bluuebunny/crossref_metadata_2025 huggingface dataset:
Desafios anestésicos em condições cirúrgicas raras na pediatria
Authors: Nelli Nunes Ana Carolina , Da Luz Damiani Giovana , Lima Silveira Izabela , Fernandes Favarim Stephany , Contin de Oliveira Gabriel Felipe , Mazzardo Vanessa , Caroline Bernardi Tuany
Published: December 2024

O manejo anestésico de crianças com condições cirúrgicas raras representa um dos maiores desafios na prática anestésica pediátrica, devido à complexidade das alterações fisiológicas, anatômicas e farmacológicas apresentadas por esses pacientes. Condições raras, como malformações congênitas, doenças metabólicas e síndromes genéticas, exacerbam as dificuldades comuns na anestesia pediátrica, exigindo abordagens altamente individualizadas e o uso de estratégias de mitigação especializadas. Este artigo revisa os principais desafios fisiológicos, técnicos e farmacológicos enfrentados no manejo anestésico de pacientes pediátricos com condições cirúrgicas raras e discute as estratégias de mitigação para otimizar os desfechos cirúrgicos. Foi realizada uma revisão narrativa da literatura, utilizando bases de dados como PubMed, Scopus, Web of Science e Google Scholar. Os termos de busca incluíram "anestesia pediátrica", "condições cirúrgicas raras", "malformações congênitas", "desafios anestésicos" e "doenças raras", com publicações selecionadas entre os anos de 2000 e 2023. Estudos focados no manejo anestésico de crianças com condições raras, particularmente em relação aos aspectos fisiológicos, técnicos e farmacológicos, foram incluídos. Os principais desafios fisiológicos estão relacionados à imaturidade dos sistemas respiratório, cardiovascular e metabólico, exacerbados pelas condições raras, como malformações cardíacas e doenças metabólicas. Do ponto de vista técnico, as dificuldades no manejo das vias aéreas e no acesso venoso são frequentes e requerem o uso de dispositivos avançados e técnicas guiadas por imagem. No âmbito farmacológico, as alterações na farmacocinética e farmacodinâmica em crianças com doenças metabólicas ou renais exigem ajustes precisos nas doses de anestésicos e monitoramento rigoroso para evitar toxicidade. Estratégias de mitigação eficazes incluem planejamento multidisciplinar pré-operatório, treinamento de equipes em simulação de cenários complexos, monitorização hemodinâmica avançada e ajustes individualizados da farmacoterapia. A anestesia em pacientes pediátricos com condições cirúrgicas raras exige uma abordagem altamente especializada, envolvendo a adaptação das técnicas anestésicas, o uso de dispositivos avançados e a integração de uma equipe multidisciplinar experiente. Ainda existem lacunas na literatura, e mais pesquisas são necessárias para desenvolver protocolos específicos que orientem o manejo de anestesia em pacientes pediátricos com condições raras, permitindo uma prática clínica mais segura e eficaz.
DESCARTE DE MEDICAMENTOS VENCIDOS E NÃO UTILIZADOS: ESTUDO SOBRE A CONSCIENTIZAÇÃO DOS PACIENTES
Authors: Aquino Silva Carina , Marini Danyelle Cristine , Campanher Ronaldo
Published: December 2024

As práticas de automedicação e armazenamento de medicamentos em residências estão profundamente enraizadas na rotina das pessoas. A automedicação é frequentemente utilizada como resposta imediata para o alívio de sintomas, enquanto o armazenamento de medicamentos em casa é uma precaução para possíveis emergências de saúde. Dessa forma, muitos medicamentos acabam ultrapassando a data de validade enquanto estão armazenados e precisam ser descartados. Este trabalho teve como objetivo analisar a conscientização de pacientes e o descarte, por parte destes, de medicamentos com data de validade expirada. O estudo referiu-se a uma pesquisa quantitativa, exploratória e transversal, por meio de revisão bibliográfica e aplicação de questionário a 100 pessoas que fazem uso de medicação sem prescrição médica e armazenam medicamentos em casa. Destes participantes, a maioria se automedica raramente (53%), sendo os analgésicos a classe de medicamentos mais utilizada (87%) e a maioria os armazena em local seco e fresco (56%). Além disso, a maioria dos participantes sempre verifica a data de validade dos medicamentos antes de fazerem uso dos mesmos (64%), conhece os riscos do uso de medicamentos após a data de validade (60%) e descarta medicamentos vencidos no lixo comum (60%). Por fim, metade dos participantes conhece os riscos ambientais e à saúde do descarte inadequado de medicamentos (50%). Conclui-se que, apesar de muitos participantes conhecerem os riscos associados ao descarte inadequado de medicamentos, a prática inadequada ainda é comum, o que sugere uma desconexão entre o conhecimento e as práticas reais.
Penerapan Data Mining terhadap Pengaruh Ritme Circadian pada Performa Belajar Mahasiswa
Authors: Soer U Darmanto , Fauziah Sifa , Fitra Ridho Yusuf
Published: December 2024

