bluuebunny/crossref_metadata_2025 huggingface dataset:
Adolescent and Caregiver Attitudes Towards Telemedicine Use in Pediatric Nephrology
Authors: Qiu Yi , Coulson Sherry , McIntyre Christopher William , Wile Brooke , Filler Guido
Published: September 2020

Background: Telemedicine is increasingly utilized as an alternative to in person consultation. Current pandemic conditions are providing additional impetus to virtual care delivery. We aimed at comparing both pediatric patient and caregiver attitudes towards telemedicine (here as tertiary center to remote health care location) as a crucial determinant of longer-term effectiveness. Methods: This mixed methods cohort study combined patient characteristics and analysis of transcribed structured telephone interviews with both pediatric nephrology patients (11-18 years) and their caregivers. Results: For 11 child-parent dyads, the median distances to tertiary center were 191 km (range 110-1378 km) and 1 km (1-54 km) to remote telemedicine location. Overall a ratio of 2:1 for telemedicine to in-person visits was favored; with caregivers more in favor of remote care than patients. Qualitative analysis found that experiences with telemedicine were distinguished by consultation-specific factors and contextual factors. Contextual factors (travel/cost savings) were valued for telemedicine by patients and caregivers. Consultation-specific factors, such as the ability to show the doctor physical symptoms, were more valued during in-person consultations, especially by patients. The overall visit type preference was related to the nature of the consultation. For regular check-ups, and for patients with less complex needs, participants felt that telemedicine offered a comparable experience to in-person visits. Conclusions: Indiscriminate transfer to chronic care predicated on mainly telemedicine approach is not compatible with user expressed attitudes (especially patients). Accurately mapping models of care to these attitudes is an essential determinant of effective management and longer-term engagement with potentially life-long health challenges.
Why Patients Dissatisfy with Medical Care in China--Evidence from the Patient Perceived Value
Authors: Qian Hui , Lu Wu , Zhang Daliang
Published: September 2020

- Background: Enlarged financial and managerial resources spending on medical improvement had rarely to decrease the crowed waiting line or increase the patient satisfaction. Investigating patients’ perceived value (PPV) gain an insight of patients’ satisfaction. PPV is a valuable perspective for hospitals to strategically improve medical care quality and performance from functional and emotional sides. - Methods: According to the theory of perceived value, an empirical study had been carried out by field survey and data collection in 7 well-known hospitals in Zhejiang Province China. 2586 questionnaires with valid data were analyzed according to PPV.- Results: Beside of the importance of functional values (effectiveness of treatment effect, reasonable and accurate prices, standardization and normalization, convenience and accessibility), the emotional values (communication with doctors/nurses, comfortable environment and facilitates) were highlighted. The preferences of patients’ perceived value were influenced by patients’ background features, and then the differentiation of patients’ satisfaction was proceeded. These patients, who are young, female, outpatient, light ill condition, high educational level and high income, tend to be relatively high demanding on medical care services but in high dissatisfaction level. Additionally, the findings show an advantage to pass the reasonability of waiting time to patients’ thought.- Conclusion: Classified convenience receiving approaches according to differentiated PPV and background features of patients, equipped up with e-enabled health care environment, can bring worthwhile patients’ satisfaction in Chinese hospitals .
What Influences the Outcome of Active Disinvestment Processes in Healthcare? A Qualitative Interview Study on five Recent Cases of Active Disinvestment
Authors: Rotteveel Adriënne Henderika , Lambooij Mattijs S. , de Rijt Joline J.A. van , Exel N.J.A. van , Moons Karel G.M. , de Wit G.A.
Published: September 2020

Background: Recent attempts of active disinvestment (i.e. withdrawal of reimbursement by means of a policy decision) of reimbursed healthcare interventions in the Netherlands have differed in their outcome: some were successful, with interventions actually being disinvested, while others were terminated at some point, implying continuation of reimbursement. This study aimed to obtain insight into recent active disinvestment processes, and to explore what aspects affect their outcome.Methods: Semi-structured interviews were conducted from January to December 2018 with stakeholders (e.g. patients, policymakers, physicians) who were involved in the policy process of five cases for which the full or partial withdrawal of reimbursement was considered in the Netherlands between 2007 and 2017: benzodiazepines, medication for Fabry disease, quit smoking programme, psychoanalytic therapy and maternity care assistance. These cases covered both interventions that were eventually disinvested and interventions for which reimbursement was maintained after consideration. Interviews were transcribed verbatim, double coded and analyzed using thematic analysis.Results: The 37 interviews showed that support for disinvestment from stakeholders, especially from healthcare providers and policymakers, strongly affected the outcome of the disinvestment process. Furthermore, the institutional role of stakeholders as legitimized by the Dutch health insurance system, their financial interests in maintaining or discontinuing reimbursement, and the possibility to relieve the consequences of disinvestment for current patients affected the outcome of the disinvestment process as well. No evidence was found of a consistent role of the formal Dutch package criteria (i.e. effectiveness, cost-effectiveness, necessity and feasibility) in active disinvestment processes.Conclusions: Contextual factors as well as the possibility to relieve the consequences of disinvestment for current patients are important determinants of the outcome of active disinvestment processes. These results provide insight into active disinvestment processes and their determinants, and provide guidance to policymakers for a potentially more successful approach for future active disinvestment processes.
Factors that influence natural menopause onset in China: a cross-sectional study
Authors: Wang Xuming , Gui Huawei , Yuan Chunyan , Liu Lijiang , Wei Jianguo , Huang Helin , Qiu Zhaohui , Yuan Xiaolu
Published: September 2020

