bluuebunny/crossref_metadata_2025 huggingface dataset:
Transmissibility of epidemic diseases caused by delay with local proportional fractional derivative
Authors: Alzahrani Abdullah Khamis , Razzaq Oyoon Abdul , Khan Najeeb Alam , Alshomrani Ali Saleh , Ullah Malik Zaka
Published: June 2021

Epidemiological models have been playing a vital role in different areas of biological sciences for the analysis of various contagious diseases. Transmissibility of virulent diseases is being portrayed in the literature through different compartments such as susceptible, infected, recovered (SIR), susceptible, infected, recovered, susceptible (SIRS) or susceptible, exposed, infected, recovered (SEIR), etc. The novelty in this endeavor is the addition of compartments of latency and treatment with vaccination, so the system is designated as susceptible, vaccinated, exposed, latent, infected, treatment, and recovered (SVELITR). The contact of a susceptible individual to an infective individual firstly makes the individual exposed, latent, and then completely infection carrier. Innovatively, the assumption that exposed, latent, and infected individuals enter the treatment compartment at different rates after a time lag is also deliberated through the existence of time delay. The rate of change and constant solutions of each compartment are studied with incorporation of a special case of proportional fractional derivative (PFD). In addition, existence and uniqueness of the system are also comprehensively elaborated. Moreover, novel dynamic assessment of the system is carried out in context with the fractional order index. Succinctly, the manuscript accomplishes cyclic epidemiological behavior of the infectious disease due to the delay in treatment of the infected individuals.
The future of basic science in orthopaedics and traumatology: Cassandra or Prometheus?
Authors: Madry Henning , Grässel Susanne , Nöth Ulrich , Relja Borna , Bernstein Anke , Docheva Denitsa , Kauther Max Daniel , Katthagen Jan Christoph , Bader Rainer , van Griensven Martijn , Wirtz Dieter C. , Raschke Michael J. , Huber-Lang Markus
Published: June 2021

Orthopaedic and trauma research is a gateway to better health and mobility, reflecting the ever-increasing and complex burden of musculoskeletal diseases and injuries in Germany, Europe and worldwide. Basic science in orthopaedics and traumatology addresses the complete organism down to the molecule among an entire life of musculoskeletal mobility. Reflecting the complex and intertwined underlying mechanisms, cooperative research in this field has discovered important mechanisms on the molecular, cellular and organ levels, which subsequently led to innovative diagnostic and therapeutic strategies that reduced individual suffering as well as the burden on the society. However, research efforts are considerably threatened by economical pressures on clinicians and scientists, growing obstacles for urgently needed translational animal research, and insufficient funding. Although sophisticated science is feasible and realized in ever more individual research groups, a main goal of the multidisciplinary members of the Basic Science Section of the German Society for Orthopaedics and Trauma Surgery is to generate overarching structures and networks to answer to the growing clinical needs. The future of basic science in orthopaedics and traumatology can only be managed by an even more intensified exchange between basic scientists and clinicians while fuelling enthusiasm of talented junior scientists and clinicians. Prioritized future projects will master a broad range of opportunities from artificial intelligence, gene- and nano-technologies to large-scale, multi-centre clinical studies. Like Prometheus in the ancient Greek myth, transferring the elucidating knowledge from basic science to the real (clinical) world will reduce the individual suffering from orthopaedic diseases and trauma as well as their socio-economic impact.
Third-wave interventions for eating disorders in adolescence – systematic review with meta-analysis
Authors: Buerger Arne , Vloet Timo D. , Haber Lisa , Geissler Julia M.
Published: June 2021

Context

Third-wave therapies have demonstrated efficacy as a treatment option for EDs in adulthood. Data on the suitability for EDs in adolescence are lacking.

Objective

To estimate the efficacy of third-wave interventions to reduce ED symptoms in adolescents in randomized controlled trials (RCTs) and uncontrolled studies.

Data sources

We systematically reviewed the databases PubMed (1976-January 2021), PsycINFO (1943-January 2021), and the Cochrane database (1995-January 2021) for English-language articles on third-wave therapies. References were screened for further publications of interest.

Study selection

RCTs and pre-post studies without control group, comprising patients aged 11–21 years (mean age = 15.6 years) with an ED diagnosis (anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified) investigating the efficacy of third-wave psychological interventions were included. Efficacy had to be evaluated according to the Eating Disorder Examination or Eating Disorder Examination-Questionnaire, the Eating Disorder Inventory-2, the Eating Disorder Inventory-3, or the Structured Interview for Anorexic and Bulimic Disorders for DSM-IV and ICD-10. The outcome assessed in the meta-analysis was the EDE total score.

Data extraction

Independent extraction of data by two authors according to a pre-specified data extraction sheet and quality indicators.

Data synthesis

We identified 1000 studies after removal of duplicates, assessed the full texts of 48 articles for eligibility, and included 12 studies with a total of 487 participants (female 97.3%/male 2.6%) in the qualitative synthesis and seven studies in the meta-analysis. Articles predominantly reported uncontrolled pre-post trials of low quality, with only two published RCTs. Treatments focused strongly on dialectical behaviour therapy (n = 11). We found moderate effects of third-wave therapies on EDE total score interview/questionnaire for all EDs (d = − 0.67; z = − 5.53; CI95% = − 0.83 to − 0.59). Descriptively, the effects appeared to be stronger in patients with BN and BED.