Perkembangan teknologi informasi telah menghasilkan data yang mencakup berbagai bidang kehidupan, termasuk di bidang pendidikan perguruan tinggi. Teknologi informasi telah menciptakan banyak data dalam berbagai aspek kehidupan, termasuk pendidikan. Di perguruan tinggi, data mahasiswa dan proses pembelajaran memberikan peluang untuk meningkatkan kualitas pendidikan, tetapi persaingan antar perguruan tinggi juga semakin kompetitif. Data mahasiswa di perguruan tinggi menyimpan informasi berharga mengenai profil dan hasil akademik mereka. Namun, menghadapi tuntutan zaman yang semakin produktif, manusia sering mengalami stres dan gangguan tidur yang dapat berdampak negatif pada performa dan kesehatan. Tidur dan ritme circadian memainkan peran penting dalam kesehatan dan produktivitas manusia. Gangguan tidur dan ritme circadian yang terganggu dapat mempengaruhi konsentrasi, memori, dan pemecahan masalah mahasiswa. Dalam konteks ini, menjaga ritme circadian yang sehat menjadi kunci penting dalam meningkatkan performa belajar mahasiswa. Penelitian ini bertujuan untuk mengkaji pengaruh ritme circadian terhadap performa belajar mahasiswa dengan menggunakan algoritma C4.5. Dengan sampel sebanyak 163 mahasiswa dari populasi sejumlah 295 mahasiswa. Sampel dibagi menjadi data training dan data testing menggunakan teknik linear sampling. Hasil dari perhitungan menggunakan algoritma C4.5 menunjukkan tingkat accuracy sebesar 81.81%, precision sebesar 96.29%, dan recall sebesar 83.87%. Hasil decision tree menunjukan adanya hubungan antara ritme circadian dengan performa belajar mereka, semakin sering mahasiswa bergadang akan mempengaruhi pencapaian akademik mereka.
The “Tatarstan Model”: Shaimiyev’s Authoritarianism and Russia’s Power Vertical
Authors: Konstantinov Martin
Published: December 2024

During the 1990s and early 2000s the Tatarstan Model was a key framework in Russia’s zfederal system, based on a power-sharing arrangement with Moscow, granting it more autonomy over its economy, culture, and policies, while still maintaining allegiance to the central government. The primary purpose of this paper is to critically analyze the Tatarstan model of governance during the four terms as president of the Republic of Tatarstan (RT) of Mintimer Shaimiyev (1991-2010). This model exemplifies a unique blend of authoritarian leadership, regional elite management, and crony capitalism. By examining how these elements interact within the context of Tatarstan, the paper aims to illuminate the implications for regional autonomy, economic development, and political stability in Russia. Based on an extensive review of theoretic literature, archival, local and national press sources, the present research employs a mixed-methods approach combining case-study, process-tracing and historical institutional analysis to examine Shaimiyev’s rule in Tatarstan. The paper details and provides evidence for the relevance of the main pillars of the TM, that have been major sources of stability for both the Tatarstan political establishment, and the RF’s “vertical of power” under Putin. Conclusions are drawn as to the crucial historic role of the Model for the overall vitality of the centre – regions power vertical in Russia.
Mitä on diakonia?
Authors: Ryökäs Esko
Published: December 2024

Artikkeli tarkastelee Diakonian tutkimus -lehden kahdenkymmenen vuodenjulkaisutoimintaa ja käsitteen diakonia ymmärtämistä aikakauskirjassa. Erityistähuomiota kiinnitetään siihen, mistä näkökulmista diakoniaa on lähestyttytänä aikana julkaistuissa tutkimusartikkeleissa ja miten nämä näkökulmatrakentuvat erilaisiksi konsepteiksi. Yhden konseptin puitteissa voi olla erilaisiatulkintoja siitä, mitä diakonia merkitsee; ratkaisevaa on lähestymissuunta. Aineistostanousevat esiin seuraavat konseptit: 1) Diakoniatoiminnasta lähtevä,2) Diakoniatyöntekijöiden työn sisältöön perustuva, 3) Diakonia riippumattomanatoimintana, 4) Alkukielestä käsin tarkasteleva, 5) Ideologiasta ja opistanouseva, sekä 6) Tutkimuskohteesta nouseva konsepti. Vaikka tutkimuksenfokus ei ole sinänsä diakonian tulkinnoissa, artikkelissa ilmaistaan toive, ettätämä luokittelu voisi myös edistää keskustelua diakonian kehityksestä. Lopuksikäsitellään aineistosta puuttuvia näkökulmia. Eri yhteiskunnallisten toimijoidenvälisen työnjaon pohdinta ja normatiiviset lähestymistavat diakoniaanovat pysyneet vähäisinä vuosien varrella.
Abstract
The article examines the twenty years of the Journal for the Study of Diaconiaand the discussions regarding the understanding of diaconia that have takenplace through its publications. Special attention is given to the perspectivesfrom which diaconia has been approached in all the research articlespublished during this period. From the material, six conceptual frameworksemerge: Those 1) Originating from diaconal action, 2) Based on the content ofdiaconal workers’ work, 3) Presenting the content of diaconia without bindingit to action, 4) Examined from the perspective of the original language, 5)Emerging from ideology and doctrine, and 6) Stemming from the researchsubject itself. Although the study’s focus is not on the interpretations of diaconiaper se, the article expresses a hope that this classification would also facilitatethe discussion on the development of diaconia. Finally, it discusses theperspectives that appear to be missing from the material. Reflections on thedistribution of roles among various societal actors and normative approachesto diaconia have remained limited over the years.
How Do Young Entrepreneurs Enhance Problem-Solving Skills and Quality Business Decision Making? Understanding the Driver Factors
Authors: Constantine Winston , Thedy Patricia Aprilia , Claudia Jenica , Anggriawan Claudia , Angdris Jacqueline Fidelia , Ardyan Elia
Published: December 2024