BackgroundThis paper aimed to explore the average natural menopause age, the span of menopausal age, and the related factors that will probably affect the natural menopause age of Chinese women. MethodsA large-scale random sampling of menopausal women aged 32-75 years in 18 provinces or municipalities throughout China was conducted using paper questionnaire surveys to investigate the menopause age, menarche age, fertility status, illness history, and living habits. The SPSS 24.0 software package was used to carry out t test, chi-square test, logistic regression, and other statistical analyses. ResultsA total of 5852 questionnaires were collected. After excluding questionnaires having no menopause, questionnaires with incomplete or invalid information, and questionnaires that may directly affect the age of menopause, such as hysterectomy, oophorectomy, and other factors that may affect natural menopause, a total of 4426 effective questionnaires have been collected, and the average age of natural menopause was 49.49 ± 3.67 years old. ConclusionFactors that may affect the age of natural menopause are weight, menarche age, marital status, drinking tea or not (often and daily), eating supplements, oral contraceptive contraception, and safe contraception.
Implementation of Multiband Communication Using SDR for Remote Application
Authors: Gummineni Madhuri , Polipalli Trinatha Rao
Published: September 2020

To develop Next Generation Wireless Communication a generic hardware design is required so that it can be driven by software to allow for future upgrades. Thus Reconfigurable Radio implements multi-band, multi-mode operation and interoperability with low-cost. For reducing response time between incompatible radios during emergencies interoperability is essential for a secure heterogeneous communication. Some of the Challenges identified for implementing reliable and reconfigurable wireless communication systems are: specific training required for using the equipment, end-to-end connectivity between devices, extending link capacity during the high peak utilization. Each device and architecture will differ based on the type of communication system. Interconnecting emerging fields enhances the performance , implementation helps to come across alternatives to overcome practical difficulties and challenges of connecting different fields to Cognitive Radio(CR). Earlier research gave prominence to theoretical and simulation-based work. This motivates us to verify interoperability in real time using SDR. This paper describes the implementation of a Multiband, multimode operation for establishing communication between different types of architecture i.e. VUSDR (HAM), Hack RF One, LoRa, RF module, GSM module and USRP N210 to prove reliability and end-to-end communication.
Health Lifestyles and Their Influence on Chinese Oldest-old’s Health Outcomes —Evidence From a Latent Class Analysis
Authors: Zhang Li , Bi Xiangyang , Ding Zhihong
Published: September 2020

BackgroundA strong association between individual health behaviors and health outcomes has been emphasized by previous analyses. However, how individual health behaviors can be classified into health lifestyles and the manner in which health lifestyles have impacted Chinese oldest-old’s health status are largely unknown.MethodsAnalyzing the 2014 Chinese Longitudinal Healthy Longevity Survey (CLHLS), latent class analysis was applied to identify predominant health lifestyles among Chinese oldest-old aged 85 to 105.ResultsFour distinct classes representing health lifestyles emerged. Health lifestyles were found to be strongly associated with Chinese oldest-old’s health outcomes which were measured by self-rated health, functional independence, cognitive function and chronic diseases, even after controlling for demographic features as well as individual and parental socioeconomic disadvantage. Findings also showed a convergence of health disparities caused by demographic and SES characteristics in very old age.ConclusionsChinese oldest-old showed four predominant health lifestyles with only 21.9% of the sample had consistently healthy lifestyle behaviors. The significant influence of health lifestyles on health remained after age 85, .highlighting the importance of promoting health lifestyles to advance the oldest-old’s health status.
Evolutionary and Functional Lessons from Human-Specific Amino-Acid Substitution Matrices
Authors: Shauli Tair , Brandes Nadav , Linial Michal
Published: September 2020

The characterization of human genetic variation in coding regions is fundamental to the understanding of protein function, structure and evolution. Amino-acid (AA) substitution matrices encapsulate the stochastic nature of such proteomic variation and are widely used in studying protein families and evolutionary processes. The conventional substitution matrices, namely BLOSUM and PAM, were constructed to reflect polymorphism across species. In this study, we analyzed the frequencies of >4.8M single nucleotide variants within the healthy human population to accurately represent proteomic variability within the human species, at codon and AA resolution. Our model exposes various AA substitutions which are observed more frequently in one specific direction than in the opposite direction. We further demonstrate that nucleotide substitution rates only partially determine AA substitution rates. Finally, we investigate AA substitutions in post-translational modification and ion-binding sites, exposing purifying selection over a range of residue-based functions. These novel matrices provide a robust baseline for the analysis of protein variation in health and disease.
Rapid and complete inactivation of SARS-CoV-2 by ultraviolet-C irradiation
Authors: Storm Nadia , McKay Lindsay , Downs Sierra , Johnson Rebecca , Birru Dagnachew , de Samber Marc , Willaert Walter , Cennini Giovanni , Griffiths Anthony
Published: September 2020

