang
Published: October 2022

Nucleosome positioning is involved in diverse cellular biological processes by regulating the accessibility of DNA sequences to DNA-binding proteins and plays a vital role. Previous studies have manifested that the intrinsic preference of nucleosomes for DNA sequences may play a dominant role in nucleosome positioning. As a consequence, it is nontrivial to develop computational methods only based on DNA sequence information to accurately identify nucleosome positioning, and thus intend to verify the contribution of DNA sequences responsible for nucleosome positioning. In this work, we propose a new deep learning-based method, named DeepNup, which enables us to improve the prediction of nucleosome positioning only from DNA sequences. Specifically, we first use a hybrid feature encoding scheme that combines One-hot encoding and Trinucleotide composition encoding to encode raw DNA sequences; afterwards, we employ multiscale convolutional neural network modules that consist of two parallel convolution kernels with different sizes and gated recurrent units to effectively learn the local and global correlation feature representations; lastly, we use a fully connected layer and a sigmoid unit serving as a classifier to integrate these learned high-order feature representations and generate the final prediction outcomes. By comparing the experimental evaluation metrics on two benchmark nucleosome positioning datasets, DeepNup achieves a better performance for nucleosome positioning prediction than that of several state-of-the-art methods. These results demonstrate that DeepNup is a powerful deep learning-based tool that enables one to accurately identify potential nucleosome sequences.
Internal Structure, Invariance, and Rasch Analyses: A Work-Life Integration-Blurring Scale
Authors: Hincapié Pinzón Juanita , da Silva Andressa Melina Becker , da Silva Monique Cristielle Silva , de Lara Machado Wagner , Moret-Tatay Carmen , de Oliveira Manoela Ziebell
Published: October 2022

The aim of the study was to develop a role blurring (RB) tool to measure work-life integration in different contexts. A final number of 19 items was examined. Psychometric properties in both Spanish and Brazilian Portuguese versions were analysed, comparing the invariance of the measure between the two countries, and setting the difficulty parameter of the items. Thus, a total of two incidental samples volunteered to participate in the study: a Spanish sample of n = 498 and a Brazilian sample of n = 379 were recruited. Confirmatory factor analysis (CFA), as well as an invariance analysis, were performed between the two countries, in order to test the homogeneity structure of the measure. In addition, the item response theory (IRT) was used to establish the probability of response and difficulty of the items through a Rasch analysis. The confirmatory factor analysis pointed to a unifactorial structure. There were no statistically significant alterations in the model fit indices, and the Rasch rating scale model (RSM) showed adequate infit and outfit values, as well as successive response categories located in the expected order for all items.
Mortality and Quality of Life with Chronic Kidney Disease: A Five-Year Cohort Study with a Sample Initially Receiving Peritoneal Dialysis
Authors: Sitjar-Suñer Miquel , Suñer-Soler Rosa , Bertran-Noguer Carme , Masià-Plana Afra , Romero-Marull Natalia , Reig-Garcia Glòria , Alòs Francesc , Patiño-Masó Josefina
Published: October 2022

The quality of life, morbidity and mortality of people receiving renal replacement therapy is affected both by the renal disease itself and its treatment. The therapy that best improves renal function and quality of life is transplantation. Objectives: To study the quality of life, morbidity and mortality of people receiving renal replacement therapy over a five-year period. Design: A longitudinal multicentre study of a cohort of people with chronic kidney disease. Methods: Patients from the Girona health area receiving peritoneal dialysis were studied, gathering data on sociodemographic and clinical variables through an ad hoc questionnaire, quality of life using the SF-36 questionnaire, and social support with the MOS scale. Results: Mortality was 47.2%. Physical functioning was the variable that worsened most in comparison with the first measurement (p = 0.035). Those receiving peritoneal dialysis (p = 0.068) and transplant recipients (p = 0.083) had a better general health perception. The social functioning of transplant recipients improved (p = 0.008). Conclusions: People with chronic kidney disease had a high level of mortality. The dimension of physical functioning worsens over the years. Haemodialysis is the therapy that most negatively effects general health perception. Kidney transplantation has a positive effect on the dimensions of energy/vitality, social functioning and general health perception.
Emphasising Organisational Routine: A Qualitative Study of Patient and Health Professional Experiences of Inpatient Oncology Care
Authors: Watermeyer Jennifer , Etheredge Harriet , Fabian June , Tager Sue
Published: October 2022