Colleges should be able to provide the ability to solve problems and make effective decisions. The aim of this study is to investigate the correlation between entrepreneurial creativity and entrepreneurial self-efficacy with problem-solving skills and the quality of business decision-making. The method of this study utilizes a quantitative research methodology, involving 195 students who are owners of firms and actively engaged in building such enterprises. Respondents must have experience in solving problems and making decisions that significantly impact their businesses. The data was analyzed using SEM-PLS. The results of this study indicate that entrepreneurial creativity can enhance entrepreneurial self-efficacy but does not improve problem-solving skills. Whereas, entrepreneurial self-efficacy can improve problem-solving skills. The improvement in problem-solving skills will have a positive impact on the quality of business decision-making.
A mixture GARCH-based recurrent neural network for financial volatility forecasting
Authors:   Lomonosov Moscow State University, Ivanov Mikhail A. , Roshchina Yanina A. ,   Lomonosov Moscow State University
Published: December 2024

This paper is devoted to the development of mathematical models of stock price volatility in financial markets, with a focus on the GARCH family models. The paper proposes to consider these models from a new perspective: as recurrent rather than autoregressive. The main idea is that GARCH econometric models can be interpreted as recurrent neural networks, especially after introducing an activation function into the equation of variance dynamics. The relevance of the study stems from the constant need to improve the accuracy of volatility forecasting in modern financial markets, especially in the context of the Russian financial system, where accurate forecasts play a key role in financial decision making. The aim of the study is to evaluate the possibility of representing GARCH models in the form of recurrent neural networks and to assess their applicability for volatility forecasting in Russian financial markets. The main objectives are to develop and test recurrent neural networks based on GARCH, combining the advantages of econometric models and machine learning models. The article proposes a modification of the standard GARCH model called GARCH-RNN, which is a recurrent neural network with multidimensional hidden state and the ReLU activation function. The methods used include econometric analysis of stock price volatility and comparison of forecast accuracy using Moscow Stock Exchange data with GARCH and GARCH-RNN models. The results of experiments on said data showed that the GARCH-RNN model provides volatility forecasting accuracy comparable to that of traditional GARCH models. Results of the study confirmed the potential of the new approach for volatility forecasting on financial markets in Russia, opening prospects for improving forecasts and making informed decisions in the market.
Reflexió
Authors: Parádi József
Published: December 2024

The author compares current civil service career models to those in the Austro-Hungarian Monarchy.
Interrogating Teachers’ Competencies in Teaching Social Science: The Social Realist Perspective
Authors: Molapo Karabo , Malatji Khashane Stephen
Published: December 2024

Teachers’ competency is one of the significant skills in the teaching profession and it relies more on pedagogical and content knowledge that teachers portray when delivering a lesson. However, the competency of teachers in Social Science teaching does not match well with the seven roles of an educator. The culture of teaching Social Science in schools has however changed. Hence, the study interrogates the teacher’s competencies in Social Science teaching using the social realist perspective. The study followed a qualitative approach placed within the interpretivism paradigm where case study design was used. Purposive sampling was used to select ten Social Science teachers from secondary schools in the Capricorn District in South Africa. Individual semi-structured interviews and document analysis were used to collect data. The data was analysed through a thematic approach. From Archer’s Social Realist Theory, the concepts of Structure, Culture and Agency were used to interpret professional competencies of Social Science teachers. The study revealed that teaching skills can only be improved by frequent or continuous workshops that incorporate both pedagogical and professional competencies. The study concluded that there is a need to ground teaching pedagogy of Social Science and embed it within the seven roles of an educator. The study recommends that the social realist theoretical lenses of Structure, Culture, and Agency be embedded in teaching to regain the competency of teachers in teaching Social Science.

Keywords: Competency, Perspective, Social Realist, Social Science Teaching
Поширення пружних хвиль у нескінченному шарі при дії миттєвого зосередженого вертикального силового удару на його поверхні
Authors: Бойчук Ольга
Published: December 2024

Запропоновано аналітичний метод розв’язання динамічної просторової задачі поширення пружних хвиль у нескінченному шарі при миттєвому зосередженому вертикальному силовому ударі Q на його поверхню, що зводиться до розв’язку системи двох звичайних лінійних диференціальних рівнянь другого порядку.
Homogenization of insect bulk samples yields more comprehensive yet comparable biodiversity data than non-destructive lysis
Authors: Wolany Lisa , Enss Julian , Leese Florian , Buchner Dominik
Published: December 2024