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has devastated global public health systems and economies, with over 23 million people infected, millions of jobs and businesses lost, and more than 800 000 deaths recorded to date. Contact with surfaces contaminated with droplets generated by infected persons through exhaling, talking, coughing and sneezing is a major driver of SARS-CoV-2 transmission, with the virus being able to survive on surfaces for extended periods of time. To interrupt these chains of transmission, there is an urgent need for devices that can be deployed to inactivate the virus on both recently and existing contaminated surfaces. Here, we describe the inactivation of SARS-CoV-2 in both wet and dry format using radiation generated by a commercially available Signify ultraviolet (UV)-C light source at 254 nm. We show that for contaminated surfaces, only seconds of exposure is required for complete inactivation, allowing for easy implementation in decontamination workflows.
CO2 Electrocatalyst Design Using Graph Theory
Authors: Wang Ziyun , Li Yuguang , Boes Jacob , Wang Ying , Sargent Edward
Published: September 2020

The electrochemical reduction of CO2 (CO2RR) to higher-order hydrocarbons or oxygenates using low-carbon electricity offers a promising path to generate renewable fuels and chemicals; however, the low selectivity of present-day CO2RR catalysts toward more valuable C3 products limits technoeconomically compelling avenues toward productization. Systematically enumerating possible intermediates and reactions to the set of possible {C1, C2, and C3} CO2RR products entails 3206 intermediates and 4506 reactions. Here we use graph theory to enumerate these possibilities comprehensively, treating intermediates as graph nodes and pathways as graph edges. C3 products fall into two groups, group A (1-propanol, allyl alcohol, and propionaldehyde) and group B (acetone and hydroxyacetone); and we find that an early branch reaction, three steps after C1-C2 coupling, bifurcates these two groups of C3 products. We develop a set of C3 descriptors and screen catalysts for CO2RR to C3 products: specifically, we screen bimetallic (doped Cu) catalysts for their combination of CO binding, C1-C1 coupling and C1-C2 coupling. Cu and also Au- and Ag-doped Cu fulfill the first two requirements; but the set of promising C1-C2 coupling catalysts (Ni-doped Pb and Al-doped Pb) needed to get to C3 is nonoverlapping with that for CO binding and C1-C1 coupling. Our findings agree with the experimental picture that Cu, while among the most productive to propanol, has been limited in F.E. to the 10-20% range; and that, to date, no single catalyst has achieved exceptional C3 productivity. We discuss tandem catalyst designs where a first catalyst promotes CO binding and C1-C1, and where these C2 and C1 intermediates can come together for coupling on a second distinct class of integrated catalysts.
What Alternative and Innovative Sources of Healthcare Finance Can Be Explored for the Sustainability of the National Health Insurance Scheme of Ghana? Perspectives of Health Managers
Authors: Laar Alexander Suuk , Asare Michael , Dalinjong Philip Ayizem
Published: September 2020

Background Sustainable healthcare financing is one of the key components for the achievement of universal health coverage (UHC) globally. This study explored health managers views on alternative and sustainable healthcare financing sources for the National Health Insurance Scheme (NHIS) in Ghana. Methods A qualitative study using in-depth interviews with 16 health facility managers were held. The participants were selected using purposive sampling. A written consent was obtained from participants prior to participation in the interview. Data was transcribed verbatim and analyzed using thematic framework approach. Results All the participants indicated reimbursement of claims to health facilities by the NHIS as the main challenge. They attributed reasons to inadequate provision of funds from Government and the National Health Insurance Authority. Concerns were raised about how the situation affected health managers’ delivery of services to insured clients. Participants suggested exploring of additional funding sources by levying of special taxes on incomes from local natural resources and telecommunication service companies in Ghana to raise additional funds. Conclusion The findings of this study are important to government of Ghana and similar settings in LMICs who are working towards sustainable financing of their UHC system.
Clinical Characteristics of Mild/moderate COVID-19 Patients with a Prolonged Negative Conversion Time of SARS-CoV-2 Nucleic Acid Detection
Authors: Yang Ya , Hu Xiaogang , Xiong Lirong , Fu Peishu , Feng Wei , Li Wei , Zhang Liwen , Sun Fengjun
Published: September 2020