Conclusion

At this stage, it is not feasible to draw conclusions regarding the efficacy of third-wave interventions for the treatment of EDs in adolescence due to the low quality of the empirical evidence. Since almost all of the identified studies used DBT, it is unfortunately not possible to assess other third-wave treatments’ efficacy.
Case studies for implementing MCDA for tender and purchasing decisions in hospitals in Indonesia and Thailand
Authors: Holtorf Anke-Peggy , Kristin Erna , Assamawakin Anunchai , Upakdee Nilawan , Indrianti Rina , Apinchonbancha Napassorn
Published: June 2021

Background

A multi-criteria decision analysis (MCDA) approach has been suggested for helping purchasers in low- and middle-income countries in an evidence-based assessment of multi-source pharmaceuticals to mitigate potential adverse consequences of price-based decisions on patient access to effective medicines. Six workshops for developing MCDA-instruments for purchasing were conducted in Indonesia, Kazakhstan, Thailand, and Kuwait in 2017–2020. In Indonesia and Thailand, two pilot-initiatives aimed to implement the instruments for hospital drug purchasing decisions.

Objective

By analysing and comparing the experiences and progress from the MCDA-workshops and the two case-examples for hospital implementation in Indonesia and Thailand, we aim to gain insights, which will support future implementation.

Methods

The selection of criteria and their average weight were compared quantitatively across the MCDA-instruments developed in all four countries and settings. Implementation experiences from two case-examples were studied, which included (1) testing the instrument across a variety of drugs in seven hospitals in Thailand and (2) implementation in one specialty hospital in Indonesia. Semi-structured interviews were conducted via web-conferences with four diverse stakeholders in the pilot implementation projects in Thailand and Indonesia. The open responses were evaluated through qualitative content analysis and synthesis using grounded theory coding.

Results

Drivers for implementation were making ‘better’ decisions, achieving transparency and a rational selection process, reducing drug shortages, and assuring consistent quality. Challenges were seen on the technical level (definition or of criteria, scoring methods, access to data) or change-related challenges (resistance, perception of increased workload, lack of competencies or capabilities, lack of resources). The comparison of the MCDA instruments revealed high similarity, but also clear need for local adaptations in each specific case.

Conclusion

A set a of measures targeting challenges related to utility, methodology, data requirements, capacity building and training as well as the broader societal impact can help to overcome challenges in the implementation. Careful planning of implementation and organizational change is recommended for ensuring commitment and fit to local context and culture. Designing a collaborative change program for each application of MCDA-based purchasing will enable healthcare stakeholders to maximally benefit in terms of quality and effectiveness of care and access for patients.
Stabilizing Li-metal host anode with LiF-rich solid electrolyte interphase
Authors: Lee Jaewoo , Park Min-Sik , Kim Jung Ho
Published: June 2021

The development of lithium (Li)-metal anode is high priority research to initiate next-generation Li batteries. Applying Li-metal in practical applications as anode still has many hurdles to clear away, such as low Coulombic efficiency and capacity degradation by the continuous formation of dead Li. We demonstrate that cobalt (Co) nanoparticle incorporation in a porous carbon host anode can play a critical role in the formation of a thick lithium fluoride dominated solid-electrolyte interphase in ether-based electrolyte. As a result, the host anode containing Co nanoparticles shows excellent electrochemical performance with high Li-metal reversible capacity and even stable long-term cyclability with no dead Li formation.
Recent advances and perspectives in efforts to reduce the production and application cost of microbial flocculants
Authors: Liu Cong , Sun Di , Liu Jiawen , Zhu Jingrong , Liu Weijie
Published: June 2021

Microbial flocculants are macromolecular substances produced by microorganisms. Due to its non-toxic, harmless, and biodegradable advantages, microbial flocculants have been widely used in various industrial fields, such as wastewater treatment, microalgae harvest, activated sludge dewatering, heavy metal ion adsorption, and nanoparticle synthesis, especially in the post-treatment process of fermentation with high safety requirement. However, compared with the traditional inorganic flocculants and organic polymeric flocculants, the high production cost is the main bottleneck that restricts the large-scale production and application of microbial flocculants. To reduce the production cost of microbial flocculant, a series of efforts have been carried out and some exciting research progresses have been achieved. This paper summarized the research advances in the last decade, including the screening of high-yield strains and the construction of genetically engineered strains, search of cheap alternative medium, the extraction and preservation methods, microbial flocculants production as an incidental product of other biological processes, combined use of traditional flocculant and microbial flocculant, and the production of microbial flocculant promoted by inducer. Moreover, this paper prospects the future research directions to further reduce the production cost of microbial flocculants, thereby promoting the industrial production and large-scale application of microbial flocculants.
Feasibility study of peer-led and school-based social network Intervention (STASH) to promote adolescent sexual health
Authors: Mitchell Kirstin R. , Purcell Carrie , Simpson Sharon A. , Broccatelli Chiara , Bailey Julia V. , Barry Sarah J. E. , Elliott Lawrie , Forsyth Ross , Hunter Rachael , McCann Mark , McDaid Lisa , Wetherall Kirsty , Moore Laurence
Published: June 2021

Background

Effective sex education is the key to good sexual health. Peer-led approaches can augment teacher-delivered sex education, but many fail to capitalise on mechanisms of social influence. We assessed the feasibility of a novel intervention (STASH) in which students (aged 14–16) nominated as influential by their peers were recruited and trained as Peer Supporters (PS). Over a 5–10-week period, they spread positive sexual health messages to friends in their year group, both in-person and via social media, and were supported to do so via weekly trainer-facilitated meetings. The aims of the study were to assess the feasibility of STASH (acceptability, fidelity and reach), to test and refine the programme theory and to establish whether the study met pre-set progression criteria for continuation to larger-scale evaluation.