The rapid advancement of molecular biodiversity monitoring tools, particularly DNA metabarcoding, has improved specimen identification in bulk samples, such as those from Malaise traps, where traditional morphological identification is impractical. While not yet standardized, a typical first step in insect bulk sample analysis is the extraction of DNA from homogenized specimens. While this step yields reliable metabarcoding results, it destroys the specimens, preventing further use in monitoring and taxonomic analysis. Non-destructive lysis, which preserves specimen integrity, is still being evaluated for its effectiveness in accurately assessing bulk sample biodiversity. In this study, we assessed the suitability of non-destructive lysis for Malaise trap samples and compared its performance with homogenization using an established metabarcoding workflow. Five bulk samples were collected with Malaise traps. Samples were first incubated in a lysis buffer containing Proteinase K (non-destructive lysis) and then homogenized. DNA was extracted from both treatments and metabarcoding was performed to compare OTU richness, accumulation, and beta diversity. On average, homogenized samples yielded 3.8% more OTUs than non-destructive lysis samples. Although homogenization provides a more comprehensive and cost-effective assessment of Malaise trap bulk samples, non-destructive lysis still recovered at least 80% of the OTUs identified through homogenization and revealed similar patterns of community change. Even though our results show that both methods yield comparable data on insect biodiversity and can be used for monitoring, we consider non-destructive lysis as not suitable for integration into automated workflows or large-scale biomonitoring due to the much higher costs. Nonetheless, this method remains important in cases where morphological integrity needs to be preserved and additional sampling is not possible.
Ce que nous dit Dewey
Authors: Kirch Noé , Zask Joëlle
Published: December 2024

Le philosophe John Dewey (1859-1952) invite à repenser la démocratie. Plus qu’un système politique, c’est un mode de vie, à cultiver dans toutes nos pratiques sociales, en liant la méthode scientifique à l’expérimentation. Entretien avec la philosophe Joëlle Zask.
Adjoint curves of special Smarandache curves with respect to Bishop frame
Authors: Damar Esra
Published: December 2024

In this paper, adjoint curves generated by means of integral curves of special Smarandache curves with respect to the Bishop frame in three-dimensional Euclidean space were introduced. Relations between the main curve and the Bishop apparatus of these adjoint curves were obtained. Some important results were given concerning the slant helix and general helix of these curves. Finally, these findings were illustrated with figures.
φόβος καὶ φόνος : peurs et fureurs guerrières lors des chasses des vaincus à la fin du IIIe et dans la première moitié du IIe siècle av. J.-C.
Authors: Saou Rémi
Published: December 2024

Le phénomène de la déroute était au cœur des pratiques et des conceptions grecques de la guerre terrestre. La presque totalité des combats qui se déroulaient en dehors des zones fortifiées se terminait par la déroute partielle ou totale de l’un des camps opposés, une réalité encore peu explorée par les historiens. Cette étude propose d’approcher le temps guerrier de la débâcle et de la poursuite de l’ennemi vaincu, qui fut considéré pendant plusieurs siècles par les Grecs comme une véritable chasse. Les textes de Polybe et de Plutarque ainsi que les sources iconographiques de la fin du IIIe et de la première moitié du IIe siècle constituent un corpus cohérent pour traiter de ces représentations et de leur continuité à l’époque hellénistique. Leur mise en image fait l’objet de la dernière partie de cette étude. Elle révèle sous un autre jour le regard que portaient les Grecs de cette période sur les violences subies ou infligées et la fureur des hommes en guerre.
Images du pouvoir royal dans les Travaux et les Jours d’Hésiode : une approche de Zeus dans le « mythe des races »
Authors: Mackowiak Karin
Published: December 2024

La fonction de Zeus dans le « mythe des races » est-elle fondée sur la justice rétributive ? Dans ce récit, que la recherche a longtemps cloisonné dans un genre (un « mythe des origines »), Hésiode élabore-t-il un Zeus de justice à l’instar d’autres passages des Travaux et des Jours ? Cette étude propose de revenir sur certains aspects critiques et méthodologiques de l’interprétation du « mythe des races », notamment sur la race des héros qui joue un rôle-clé pour comprendre la figure de Zeus. Une approche historienne est ici proposée qui met le récit en perspective avec les objectifs poétiques d’Hésiode et les problématiques sociopolitiques de la Grèce du VIIe siècle av. J.-C.
XXX Italian Melanoma Intergroup National Congress | 27-29 September 2024, Rimini, Italy
Authors: (IMI) Italian Melanoma Intergroup
Published: December 2024

Abstracts from the Italian Melanoma Intergroup (IMI) XXX National Congress
Neglected Plasmodium vivax malaria in northeastern States of India
Authors: Sharma Vinod P. , Dev Vas , Phookan Sobhan
Published: December 2024

Background & objectives:

The northeastern States of India are co-endemic for Plasmodium falciparum and P. vivax malaria. The transmission intensity is low-to-moderate resulting in intermediate to stable malaria. Malaria control prioritized P. falciparum being the predominant and life threatening infection (>70%). P. vivax malaria remained somewhat neglected. The present study provides a status report of P. vivax malaria in the northeastern States of India.

Methods:

Data on spatial distribution of P. vivax from seven northeastern States (Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland and Tripura) were analysed retrospectively from 2008–2013. In addition, cross-sectional malarial surveys were conducted during 1991-2012 in malaria endemic pockets across the States of Assam, Meghalaya, Mizoram and Tripura to ascertain the prevalence of P. vivax in different age groups.

Results:

Vivax malaria was encountered in all northeastern States but there existed a clear division of two malaria ecotypes supporting ≤30 and >30 per cent of total malaria cases. High proportions of P. vivax cases (60–80%) were seen in Arunachal Pradesh and Nagaland in the north with alpine environment, 42-67 per cent in Manipur, whereas in Assam it varied from 23-31 per cent with subtropical and tropical climate. Meghalaya, Tripura and Mizoram had the lowest proportion of P. vivax cases. Malaria cases were recorded in all age groups but a higher proportion of P. vivax consistently occurred among <5 yr age group compared to P. falciparum (P<0.05). P. vivax cases were recorded throughout the year with peak coinciding with rainy season although transmission intensity and duration varied.