Background: Although the experience of hospitalisation for cancer management has been widely researched, such research from the African sub-continent is limited. Objective: This study explored experiences of patient care in a tertiary, inpatient oncology setting in urban South Africa, from the point of view of patients and health professionals. Methods: In-depth interviews and focus groups were conducted with participants. Participants included oncology inpatients, oncologists, nurses and nursing management (N = 46) at an oncology unit in Johannesburg, South Africa. Data were analysed by a multidisciplinary research group using reflexive thematic analysis principles. Results: Our results suggest that barriers to establishing effective organisational routines included communication breakdowns between patients and healthcare providers, a lack of predictability in interactions with doctors, deficient access to information and diminished confidence in nurses. Conclusions: Oncology inpatients may not feel in control of their circumstances, in part due to lacking routine in the hospital setting. Ironically, nurses, who are often at the frontline of patient management, appear to be underutilised or disabled by the healthcare system as conveyors of information. Implications for practice: Robust organisational routines for oncology inpatients may be a good mechanism for allaying uncertainty and conferring a sense of control. Nursing staff, as the individuals with the most direct patient contact, could be instrumental in nurturing organisational routines towards improving patient perceptions of care.
Feasibility of a Hospital Information System for a Military Public Organization in the Light of the Multi-Criteria Analysis
Authors: Pereira Ruan Carlos Alves , Moreira Miguel Ângelo Lellis , Costa Igor Pinheiro de Araújo , Tenório Fabrício Maione , Barud Naia Augusto , Fávero Luiz Paulo , Al-Qudah Anas Ali , Gomes Carlos Francisco Simões , Santos Marcos dos
Published: October 2022

The healthcare environment presents a large volume of personal and sensitive patient data that needs to be available and secure. Information and communication technology brings a new reality to healthcare, promoting improvements, agility and integration. Regarding high-level and complex decision-making scenarios, the Brazilian Navy (BN), concerning its healthcare field, is seeking to provide better management of its respective processes in its hospital facilities, allowing accurate control of preventive and curative medicine to members who work or have served there in past years. The study addresses the understanding, structure and clarifying variables related to the feasibility of technological updating and installing of a Hospital Information System (HIS) for BN. In this scenario, through interviews and analysis of military organization business processes, criteria and alternatives were established based on multi-criteria methodology as a decision aid. As methodological support for research and data processing, THOR 2 and PROMETHEE-SAPEVO-M1 methods were approached, both based on the scenarios of outranking alternatives based on the preferences established by the stakeholders in the problem. As a result of the methodological implementation, we compare the two implemented methods in this context, exposing the Commercial Software Purchase and Adoption of Free Software, integrated into Customization by the Marine Studies Foundation, as favorable actions to be adopted concerning HIS feasibility. This finding generates a comprehensive discussion regarding the BN perspective and changes in internal development in the military environment, prospecting alignment to the culture of private organizations in Information Technology for healthcare management. In the end, we present some conclusions concerning the study, exploring the main points of the decision-making analysis and for future research.
The Role of Volunteers in a Swimming Organization for Persons with Disabilities
Authors: Vernerova Alena , Marova Ivana , Chmelik Frantisek
Published: October 2022

Participation in leisure time physical activity (LTPA) has considerable health-related, psychological, and social benefits. However, the involvement of individuals with disabilities is considerably less than that of their peers without disabilities. A higher rate of participation of individuals with disabilities in LTPA may be achieved by the active involvement of volunteers. This study aimed to describe the importance of volunteer involvement in a swimming organization focused on individuals with disabilities, as perceived by all participants, including swimmers with disabilities, their parents, volunteers, and coaches. The organization uses volunteers as swimming instructors who work individually with swimmers with disabilities. The data were obtained through 11 semi-structured interviews with swimmers with disabilities and their parents, volunteers, and coaches. The interviews were transcribed verbatim and analyzed using a five-step inductive thematic analysis. As a result of the cooperation with the volunteer swimming instructors, swimmers with disabilities felt an improved range of movement, greater independence, and higher self-esteem than before they started using the services of the swimming organization. Consequently, even individuals with severe disabilities can participate in LTPA. Membership to the organization also provided space for the establishment of new social relations, and the instructors described them accepting persons with disabilities as their equals. More importantly, the involvement of volunteers enables organizations to provide respite care for parents.
Development of Evaluation Indicators for Sports Facilities for People with Disabilities Considering the Universal Design: Focusing on the Republic of Korea
Authors: Yi Eunsurk , Jeon Sang-Wan , Oh Ahra
Published: October 2022

