Search

Introduction: Breast cancer is the most common cancer among women. The occurrence of breast cancer in the female Libyan population is strongly associated with young age with nearly 70.9% of cases arising in female individuals who are 50 years or younger. In 2004 breast cancer in Libya was the most common malignancy in females as recorded by Benghazi Cancer Registry. Aim: To determine the knowledge, attitudes, and practices (KAP) of Libyan females attending primary health care centers in Benghazi regarding breast cancer. Methodology: A cross – sectional descriptive study, total of 500 women attending health care centers in Benghazi. Result: Nearly all participants 499 (99.8%) had heard about breast cancer, 295(59%) of participants had never heard about breast self-examination (BSE), the majority of them had not practiced BSE 344 (68.8%), 137 (27.4%) underwent screening by CBE, most of them 442 (88.4%) had not performed mammogram examination. Conclusion: The result revealed that the Libyan women attending the selected health care institutions had a good knowledge level about basic information regarding breast cancer, its signs, symptoms and its risk factors. It revealed they had poor knowledge for BSE, CBE and mammography, and had positive attitudes but poor practice.

Introduction: Diabetes Mellitus Type 2 DM (T2DM) is a metabolic disorder that accounts for 90% to 95% of all cases of DM. The success of T2DM therapy in controlling blood glucose with self-management can be influenced by individual characteristics, knowledge, health status, health system, and selection of anti-diabetic drugs. Self-management of DM patients is the attitude that patients apply to their understanding of DM, such as controlling diet, physical activity, medication adherence, and glucose management. Education by health workers about basic information on controlling glucose levels and the prevention of complications will improve the self-management of T2DM patients. Objective: This Community Service Program (CSP) aims to increase knowledge, self-management, and control of glucose levels in T2DM patients. Method: This CSP method uses lectures with leaflet media, discussions, questions and answers, and interviews, covering the preparation to evaluation stages individually. Measurement of self-management using the Diabetes Self-management Questionnaire (DSMQ). PCM partner is an Integrated Service for the Elderly in Tipar Kidul Village, Ajibarang. Result: The results of this CSP are that the blood glucose levels of CSP participants have an average blood glucose value of 244.8 mg/dl. As many as 26 (86.3%) are in the uncontrolled and hyperglycemic categories. The result was that the participants' blood glucose levels were 244.8 mg/dl, and 26 (86.3%) were in the uncontrolled or hyperglycemic category. Participants' self-management had a mean value of 37.4, included in the high or good level, and 19 (63%) were in the sufficient category. Conclusion: The outputs of this CSP activity are leaflets as educational media, intellectual property rights certificates of educational brochures, and publications in CSP journals.

This article mathematically models the migration of radio-active molecules injected into the human body during a medical examination of the Positron emission tomography type. It is a medical examination used (requested) for the detection of cancer in a human body. The article begins with a description of the migration processes of a particle. Then the modeling equations are introduced.

Prostate cancer is the most common malignancy and the third most common cause of death in Canadian men. In light of evolving diagnostic pathways for prostate cancer and the increased use of MRI, which now includes its use in men prior to biopsy, the Canadian Association of Radiologists established a Prostate MRI Working Group to produce a white paper to provide recommendations on establishing and maintaining a Prostate MRI Programme in the context of the Canadian healthcare system. The recommendations, which are based on available scientific evidence and/or expert consensus, are intended to maintain quality in image acquisition, interpretation, reporting and targeted biopsy to ensure optimal patient care. The paper covers technique, reporting, quality assurance and targeted biopsy considerations and includes appendices detailing suggested reporting templates, quality assessment tools and sample image acquisition protocols relevant to the Canadian healthcare context.