Interpretation & conclusions:

In northeast India, P. vivax is a neglected infection. Estimating the relapsing pattern and transmission dynamics of P. vivax in various ecological settings is an important pre-requisite for planning malaria elimination in the northeastern States.
Performance of Revised National Tuberculosis Control Programme (RNTCP) in tribal areas in India
Authors: Muniyandi M. , Rao V.G. , Bhat J. , Yadav R.
Published: December 2024

Background & objectives:

The Revised National Tuberculosis Control Programme (RNTCP) provides free diagnostic and treatment services to all tuberculosis (TB) patients registered under it. Equitable access, implying a preference for the most hard-to-reach groups particularly for tribal areas, is a major concern for RNTCP. This study was conducted to assess the performance of RNTCP in terms of case detection and cure rates in areas dominated by tribal groups in India.

Methods:

We used the RNTCP data collected by the Central TB Divison, Government of India. RNTCP has a systematic monitoring mechanism which tracks the outcome of every patient put on treatment. There is a standardized recording and reporting structure in place; indicators are monitored regularly at every level of the health system; and regular supervision ensures quality of the Programme. The main indicators include the number of cases diagnosed and the percentage of patients who are successfully treated. These indicators were used to assess the RNTCP performance in tribal areas.

Results:

We observed a poor performance in terms of case detection rate (CDR) in tribal and backward districts as compared with other districts in India. Among tribal districts 53 per cent in 2010, 45 per cent in 2011 and 56 per cent in 2012 had CDR of new smear positive <70%. It was also observed that 26 per cent of tribal dominated districts had CDR of <51 per cent in 2012. More than 50 per cent of tribal districts were not able to achieve more than 85 per cent of cure rate.

Interpretation & conclusions:

The findings of this study suggested that the overall RNTCP performance in tribal areas was not optimal, and the target of >85 per cent of core rate was achieved by less than half of the tribal districts.
Situation of drug resistant tuberculosis in Saharia tribe of central India
Authors: Bhat J. , Rao V.G. , Yadav R. , Muniyandi M. , Sharma R. , Karfarma C. , Luke C.
Published: December 2024

Background & objectives:

The information on multidrug resistant tuberculosis (MDR-TB) situation amongst Saharia, one of the Particularly Vulnerable Tribal Groups (PVTGs) in Madhya Pradesh, India, is not available. Hence, this study was undertaken to find the situation of MDR-TB amongst Saharia PVTG in two districts of Madhya Pradesh.

Methods:

Community based cross-sectional TB prevalence surveys were conducted among Saharia PVTG in Gwalior and Shivpuri districts of Madhya Pradesh. Chest symptomatics were identified from the individual registered for the study. Two sputum samples were collected from each of the eligible individuals, transported to the laboratory, and were examined by Ziehl-Neelsen (Z-N) smear microscopy and solid medium culture methods. Drug susceptibility testing of the isolates was done by indirect proportion method on solid medium.

Results:

MDR rate was 2.2 per cent of new cases and 8.2 per cent among the previously treated cases of TB in Gwalior while it was two per cent among the previously treated cases in Shivpuri district.

Interpretation & conclusions:

Though the prevalence of tuberculosis in these districts was alarmingly high, the MDR rates were more or less similar to national average. However, the findings of this study highlight the need for active intervention so that the MDR-TB is kept under control.
Levels, trends & predictors of infant & child mortality among Scheduled Tribes in rural India
Authors: Sahu Damodar , Nair Saritha , Singh Lucky , Gulati B.K. , Pandey Arvind
Published: December 2024

Background & objectives:

The level of infant and child mortality is high among Scheduled Tribes particularly those living in rural areas. This study examines levels, trends and socio-demographic factors associated with infant and child mortality among Scheduled Tribes in rural areas.

Methods:

Data from the three rounds of the National Family Health Survey (NFHS) of India from 1992 to 2006 were analysed to assess the levels and trends of infant and child mortality. Univariate and multivariate Cox proportional hazard model were used to understand the socio-economic and demographic factors associated with mortality during 1992–2006.

Results:

Significant change was observed in infant and child mortality over the time period from 1992-2006 among Scheduled Tribes in rural areas. After controlling for other factors, birth interval, household wealth, and region were found to be significantly associated with infant and child mortality. Hazard of infant mortality was highest among births to mothers aged 30 yr or more (HR=1.3, 95% CI=1.1-1.7) as compared with births to the mother's aged 20-29 yr. Hazard of under-five mortality was 42 per cent (95% CI=1.3-1.6) higher among four or more birth order compared with the first birth order. The risk of infant dying was higher among male children (HR = 1.2, 95% CI=1.1-1.4) than among female children while male children were at 30 per cent (HR=0.7, 95% CI=0.6-0.7) less hazard of child mortality than female children. Literate women were at 40 per cent (HR=0.6, 95% CI=0.50-0.76) less hazard of child death than illiterate women.