We developed evaluation indicators for sports facilities for people with disabilities and adopted the universal design to conduct Delphi surveys on sports facilities and sports experts. First, the range of universal design element reflection and the method of deriving the evaluation indicators were established through a literature review. Second, 21 experts conducted the first Delphi survey to select the important features of the seven principles of universal design and describe the necessary sub-factors to consider when designing sports facilities. The described elements were divided into 15 categories, and 49 sub-factors were extracted. Third, based on the evaluation of the indicators’ content, acceptance was investigated, and the survey data were analyzed through indicators of reliability and validity of the sub-factors and categories. Fourth, we discussed whether to accept the standard value on the basis of the evaluation index through an expert meeting. Subsequently, the final evaluation index was obtained. The developed evaluation index should be applied by the operators and users of public sports facilities, and validation work is needed. Guidelines for applying the universal design to various sports facilities for people with disabilities should be developed. The financing of sports facilities applying the universal design and related policies should be discussed.
Current Expertise, Opinions, and Attitude toward TNF-⍺ Antagonist Biosimilars among Physicians: A Self-Administered Online Survey in Western Switzerland
Authors: Krstic Marko , Devaud Jean-Christophe , Sadeghipour Farshid , Marti Joachim
Published: October 2022

Tumor necrosis factor-alpha (TNF-⍺) antagonists are biological drugs with multiple authorized biosimilars. Biosimilars are becoming critical to the financial sustainability of health systems. Recent studies emphasize that physicians’ knowledge regarding biosimilars has not yet progressed sufficiently to overcome their concerns regarding biosimilars’ safety and efficacy. To assess the current knowledge, opinions, and attitudes toward TNF-⍺ antagonist biosimilars among postgraduate physicians and specialists, an anonymous, self-administered survey was implemented on SurveyMonkey between February and May 2022. The survey was validated through think-aloud interviews with senior and postgraduate physicians in rheumatology, gastroenterology, and immunoallergology, and a senior epidemiologist. Participant recruitment was conducted with the help of the physicians’ professional societies and departmental head physicians of two university hospitals in Western Switzerland. Most physicians felt more comfortable initiating a TNF-⍺ antagonist biosimilar in biologic-naive patients (BNPs) than switching patients stabilized on the original biologic (originator). However, most participants agreed that BNPs should start treatment with the biosimilar rather than the originator when available. Postgraduate physicians and specialists in rheumatology, gastroenterology, and immunoallergology who participated in this survey were familiar with TNF-⍺ antagonist biosimilars and were confident in prescribing them. Yet, they still preferred to avoid switching a patient already on the originator.
The Influence of Orthodontic Treatment Need on Oral Health-Related Quality of Life among 12–18-Year-Old Adolescents in Riyadh
Authors: Ajwa Nancy , AlHammad Arwa , AlAmmar Luluh , AlMarjan Munira , AlShugair Talal , AlManie Leen , Bangalore Durgesh
Published: October 2022

This study assessed the prevalence of orthodontic treatment needs and oral health-related quality of life (OHRQoL) in 12–18-year-old adolescents and explored the association between OHRQoL and treatment needs, gender, education level and family income. A total of 243 participants with no prior history of orthodontic treatment were included in this cross-sectional study utilizing a standardized self-explanatory questionnaire and clinical examination. The questionnaire consisted of two parts. The first part included the participants’ demographics (age, gender, education level, economic status) and the second part contained the Arabic version of the oral health impact profile (OHIP)-14, which consists of 14 questions to assess the impact of the severity of malocclusion on routine activities. The clinical examination involved the dental health component (DHC) index of orthodontic treatment needs (IOTN). The outcome of the study showed that 46% of participants had little or no treatment needs, followed by 23.5% with borderline needs, and 30.5% with severe needs. Female participants had higher mean OHIP-14 scores (10.94 ± 8.17) compared to their male counterparts (8.44 ± 7.15), and the difference in the mean scores was significant (p = 0.015). The educational level did not significantly influence the mean OHIP-14 scores (p = 0.723), whereas the family income correlated negatively with the mean OHIP-14 scores. Participants with less family income had higher mean OHIP-14 scores (11.53 ± 8.67) compared to participants with high (8.22 ± 6.71) and average family income (10.68 ± 8.30). The mean OHIP-14 scores between the family income groups were statistically significant (p = 0.036). The overall OHIP-14 score of the participants was 9.67 ± 7.75. The need for orthodontic treatment is crucial among adolescents. It is recommended to have regular orthodontic consultations for adolescents and prompt referral for treatment to improve the OHRQoL.
The Cost-Effectiveness Analysis of Gamiguibi-Tang versus Hwangryunhaedok-Tang for Patients with Insomnia Disorder Based on a Randomized Controlled Trial
Authors: Lee Ji-Eun , Jung In-Chul , Lee So-Young , Lim Jung-Hwa , Kim Bo-Kyung , Cho Eun
Published: October 2022