Background: The impact of COVID-19 has been devastating on a global scale. Our study aimed to identify factors in predicting prolonged negative conversion time (NCT) of SARS-CoV-2 RNA in mild/moderate COVID-19 patients. Methods: The clinical features and treatment outcomes were retrospectively analyzed from 32 hospitalized mild/moderate COVID-19 patients. Then univariate and multivariate analysis were used to predict in the factors of prolonged NCT of SARS-CoV-2 RNA.Results: The general clinical symptoms were cough (78.1%), fever (75%), diarrhea (68.8%), expectoration (56.3%), and nausea (37.5%). More than 40% of the patients had decreased erythrocyte, hemoglobin and leucocyte and 93.8% patients were detected in abnormalities of chest CT. The median NCT of SARS-CoV-2 RNA was 19.5 days (IQR: 14.25–25). Univariate analysis found fever, nausea, diarrhea and abnormalities in chest CTs were positively associated with prolonged NCT of viral RNA (P<0.05). The multivariate Cox proportional hazard model revealed that fever [Exp (B), 0.284; 95% CI, 0.114‑0.707; P＜0.05] and nausea [Exp (B), 0.257; 95%CI, 0.096‑0.689; P＜0.05] were two significant independent factors. Conclusions: Fever, nausea, diarrhea and abnormalities in chest CT are potential factors for predicting prolonged NCT of viral RNA. Moreover, Fever and nausea were two significant independent factors in prolonged NCT of viral RNA in mild/moderate COVID-19 patients.
Rapid Recovery from Critical COVID-19 Respiratory Failure after treatment with VIP
Authors: Youssef J. Georges , Javitt Jonathan , Al-Saadi Mukhtar , Zahiruddin Faisal , Beshay Sarah , Bittar Mohammad Z.
Published: September 2020

Background: Vasoactive Intestinal Peptide (VIP) blocks replication of the SARS-CoV-2 virus, inhibits cytokine synthesis, prevents cytopathy, and upregulates surfactant production in human pulmonary cells. RLF-100™ (aviptadil), is currently in phase 2/3 trials with FDA Fast Track designation for treating Critical COVID-19 with Respiratory Failure. Methods: Case series of 21 consecutive with Critical COVID-19 and multiple co-morbidities, treated with intravenous aviptadil (synthetic VIP). Sixteen patients were treated with ventilation alone and five with extracorporeal membrane oxygenation (ECMO). Results: So far, 19 of 21 patients have survived. Improved radiographic appearance was seen in both lungs of 17 patients and in one lung of 2 patients. A mean 2.5-fold increase in PaO2:FiO2 ratio was seen (P<0.0001) with complete remission from respiratory failure in 9 patients and ongoing improvement in 10. Seven patients were discharged from the hospital, 7 sent to intermediate care, and 5 remain in the ICU. Four of 5 patients on ECMO have been decannulated, and thus far three have been discharged. A 75% (95% CI±3%: P<.001) reduction in IL-6 was seen with corresponding decrease in C-reactive protein. A median 3 point reduction (mean 2.7; P<0.001) in the WHO Ordinal Scale was observed (P<.001). Comment: The short term outcome in these 21 patients represent a dramatic response in patients whose comorbidities precluded their randomization in all other trials of COVID therapeutics and who were previously treated with remdesivir, tocilizumab, or convalescent plasma. Improvement in radiographic appearance, oxygenation requirement, and inflammatory markers is consistent with in vitro evidence of direct anti-viral effect
The Impact of Colchicine on The COVID-19 Patients; A Clinical Trial Study
Authors: Salehzadeh Farhad , Pourfarzi Farhad , Ataei Sobhan
Published: September 2020

Background: Severe acute respiratory syndrome COVID-19 infection has evolved into a global pandemic. This study has been designed to evaluate colchicine anti-inflammatory effect on the symptoms course, duration of hospitalization, morbidity and mortality rate, of COVID-19 patients.Methods: In this prospective, open-label, randomized and double blind clinical trial, 100 patients hospitalized with COVID-19 were randomized in a 1:1 allocation from May 21 to June 20, 2020, to either standard medical treatment (Hydroxychloroquine) or colchicine with standard medical treatment. The study took place in Imam Reza hospital of Ardabil city in Iran, with trial registration ID: 47707 (irct.ir). Colchicine group were received 1 mg tablet of colchicine daily alongside the Hydroxychloroquine for 6 days. Primary end points were (1) Length of hospitalization; (2) symptoms and (3) Co-existed disease. Secondary end points were examined 2 weeks after discharge and included (1) mortality and morbidity; (2) re-admission and (3) symptoms. Results: Overall, 100 patients (59 [59%] female; median age, 56 years) fulfilled the admission criteria and were included and randomized at 2 clinical groups. There was no significant difference between the two groups in terms of age and sex. Two groups were not significantly different in terms of underlying diseases and various clinical and para clinical findings although there were not any different during Post-discharge follow-up except for duration of fever (P<0.05). Comparing two groups showed significantly different only in the duration of hospitalized (P<0.05). Although in colchicine group dyspnea was improved more rapid than the placebo group, but it was not meaningful. Conclusion: Colchicine can be effective in reducing systemic symptoms of COVID-19 by inhibiting inflammatory biomarkers.Current Controlled prospective Trials registration ID that has been approved by ICMJE and WHO ICTRP registry is IRCT20200418047126N1, and the date of registration is 2020-05-14.
Practice and Factors Influencing Partograph Utilization on the Delivery of nursing care: An analytical Cross – Sectional Study among Nurses in Singida, Tanzania
Authors: Peter Dedius E. , Millanzi Walter C. , Joho Angelina A.
Published: September 2020