Interpretation & conclusions:

Mortality differentials by socio-demographic and economic factors were observed over the time period (1992-2006) among Scheduled Tribes (STs) in rural India. Findings support the need to focus on age at first birth and spacing between two births.
C1q Levels: A Reliable Biomarker for Differentiating Active and Latent Tuberculosis Infection
Authors: Darougar Sepideh , Moniri Afshin , Baghaei Parvaneh , Mortaz Esmaeil , Sadr Makan , Moniri Arad , Marjani Majid , Tabarsi Payam
Published: December 2024

Background:

Tuberculosis (TB) poses a significant public health challenge, particularly because it can exist in an asymptomatic latent phase. Latent TB infection indicates the presence of Mycobacterium tuberculosis without clinical symptoms. Effectively distinguishing between active and latent TB is essential, especially in regions with high TB prevalence, as it may help reduce transmission rates. This study aims to evaluate C1q as a potential biomarker for differentiating active TB from latent forms.

Methods:

This prospective cross-sectional study was conducted from January 2017 to February 2018, involving HIV-negative adults aged 18 and older attending TB clinics. Participants were categorized based on clinical symptoms, imaging results, and laboratory tests into active or latent TB. Blood samples were collected to assess serum C1q levels, which were then compared between the two groups.

Results:

Out of 81 patients referred for TB evaluation, 38 were diagnosed with active TB. The overall median C1q level was 6.46 μg/ml (interquartile range 4.66–10). The active TB group exhibited significantly elevated C1q levels (10.21 μg/ml) compared to the latent TB group (6.03 μg/ml, P < 0.001). The area under the receiver operating characteristic curve for C1q in distinguishing active from latent TB was 0.74 (95% confidence interval, 0.63–0.85), with sensitivity varying between 61% and 82% at different threshold values.

Conclusions:

C1q shows potential as a reliable and easily obtainable biomarker for differentiating active TB from latent infection, demonstrating high sensitivity. These results underscore the need for further research to explore the clinical application of C1q in TB diagnostics.
Tuberculosis Masquerading Foreign Body in Children
Authors: Ghaffaripour Hosseinali , Asi Maedeh , Valinejadi Ali , Hassanzad Maryam , Khakkard Tayyebeh , Kiani Arda , Mohammadpour Leila
Published: December 2024

Foreign body aspiration (FBA) is a common issue in children, particularly boys, and can be life-threatening. Early removal of the foreign body (FB) leads to recovery, but delayed diagnosis may cause complications such as granuloma, recurrent pneumonia, and atelectasis. This condition often results from a child’s curiosity, with factors such as inadequate swallowing reflex and activity during eating contributing to the risk. The right bronchus is the most common site for FB impaction. In this case, a child presented with persistent productive cough and shortness of breath. Initial computed tomography scans suggested pneumonia and mucoid impaction in the right lung, raising concern for tuberculosis due to a family history. However, further ultrasound and clinical findings confirmed FBA. The FB, a pen cap, was removed via bronchoscopy, and the patient’s symptoms resolved. Follow-up care was provided to ensure continued recovery.
Exploring the Genetic Landscape of Mycobacterium tuberculosis: Unlocking the Differences in Between Latent and Active Tuberculosis
Authors: Velayati Ali Akbar , Mitaria Satoshi , Farnia Parissa , Farnia Poopak , Ghanavi Jaladein , Maleknia Mohsan , Murase Yoshiro , Hoffner Sven
Published: December 2024

Background:

Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB), can enter a dormant phase within host tissues, complicating treatment and highlighting the need to investigate the genetic changes associated with dormancy.

Methods:

This study examined clinical isolates of MTB, representing a range of susceptibility profiles and standard reference laboratory strains, i.e., H37Rv and Mycobacterium bovis bacillus Calmette–Guérin. Each strain was subcultured in a controlled laboratory environment to analyze two distinct phases: one maintained in vitro under a double-stress dormancy model using the Wayne model (characterized by the absence of oxygen and nutrients) for 12 months, and the other examined during its exponential growth phase. Whole-genome sequencing and protein structure analysis using bioinformatics tools were performed to characterize and compare mutations in isolates at each phase.

Results:

Three distinct frameshift mutations were identified in the fbiC, PPE35, and ald genes, and one upstream mutation in whiB6 genes in all studied isolates under dormancy, irrespective of their susceptibility patterns (P < 0.01). Among drug-resistant strains, at the exponential phase isolated from patients with prolonged treatment, 5%–7% had PPE35, ald mutations, whereas 95% had the whiB6 mutation, suggesting that adaptive stress responses may be triggered under in vivo conditions.

Conclusions:

The newly identified frameshift mutations (fbiC, PPE35, and ald genes), consistently found in both laboratory and clinical isolates, seem to play a critical role in the survival of MTB during dormancy. Based on these findings, designing a molecular test to differentiate between active and latent TB possibly enables timely prophylactic interventions.
Relevance of Preoperative Vessel Mapping and Early Postoperative Ultrasonography in Predicting Arteriovenous Fistula Failure in Chronic Kidney Disease Patients
Authors: Gupta Shikhar , Ahmed Mehtab , Sayema  , Haseen Azam , Quaiser Saif
Published: December 2024

Introduction:

The increasing prevalence of chronic kidney disease (CKD), coupled with advancements in the diagnosis and treatment of renal diseases and improvements in life expectancy, has led to a greater number of patients requiring hemodialysis. The preferred method of vascular access for hemodialysis is AV fistula formation; however, it is associated with a high rate of failure. In our prospective study, we focused on 40 CKD patients planned for initiation of maintenance hemodialysis.

Methods:

We employed preoperative ultrasound mapping to assess cephalic vein diameter, compressibility, and colour flow, as well as radial and brachial artery diameter, peak systolic velocity, and intimal wall calcification. Postoperatively, ultrasound examinations were conducted on day 7 and at 6 weeks to evaluate fistula blood volume and detect any complications.

