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Background: Various population-based studies have shown Hispanic/Latino ethnicity is a risk factor for worse survival in patients with gastric cancer linked to disparate access to care. We aimed to address whether Hispanic patients treated within safety-net hospital systems continue to experience this survival deficit compared to non-Hispanic patients. Methods: We performed a retrospective cohort study comparing survival between Hispanic and non-Hispanic patients diagnosed with gastric adenocarcinoma between January 1, 2016, and December 31, 2020, within Los Angeles County's safety-net hospital system. Gastric cancer-specific survival was compared between the two cohorts using the Kaplan-Meier estimate and Cox proportional-hazards regression model. Results: In total, 448 patients who received care from five medical centers were included; 348 (77.7%) patients self-identified as Hispanic and 100 (22.3%) as non-Hispanic. Mean follow-up time was 2.0 years (median 0.91 years, IQR, 0.34-2.5 years). Hispanic patients were found to be diagnosed at a younger age (55.6 vs. 60.7 years, P < 0.01), demonstrate higher state area deprivation index (6.4 vs. 5.0, P < 0.01), and present with metastatic disease (59.8% vs. 45%, P = 0.04). After adjusting social and oncologic variables, Hispanic ethnicity remained an independent risk factor for worse survival [HR 1.56, (95% CI, 1.06-2.28); P = 0.02]. Conclusions: Hispanic patients treated within a large, multicenter safety-net hospital system experience worse survival compared to non-Hispanic patients. This suggests ethnic disparities exist within safety-net hospital systems, independent of known clinicopathologic factors. Impact: Improving outcomes for Hispanic patients with gastric cancer requires future efforts aimed at defining and addressing these unidentified barriers to care. [ABSTRACT FROM AUTHOR]