Methods

The overall design was a non-randomised feasibility study of the STASH intervention in 6 schools in Scotland. Baseline (n=680) and follow-up questionnaires (approx. 6 months later; n=603) were administered to the intervention year group. The control group (students in year above) completed the follow-up questionnaire only (n=696), 1 year before the intervention group. The PS (n=88) completed a brief web survey about their experience of the role; researchers interviewed participants in key roles (PS (n=20); PS friends (n=22); teachers (n=8); trainers (n=3)) and observed 20 intervention activities. Activity evaluation forms and project monitoring data also contributed information. We performed descriptive quantitative analysis and thematic qualitative analysis.

Results

The PS role was acceptable; on average across schools >50% of students nominated as influential by their friends, signed up and were trained (n=104). This equated to 13% of the year group. Trained PS rarely dropped out (97% completion rate) and 85% said they liked the role. Fidelity was good (all bar one trainer-led activity carried out; PS were active). The intervention had good reach; PS were reasonably well connected and perceived as ‘a good mix’ and 58% of students reported exposure to STASH. Hypothesised pre-conditions, contextual influences and mechanisms of change for the intervention were largely confirmed. All bar one of the progression criteria was met.

Conclusion

The weight of evidence supports continuation to full-scale evaluation.

Trial registration

Current controlled trials ISRCTN97369178
Perceptions of anonymised data use and awareness of the NHS data opt-out amongst patients, carers and healthcare staff
Authors: Atkin C. , Crosby B. , Dunn K. , Price G. , Marston E. , Crawford C. , O’Hara M. , Morgan C. , Levermore M. , Gallier S. , Modhwadia S. , Attwood J. , Perks S. , Denniston A. K. , Gkoutos G. , Dormer R. , Rosser A. , Ignatowicz A. , Fanning H. , Sapey E. ,   On behalf of the PIONEER Data Hub
Published: June 2021

Background

England operates a National Data Opt-Out (NDOO) for the secondary use of confidential health data for research and planning. We hypothesised that public awareness and support for the secondary use of health data and the NDOO would vary by participant demography and healthcare experience. We explored patient/public awareness and perceptions of secondary data use, grouping potential researchers into National Health Service (NHS), academia or commercial. We assessed awareness of the NDOO system amongst patients, carers, healthcare staff and the public. We co-developed recommendations to consider when sharing unconsented health data for research.

Methods

A patient and public engagement program, co-created and including patient and public workshops, questionnaires and discussion groups regarding anonymised health data use.

Results

There were 350 participants in total. Central concerns for health data use included unauthorised data re-use, the potential for discrimination and data sharing without patient benefit. 94% of respondents were happy for their data to be used for NHS research, 85% for academic research and 68% by health companies, but less than 50% for non-healthcare companies and opinions varied with demography and participant group.

Questionnaires showed that knowledge of the NDOO was low, with 32% of all respondents, 53% of all NHS staff and 29% of all patients aware of the NDOO.

Recommendations to guide unconsented secondary health data use included that health data use should benefit patients; data sharing decisions should involve patients/public. That data should remain in close proximity to health services with the principles of data minimisation applied. Further, that there should be transparency in secondary health data use, including publicly available lists of projects, summaries and benefits. Finally, organisations involved in data access decisions should participate in programmes to increase knowledge of the NDOO, to ensure public members were making informed choices about their own data.

Conclusion

The majority of participants in this study reported that the use of healthcare data for secondary purposes was acceptable when accessed by NHS. Academic and health-focused companies. However, awareness was limited, including of the NDOO. Further development of publicly-agreed recommendations for secondary health data use may improve both awareness and confidence in secondary health data use.
Who should I involve in my research and why? Patients, carers or the public?
Authors: Staley Kristina , Elliott Jim , Stewart Derek , Wilson Roger
Published: June 2021

Patient and public involvement in research helps to make it more relevant and useful to the end-users. Involvement influences the design, delivery and dissemination of research, ultimately leading to better services, treatments and care. Researchers are therefore keen to involve patients, carers and public in their work, but are sometimes uncertain about who to involve. Some confusion may arise from the terms used. The UK’s catch-all term ‘patient and public involvement’ suggests this is a single activity, that perhaps both ‘patient’ and ‘public’ input are needed, or that either will do. The terms ‘patient’, ‘carer’ and ‘public’ have been defined, but are not used consistently. In fact there are many different contexts for involvement and many different kinds of decisions made, which then determine whose input will be most valuable.