(1) Insomnia is associated with poor quality of life and loss of productivity, and is a significant economic burden on society. Gamiguibi-tang (GGBT) is the most frequently prescribed herbal medicine for insomnia treatment. Hwangryunhaedok-tang (HHT) is used as an insured herbal medicine for insomnia in the Korean National Health Insurance (NHI) system. This study aims to evaluate the cost-effectiveness of GGBT versus HHT in patients with insomnia disorders based on clinical trial data; (2) Methods: The EuroQol five-dimension scale (EQ-5D) was used to estimate quality-adjusted life-years (QALY). Direct and non-direct medical costs and lost productivity costs were estimated. The cost-effectiveness of GGBT was compared with HHT treatments over six weeks from a societal perspective; (3) Results: A total of 81 patients who underwent GGBT (n = 56) and HHT (n = 25) treatment completed the clinical trial. The EQ-5D score improved significantly more in the GGBT than in the HHT group (0.02 vs. −0.03, p < 0.05). The QALYs for six weeks were slightly greater in GGBT (0.0997) than in the HHT group (0.0987); however, the total costs incurred were approximately 9% less in GGBT ($934) than in the HHT group ($1029). GGBT was found to be a more economically dominant treatment option compared to HHT for treating insomnia; (4) Conclusions: Among herbal medicines, GGBT may be a cost-effective option for treating insomnia from a societal perspective in Korea.
Older Adults and Positive Mental Health during the Second and Sixth COVID-19 Waves in Spain
Authors: Moret-Tatay Carmen , Cloquell-Lozano Alexis , Pérez-Bermejo Marcelino , Arteaga-Moreno Francisco Javier
Published: October 2022

The spread of the COVID-19 virus was a worldwide phenomenon, which was unprecedented in modern times. The restriction measures can be perceived as a heavy burden for mental health during this period, particularly for some groups. The aim of this study is to examine a positive mental health model across ages, where a moderated mediation model is proposed involving sex differences and confidence in coping with COVID-19. Two independent samples were studied during the second and sixth waves in Spain: n = 2861 and n = 2462, respectively. The main conclusions can be described as follows: (i) while age was not related to mental health during the second wave, a positive relationship was found between it and the sixth one; (ii) age was positively related to the confidence in coping with COVID-19 during both of the waves; (iii) women showed worse scores for the variables in the study than the men did during the second wave, but this pattern was reversed in the sixth one; (iv) after a moderated mediation model on the relationship between age and positive mental health in terms of confidence in coping with COVID-19 and sex, an interaction was found for the second wave but not for the sixth one. These results suggest that older adults and women would develop more strategies and resources for a positive mental health across time.
Clinical Application of Individualized 3D-Printed Templates in the Treatment of Condylar Osteochondroma
Authors: Ma Wen , Niu Shiwei , Wang Lidong , Peng Canbang , Fu Shuai , Zhang Changbin , Cui Qingying , Wang Sihang , Li Ming , Xu Yanhua
Published: October 2022

Background: Osteochondroma (OC) is one of the most common benign tumors of the long bones, but it rarely occurs in the maxillofacial skeleton. However, mandibular condylar OC often leads to severe facial deformity in affected patients, including facial asymmetry, deviation of the chin, and malocclusion. This study aimed to explore the clinical application of individualized 3D-printed templates to accurately and effectively treat condylar OC. Methods: A total of 8 patients with mandibular condylar OC were treated from July 2015 to August 2021. The enrolled patients (5 women and 3 men) had a median age of 27 years (range: 21–32 years). All patients exhibited symptoms of facial asymmetry and occlusal disorders preoperatively. The digital software used to virtually design the process consisted of three-dimensional reconstruction, 3D-cephalometry analysis, virtual surgery, individualized templates, and postoperative facial soft-tissue prediction. A set of 3D-printed templates (DOS and DOT) were used in all cases to stabilize the occlusion and guide the osteotomy. Then, pre- and post-operative complications, mouth opening, clinical signs, and the accuracy of the CT imaging analysis were all evaluated. All the measurement data were presented as means ± SD; Bonferroni and Tamhane T2 multiple comparison tests were used to examine the differences between the groups. Results: All patients healed uneventfully. None of the patients exhibited facial nerve injury at follow-up. In comparing the condylar segments with T0p and T1, the average deviation of the condylar segments was 0.5796 mm, indicating that the post-operative reconstructed condyles showed a high degree of similarity to the reconstruction results of the virtual surgical plan. Conclusions: Individualized 3D-printed templates simplified surgical procedures and improved surgical accuracy, proving to be an effective method for the treatment of patients with slight asymmetric deformities secondary to condylar OC.
Application of Artificial Intelligence in Screening for Adverse Perinatal Outcomes—A Systematic Review
Authors: Feduniw Stepan , Golik Dawid , Kajdy Anna , Pruc Michał , Modzelewski Jan , Sys Dorota , Kwiatkowski Sebastian , Makomaska-Szaroszyk Elżbieta , Rabijewski Michał
Published: October 2022