Our purpose was to synthesize evidence in the literature to determine the diagnostic accuracy of cone-beam CT (CBCT) for the detection of intracranial hemorrhage (ICH) and hemorrhage types, including intraparenchymal hemorrhage (IPH), subarachnoid hemorrhage (SAH), and intraventricular hemorrhage (IVH). We performed a meta-analysis following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Our protocol was registered with International Prospective Register of Systematic Reviews (PROSPERO-CRD42021261915). Systematic searches were last performed on April 30, 2024, in EMBASE, PubMed, Web-of-Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases. Inclusion criteria were (1) studies reporting diagnostic metrics of CBCT for ICH and (2) studies using a reference standard to determine ICH. Exclusion criteria were (1) case reports, abstracts, reviews and (2) studies without patient-level data. Pooled estimates and 95% confidence intervals (CIs) were calculated for diagnostic odds ratios (DORs), sensitivity, and specificity using random-effects and common-effects models. Mixed methods appraisal tool was used to evaluate risk of bias. Seven studies were included in the meta-analysis yielding 466 patients. Mean or median age ranged from 54 to 75 years. Female patients represented 51.4% (222 of 432) in reported studies. Multidetector CT was the reference standard in all studies. DOR, pooled sensitivity, and pooled specificity for ICH were 5.28 (95% CI: 4.11-6.46), 0.88 (95% CI: 0.79-0.97), and 0.99 (95% CI: 0.98-1.0). Pooled sensitivity for IPH, SAH, and IVH was 0.98 (95% CI: 0.95-1.0), 0.82 (95% CI: 0.57-1.0), and 0.78 (95% CI: 0.55-1.0). Pooled specificity for IPH, SAH, and IVH was 0.99 (95% CI: 0.98-1.0), 0.99 (95% CI: 0.97-1.0), and 1.0 (95% CI: 0.98-1.0). CBCT had moderate DOR and high pooled specificity for ICH and hemorrhage types. However, pooled sensitivity varied by hemorrhage type, with the highest sensitivity for IPH, followed by SAH and IVH. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Digital interventions to improve retention in HIV care are critical to ensure viral suppression and prevent further transmission. AIDS Healthcare Foundation Healthcare Centers are centers across the United States that provide primary HIV care. Traditionally, the Healthcare Centers conduct phone calls with patients to schedule and confirm appointments, as well as share laboratory results. In 2017, Healthvana piloted a digital platform at AIDS Healthcare Foundation Healthcare Centers to send patients SMS text message appointment reminders and allow patients to review their upcoming appointment and view their laboratory results in the web-based patient portal. Objective: A national implementation in 15 US states and Washington, DC, of this digital intervention pilot by Healthvana aims to determine whether SMS appointment reminders and web-based patient portal logins improved retention in care compared to traditional methods. Methods: A retrospective analysis of 40,028 patients living with HIV was conducted at the 61 AIDS Healthcare Foundation Healthcare Centers between January 2, 2017, and May 22, 2018. Patients were invited to enroll in Healthvana's digital intervention pilot, allowing for a natural, organization-wide case-control study. Separate binary logistic regression models evaluated the relationship between receiving SMS appointment reminders and completing scheduled appointments, as well as the relationship between logging into the web-based patient portal and completing scheduled appointments. Four scheduled consecutive appointments for each patient were included in the analysis to account for 1 full year of data per patient. Results: Patients who received the SMS appointment reminder were 1.7 times more likely to complete appointment 1 compared to patients who did not receive the SMS appointment reminder (P <.001). In addition, patients who received the SMS appointment reminder were 1.6 times more likely to complete appointment 2 (P <.001), 1.7 times more likely to complete appointment 3 (P <.001), and 1.8 times more likely to complete appointment 4 (P <.001) compared to patients who did not receive the SMS appointment reminder. Patients who logged in to the web-based patient portal prior to their scheduled appointment were 7.4 times more likely to complete appointment 1 compared to patients who did not log in (P <.001). In addition, patients who logged in to the web-based patient portal prior to their scheduled appointment were 3.6 times more likely to complete appointment 2 (P <.001), 3.2 times more likely to complete appointment 3 (P <.001), and 2.8 times more likely to complete appointment 4 (P <.001) compared to patients who did not log in. Conclusions: HIV primary care appointment completion was higher when patients engaged with Healthvana's digital platform. Digital technology interventions to ensure patients complete their scheduled HIV care appointments are imperative to curb the HIV epidemic. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Vitiligo is an acquired pigmentary disorder, which is usually progressive and irreversible if left untreated. Structured databases such as registries are required to continuously collect standard data about patients with the same disease. OBJECTIVES: This study aimed to design and implement a vitiligo registry and evaluate its usability in Iran. METHODOLOGY: This research was conducted in four stages: determining the minimum data set required for the registry, creating a conceptual model using unified modeling language diagrams and Sparx Enterprise Architect software, implementing the registry in the PhpStorm programming environment, and evaluating the software usability based on the responses of 17 end users to a questionnaire. RESULTS: The required data items, consisting of 127 items in eight categories, were approved by the experts and used to design the vitiligo registry. Then, the software was designed and implemented. In the assessment stage, the software received a 89.5% approval rate from its users. CONCLUSION: Developing a vitiligo registry with high usability as well as making decisions based on the registry data can improve understanding of the disease and facilitate research in this field. As a result, high-quality services could be provided to patients nationwide. [ABSTRACT FROM AUTHOR]