Clarity about the ‘why’ can help answer the ‘who’ question. However, not all researchers are clear about the purpose of involvement. While it is often understood to have a moral purpose, or to improve research quality, this doesn’t always identify who needs to be involved. When learning is understood to be the purpose of involvement, then the most appropriate people to involve are those with relevant experiential knowledge. In research projects, these are people with lived experience of the topic being investigated. This could be patients, carers, members of the public or health professionals.

In this article we discuss how involving people who do not have the relevant experiential ‘lived’ knowledge may contribute to ineffective or tokenistic involvement. These people are as likely as researchers to make assumptions, risking missing key insights or resulting in outcomes that are off-putting or even harmful to research participants.

We conclude that greater attention needs to be given to the question of who to involve. Raising awareness of the significance of experiential knowledge and the contextual factors that determine whose input will be most useful will help everyone to understand their roles and improve the quality of involvement. It will help to maximise the opportunities for learning, increasing the likelihood of impact, and helping to achieve the ultimate goal of improved health and services.
68Ga-FAPI-04 PET/MR is helpful in differential diagnosis of pancreatitis from pancreatic malignancy compared to 18F-FDG PET/CT: a case report
Authors: Shou Yi , Xue Qiaoyi , Yuan Jianmin , Zhao Jun
Published: June 2021

Introduction

68Ga-fibroblast activation protein-specific enzyme inhibitor 04 (FAPI-04) is a radiolabelled molecular agent targeting the inhibitor of fibroblast activation protein (FAP), which is often present in tumor stroma and inflammatory tissue with prominent fibroblast proliferation. FAPI-04 is a promising PET tracer for tumor imaging as well as IgG4-related disease (IgG4-RD).

Case description

We herein present a case where 68Ga-FAPI PET/MR helped to diagnose IgG4-RD that involved pancreas and bile duct. A 62-year-old patient suffered from diffusive discomfort at middle upper abdomen and presented brown urine. Blood test revealed abnormal liver function and elevated IgG4 (4.830g/L↑). 18F-FDG PET showed enlarged uncinate process and dilated bile duct tree. Mild increase of FDG uptake in uncinate process and head of pancreas indicated possible pancreatic malignancy, but the clinical evidence was not sufficient and histology examination was negative. 68Ga-FAPI PET revealed prominent increased radioactivity distribution in the entire pancreas and bile duct, suggesting IgG4-RD.

Conclusion

FAPI-04 is not only a good PET imaging tracer for tumors, but also for prominent fibroblast-mediated inflammation. FAPI imaging should be considered when the diagnosis using 18F-FDG imaging is ambiguous. The presented case illustrates that 68Ga-FAPI-04 PET is helpful in improving the differential diagnosis of pancreatitis and pancreatic cancer.
Electrophysiological biomarkers of central nervous system affection in cases of chronic obstructive pulmonary disease (COPD)
Authors: Ali Hossam Abd El Monem , Al-Adl Ahmed Salama
Published: June 2021

Background

Chronic obstructive pulmonary disease is associated with significant systemic abnormalities which includes systemic inflammation and neurohormonal activation that are considered the main mechanisms of the pathophysiology in systemic involvement. The aim of the present study was to detect the subclinical affection of the central nervous system in patients with stable chronic obstructive pulmonary disease.

Results

Forty patients with chronic obstructive pulmonary disease were enrolled in this study and 30 healthy subjects as a control group. All patients and healthy subjects were submitted to full history taking, clinical examination, arterial blood gases, spirometry, evoked potential, and electroencephalogram. Regarding to brain stem auditory evoked potentials, there was a statistically significant increase of latency of waves numbers I, III, and V, and a statistically significant increase of interpeak latencies I–III in the COPD group when compared to the control group. On the other hand, there was a statistically significant decrease of brain stem auditory evoked potential I and V amplitudes on both sides in the COPD group when compared to the control group. In visual evoked potential, there was a statistically significant increase of latency and decrease of amplitude of P100. In addition, there was a statistically significant increase of electroencephalogram changes in the COPD group when compared to the control group (20.0% vs. 3.3%, respectively).

Conclusion

In patients with chronic obstructive pulmonary disease, the central nervous system could be affected subclinically as the severity of chronic obstructive pulmonary disease increased, and the patient should be electrophysiologically monitored for early detection of nervous system affection.
Duplex ultrasonography as prognostic tool of acute ischemic stroke patients
Authors: El-khatib Mohamed El-Sayed , El Ahwal Shereen Ahmed
Published: June 2021

Background

Cerebral stroke is a major source of mortality and morbidity. Duplex ultrasonography is used to evaluate carotid and cerebral arteries. The objectives of this work are to study the correlation between carotid duplex parameters with risk factors of ischemic stroke and evaluate duplex parameter as prognostic tool of ischemic stroke.

Methods

The study was conducted on 100 patients presented by acute ischemic stroke submitted to history taking, medical, and neurological examination. Neurological deficit was assessed by National Institute of Health Stroke Scale (NIHSS); the functional state of the patients was assessed by modified Rankin scale (mRS). Brain CT and/or MRI, routine laboratory investigations, extracranial, and transcranial duplex (TCD) were done.