(1) Background: AI-based solutions could become crucial for the prediction of pregnancy disorders and complications. This study investigated the evidence for applying artificial intelligence methods in obstetric pregnancy risk assessment and adverse pregnancy outcome prediction. (2) Methods: Authors screened the following databases: Pubmed/MEDLINE, Web of Science, Cochrane Library, EMBASE, and Google Scholar. This study included all the evaluative studies comparing artificial intelligence methods in predicting adverse pregnancy outcomes. The PROSPERO ID number is CRD42020178944, and the study protocol was published before this publication. (3) Results: AI application was found in nine groups: general pregnancy risk assessment, prenatal diagnosis, pregnancy hypertension disorders, fetal growth, stillbirth, gestational diabetes, preterm deliveries, delivery route, and others. According to this systematic review, the best artificial intelligence application for assessing medical conditions is ANN methods. The average accuracy of ANN methods was established to be around 80–90%. (4) Conclusions: The application of AI methods as a digital software can help medical practitioners in their everyday practice during pregnancy risk assessment. Based on published studies, models that used ANN methods could be applied in APO prediction. Nevertheless, further studies could identify new methods with an even better prediction potential.
A Phenominological Qualitative Study of Factors Influencing the Migration of South African Anaesthetists
Authors: Fletcher-Nkile Leilanie , Mrara Busisiwe , Oladimeji Olanrewaju
Published: October 2022

Background: The anaesthetic workforce is a scarce resource in South Africa (SA), and the media frequently reports that anaesthetists are leaving the country in search of better opportunities in well-resourced countries. The aim of this study was to explore the factors influencing the migration intentions of South African anaesthetists. Methods: This study utilised a qualitative methodology in the form of virtual interviews. A total of 23 interviews were conducted on purposefully selected participants using a snowball approach. The interviews were transcribed and coded into emerging themes using MAXQDA version 2022. Thematic content analysis was subsequently performed. Results: The study found that all SA-based participants were considering emigrating, while those who had already emigrated had no plans to return to SA in the near future. Push factors prompted the consideration of emigration, and these were related to unsatisfactory living and working conditions in South Africa, such as a high level of crime and corruption, and the country’s overall poor resources and infrastructure. Destination countries were chosen based on their pull factors such as better working conditions and opportunities for professional growth. These pull factors frequently outweighed South Africa’s push factors and are therefore critical in the decision to emigrate. The main recommendations from the participants include facilitating collaboration between the public and private sectors, expanding the available sub-specialties in SA, and recognising fellowships in South African hospitals. The study participants were of the view that South African anaesthesiologists would be motivated to stay by a combination of patriotism and hope for the future. Conclusions and Policy Recommendations: The Anaesthetic workforce in South Africa is at critical risk and is unlikely to stabilise soon. Concerted efforts should be made by all concerned to explore ways of retaining the staff, considering the recommendations of the participants. Relevant key stakeholders in training and regulation of anaesthetics practice such as the Health Professions Council of South Africa, South African Society of Anaesthesiologists, and the Colleges of Medicine of South Africa should collaborate and prioritise mechanisms of monitoring emigration and intervening on modifiable professional and socio-political factors.
Automated Bone Age Assessment: A New Three-Stage Assessment Method from Coarse to Fine
Authors: Xu Xinzheng , Xu Huihui , Li Zhongnian
Published: October 2022