Evaluation of the behavior of adsorbed layers of the protein-surfactant mixture at air-water interfaces has recently received great attention due to their many applications in food and pharmaceutical industries. This research study employs rising bubble method to investigate the qualitative study of surface activities of two kinds of proteins, i.e., Beta-Lactoglobulin (BLG) and Beta-Casein (BCS), non-ionic surfactant of C10DMPO, and the mixtures of them at different concentrations at the air-water interface. The similarity between measured local velocity profiles results from the fact that all the mentioned materials are surface-active, can create the Marangoni effect, and develop a dynamic adsorption layer. Given the insignificant interaction between the protein and surfactant molecules, stable complex structures cannot be formed in the protein-C10DMPO mixture. The mixture velocity profile is more similar to that of the surfactant resulting from the replacement of protein molecules or complexes with free surfactant at the bubble interface. It is found that the mixture of non-ionic surfactant and BCS has minor synergetic effect, while for its mixture with BLG, a negative synergy resulting from the shape of protein is observed. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) vaccines can significantly reduce the burden of HPV-associated cancers, but remain underutilized. We evaluated a multi-component, system-level intervention to improve HPV vaccination in a large Federally Qualified Health Center (FQHC) that serves a primarily low income Latino population. Methods: From January 2015 through March 2017, we evaluated the effectiveness of a multi-component, system-level intervention to improve HPV vaccination rates in eight clinics randomly assigned to study condition (four intervention, four usual care). The intervention included parent reminders for HPV vaccine series completion, provider training, clinic-level audit and feedback, and workflow modifications to reduce missed opportunities for vaccination. Using a difference-in-differences approach, we compared HPV vaccination rates among patients, ages 11 to 17 during a 12-month preintervention period and a 15-month intervention period. Linear mixed models were used to estimate intervention effects on vaccine initiation and completion. Results: The sample included approximately 15,000 adolescents each quarter (range 14,773-15,571; mean age 14 years; 51% female, 88% Latino). A significantly greater quarterly increase in HPV vaccine initiation was observed for intervention compared with usual care clinics (0.75 percentage point greater increase, P < 0.001), corresponding to 114 additional adolescents vaccinated per quarter. The intervention led to a greater increase in HPV vaccine completion rates among boys (0.65 percentage point greater increase, P < 0.001), but not girls. Conclusions: Our system-level intervention was associated with modest improvements in HPV vaccine initiation overall and completion among boys. Impact: Study findings have implications for reducing HPV-related cancers in safety net populations. [ABSTRACT FROM AUTHOR]

Disparities in care of older adults in cancer treatment trials and emergency department (ED) use exist. This report provides a baseline description of older adults ≥65 years old who present to the ED with active cancer. Planned secondary analysis of the Comprehensive Oncologic Emergencies Research Network observational ED cohort study sponsored by the National Cancer Institute. Of 1564 eligible adults with active cancer, 1075 patients were prospectively enrolled, of which 505 were ≥ 65 years old. We recruited this convenience sample from eighteen participating sites across the United States between February 1, 2016 and January 30, 2017. Compared to cancer patients younger than 65 years of age, older adults were more likely to be transported to the ED by emergency medical services, have a higher Charlson Comorbidity Index score, and be admitted despite no significant difference in acuity as measured by the Emergency Severity Index. Despite the higher admission rate, no significant difference was noted in hospitalization length of stay, 30-day mortality, ED revisit or hospital admission within 30 days after the index visit. Three of the top five ED diagnoses for older adults were symptom-related (fever of other and unknown origin, abdominal and pelvic pain, and pain in throat and chest). Despite this, older adults were less likely to report symptoms and less likely to receive symptomatic treatment for pain and nausea than the younger comparison group. Both younger and older adults reported a higher symptom burden on the patient reported Condensed Memorial Symptom Assessment Scale than to ED providers. When treating suspected infection, no differences were noted in regard to administration of antibiotics in the ED, admissions, or length of stay ≤2 days for those receiving ED antibiotics. We identified several differences between older (≥65 years old) and younger adults with active cancer seeking emergency care. Older adults frequently presented for symptom-related diagnoses but received fewer symptomatic interventions in the ED suggesting that important opportunities to improve the care of older adults with cancer in the ED exist. [ABSTRACT FROM AUTHOR]

Background and Aims: Atherosclerosis as a chronic inflammatory disorder of the arterial wall is the main leading cause of the cardiovascular disease (CVD). Caspase-dependent pyroptosis plays a pivotal role in the pathogenesis of CVD. Selenium (Se) is an important component of the antioxidant defense and plays a crucial role in cardiovascular health. This study aimed to investigate the effects of daily consumption of sodium selenite and Se-enriched yeast on the expression of pyroptosis-related genes, and biomarkers of oxidative stress in patients with atherosclerosis.Methods and Results: In this randomized, double-blinded, placebo-controlled clinical trial, 60 patients with atherosclerosis were recruited. Participants received 200 μg/day of sodium selenite, Se-enriched yeast, or placebo for 8 following weeks. The pyroptosis-related genes' mRNA expression in peripheral blood mononuclear cells (PBMCs) was assessed before and after the intervention. Also, the levels of superoxide dismutase (SOD), malondialdehyde (MDA), nitric oxide (NO), and glutathione peroxidases (GPX) were measured at baseline and following the intervention. Following sodium selenite and Se-enriched yeast supplementation, the relative expression levels of TLR4, ASC, NLRP3, and NF-κB1 were significantly downregulated (p < 0.05). Furthermore, the changes in GPX were significantly increased after selenite and yeast supplementation (p < 0.05). Also, selenite and yeast consumption caused a statistically significant decrease in the change of MDA level (p < 0.05).Conclusion: In summary, these findings showed that Se supplementation may reduce inflammation through down-regulation of some pro-inflammatory genes, improving antioxidant defenses in atherosclerosis patients. Further research is required to come to a definite conclusion of selenium supplementation on the CVD risk. This study was registered on the Iranian Registry of Clinical Trials website (identifier: RCT20110123005670N28; https://www.irct.ir/). [ABSTRACT FROM AUTHOR]