Results

The end diastolic velocities (EDVs) and peak systolic velocities (PSVs) of common carotid arteries (CCA) were significantly decreased in smokers and hypertensive (P<0.05). Smoking and hypertension were positively correlated with resistive index (RI). In 80 patients, PSV in the symptomatic middle cerebral artery (MCA) did not exceed 70 cm/s within averaged 50.7 ± 4.6 cm/s. EDV was 12.0 ± 3.0 cm/s, RI was 0.78 ± 0.05, and pulsativity index (PI) was 1.61 ± 0.09. There was significant difference in all hemodynamic parameters in comparison with the asymptomatic side.

Conclusion

Patients who have risk factors of stroke should be evaluated with duplex ultrasonography. Duplex parameters can give informative data about prognosis and outcome.
The space–time references of BeiDou Navigation Satellite System
Authors: Han Chunhao , Liu Li , Cai Zhiwu , Lin Yuting
Published: June 2021

The BeiDou Navigation Satellite System (BDS) is essentially a precise time measurement and time synchronization system for a large-scale space near the Earth. General relativity is the basic theoretical framework for the information processing in the master control station of BDS. Having introduced the basic conceptions of relativistic space–time reference systems, the space–time references of BDS are analyzed and the function and acquisition method of the Earth Orientation Parameters (EOP) are briefly discussed. The basic space reference of BDS is BeiDou Coordinate System (BDCS), and the time standard is the BDS Time (BDT). BDCS and BDT are the realizations of the Geocentric Terrestrial Reference System (GTRS) and the Terrestrial Time (TT) for BDS, respectively. The station coordinates in the BDCS are consistent with those in International Terrestrial Reference Frame (ITRF)2014 at the cm–level and the difference in scale is about $$1.1 \times 10^{ - 8}$$

1.1
×

10

-
8

. The time deviation of BDT relative to International Atomic Time (TAI) is less than 50 ns and the frequency deviation is less than $$2 \times 10^{ - 14}$$

2
×

10

-
14

. The Geocentric Celestial Reference System (GCRS) and the solar Barycentric Celestial Reference System (BCRS) are also involved in the operation of BDS. The observation models for time synchronization and precise orbit determination are established within the GCRS framework. The coordinate transformation between BDCS and GCRS is consistent with the International Earth Rotation and Reference Systems Service (IERS). In the autonomous operation mode without the support of the ground master control station, Earth Orientation Parameters (EOP) is obtained by means of long-term prediction and on-board observation. The observation models for the on-board astrometry should be established within the BCRS framework.
Obstetric, maternal, and neonatal outcomes in COVID-19 compared to healthy pregnant women in Iran: a retrospective, case-control study
Authors: Taghavi Seyed-Abdolvahab , Heidari Solmaz , Jahanfar Shayesteh , Amirjani Shakiba , Aji-ramkani Amireh , Azizi-Kutenaee Maryam , Bazarganipour Fatemeh
Published: June 2021

Background

The purpose of the present study was to evaluate obstetric, maternal, and neonatal outcomes in COVID-19 compared to healthy pregnant women in Iran.

Results

A case-control study was conducted on 55 COVID-19 as the case and 55 matched control pregnant women in Hormozgan, Iran. Patients were considered to be cases if they had a positive COVID-19 test plus a positive chest X-ray result. Our measures were COVID-19 symptoms, including laboratory evaluations, clinical symptoms, and maternal and neonatal outcomes.

The most prevalent symptoms related to COVID-19 were fever (69.09%) and cough (58.18%). Less common symptoms included fatigue, diarrhea, shortness of breath, sore throat, and myalgia. Hydroxychloroquine/chloroquine (58.18%) and antibiotic therapy (45.45%) were the most prevalent management in COVID-19 patients. Based on our findings, maternal and obstetric outcomes—neonatal in case groups—such as mode of delivery, premature rupture of membrane, postpartum hemorrhage, perineal resection rate, neonates’ birth weight, Apgar score, and neonatal asphyxia rate were similar to pregnant women without COVID-19. We observed a higher incidence rate of premature delivery in COVID-19 cases (25 vs. 10%) (p< 0.05). In the present study, we found that women with COVID-19 had a more than twofold increased odds of preterm labor. History of preterm delivery was also associated with high twofold odds of preterm labor.

Conclusion

We observed a higher incidence rate of premature delivery in COVID-19 cases. Women with COVID-19 had a more than twofold increased odds of preterm labor. Considering prematurity has high morbidity and is regarded as the primary cause of mortality in children under 5 years old, more case-control studies are needed to ascertain the results.
Predictors of early rebleeding after endoscopic therapy of first variceal bleeding in liver cirrhosis
Authors: Alia Maha Salah Abu , Elsawy Abdallah Ahmed , Elarabawy Reda Abdelsamaie , Hegazy Hegazy Mohamed
Published: June 2021

Background

Despite the great advancement in therapeutic modalities for esophageal varices, early variceal rebleeding still occurs at high rates leading to an exaggeration of the morbidity and mortality for cirrhotic patients, so meticulous follow-up with optimum prediction and proper preventive measures for early variceal rebleeding are mandatory for increasing survival of those patients. In this respect, we evaluated the clinical, laboratory, abdominal ultrasound, and endoscopic criteria of variceal cirrhotic patients as possible risk predictors of early variceal rebleeding after endoscopic control of first variceal bleeding. All included patients were followed up blindly for 12 weeks after endoscopic control of bleeding for ascertainment of first variceal rebleeding. The demographic, clinical, laboratory, abdominal ultrasound, and upper gastrointestinal endoscopic criteria were evaluated for all patients at first admission.