Results:

A significant association between fistula failure and cephalic vein diameter, brachial artery diameter, intimal vessel wall calcification, and comorbid conditions like diabetes mellitus was observed. Furthermore, blood flow at day 7 was notably lower in the failure group compared to those with a functioning fistula and any fistula with blood flow <154 ml/min on day 7 may be predictive of early fistula failure.

Conclusion:

Preoperative vessel mapping and early postoperative ultrasonography is indispensable for patients who require AV fistula formation for hemodialysis and provide valuable information for selecting suitable vessels for successful fistula creation and enable early intervention to salvage a failing fistula after the surgery. By utilizing this, necessary steps can be taken optimize the outcomes of AV fistula formation.
Effect of Preoperative Pulmonary Hypertension on the Course of Right Ventricular Function: A Three-dimensional Echocardiographic Study in Valvular Surgery Patients
Authors: Ito Shinya , Yoshitani Kenji , Fukushima Satsuki , Matsuda Hitoshi
Published: December 2024

Context:

Postoperative right heart failure is a poor prognostic factor after cardiac surgery. However, the factors that influence perioperative right ventricular (RV) function remain unknown. This study investigated whether preoperative pulmonary hypertension (PH) affects changes in RV systolic function during the perioperative period.

Aims:

This study aimed to determine the effect of preoperative PH on changes in RV systolic function in patients undergoing aortic or mitral valve surgery.

Settings and Design:

This was a retrospective review of three-dimensional echocardiographic datasets of 157 patients undergoing aortic or mitral valve surgery.

Materials and Methods:

Patients were classified into the PH (n = 105) or non-PH (n = 51) group based on preoperative right heart catheterization findings. RV ejection fraction and RV longitudinal strain (RVLS) of the free wall and septum were calculated using semiautomated image analysis software at four time points: before surgery, end of surgery, 3 months after surgery, and 1 year after surgery.

Statistical Analysis Used:

A mixed-effects model was used to compare changes in RV function between groups.

Results:

Over 1 year, no significant differences in trends were observed between groups for any of the parameters. However, a significant deterioration in free wall RVLS was observed in the non-PH group when focusing on the change from baseline to 1 year (P value for interaction = 0.013).

Conclusions:

In patients undergoing valvular surgery, the presence of preoperative PH did not significantly influence changes in RV function throughout the perioperative period.
Pediatric Three-dimensional Transesophageal Echocardiography: A Game Changer in Congenital Heart Disease
Authors: Di Salvo Giovanni , Pozza Alice , Castaldi Biagio , Galzerano Domenico , Pergola Valeria
Published: December 2024

Background:

Despite its potential, pediatric three-dimensional (3D) transesophageal echocardiography (TEE) faced technical limitations due to the size and rigidity of early probes designed for adults.

Aim:

In this paper, we present our experience in using the new pediatric 3D TEE probe in complex congenital heart disease (CHD).

Methods:

Recent advancements in the field of miniaturization have led to the development of a new pediatric 3D TEE probe, specifically designed for young children (weight ≥4.5 kg). This probe features a smaller, flexible design and high-spatial and temporal resolution, enabling detailed views of intracardiac structures and real-time imaging crucial for complex diagnosis, planning interventional and surgical procedures. We used this new probe in pediatric cases (weight between 4.5 and 6 kg) with complex congenital heart disease.

Results:

In double-outlet right ventricle or in Taussig Bing anomaly the new 3D TEE probe enabled detailed assessment of ventricular septal defect and its relations with tricuspid valve apparatus, and provided details of mitral valve leaflets not detectable by the transthoracic approach, even in small children.

Conclusions:

These cases highlight the probe‘s ability to provide detailed anatomical information, enhancing surgical planning and outcomes. The pediatric 3D TEE probe has the potential to be a game changer in defining intracardiac anatomy in complex CHD.
Investigation of the Effect of Calibration Curves Obtained from Different Computed Tomography Devices on the Dose Distribution of Tomotherapy Plans
Authors: Demir Hikmettin , Gül Osman Vefa , Kanyilmaz Gül
Published: December 2024

Purpose:

This study investigated the effect of Hounsfield units (HU)-relative electron density (RED) calibration curves obtained with devices from three different Computed Tomography (CT) manufacturers on dose distribution in Accuray Precision planning of patients with lung cancer.

Methods:

All CT data required for treatment planning system (TPS) were obtained using the Tomotherapy “cheese” phantom. HU RED calibration curves were created with images obtained from Siemens Somatom, GE Optima, and Toshiba Aquilion devices. The obtained calibration curve was extrapolated. CT images of lung cancer patients were acquired on a single device and treatment plans were created. The existing plans were recalculated using three calibration curves and the effect of the HU RED calibration curve on dose distribution was analyzed.

Results:

The results showed that different CTs did not produce significant dose differences in organ doses and PTV for Accuray TPS.

Conclusions:

Based on clinical judgment, images from different CT devices can be used in treatment planning.
Development and Validation of Cloud-based Heart Rate Variability Monitor
Authors: Bhat Sushma N. , Jindal Ghanshyam D. , Nagare Gajanan D.
Published: December 2024

Context:

This article introduces a new cloud-based point-of-care system to monitor heart rate variability (HRV).