Primary healthcare will not be effective unless there is a proper referral system. In contrast, comparing the performance of healthcare systems provides an opportunity for policy makers to determine the status of the country's healthcare system compared with their international counterparts. Therefore, we ranked the countries in terms of indicators affected by the referral system. This study was conducted in 2020. In the first phase, which was to determine the indicators affected by a country's referral system, data were collected by the Delphi method, and therefore, 13 indicators with a content validity ratio equal to or greater than 0.42 were selected. In the second phase, the data of 13 indicators selected in the first phase were extracted from the 2018 and 2019 World Health Organization reports. The weight of the indicators was calculated based on the Decision-Making Trial and Evaluation Laboratory method–based Analytic Network Process (DANP) and Shannon's entropy, and the VIekriterijumsko KOmpromisno Rangiranje (VIKOR) method was used to rank the countries. SPSS 24 and Excel 2013 software were used for data analysis. Switzerland, Germany, and Sweden ranked first, second, and third, respectively. In all the 3 countries, there are no mandatory gatekeeping systems. Physicians, especially general practitioners, are the core of primary healthcare, and in all the 3 countries, there is a uniform and coherent health financing system that is either based on mandatory health insurance (Switzerland and Germany) or taxes (Sweden). India had the lowest ranking. It seems that the study of the health system of the countries that have obtained higher rankings can indicate their efforts in establishing a gatekeeping system, family physician program, and appropriate financing system. Therefore, other countries can study successful countries and copy them as a model to improve their health system. • The researchers used few indicators to rank the countries. • The decision-making trial and evaluation laboratory method–based analytic network process and Shannon's entropy were used to weigh the indicators affected by the referral system, and Vlsekriterijumska Optimizacija I Kompromisno Resenje was used to rank the countries. • Policy makers can take high-ranking countries as a model to improve their health system. [ABSTRACT FROM AUTHOR]

Lung cancer screening (LCS) decreases lung cancer mortality; however, that reduction depends upon screening adherence. The purpose of this study was to determine factors associated with adherence rate for LCS among patients with negative baseline CT results in a multi-integrated health care network. A retrospective analysis was conducted among patients with negative baseline CT results in a multi-integrated health care network LCS program between January 2015 and January 2020. The two outcomes were adherence for the first and second subsequent LCS studies. Negative baseline result was defined as a Lung CT Screening Reporting and Data System score 0, 1, or 2. Adherence was defined as undergoing a follow-up study within 11 to 15 months of a prior scan. Multivariable logistic regression was used to determine significant predictors of adherence, adjusting for patient demographics, median household income (on the basis of geocoding ZIP codes from the US Census Bureau), smoking history, screening sites, and provider specialty. A total of 30.7% (512 of 1,668) and 16.3% (270 of 1,660) of patients were adherent for the first two annual subsequent screens, respectively. First-year adherence was higher among former smokers and varied by site and provider specialty. Second-year adherence was higher among former smokers and varied by site, provider specialty, and pack-years smoked. Adherence to LCS in a multihospital integrated health care network was poor and even lower at year 2. The identified factors associated with adherence may serve as targets to increase LCS adherence and decrease lung cancer mortality. [ABSTRACT FROM AUTHOR]