Results

By univariate regression analysis, the statistically significant predictors for early variceal rebleeding were serum albumin, serum bilirubin, prothrombin concentration, Child-Pugh score, platelet count, spleen diameter, ascites, portal vein diameter and velocity, variceal size, variceal location, and red color sign. By using multivariate regression analysis, the most independent significant predictors were Child-Pugh score (sig: 0.001 and OR: 1.661), platelets count (sig: 0.000 and OR: 0.956), portal vein velocity (sig: 0.000 and OR: 0.664), variceal grading (sig: 0.000 and OR: 3.964), and variceal red color sign (sig: 0.000 and OR: 4.964). We used the multivariate regression coefficients for the significant predictors to build up early variceal rebleeding risk (EVRR) score with a significant discriminatory performance (AUC: 0.965 and sig: 0.000).

Conclusion

Child-Pugh score, platelet count, portal vein velocity, variceal grading, and variceal red color sign are independent risk predictors for early variceal rebleeding after successful control of first variceal bleeding in cirrhotic patients. Our proposed EVRR score could be helpful for the prediction of early variceal rebleeding in cirrhotic patients after endoscopic control of acute variceal bleeding; however, it should be externally validated in large prospective studies.
Effects of a prosody rehabilitation program on expression of affect in preschool children with hearing impairment: a randomized trial
Authors: Sobhy Ossama A. , Abdou Rania M. , Ibrahim Sara M. , Hamouda Nesrine H.
Published: June 2021

Background

Children with hearing impairment are deprived of their source of linguistic input which in turn leads to linguistic and prosodic deficits that negatively affect language and social development. Linguistic aspects other than prosody have received considerable attention in studies concerned with hearing-impaired children with little literature addressing how to improve their affective prosodic deficits. The aim of the current study is to adapt and apply the “prosody treatment program” and detect the effect of prosodic rehabilitation on affect production and language development in Egyptian hearing-impaired children. This study was conducted on 21 children with sensorineural hearing loss. The subjects were randomly divided into two groups, group A (cases) and group B (control) by block randomization. The subjects of the study were evaluated pre and post-therapy by a protocol for assessment of their prosodic skills using subjective and objective measures. Both groups received the usual auditory and language rehabilitation therapy. The case group additionally received rehabilitation for prosody using the “prosody treatment program” for 3 months.

Results

Results showed a statistically significant improvement in the subjective scores and most of the objective scores of the assessed affective prosodic skills when comparing pre-therapy and post-therapy scores in the cases group, and when comparing both studied groups post-therapy.

Conclusions

Prosodic training has an additional benefit evident in improving affective prosodic skills of hearing-impaired children compared to conventional therapy alone with a positive effect on their linguistic development.

Trial registration

The trial is registered atwww.clinicaltrials.govNCT04691830. Registered under the name “Adaptation of a Rehabilitation Program for Prosody and its Application on Egyptian Hearing Impaired Children”. Retrospectively registered:
Driving Pressure–Guided Individualized Positive End-Expiratory Pressure in Abdominal Surgery: A Randomized Controlled Trial
Authors: Zhang Chengmi , Xu Fengying , Li Weiwei , Tong Xingyu , Xia Ran , Wang Wei , Du Jianer , Shi Xueyin
Published: June 2021

BACKGROUND:

The optimal positive end-expiratory pressure (PEEP) to prevent postoperative pulmonary complications (PPCs) remains unclear. Recent evidence showed that driving pressure was closely related to PPCs. In this study, we tested the hypothesis that an individualized PEEP guided by minimum driving pressure during abdominal surgery would reduce the incidence of PPCs.

METHODS:

This single-centered, randomized controlled trial included a total of 148 patients scheduled for open upper abdominal surgery. Patients were randomly assigned to receive an individualized PEEP guided by minimum driving pressure or an empiric fixed PEEP of 6 cm H2O. The primary outcome was the incidence of clinically significant PPCs within the first 7 days after surgery, using a χ2 test. Secondary outcomes were the severity of PPCs, the area of atelectasis, and pleural effusion. Other outcomes, such as the incidence of different types of PPCs (including hypoxemia, atelectasis, pleural effusion, dyspnea, pneumonia, pneumothorax, and acute respiratory distress syndrome), intensive care unit (ICU) admission rate, length of hospital stay, and 30-day mortality were also explored.

RESULTS:

The median value of PEEP in the individualized group was 10 cm H2O. The incidence of clinically significant PPCs was significantly lower in the individualized PEEP group compared with that in the fixed PEEP group (26 of 67 [38.8%] vs 42 of 67 [62.7%], relative risk = 0.619, 95% confidence intervals, 0.435–0.881; P = .006). The overall severity of PPCs and the area of atelectasis were also significantly diminished in the individualized PEEP group. Higher respiratory compliance during surgery and improved intra- and postoperative oxygenation was observed in the individualized group. No significant differences were found in other outcomes between the 2 groups, such as ICU admission rate or 30-day mortality.