Bone age assessment (BAA) based on X-ray imaging of the left hand and wrist can accurately reflect the degree of the body’s physiological development and physical condition. However, the traditional manual evaluation method relies too much on inefficient specialist labor. In this paper, to propose automatic BAA, we introduce a hierarchical convolutional neural network to detect the regions of interest (ROI) and classify the bone grade. Firstly, we establish a dataset of children’s BAA containing 2518 left hand X-rays. Then, we use the fine-grained classification to obtain the grade of the region of interest via object detection. Specifically, fine-grained classifiers are based on context-aware attention pooling (CAP). Finally, we perform the model assessment of bone age using the third version of the Tanner–Whitehouse (TW3) methodology. The end-to-end BAA system provides bone age values, the detection results of 13 ROIs, and the bone maturity of the ROIs, which are convenient for doctors to obtain information for operation. Experimental results on the public dataset and clinical dataset show that the performance of the proposed method is competitive. The accuracy of bone grading is 86.93%, and the mean absolute error (MAE) of bone age is 7.68 months on the clinical dataset. On public dataset, the MAE is 6.53 months. The proposed method achieves good performance in bone age assessment and is superior to existing fine-grained image classification methods.
Video-Twin Technique for Airway Management, Combining Video-Intubating Stylet with Videolaryngoscope: A Case Series Report and Review of the Literature
Authors: Jhuang Bo-Jyun , Luk Hsiang-Ning , Qu Jason Zhensheng , Shikani Alan
Published: October 2022

Direct laryngoscopy (DL) and videolaryngoscopy (VL) have been the most commonly used airway management modalities in the last several decades. Meanwhile, various optional airway tools (e.g., supraglottic devices, fiberoptic bronchoscopes) have been used for alternative rescue modalities when anticipated or unexpected difficulties in airway management has occurred. In recent decades, optical stylets and video-assisted intubating stylets have become another option for difficult airway scenarios. In contrast to other approaches, we have adopted the Shikani video-assisted intubating stylet technique (VS) for both routine and difficult airway management scenarios. In this case series report, we present the video-twin technique, combining a videolaryngoscope with a video-assisted intubating stylet in various clinical case scenarios. We propose that such a combination is easy to learn and employ and is particularly beneficial in situations where an expected difficult airway (EDA) is encountered.
Challenges of Digital Building Data Usage with a Focus on the Digital Documentation of Heritage Buildings—Results from an Online Survey
Authors: Khalil Ahmed , Stravoravdis Spyridon
Published: October 2022

The AEC industries as well as the heritage sector are facing a number of issues that relate to the management of building digital data. Two of the most prominent ones are the interoperability of data and data longevity. In order to better understand the extent of these issues for the general AEC industry and heritage buildings sectors, an online survey was designed to help quantify them and reveal the opinions of professionals and academics in the field. The online survey highlighted a clear latency in BIM adoption in the heritage sector as only 51% of the heritage participants use BIM in their projects compared to 63% of AEC participants. The reasons for this were further explored in the participants’ comments, as most of the reasons revolved around the issues of BIM data interoperability and longevity, considering the complex and interdisciplinary nature of heritage projects. The survey responses highlighted that data longevity is a crucial challenge for the heritage sector in particular as the need for future re-accessibility of digital data is clear in the results, showing that more than 82% of the heritage participants need to re-access their data in the future. The results also showed the prevalence of BIM interoperability issues and highlighted that the heritage sector is more prone to interoperability issues compared to the general AEC industry as 67% of heritage BIM participants and 50% of AEC BIM participant have faced some issues of BIM interoperability. In total, 72% of the standardised BIM participants agreed that standardised BIM formats could be a promising solution to mitigate the interoperability challenges, while only 57% thought that standardised BIM formats are reliable in their current status. Moreover, the online survey explored the variation in the needs of different disciplinary groups including rates of BIM adoption, use of standardised BIM formats, and needs for access to different heritage buildings data categories. Participants also presented their views on what would be an ideal medium for long-term storage of heritage buildings digital documentation data for future access, with some views being sceptical concerning BIM in its current status. This paper presents the findings of this extensive online survey.
Fragility Curves for Historical Structures with Degradation Factors Obtained from 3D Photogrammetry
Authors: Gil-Martín Luisa María , Hdz.-Gil Luisa , Kohrangi Mohsen , Menéndez Esperanza , Hernández-Montes Enrique
Published: October 2022

The influence of the effects of the degradation of materials on the seismic fragility of Cultural Heritage buildings in Granada (Spain) is investigated. The degradation of the material, which mainly happens at the lower levels of the façades, is obtained by using 3D photogrammetry data. Fragility curves for three cultural heritage constructions in Granada are calculated by using FE nonlinear dynamic analyses for both non-deteriorated and deteriorated geometries. The Finite Elements (FE) models, based on the macro-modelling technique, are subjected to ground motions for the city of Granada, which were selected by considering Probabilistic Seismic Hazard Analysis (PSHA) methodology with their probability of occurrence. The response of each model is analyzed for different seismic Intensity Measure (IM) levels, which, in this study, correspond to average pseudo-acceleration. The procedure is applied to three monuments in Granada that were built with two different constructions materials: calcarenite and rammed earth. The damage mechanisms considered are roof displacement or maximum compressive principal stress, depending on each case. The results show that the restoration works that have been carried out has prevented structural failures in the rammed earth construction studied, and that, during future seismic events, special attention must be paid to the level of compressive strengh reached in the Santa Pudia calcarenite used at the San Jerónimo monastery.
Vegetative Characteristics of Three Apricot Cultivars Grafted on Six Different Rootstocks
Authors: Mendelné Pászti Edina , Bujdosó Géza , Mendel Ákos
Published: October 2022