Background

Partograph is the graphic recording for labour management and monitoring of pregnant women in labour pain. The well-plotted data allow the nurse to recognize any abnormal conditions earlier and decide to employ proper actions to the particular pregnant mother in labour pain during the delivery of nursing care. However, its uses have been recommended by WHO among nurses around the globe but it is not fully utilized. This study aimed to determine the level of practice and factors influencing partograph utilization among nurses in Singida, Tanzania.
Methods

Analytical cross sectional study was conducted involving 150 nurses randomly selected from Sokoine health center and Singida Regional Referral Hospital in Singida municipality, Tanzania from January to February 2020. A self-administered structured questionnaire on partograph use to deliver maternal care among pregnant women was the main data collection tool. The Statistical Package for Social Science (SPSS) software program version 23 was used for data entry, screening, processing, and analysis. Both descriptive and inferential statistics were employed in which findings were presented in tables.
Results

Out of 150 nurse midwives 58.7% (n = 88) were females. Only 38.7% (n = 58) of the study respondents had a high level of practice on the utilization of partograph during labour monitoring. Their levels of education were identified to be a protective factor because those who had University education were more times likely to practice using partograph when delivering care compared to other lower education levels (AOR = 16.757; 95%CI: 6.394; 43.915; p < 0.01). Also, their professional qualifications were discovered to be a protective factor because nurse officers and midwives officers were more times likely to practice using partograph as compared to other professional qualifications (AOR = 8.323; p = 0.004; 95%CI: 0.098; 0.642).
Conclusion

This study found that many nurses in Singida municipality had a low level of practice in utilizing partograph when delivering of health care among patients. Continuous and formal supportive supervisions and on job training at national and health facilities need to be emphasized and adhered to promote quality of health services by use of partograph and cost-effective maternal and newborns health.
Prevalence of Escherichia Coli O157:H7 and Associated Factors in Under-five Children in Eastern Ethiopia
Authors: Getaneh Dawit Kassaye , Hordofa Lemessa Oljira , Ayana Desalegn Admassu , Tessema Tesfaye Sisay , Regassa Lemma Demissie
Published: September 2020

Background: Escherichia coli O157:H7 is one of the most potent zoonotic pathogens that causes mild diarrhea and leads to hemolytic uremic syndrome or death. This study was aimed to assess the prevalence and determinants of Escherichia coli O157:H7 related to diarrhea among under-five children with acute diarrhea. Methods: A cross-sectional study design was carried out in 2018 on 378 under-five-year children recruited randomly from Hospitals in Eastern Ethiopia. Stool specimens were collected and processed using enrichment, differential and selective medium. Among isolates, Escherichia coli O157:H7 was confirmed using latex test (Oxoid, Basingstoke, Hants, England). Factors associated with E. coli O157:H7 infection were identified using binary and multivariable logistic regression. Associations were reported by odds ratio with 95 % confidence interval. Results: Magnitude of E. coli O157:H7 related diarrhea was 15.3% (95%CI: 11.8-19.5). The E.coli infection was positively associated with rural residence (AOR;3.75, 95%CI:1.26-11.20), consumption of undercooked meat (AOR;3.95, 95%CI: 1.23-12.67), raw vegetables and/or fruit juice (AOR;3.37, 95%CI:1.32-8.62), presence of bloody diarrhea (AOR;4.42, 95% CI:1.78-10.94), number of under-five children in a household (AOR;7.16, 95%CI: 2.90-17.70), presence of person with diarrhea in a household (AOR;4.22, 95% CI: 1.84-12.69), owning domestic animal (AOR;3.87, 95% CI: 1.48-10.12) and uneducated mother (AOR;3.14, 95%CI: 1.05-9.42).Conclusion: The magnitude of E. coli O157:H7 related diarrhea among under-five children is relatively high in Eastern Ethiopia. The E. coli infection was associated with sanitation and hygiene in a household. Thus, education focused on food cooking and handling, child care and household sanitation associated with animal manure in rural resident children are helpful it.
Patient Safety in Outpatient Care: Results of A Multicenter Cross-Sectional Study About Medication Errors and Medication Management
Authors: Strube-Lahmann Sandra , Müller-Werdan Ursula , Klingelhöfer-Noe Jürgen , Suhr Ralf , Lahmann Nils Axel
Published: September 2020