CONCLUSIONS:

The application of individualized PEEP based on minimum driving pressure may effectively decrease the severity of atelectasis, improve oxygenation, and reduce the incidence of clinically significant PPCs after open upper abdominal surgery.
Photonic approaches for the thermal control of photovoltaics
Authors: Περράκης Γεώργιος
Published: June 2021

Οι φωτοβολταϊκές διατάξεις μετατρέπουν την ηλιακή ενέργεια σε ηλεκτρική ενέργεια. Ωστόσο, η απόδοση αυτής της μετατροπής επηρεάζεται αρνητικά από τη θερμοκρασία λειτουργίας τους. Επιπλέον, οι υψηλές θερμοκρασίες λειτουργίας μειώνουν τον χρόνο ζωής των φωτοβολταϊκών. Οι συμβατικές στρατηγικές για ψύξη καταναλώνουν επιπλέον ενέργεια και αυξάνουν σημαντικά την πολυπλοκότητα του συστήματος. Σε αυτήν τη μελέτη, αναπτύχθηκε ένα ακριβές οπτο-ηλεκτρο-θερμικο μοντέλο με στόχο την εκμετάλλευση της ηλεκτρομαγνητικής ακτινοβολίας του Ήλιου ως πηγή ενέργειας αλλά και την εκμετάλλευση του Διαστήματος (έξω από τη γήινη ατμόσφαιρα) ως μία “ανεξάντλητη ψύκτρα” με πολύ χαμηλότερη θερμοκρασία (~ 3 K) από αυτή της ατμόσφαιρας (~ 300 K). Η βέλτιστη αξιοποίηση και των δύο αυτών «πηγών» μπορεί να οδηγήσει στην αύξηση της απόδοσης φωτοβολταϊκών διατάξεων είτε μέσω της αύξησης της απορρόφησης της ηλιακής ακτινοβολίας απ’ τις διατάξεις αυτές είτε μέσω της μείωσης της θερμοκρασίας λειτουργίας τους με την απευθείας εκπομπή θερμικής ηλεκτρομαγνητικής ακτινοβολίας στο Διάστημα. Οι τρόποι επίτευξης αυτής της αξιοποίησης είναι μέσω κατάλληλης ενσωμάτωσης στα φωτοβολταϊκά κατάλληλων δομών στη κλίμακα των νανο/μικρο-μετρων για την αποτελεσματική αλληλεπίδραση με τα επιθυμητά μήκη κύματος του φωτός. Όπως δείχνουμε στη μελέτη μας τα σημαντικότερα πλεονεκτήματα αυτών των τεχνικών αποτελούν η παθητική λειτουργία, χωρίς να απαιτείται επιπλέον ενέργεια, η φιλική προς το περιβάλλον λειτουργία, αλλά και η αύξηση του χρόνου ζωής των συσκευών.
Development, validation and reliability of a questionnaire for assessment of physician's knowledge, attitude and practices (KAPs) regarding foodborne diseases in the Kingdom of Saudi Arabia
Authors: AL-Mohaithef Mohammed
Published: June 2021

Background: The burden of foodborne illness is considered to be high across the world.  Based on the Knowledge-Attitude-Practice (KAP) model, physician’s awareness is essential for conducting individualized treatments, thus reducing the burden of foodborne illness. However, there have been no validated questionnaires specific to the awareness of physicians with foodborne diseases. This study aims to develop and validate a KAP questionnaire for physicians to assess their awareness about the diagnosis and management of foodborne illness.  

Methods The questionnaire was developed in three phases: a comprehensive literature review, face and content validity, followed by a reliability test by internal consistency. A cross-sectional study was designed in Abha, Saudi Arabia. Physicians (n=125) were opportunistically recruited from both public and private primary healthcare centers. The questionnaire’s content and validity were confirmed by experts in their corresponding fields. After signing the informed consent, the study participants received the questionnaire to evaluate their KAPs on foodborne diseases.  Results: A total of 160 physicians from both public and private primary health care centers were approached to enrol 125 study participants into the survey (response rate 78.13%). Of the 31 items designed for assessing the KAP of physicians on foodborne illnesses, three items were excluded after Cronbach’s α analysis. In total, 29 items were included in the final set of the questionnaire. Results of different validity and reliability analyses suggest the questionnaire has a high face and content validity as well as good reliability in internal consistency and stability. Conclusions: This study introduces a newly developed questionnaire with good reliability and validity values that can assess physician’s awareness of foodborne disease. The awareness questionnaire, as a study instrument, had a favourable acceptance among physicians. It is a sound method for evaluating and measuring levels of foodborne disease-related awareness among physicians in Abha, Saudi Arabia.
Shifting dynamics: Changes in the relationship between total fertility rate and contraceptive prevalence rate in Jordan between 2012 and 2017
Authors: Bietsch Kristin , Arbaji Ali , Mason Jennifer , Rosenberg Rebecca , Al Ouri Malak
Published: June 2021

Background: Between the two most recent Population and Family Health Surveys, Jordan saw a dramatic decline in the Total Fertility Rate (TFR) from 3.5 to 2.7 in 5.5 years.  Over the same period, modern contraceptive use also declined, from 61.2% to 51.8% among married women.  This decrease in both TFR and the contraceptive prevalence rate (CPR) diverges from the typical relationship seen between these two factors whereby historically as CPR increases, TFR decreases.  This paper explores this unique pattern using multiple methodologies. 