Purpose: Lung cancer screening (LCS) decreases lung cancer mortality; however, that reduction depends upon screening adherence. The purpose of this study was to determine factors associated with adherence rate for LCS among patients with negative baseline CT results in a multi-integrated health care network.Methods: A retrospective analysis was conducted among patients with negative baseline CT results in a multi-integrated health care network LCS program between January 2015 and January 2020. The two outcomes were adherence for the first and second subsequent LCS studies. Negative baseline result was defined as a Lung CT Screening Reporting and Data System score 0, 1, or 2. Adherence was defined as undergoing a follow-up study within 11 to 15 months of a prior scan. Multivariable logistic regression was used to determine significant predictors of adherence, adjusting for patient demographics, median household income (on the basis of geocoding ZIP codes from the US Census Bureau), smoking history, screening sites, and provider specialty.Results: A total of 30.7% (512 of 1,668) and 16.3% (270 of 1,660) of patients were adherent for the first two annual subsequent screens, respectively. First-year adherence was higher among former smokers and varied by site and provider specialty. Second-year adherence was higher among former smokers and varied by site, provider specialty, and pack-years smoked.Conclusions: Adherence to LCS in a multihospital integrated health care network was poor and even lower at year 2. The identified factors associated with adherence may serve as targets to increase LCS adherence and decrease lung cancer mortality. [ABSTRACT FROM AUTHOR]

Background: Introduction of the human papillomavirus (HPV) vaccine in 2006 was a game-changing advance in cancer control. Despite the vaccine's potential cancer prevention benefits, uptake remains low. We utilized a randomized design to evaluate a multicomponent intervention to improve HPV vaccine uptake among low-income, ethnic minority adolescents seeking services through a county health department telephone hotline. Methods: Hotline callers who were caregivers of never-vaccinated adolescents (11-17 years) were randomized by call-week to intervention or control conditions. The intervention included brief telephone and print education, delivered in multiple languages, and personalized referral to a low-cost/free vaccine provider. Participants completed baseline (n = 238), 3-month (n = 215), and 9-month (n = 204) telephone follow-up surveys. Results: HPV vaccine initiation rates increased substantially by 9-month follow-up overall, although no differences were observed between intervention and control groups (45% vs. 42%, respectively, P > 0.05). We also observed significant improvements in perceived HPV risk, barriers to vaccination, and perceived knowledge in both study conditions (P < 0.05). Conclusions: A low-intensity county hotline intervention did not produce a greater increase in HPV vaccination rates than routine practice. However, 44% of unvaccinated adolescents in both conditions received at least one dose of the vaccine, which can be viewed as a successful public health outcome. Future studies should evaluate more intensive interventions that address accessing and utilizing services in complex safety net settings. Impact: Study results suggest the need for investigators to be aware of the potential priming effects of study participation, which may obscure the effect of low-intensity interventions. [ABSTRACT FROM AUTHOR]

Purpose: The ACR developed the Lung CT Screening Reporting and Data System (Lung-RADS) to standardize the diagnostic follow-up of suspicious screening findings. A retrospective analysis showed that Lung-RADS would have reduced the false-positive rate in the National Lung Screening Trial, but the optimal timing of follow-up examinations has not been established. In this study, we assess the effectiveness of alternative diagnostic follow-up intervals on lung cancer screening.Methods: We used the Lung Cancer Outcome Simulator to estimate population-level outcomes of alternative diagnostic follow-up intervals for Lung-RADS categories 3 and 4A. The Lung Cancer Outcome Simulator is a microsimulation model developed within the Cancer Intervention and Surveillance Modeling Network Consortium to evaluate outcomes of national screening guidelines. Here, among the evaluated outcomes are percentage of mortality reduction, screens performed, lung cancer deaths averted, screen-detected cases, and average number of screens and follow-ups per death averted.Results: The recommended 3-month follow-up interval for Lung-RADS category 4A is optimal. However, for Lung-RADS category 3, a 5-month, instead of the recommended 6-month, follow-up interval yielded a higher mortality reduction (0.08% for men versus 0.05% for women), and a higher number of deaths averted (36 versus 27), a higher number of screen-detected cases (13 versus 7), and a lower number of combined low-dose CTs and diagnostic follow-ups per death avoided (8 versus 5), per one million general population. Sensitivity analysis of nodule progression threshold verifies a higher mortality reduction with a 1-month earlier follow-up for Lung-RADS 3.Conclusions: One-month earlier diagnostic follow-ups for individuals with Lung-RADS category 3 nodules may result in a higher mortality reduction and warrants further investigation. [ABSTRACT FROM AUTHOR]