Background: Medication errors occur frequently. Studies assume that up to 30% of care recipients are exposed to a possible medication error. Specific medication errors include taking the wrong doses or quantities of medication as well as omitting medication. For the outpatient sector, the study situation regarding such errors is limited. Therefore, it was investigated how often medication errors occur or have been reported and whether they are related to training, quality assurance measures and other structural conditions of outpatient care services. Methods: A Germany-wide cross-sectional study was conducted in the winter of 2016/2017 among care employees of outpatient care services. A total of 107 outpatient care services with 656 employees were included in the study. Within the framework of logistic regressions, correlations were investigated between errors committed and errors reported in terms of the years of work experience, completed medication training, the type of employment, geographical location of employment, application of the dual control principle, and the number of patients per shift. Results: A total of 107 outpatient care services could be included in the study, with 656 employees. Of 413 fully qualified nurses, 48.9% stated that they had themselves made an error in a 12-month period. Of all care workers questioned, 30.2% said they had reported errors, with 127 people providing no information on this issue. Provided that nurses had attended medication training within the last two years, the odds of not making medication-related errors were almost twice as high (odds ratio (OR) 1.79; confidence interval (CI) 1.42 - 3.09). Whenever nursing staff applied the dual control principle, the odds of not making a mistake were more than three times higher (OR 3.13; IK 1.88-5.20) than when the principle was not applied. The odds of reporting an error were almost twice as high (OR 1.92; IK 1.18-3.13) when the dual control principle was used compared to when it was not used. Conclusion: Medication-related errors occur frequently in outpatient care. Regular training and adequate quality management measures (e.g. application of the dual control principle) can help to make the medication process safer for everyone involved in outpatient care.
Webinar Education in Ophthalmology during the COVID-19 Pandemic: A Survey Study
Authors: Joltikov Katherine , Edward Deepak P. , MacIntosh Peter
Published: September 2020

Background: Ophthalmology education is changing amidst the COVID-19 pandemic. The purpose of this study is to describe and evaluate the implementation of webinars combined with online resources for review for ophthalmology trainees. Methods: This is a single-center descriptive survey study. A validated survey tool was distributed 2 months after implementation of webinar education. The survey population comprised residents, fellows, and faculty in a Chicago ophthalmology training program.Results: Eighteen residents (100% response rate), 9 fellows (81.8% response rate) and 20 faculty members (44.4% response rate) responded to the survey. Barriers to webinar education and limitations to learning during webinars were rated as low in both groups (avg. 1.98 ± 2.04 and 2.16 ± 1.82, respectively). The educational value of the webinars was moderately well rated (avg. 7.35 ± 1.66). Interest in webinars replacing in-person lectures was neutral (avg. 5.45 ± 2.54). Faculty expressed fewer barriers (p = 0.005), and a higher preference to use webinar education frequently (p = 0.003) and instead of in-person lectures (p = 0.009), compared to trainees. Conclusions: The findings of this survey suggest that webinars in ophthalmology education are effective and feasible, with some perceived limitations.
Observation of magnetic adatom-induced Majorana vortex and its fusion with field-induced Majorana vortex in an iron-based superconductor
Authors: Fan Peng , Yang Fazhi , Qian Guojian , Chen Hui , Zhang Yu-Yang , Li Geng , Huang Zihao , Xing Yuqing , Kong Lingyuan , Liu Wenyao , Jiang Kun , Shen Chengmin , Du Shixuan , Schneeloch John , Zhong Ruidan , Gu Genda , Wang Ziqiang , Ding Hong , Gao Hong-Jun
Published: September 2020

Braiding Majorana zero modes is essential for fault-tolerant topological quantum computing. Iron-based superconductors with nontrivial band topology have recently emerged as a surprisingly promising platform for creating distinct Majorana zero modes in magnetic vortices in a single material and at relatively high temperatures. The magnetic field-induced Abrikosov vortex lattice makes it difficult to braid a set of Majorana zero modes or to study the fusion of a Majorana doublet due to overlapping wave functions. Here we report the observation of the proposed quantum anomalous vortex with integer quantized vortex core states and Majorana zero mode induced by magnetic Fe adatoms deposited on the surface and the realization of its fusion with a nearby field-induced Majorana vortex in iron-based superconductor FeTe0.55Se0.45. We also observe vortex-free Yu-Shiba-Rusinov bound states at the Fe adatoms with a weaker coupling to the substrate, and discover a reversible transition between Yu-Shiba-Rusinov states and Majorana zero mode by manipulating the exchange coupling strength. The dual origin of the Majorana zero modes, from magnetic adatoms and external magnetic field, provides a new single-material platform for studying their interactions and braiding in superconductors bearing topological band structures.
Prognostic value of eight immune gene signatures in pancreatic cancer patients
Authors: Wang Wenting , Xu Zhijian , Wang Ning , Yao Ruyong , Qin Tao , Lin Hao , Yue Lu
Published: September 2020