The continuous innovation in the aspect of apricot cultivars and rootstocks requires comparative trials, which can be evaluated by precise and repeated measurements. An experiment is established, initiated from the recent trends for the Central-European region. Our aim was to evaluate the characteristics of the observed rootstock-scion combinations during their non-bearing period under irrigated conditions. ‘Montclar’, ‘Myrobalan 29C’, ‘Wavit’, ‘Rootpac R’ and ‘Fehér besztercei’ were used as rootstock, in addition to the apricot selected seedling. Evaluation of rootstocks was carried out in combination with ‘Bergarouge’, ‘LilyCot’, and the traditional Hungarian cultivar called ‘Gönci Magyar kajszi’. The control combination was ‘Gönci Magyar kajszi’ grafted on apricot selected seedling. The experiment was established in spring of 2018 with 3 × 5 m spacing. The results showed strong influence of rootstock on the vigor of grafted scions. The regression relationships between the total height of trees and the canopy diameter, and the shoot length were linear. Furthermore, relationships between the trunk cross-section area and the total height of trees, the canopy diameters, the shoot lengths, as well as the canopy volume were positive and non-linear.
Adoption of Integrated Pest Management for Red Palm Weevil Control among Farmers in Saudi Arabia
Authors: Alotaibi Bader Alhafi , Ahmed Ali , Al-Zaidi Abdullah Awad , Kassem Hazem S.
Published: October 2022

The red palm weevil (RPW), Rhynchophorus ferrugineus, is widely considered to be highly invasive and the most damaging insect pest affecting palms in the world. Nonetheless, the prevention or significant slowing of the spread of RPW mainly relies on the application of integrated pest management (IPM) programs. This study aimed to evaluate farmers’ adoption of RPW IPM practices and examine the differences in adoption according to the farmers’ socio-economic attributes and their farm characteristics. The data were collected from 156 farmers through structured questionnaires by the Al-Kharaj governorate, Saudi Arabia. The findings showed that the farmers moderately adopted the categories of legislative control (54.77%) and cultural practices (50.44%), whereas they were showed a low-level adoption regarding the prevention, mechanical control, and chemical control categories. The cluster analysis revealed two variable farmer segments, “low adopters” and “moderate adopters”, based on the average level of adoption of the 23 IPM practices examined. The cluster of “moderate adopters” accounted for 57.1% of the samples and had a higher average adoption in terms of all the practices investigated. Significant differences (p < 0.01) were found between the two groups of farmers, corresponding to their age, education level, farm size, farming experience, number of date palm trees on the farm, off-farm income, farming activities, source of irrigation, type of irrigation, growing of the ‘Khodri’ cultivar, growing of the ‘Barhi’ cultivar, and tree spacing. The results suggest that implementing campaigns to increase public awareness of the consequences resulting from the non-adoption of IPM, enhancing the participation of date palm farmers in the area-wide IPM strategy, and improving recognition behavior by detecting RPW with digital devices are useful actions.
Experimental Investigation of the Effects of Porosity, Hydraulic Conductivity, Strength, and Flow Rate on Fluid Flow in Weakly Cemented Bio-Treated Sands
Authors: Konstantinou Charalampos , Biscontin Giovanna
Published: October 2022

Fluid injection in a porous medium is the underlying mechanism for many applications in the fields of groundwater hydraulics, hydrology and hydrogeology, and geo-environmental engineering and in the oil and gas industry. Fluid flow experiments in porous media with a viscous fluid at varying injection rates were conducted in a modified Hele-Shaw setup. The granular media were three-dimensional bio-cemented sands of various grain sizes across various cementation levels, generating a matrix of various hydraulic conductivities, porosities, and strengths. The fluid injection experiments showed that a cavity-like fracture developed, which transitioned to crack-like fractures at higher cementation levels (hence, higher strength). As the flow rate increased, less infiltration was evident and higher breakdown pressure was observed, with propagation pressure reducing to zero. It was harder to induce an opening in cemented specimens with higher hydraulic conductivity and a larger pore network despite their lower strength due to excessive infiltration dominance, which inhibited the build-up of pressure required to generate a fracture. The results of this study suggest that, when designing fluid injection programs, the combined effects of hydraulic conductivity and strength need to be carefully considered.
Application of the RAPS Method of Time Series Analysis to the Assessment of Grout Curtain Performance in Karst—A Case Study of the Hydro Energy Power Plant (HEPP) Mostar Dam in Bosnia and Herzegovina
Authors: Đurin Bojan , Raič Mirna , Sušilović Petra
Published: October 2022