Determining surveillance intervals for patients with colorectal polyps is critical but time-consuming and challenging to do reliably. We present the development and assessment of a pipeline that leverages natural language processing techniques to automatically extract and analyze relevant polyp findings from free-text colonoscopy and pathology reports. Using this information, we categorized individual patients into 6 postcolonoscopy surveillance intervals defined by the U.S. Multi-Society Task Force on Colorectal Cancer. Using a set of 546 randomly selected colonoscopy and pathology reports from 324 patients in a single health system, we used a combination of statistical classifiers and rule-based methods to extract polyp properties from each report type, associate properties with unique polyps, and classify a patient into 1 of 6 risk categories by integrating information from both report types. We then assessed the pipeline's performance by determining the positive predictive value (PPV), sensitivity, and F-score of the algorithm, compared with the determination of surveillance intervals by a gastroenterologist. The pipeline was developed using 346 reports (224 colonoscopy and 122 pathology) from 224 patients and evaluated on an independent test set of 200 reports (100 colonoscopy and 100 pathology) from 100 patients. We achieved an average PPV, sensitivity, and F-score of.92,.95, and.93, respectively, across targeted entities for colonoscopy. Pathology extraction achieved a PPV, sensitivity, and F-score of.95,.97, and.96. The system achieved an overall accuracy of 92% in assigning the recommended interval for surveillance colonoscopy. This study demonstrates the feasibility of using machine learning to automatically extract findings and classify patients to appropriate risk categories and corresponding surveillance intervals. Incorporating this system can facilitate proactive and timely follow-up after screening colonoscopy and enable real-time quality assessment of prevention programs and providers. [ABSTRACT FROM AUTHOR]

The mechanical properties of fiber reinforced polymer (FRP) materials have been of great interest in recent years as the applications of these materials in civil engineering and other industries have expanded. However, the utilization of FRP products, especially for new materials, has been limited because of a lack of complete knowledge about their properties. The primary objective of this study is to determine the various mechanical properties of five commonly used FRP materials. The study found that carbon FRP and high-strength glass FRP would be the best suitable materials for rehabilitation of structural elements when an increase in strength and stiffness is the primary objective. However, basalt FRP and E-glass FRP would be a far better choice for rehabilitation when ductility is the primary objective. The other objective of this study was to evaluate the application of a new digital technology, known as digital image correlation (DIC) technique, for the determination of mechanical properties of FRP materials. In this study, the strain data obtained from the DIC method were validated with strain data obtained from conventional methods (strain gage). It was found that DIC is a reliable and accurate noncontact testing method that can be successfully used for determining mechanical properties of various FRP materials. [ABSTRACT FROM AUTHOR]

Discrete choice experiment (DCE) has been increasingly used in studies investigating preferences of the health workforce. This pilot study aimed to provide a comprehensive protocol for design and quality assessment of a DCE to elicit preferences of general practitioners for the choice of specialty. We conducted 3 rigorous qualitative studies, including a review of literature, qualitative interviews, and focus group discussion to develop attributes and levels of the DCE. Then a D-efficient fractional factorial design was applied to generate choice tasks and to block them into 4 equal versions using SAS software. Two hundred and forty general practitioners participated in a pilot study conducted to evaluate the quality of the instrument using 7 tests. The qualitative studies resulted in the development of 8 attributes and 24 levels. Experimental design led to the generation of 36 choice tasks divided into 4 blocks. The pilot study revealed that the instrument has validity and reliability and also indicated that the design is comprehensible and feasible. This study provided an integrated, comprehensive framework for development and quality assessment of a DCE that could be used in other studies. The pilot study indicated that the instrument is of sufficient quality because it was developed using rigorous qualitative studies and accurate experimental design method. • Discrete choice experiment (DCE) has been increasingly used in health studies. • This study contributes to the knowledge about the development of DCE by providing a detailed protocol on designing the survey and reporting on the results of instrument pilot testing for feasibility, comprehensibility, validity, and reliability. • This protocol can be used as a comprehensive guide in studies aimed at examining health workforce preferences. [ABSTRACT FROM AUTHOR]