BackgroundPancreatic cancer is one of the most common malignant tumors of the digestive tract, and it has a poor prognosis. Traditional methods are not effective to accurately assess the prognosis of patients with pancreatic cancer. Immunotherapy is a new promising approach for the treatment of pancreatic cancer; however, some patients do not respond well to immunotherapy, which may be related to tumor microenvironment regulation. In this study, we use gene expression database to mine important immune genes and establish a prognostic prediction model for pancreatic cancer patients. We hope to provide a feasible method to evaluate the prognosis of pancreatic cancer and provide valuable targets for pancreatic cancer immunotherapy.ResultsWe used univariate Cox proportional hazard regression analysis, the least absolute shrinkage and selection operator (LASSO), and multivariate COX regression analysis to screen 8 genes related to prognosis from the 314 immune-related genes, and used them to construct a new clinical prediction model in the TCGA pancreatic cancer cohort. Subsequently, we evaluated the prognostic value of the model. The Kaplan–Meier cumulative curve showed that patients with low risk scores survived significantly longer than patients with high risk scores. The area under the ROC curve (AUC value) of the risk score was 0.755.The univariate COX analysis showed that the risk score was significantly related to overall survival (OS) (HR = 1.406, 95% CI = 1.237 ~ 1.598, P <0.001), and multivariate analysis showed that the risk score was an independent prognostic factor (HR = 1.400 95% CI = 1.287 ~ 1.522, P <0.001). Correlation analysis found that immune genes are closely related to tumor immune microenvironment.Conclusions﻿Based on the TCGA-PAAD cohort, we identified immune-related markers with independent prognostic significance, validated, and analyzed their biological functions, to provide a feasible method for the prognosis of pancreatic cancer and provide potentially valuable targets for pancreatic cancer immunotherapy.
Alternating Hemiplegia of Childhood and Neurological Comorbidities. Variable Intrafamilial Clinical Features.
Authors: Pavone Piero , Pappalardo Xena Giada , Mustafa Naira , Cho Sung Yoon , Jin Dong Kyu , Incorpora Gemma , Falsaperla Raffaele , Marino Simona Domenica , Corsello Giovanni , Parano Enrico , Ruggieri Martino
Published: September 2020

BACKGROUND Alternating Hemiplegia of Childhood (AHC) is an uncommon and complex disorder characterized by age of onset before 18 months, recurrent hemiplegia of one or either sides of the body or quadriplegia. Developmental delay, epilepsy, tonic or dystonic spells, nystagmus and autonomic manifestations are frequently reported manifestations. AHC is mainly caused by mutations in ATP1A3 gene, and to a lesser extent in ATP1A2 gene.CASE PRESENTATION Clinical and genetic findings of a couple of twins and a couple of siblings affected by AHC from two different Italian families were deeply examined. Intrafamilial clinical variability was shown in the present cases. A pathogenic variant rs606231437 in ATP1A3 gene was detected in twins, while in one of the siblings was found a novel variant of GRIN2A (c.3175T>A) gene, shared by the other brother who also had a variant in SCN1B (c.632G>A) and KCNQ2 (c.1870G>A) genes.CONCLUSIONS Developmental delay, epileptic seizures and motor dysfunction are features frequently associated to paroxysmal hemiplegic attacks. Hemiplegic episode is only a sign even if the most remarkable of several neurological comorbidities in AHC carriers. Therefore, we suggest that the view of the disorder should be greatly changed to the term “AHC spectrum disorder". The comparison of molecular analysis among the four probands brings out how the genetic framework is not recurrent, but may result from an unexpected greater genetic heterogeneity, such as seen in siblings carrying a new set of gene variants implicated in channelopathies likely to be eligible as further risk factors for AHC.
Machine learning approaches to the determinants of women’s vasomotor symptoms using general hospital data
Authors: Ryu Ki-Jin , Yi Kyong Wook , Kim Yong Jin , Shin Jung Ho , Hur Jun Young , Kim Tak , Seo Jong Bae , Lee Kwang-Sig , Park Hyuntae
Published: September 2020

Background

To analyze the determinants of women’s vasomotor symptoms (VMS) using machine learning.
Methods

Data came from Korea University Anam Hospital in Seoul, Korea, with 3298 women, aged 40–80 years, who attended their general health check from January 2010 to December 2012. Five machine learning methods were applied and compared for the prediction of VMS, measured by a Menopause Rating Scale. Variable importance, the effect of a variable on model performance, was used for identifying major determinants of VMS.
Results

In terms of the mean squared error, the random forest (0.9326) was much better than linear regression (12.4856) and artificial neural networks with one, two and three hidden layers (1.5576, 1.5184 and 1.5833, respectively). Based on variable importance from the random forest, the most important determinants of VMS were age, menopause age, thyroid stimulating hormone, monocyte and triglyceride, as well as gamma glutamyl transferase, blood urea nitrogen, cancer antigen 19 − 9, C-reactive protein and low-density-lipoprotein cholesterol. Indeed, the following determinants ranked within the top 20 in terms of variable importance: cancer antigen 125, total cholesterol, insulin, free thyroxine, forced vital capacity, alanine aminotransferase, forced expired volume in one second, height, homeostatic model assessment for insulin resistance and carcinoembryonic antigen.
Conclusions

Machine learning provides an invaluable decision support system for the prediction of VMS. For preventing VMS, preventive measures would be needed regarding the thyroid function, the lipid profile, the liver function, inflammation markers, insulin resistance, the monocyte, cancer antigens and the lung function.
Telehealth Consultations in General Practice During a Pandemic Lockdown: Survey and Interviews on Patient Experiences and Preferences
Authors: Imlach Fiona , McKinlay Eileen , Middleton Lesley , Kennedy Jonathan , Pledger Megan , Russell Lynne , Churchward Marianna , Cumming Jacqueline , McBride-Henry Karen
Published: September 2020