Ice deposits on Earth provide an extended record of volcanism, planetary climate, and life. On Mars, such a record may extend as far back as tens to hundreds of millions of years (My), compared to only a few My on Earth. Here, we propose and demonstrate a compact instrument, the Melter-Sublimator for Ice Science (MSIS), and describe its potential use cases. Similar to current use in the analysis of ice cores, linking MSIS to downstream elemental, chemical, and biological analyses could address whether Mars is, or was in the recent past, volcanically active, enable the creation of a detailed climate history of the late Amazonian, and seek evidence of subsurface life preserved in ice sheets. The sublimation feature can not only serve as a preconcentrator for in-situ analyses, but also enable the collection of rare material such as cosmogenic nuclides, which could be returned to Earth and used to confirm and expand the record of nearby supernovas and long-term trends in space weather. Missions to Ocean Worlds such as Europa or Enceladus will involve ice processing, and there MSIS would deliver liquid samples for downstream wet chemistry analyses. Our combined melter-sublimator system can thus help to address diverse questions in heliophysics, habitability, and astrobiology., Comment: 10 pages, 5 figures

Magnetic resonance imaging is the current gold standard imaging modality for diagnosing anterior cruciate ligament (ACL) tears. However, ultrasound has grown in popularity for detecting ACL injuries because of its low cost, portability, and dynamic assessment capabilities. Recent studies demonstrate high sensitivity and specificity for diagnosing isolated ACL tears via ultrasound, but tremendous heterogeneity remains for optimal technique including patient positioning, transducer placement, and dynamic versus static ultrasound usage. As ultrasound becomes ubiquitous in clinics, training rooms, and on the sidelines, identifying objective and sensitive measurements to appropriately screen athletes for significant knee injuries is imperative. This article aims to review the current role of diagnostic ultrasound in ACL injuries and propose a standardized version of the Prone Lachman with Ultrasound test, which is an objective, reliable, and easily reproducible technique to evaluate ACL competency. Developing a standardized protocol will expand the use of point-of-care ultrasound, which may reduce cost and improve efficiency in care.

Background: Globally, there is increasing interest in the use of real-world data (RWD) and real-world evidence (RWE) to inform health technology assessment (HTA) and reimbursement decision-making. Using current practices and case studies shared by eleven health systems in Asia, a non-binding guidance that seeks to align practices for generating and using RWD/RWE for decision-making in Asia was developed by the REAL World Evidence In ASia for HEalth Technology Assessment in Reimbursement (REALISE) Working Group, addressing a current gap and needs among HTA users and generators. Methods: The guidance document was developed over two face-to-face workshops, in addition to an online survey, a face-to-face interview and pragmatic search of literature. The specific focus was on what, where and how to collect RWD/ RWE. Results: All 11 REALISE member jurisdictions participated in the online survey and the first in-person workshop, 10 participated in the second in-person workshop, and 8 participated in the in-depth face-to-face interviews. The guidance document was iteratively reviewed by all working group members and the International Advisory Panel. There was substantial variation in: (a) sources and types of RWD being used in HTA; and (b) the relative importance and prioritization of RWE being used for policymaking. A list of national-level databases and other sources of RWD available in each country was compiled. A list of useful guidance on data collection, quality assurance and study design were also compiled. Conclusion: The REALISE guidance document serves to align the collection of better quality RWD and generation of reliable RWE to ultimately inform HTA in Asia.

BACKGROUND Heart failure (HF) is the leading cause of hospitalization among older adults in the United States. There are substantial racial and geographic disparities in HF outcomes, with patients living in southern US states having a mortality rate 69% higher than the national average. Self-management behaviors, particularly daily weight monitoring and physical activity, are extremely important in improving HF outcomes; however, patients typically have particularly low adherence to these behaviors. With the rise of digital technologies to improve health outcomes and motivate health behaviors, sensor-controlled digital games (SCDGs) have become a promising approach. SCDGs, which leverage sensor-connected technologies, offer the benefits of being portable and scalable and allowing for continuous observation and motivation of health behaviors in their real-world contexts. They are also becoming increasingly popular among older adults and offer an immersive and accessible way to measure self-management behaviors and improve adherence. No SCDGs have been designed for older adults or evaluated to test their outcomes. OBJECTIVE This randomized clinical trial aims to assess the efficacy of a SCDG in integrating the behavioral data of participants with HF from weight scale and activity tracker sensors to activate game progress, rewards, and feedback and, ultimately, to improve adherence to important self-management behaviors. METHODS A total of 200 participants with HF, aged ≥45 years, will be recruited and randomized into 2 groups: the SCDG playing group (intervention group) and sensor-only group (control group). Both groups will receive a weight scale, physical activity tracker, and accompanying app, whereas only the intervention group will play the SCDG. This design, thereby, assesses the contributions of the game. All participants will complete a baseline survey as well as posttests at 6 and 12 weeks to assess the immediate effect of the intervention. They will also complete a third posttest at 24 weeks to assess the maintenance of behavioral changes. Efficacy and benefits will be assessed by measuring improvements in HF-related proximal outcomes (self-management behaviors of daily weight monitoring and physical activity) and distal outcomes (HF hospitalization, quality of life, and functional status) between baseline and weeks 6, 12, and 24. The primary outcome measured will be days with weight monitoring, for which this design provides at least 80% power to detect differences between the 2 groups. RESULTS Recruitment began in the fall of 2022, and the first patient was enrolled in the study on November 7, 2022. Recruitment of the last participant is expected in quarter 1 of 2025. Publication of complete results and data from this study is expected in 2026. CONCLUSIONS This project will generate insight and guidance for scalable and easy-to-use digital gaming solutions to motivate persistent adherence to HF self-management behaviors and improve health outcomes among individuals with HF. CLINICALTRIAL ClinicalTrials.gov NCT05056129; https://clinicaltrials.gov/ct2/show/NCT05056129 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/45801