This study aimed to assess the effect of Citrus aurantium L. flower on the distance between two cycles, physical activity, days of bleeding, and intensity of dysmenorrhoea (primary objectives), and complications of interventions or adverse effects (secondary purpose). This double-blind, randomised controlled clinical trial was conducted on 105 girls (15–20 years old) with primary dysmenorrhoea. In the intervention cycles, from the first to the third day, participants received 250 mg C. aurantium flower hydro-alcoholic extract capsule, Mefenamic acid (MA) capsule, or placebo three times a day based on the study groups. The results showed that the severity of dysmenorrhoea in the groups consuming C. aurantium flower and MA was significantly lower than that before the intervention and compared to the placebo group (P < 0.001), which this reduction in the severity of pain in the C. aurantium flower group was also significantly higher than that of the MA group (P < 0.001) at the first and second days. C. aurantium flower had higher efficacy and satisfaction rate and lower side effects in reducing the severity of primary dysmenorrhoea compared to MA. [ABSTRACT FROM AUTHOR]

The article presents the discussion on Rock art, which can be found in almost all parts of the world. Topics include Saeed Rahimi, as the subject of his dissertation, studied and analysed the newly discovered petroglyphs of Arak and Shazand, Markazi Province; and Domesian petroglyphs extend over 2 km in the lower parts of foothills, 3 km south-east of Domesian village near Khomeyn, Markazi Province of Iran.

Introduction: Intracranial injury in elderly patients presenting with minor head trauma is often overlooked in the emergency department (ED). Our suburban community-based level II trauma hospital developed and implemented the level III trauma protocol (L3TP) in January 2016 to better evaluate and diagnose intracranial injury in elderly patients presenting with minor head trauma after a fall. The L3TP requires that the ED physician immediately assess all patients meeting the following criteria 1) Age ≥ 65 years old. 2) Currently taking any anticoagulant or antiplatelet agents. 3) Presenting in the ED with a potential head injury after a fall. The ED physician determines if these high-risk patients require emergent imaging, obviating the need for trauma team activation unless an intracranial hemorrhage (ICH) is found. The purpose of this study was to assess the impact of the novel L3TP on resource utilization and patient outcome.Methods: Our retrospective cohort study included patients who met the L3TP inclusion criteria and had an ICH diagnosed by non-contrast computed tomography (CT). We compared patients triaged by the L3TP (January to December 2017) to patients triaged before the L3TP was implemented (January to August 2015) in order to assess the impact of the L3TP on resource utilization and patient outcome. The data was analyzed using two independent samples t-tests and Chi-square tests.Results: Patients triaged by the L3TP had a significantly shorter average length of time from arrival in the ED to CT (level III trauma 0.64 h vs control 2.37 h, (d = 1.73; 95% CI = 1.42, 2.04), p ≤ 0.0001) and ED length of stay (level III trauma 2.55 h vs control 4.72 h, (d = 2.17; 95% CI = 1.21, 3.13), p ≤ 0.0001). There was insufficient evidence to conclude that there was any difference in health outcomes between the control and level III trauma groups.Conclusion: The L3TP is an effective and resource efficient protocol that quickly identifies ICH in elderly patients without activating the trauma team for every elderly patient presenting to the ED with a potential head injury after a fall. [ABSTRACT FROM AUTHOR]