BackgroundDuring the first COVID-19 pandemic ‘lockdown’ in Aotearoa/New Zealand (March-May 2020, in which strict ‘stay at home’ measures were introduced), general practices were advised to use telephone and video consultations (telehealth) wherever possible instead of the usual in-person visits. This was a sudden change for most practices and patients. This research aimed to explore how patients accessed general practice during lockdown and evaluate their experiences with telehealth, to inform how telehealth could be most effectively used in the future. MethodsUsing a mixed-method approach, we undertook an online survey and in-depth interviews with adults (>18 years) who had contact with practices during lockdown, recruited through social media and email lists. We present descriptive statistics from the survey data (n=1,010) and qualitative analysis of interview data (n=38) and open-ended survey questions, using a framework of access to health care, from the patient’s perspective.ResultsIn general, patients reported high satisfaction with telehealth in general practice during lockdown. Telehealth was convenient and allowed patients to safely access health care without having to weigh-up the fear of COVID-19 infection against the need to be seen. Telehealth worked best for routine and familiar health issues and when rapport was established between patients and clinicians. This was easier with a pre-existing clinical relationship, but not impossible without one. Telehealth was less suitable when a physical examination was needed, when the diagnosis was unknown or for patients who had a strong preference to be seen in-person. ConclusionsEven in this disruptive lockdown period, that prompted an unexpected and rapid implementation of telehealth services in general practices, most patients had positive experiences with telehealth. In the future, patients want the choice of consultation type to match their needs, circumstances, and preferences. Technological issues and funding barriers may need to be addressed, and clear communication for both patients and clinicians is needed about key aspects of telehealth (e.g. cost, appropriateness, privacy). Maintaining telehealth as an option post-lockdown has the potential to increase timely and safe access to primary health care for many patients.
Assessing the Effect of Virtual Education on Information Literacy Competency for Evidence-based Practice of the Undergraduate Nursing Students 
Authors: Shamsaee Maryam , Magholian Parvin , Ahmadian Leila , Farokhzadian Jamileh , Fatehi Farhad
Published: September 2020

Background: Information literacy is one of the important prerequisites for an effective evidence-based practice (EBP). Therefore, it is necessary to pay attention to curricular development and use new educational methods such as virtual education to strengthen information literacy competency in nursing students. This study investigated the effect of virtual education on nursing students’ information literacy competency for EBP.Methods: This interventional study was performed with two groups of intervention and control and a pretest and posttest design. Seventy-nine nursing students were selected and assigned into the intervention or control groups by random sampling. Virtual education of the information literacy was uploaded on a website in the form of seven modules delivered in four weeks. Questionnaires of demographic information and information literacy for EBP were used to collect data before and one month after the virtual education.Results: The results showed no significant difference between the control and intervention groups in all dimensions of information literacy competency in the pre-test stage. In the post-test, the virtual education improved some dimensions of information literacy competency for EBP including information seeking skills (t= 3.144, p= 0.002) and knowledge about search operators (t= 39.84, p= 0.001) in the intervention groups compared with the control group. Virtual education of the information literacy did not have any significant effect on nursing students in terms of use of different information resources and development of search strategy and frequency of the correct answer to the question of formulating a search strategy in intervention group (p>0.05). Conclusion: Virtual education had a significant effect some demotions of the information literacy competency for EBP in nursing students. Nursing professors and educators are recommended to train information literacy by integrating virtual and face-to-face education. Researchers should also examine the effectiveness of these interventions, their barriers and facilitators.
Prevalence and Factors Associated With HIV Self-testing Uptake Among Men Who Have Sex With Men in Ningbo, China: A Cross-sectional Study
Authors: Hong Hang , Shi Hong-bo , Jiang Hai-bo , Dong Hong-jun , Shen Yun-liang
Published: September 2020

BackgroundHIV testing and early linkage to care are critical for reducing the risk of HIV transmission. HIV self-testing (HIVST) is an useful tool for increasing HIV testing frequency.This study aimed to investigate HIVST rates among men who have sex with men (MSM), the characteristics of MSM who had HIVST, and factors associated with HIVST uptake among MSM in Ningbo, China. MethodsA cross-sectional study was conducted from April to October 2019 in Ningbo,China. Participants were aged at least 18 years and having had sexual contact with men in the past year. Proportions were used for categorical variables. Adjusted Odds Ratio (AOR) and 95% Confidence Interval (CI) for characteristics associated with HIVST uptake was processed by multiple logistic regression models.ResultsAmong a sample of 699 MSM recruited, 38.2% had reported previous use of an HIV self-test kit. A greater proportion of HIVST Users had a higher frequency of HIV testing(≥2 times: 70.0% versus 41.2%, p<0.001) in the past one year. Factor associated with HIVST uptake was gay apps use(AOR=1.86,CI=1.13-3.05), multiple male sex partners (AOR=1.90,CI=1.29-2.80), frequency of male-male sexual contact ≥1 times per week(AOR=1.86, CI=1.30-2.66), syphilis infection(AOR=5.48, CI=2.53-11.88).ConclusionsFurther HIVST education should be strengthened for school-aged children and teenagers, and free HIVST kits may be provided to low-income high-risk MSM through gay apps and NGOs to achieve the increased HIV testing frequency.