Aims:

Medical investigations carried out at dispensaries or hospitals impose substantial physiological and psychological stress (white coat effect), disrupting cardiovascular homeostasis, which can be taken care by point-of-care cloud computing system to facilitate secure patient monitoring.

Settings and Design:

The device employs MAX30102 sensor to collect peripheral pulse signal using photoplethysmography technique. The non-invasive design ensures patient compliance while delivering critical insights into Autonomic Nervous System activity. Preliminary validations indicate the system’s potential to enhance clinical outcomes by supporting timely, data-driven therapeutic adjustments based on HRV metrics.

Subjects and Methods:

This article explores the system’s development, functionality, and reliability. System designed is validated with peripheral pulse analyzer (PPA), a research product of electronics division, Bhabha Atomic Research Centre.

Statistical Analysis Used:

The output of developed HRV monitor (HRVM) is compared using Pearson’s correlation and Mann–Whitney U-test with output of PPA. Peak positions and spectrum values are validated using Pearson’s correlation, mean error, standard deviation (SD) of error, and range of error. HRV parameters such as total power, mean, peak amplitude, and power in very low frequency, low frequency, and high frequency bands are validated using Mann–Whitney U-test.

Results:

Pearson’s correlation for spectrum values has been found to be more than 0.97 in all the subjects. Mean error, SD of error, and range of error are found to be in acceptable range.

Conclusions:

Statistical results validate the new HRVM system against PPA for use in cloud computing and point-of-care testing.
Backside Irradiation of Ultraviolet-A for Correcting Nonuniformity Error of Gafchromic XR-QA2 Films
Authors: Tanki Nobuyoshi , Goto Sachiko , Katsuda Toshizo , Gotanda Rumi , Gotanda Tatsuhiro , Kuwano Tadao
Published: December 2024

Purpose:

Radiochromic film is used for quality assurance and quality control of X-ray equipment in the diagnostic radiology. In addition, three-dimensional dose distribution of computed tomography (CT) is measured. To correct the nonuniformity and uncertainty of radiochromic films for dose measurement of CT, the films are preirradiated ultraviolet (UV)-A rays. There is a difference in the UV protection strength of radiochromic films. A concern exists about the effects of the UV-A irradiation intensity. We thus irradiated with UV-A rays from the backsides of the films to assess if backside irradiation was possible.

Materials and Methods:

Gafchromic XR-QA2 and RTQA2 were used in this study. The UV-A rays were simultaneously irradiated on the front and backsides of each film for 12 h. The yellow layer of each film was scanned and imaged. The average pixel values ± standard deviations (SDs) were compared. In the statistical analysis, a paired t-test was performed. To compare, the active-layer densities engendered by the UV-A rays. Calibration curve was created with 48 h of preirradiation of UV-A.

Results:

The mean pixel values ± SD for Gafchromic XR-QA2 on the front and backsides were 130.776 ± 0.812 and 81.015 ± 1.128, respectively. On the other hand, the mean pixel values ± SD for Gafchromic RTQA2 on the front and backsides were 62.299 ± 1.077 and 133.761 ± 1.365, respectively. The statistical results of the paired t-test were significantly different (P < 0.01) between both films. Fitting equation of the calibration curve is shown below. y = -390.47 ± 200 + (443.45 ± 10x80).5068 ± 0.0434.

Conclusion:

Based on the relationship between the sensitivity of the active layer to UV-A rays and the strength of UV protection on the surface, we concluded that backside irradiation is recommended for Gafchromic XR-QA2, and frontside irradiation is recommended for Gafchromic RTQA2.
Evaluating the Responses of the THOR and Hybrid III Small Female ATDs
during Frontal Sled Tests
Authors: Boyle David M. , Albert Devon L. , Hardy Warren N. , Kemper Andrew R.
Published: December 2024

There is evidence to suggest that males and females respond differently in motor
vehicle collisions, making it important to study how both sexes respond to
vehicle safety systems. The THOR 5th-percentile female (THOR-05F)
anthropomorphic test device (ATD) was developed to represent a small female
occupant better than the Hybrid III 5th-percentile female (HIII-05F)
ATD. However, there are few studies in which they have been directly compared.
Therefore, the objective of this study was to compare the responses of the two
ATDs in matched frontal sled tests simulating a realistic driver seat
environment. A 7th-generation Toyota Camry driver seat test buck was used with
Camry parts (i.e., 3-point belt, modified seat, steering wheel, airbag, and
column). The belt was equipped with a 4-kN load limiter and pretensioner. Rigid
foam (65 psi) was used to represent the knee bolster. Thirteen tests were
conducted using speeds of 30 and 56 kph. Chest bands were used to measure
external chest deflection. Greater neck compression loads, flexion moments, and
extension moments were measured in the HIII-05F tests due to different airbag
interactions compared to the THOR-05F. Upper neck compression in the HIII-05F
was greater for the 30 kph tests than the 56 kph, reinforcing a need to research
crashworthiness at lower speeds. Chest deflections were greater in the THOR-05F
tests, which was likely due to the more compliant rib cage. External chest
deflections indicated that belt routing and breast tissue influenced the
location and magnitude of maximum chest deflections. External deflections also
indicated that the HIII-05F rib cage might be more coupled bilaterally than the
THOR-05F. Femur loads were slightly greater in the THOR-05F, although knee
bolster loads were greater for the 56 kph HIII-05F tests. Future work will
include conducting matched small female PMHS sled tests.