Concerning the media’s properties, there is always a possibility of changing groundwater flow conditions surrounding hydroelectric power plants. Causes for such events could be natural or anthropogenic, which is, in many cases, not so obvious to determine. In addition, determining a period when changes in the groundwater flow occur is a complex task. All of the above mentioned are of crucial importance due to the operational work of hydropower plants, i.e., the optimization of the inflow and outflow of the water in the turbine, regardless of the hydropower plant type. All types listed require a particular approach for solving such issues. Rescaled Adjusted Partial Sums (RAPS) is an appropriate time-series analysis method. In this specific case, observed fluctuations in the time series of the groundwater levels could lead to conclusions about possible irregularities in the shallow as well as the deep zones of the underground water. The concept was shown in this paper in the example of the hydroelectric power plant Mostar dam in Bosnia and Herzegovina. It should be noted that the defined methodology was a novel procedure for analyzing and determining the pathways of the flow of groundwater in the surrounding hydropower plant dams. In other words, such analysis could be conducted without the need for complex and expensive drilling and geophysical surveys, tracing, and all other methods.
HPV Vaccine Hesitancy and Influencing Factors among University Students in China: A Cross-Sectional Survey Based on the 3Cs Model
Authors: Huang Yan , Chen Cheng , Wang Lei , Wu Huamei , Chen Ting , Zhang Luying
Published: October 2022

The burden of disease caused by cervical cancer ranked second among female tumors in China. The HPV vaccine has been proven to be a cost-effective measure to prevent cervical cancer, but the vaccination rate remained low to date among university students. This study aimed to understand the status quo of HPV vaccine hesitancy among university students across China during the COVID-19 pandemics and systematically analyze determinants of HPV vaccine hesitancy based on the WHO 3Cs model. Cross-sectional data were collected using an online survey of female university students in four cities across China in June 2022. Multinomial logistic regression was adopted to determine factors influencing vaccine hesitancy based on the 3Cs model with three dimensions, namely complacency, convenience, and confidence. Among 1438 female university students surveyed in this study, 89.7% did not hesitate to vaccinate against HPV, only 8.9% hesitated to some extent, and 1.4% refused to vaccinate. The actual vaccination rate for the HPV vaccine was 34.2%. Based on the 3Cs model, this study found that the trust on the efficacy of vaccines, risk perception of being infected by HPV, price, and distance/time were influencing factors of vaccine hesitancy. Knowledge of the HPV vaccine and sociodemographic characteristics, such as education levels, were also statistically relevant. Therefore, it is recommended that relevant scientific knowledge on cervical cancer and the HPV vaccine should be spread on campus, the vaccination appointment procedure should be simplified, and the affordability of vaccination should be increased through strategic purchasing or providing subsidies, so as to reduce HPV vaccine hesitancy.
Clinical Decision-Making for Appendectomy in Kosovo: A Conjoint Analysis
Authors: Hoxha Ilir , Duraj Bajram , Xharra Shefki , Avdaj Afrim , Beqiri Valon , Grezda Krenare , Selmani Erza , Avdiu Blerta , Cegllar Jakob , Marušič Dorjan , Osmani Aferdita
Published: October 2022

Objective: The objective was to investigate the association of clinical attributes with decision making for performing appendectomy and making preoperative preparations for appendectomy. Method: A conjoint analysis with 17 clinical scenarios was executed with surgeons employed at public hospitals in Kosovo. Setting: The study was conducted at two public hospitals in Kosovo that have benefited from quality-improvement interventions. Participants: The participants included 22 surgeons. Outcome measures: The primary outcome was the overall effect of clinical attributes on the decision to perform appendectomy and make the preoperative preparations for appendectomy. Results: In the regression analyses, several attributes demonstrated statistically significant effects on the clinical decision to perform appendectomy and on the practice of preoperative preparation. Conclusions: We found that several factors influenced the decision to perform appendectomy and the practices for preoperative preparation. Nevertheless, the small sample size limited our efforts to interpret the results. These findings could assist Kosovo in the design and implementation of future similar studies and in fostering quality improvement measures that address clinical decision making and the lack of process standardization in the delivery of surgical care.