Background: Liver cancer is one of the most rapidly increasing cancers in the United States, and hepatocellular carcinoma (HCC) is its most common form. Disease burden and risk factors differ by sex and race/ethnicity, but a comprehensive analysis of disparities by socioeconomic status (SES) is lacking. We examined the relative impact of race/ethnicity, sex, and SES on HCC incidence, stage, and survival. Methods: We used Surveillance, Epidemiology, and End Results (SEER) 18 data to identify histologically confirmed cases of HCC diagnosed between January 1, 2000 and December 31, 2015. We calculated age-adjusted HCC incidence, stage at diagnosis (local, regional, distant, unstaged), and 5-year survival, by race/ethnicity, SES and sex, using SEER*Stat version 8.3.5. Results: We identified 45,789 cases of HCC. Incidence was highest among low-SES Asian/Pacific Islanders (API; 12.1) and lowest in high-SES Whites (3.2). Incidence was significantly higher among those with low-SES compared with high-SES for each racial/ethnic group (P < 0.001), except American Indian/Alaska Natives (AI/AN). High-SES API had the highest percentage of HCC diagnosed at the local stage. Of all race/ethnicities, Blacks had the highest proportion of distant stage disease in the low- and high-SES groups. Survival was greater in all high-SES racial/ethnic groups compared with low-SES (P < 0.001), except among AI/ANs. Black, low-SES males had the lowest 5-year survival. Conclusions: With few exceptions, HCC incidence, distant stage at diagnosis, and poor survival were highest among the low-SES groups for all race/ethnicities in this national sample. [ABSTRACT FROM AUTHOR]

Using Tchebichef Moments, this study has introduced a new method for imperceptible watermarking of the medical images with a high embedding capacity and robustness against the various attacks. The suggested method applies conditional quantization based on dither modulation to minimize the number of the moment orders that need to be changed. Reduction of modified moments increases the watermark imperceptibility and hence decreases the attacks probability. The proposed method has been examined in the presence of such factors as quantization step and watermark size. Experimental results show that average PSNR is 53.91 dB for 16384 embedding watermark bits. Moreover, the introduced algorithm has been tested for known attacks like scaling, cropping, noise, etc. It has been shown that our proposed method has proper security and robustness against various attacks. In addition, zero false positive rate on non-watermarked images has been obtained. [ABSTRACT FROM AUTHOR]

Ontology-based similarity measures have received much importance in recent years. In many real-world cases, the domain considered in the ontological similarity assessment consists of uncertainty or incomplete information. Such vagueness has led to the successful implementation of fuzzy ontology (FO)-based similarity measures. Despite various applications of FO-based similarity measures, limited methods have so far been proposed for this purpose. Accordingly, this paper presents a generic model for semantic similarity assessment based on a fuzzy ontology. The proposed approach relies on the broad literature of Crisp Ontology-based Structural Semantic Similarity Measures (CO-SSSM). It provides an approach for mapping CO-SSSMs to fuzzy context. Consequently, the proposed generic model can be applied to various CO-SSSMs to develop their corresponding FO-SSSMs. In this regard, as an empirical investigation, four of the common CO-SSSMs were selected, their equivalent FO-SSSMs were developed by means of the proposed approach, and the accuracy of their similarity assessment was compared with each other. The results show the power of FO-SSSMs in describing the relations between concepts and their superiority over CO-SSSMs. [ABSTRACT FROM AUTHOR]

Direct-to-angiography (DTA) is a novel care pathway for endovascular treatment (EVT) of acute ischemic stroke (AIS) that has been shown to reduce time-to-treatment and improve clinical outcomes for EVT-eligible patients. The institutional costs of adopting the DTA pathway and the many factors affecting costs have not been studied. In this study, we assess the costs and main cost drivers associated with the DTA pathway compared to the conventional CT pathway for patients presenting with AIS and suspected LVO in the anterior circulation. Time driven activity based costing (TDABC) model was used to compare costs of DTA and conventional pathways from the healthcare institution perspective. Process mapping was used to outline all activities and resources (personnel, equipment, materials) needed for each step in both pathways. The cost model was developed using our institutional patient database and average New York state wages for personnel costs. Total, incremental and proportional costs were calculated based on institutional and patient factors affecting the pathways. DTA pathway accrued additional $82,583.61 (9%) in total costs compared to the conventional approach for all AIS patients. For EVT-ineligible patients, the DTA pathway incurred additional $82,964.37 (76%) in total costs compared to the CT pathway. For EVT eligible patients, the total and per-patient costs were greater in the CT pathway by $380.76 (0.04%) and $5.60 (0.04%) respectively. As the DTA pathway incurred additional $82,964.37 for EVT-ineligible patients, appropriate patient selection criteria are needed to avoid transferring EVT-ineligible patients to the angiography suite. [ABSTRACT FROM AUTHOR]