Methods: First, we validate the survey data using nationally collected data on fertility and contraceptive distribution.  Second, we look to changes that have historically influenced changes in CPR and TFR, including changes in ideal family size and wanted fertility rates. Third, we explore proximate determinants and other influences on fertility and changes in contraception, examining the changes in the method mix and unmet need; marriage patterns, including the demographics of the married population, spousal separation, and time since last sex; postpartum insusceptibility; infecundity, both primary and secondary; and abortion, to see if any have shifted significantly enough to allow for fertility to decline with less contraceptive use.

Results: We find that the decline in fertility in Jordan was driven by a reduction in mistimed or unwanted pregnancies and there was a significant increase in the share of reproductive aged women who are infecund. We also concluded that the changes in fertility and contraceptive use are driven by changes in Jordanian nationals, not by the growing Syrian refugee population.

Conclusions: Jordan is not the only country to be experiencing a shift in the typical relationship between CPR and TFR.  Results can inform both future approaches for family planning programs and our expectations regarding what kind of change our family planning investments might buy.
Optimising the Timing of whooping cough Immunisation in MUMs: a randomised controlled trial investigating the timing of pertussis vaccination in pregnancy (OpTIMUM): a protocol paper
Authors: Calvert Anna , Karampatsas Konstantinos , Andrews Nick , England Anna , Hallis Bassam , Jones Christine E. , Khalil Asma , Le Doare Kirsty , Matheson Mary , Snape Matthew D. , Heath Paul T. ,   OpTIMUM Study Group
Published: June 2021

Background: Pertussis is a highly infectious respiratory illness caused by the bacteria Bordetella pertussis. A resurgence of pertussis, even in countries with good vaccine coverage, has led to an increase in infant deaths. In response to this, many countries have introduced pertussis vaccination in pregnancy. This strategy is effective at preventing infant disease, but there remains uncertainty about what gestational timing is best to ensure maximal protection of the infant. These uncertainties are the rationale for this randomised controlled trial and a sub-study investigating pertussis-specific antibody in breastmilk.  

Protocol: We will recruit 354 pregnant women and will randomise them to receive their pertussis vaccination in one of three gestational age windows: ≤23+6, 24-27+6 and 28-31+6 weeks of gestation.  Vaccination will be with Boostrix-IPV® and participants will be asked to complete a symptom diary for seven days following vaccination. Blood sampling will be performed prior to vaccination, two weeks following vaccination and at the time of delivery. A cord blood sample will be collected at delivery and a blood sample collected from the infant 4-10 weeks after completion of the primary immunisations. Individuals participating in the breastmilk sub-study will provide a sample of colostrum within 48 hours of delivery and samples of breastmilk at two weeks and around five-six months. Blood samples will be analysed using enzyme linked immunosorbent assay (ELISA) techniques for pertussis toxin, filamentous haemagglutinin and pertactin. A subset of serum samples will also be analysed using a functional assay. Colostrum and breastmilk samples will be analysed using functional assays.

Discussion: Although pertussis vaccination has been shown to be safe and effective in pregnancy there remains debate about the optimal timing for the administration during pregnancy. This study will investigate antibody responses in serum and breastmilk when vaccination is performed in three different time periods.

Clinicaltrials.gov registration: NCT03908164 (09/04/2019)
Human movement patterns of farmers and forest workers from the Thailand-Myanmar border
Authors: Tun Sai Thein Than , Min Myo Chit , Aguas Ricardo , Fornace Kimberly , Htoo Gay Nay , White Lisa J. , Parker Daniel M.
Published: June 2021

Background: Human travel patterns play an important role in infectious disease epidemiology and ecology. Movement into geographic spaces with high transmission can lead to increased risk of acquiring infections. Pathogens can also be distributed across the landscape via human travel. Most fine scale studies of human travel patterns have been done in urban settings in wealthy nations. Research into human travel patterns in rural areas of low- and middle-income nations are useful for understanding the human components of epidemiological systems for malaria or other diseases of the rural poor. The goal of this research was to assess the feasibility of using GPS loggers to empirically measure human travel patterns in this setting, as well as to quantify differing travel patterns by age, gender, and seasonality.

Methods: In this pilot study we recruited 50 rural villagers from along the Myanmar-Thailand border to carry GPS loggers for the duration of a year. The GPS loggers were programmed to take a time-stamped reading every 30 minutes. We calculated daily movement ranges and multi-day trips by age and gender. We incorporated remote sensing data to assess patterns of days and nights spent in forested or farm areas, also by age and gender.

Results: Our study showed that it is feasible to use GPS devices to measure travel patterns, though we had difficulty recruiting women and management of the project was relatively intensive. We found that older adults traveled farther distances than younger adults and adult males spent more nights in farms or forests.

Conclusion: The results of this study suggest that further work along these lines would be feasible in this region. Furthermore, the results from this study are useful for individual-based models of disease transmission and land use.