Contains fulltext : 294548.pdf (Publisher’s version ) (Open Access) OBJECTIVES: Uncertainty is a fundamental component of decision making regarding access to and pricing and reimbursement of drugs. The context-specific interpretation and mitigation of uncertainty remain major challenges for decision makers. Following the 2021 HTAi Global Policy Forum, a cross-sectoral, interdisciplinary HTAi-DIA Working Group (WG) was initiated to develop guidance to support stakeholder deliberation on the systematic identification and mitigation of uncertainties in the regulatory-HTA interface. METHODS: Six online discussions among WG members (Dec 2021-Sep 2022) who examined the output of a scoping review, two literature-based case studies and a survey; application of the initial guidance to a real-world case study; and two international conference panel discussions. RESULTS: The WG identified key concepts, clustered into twelve building blocks that were collectively perceived to define uncertainty: "unavailable," "inaccurate," "conflicting," "not understandable," "random variation," "information," "prediction," "impact," "risk," "relevance," "context," and "judgment." These were converted into a checklist to explain and define whether any issue constitutes a decision-relevant uncertainty. A taxonomy of domains in which uncertainty may exist within the regulatory-HTA interface was developed to facilitate categorization. The real-world case study was used to demonstrate how the guidance may facilitate deliberation between stakeholders and where additional guidance development may be needed. CONCLUSIONS: The systematic approach taken for the identification of uncertainties in this guidance has the potential to facilitate understanding of uncertainty and its management across different stakeholders involved in drug development and evaluation. This can improve consistency and transparency throughout decision processes. To further support uncertainty management, linkage to suitable mitigation strategies is necessary.

It has previously been demonstrated in tissue-mimicking phantoms and in tissue that envelope statistics of US backscatter are affected by changes in the scatterer properties [1–4, 32, 37]. At higher frequencies the wavelength of the US begins to approach the size of cells and cellular components and at this scale the envelope statistics of HFUS backscatter become more sensitive to structural changes within cells. To investigate the relation between the envelope statistics and cell structure, experiments were performed in vitro. The physical meaning of the fit parameters was evaluated by investigating HFUS backscatter from suspensions of various concentrations of two different cell lines of different sizes.

During cell death a series of structural changes occur within the cell. We have shown that cell ensembles and tissues undergoing structural changes associated with various cell death pathways can be detected using high-frequency ultrasound. In our effort to better understand the nature of backscatter from collections of cells (which emulate tissues), we have collected raw RF backscatter data from cells of two different sizes in solutions for a series of concentrations or in pellet form. Human acute myeloid leukemia cells (AML-5, ~10µm in diameter) and transformed prostate cells (~25-30µm in diameter) were imaged either in suspension or in pellet form. Images and radiofreqeuncy data were acquired using a VS40B ultrasound instrument (VisualSonics Inc., Toronto, Ont) and 20MHz, 30MHz and 40MHz transducers with -6dB bandwidths approaching 100%. The cells were either imaged in degassed phosphate buffered solution in which their volumetric fraction increased from 0.0025% to 2%, or in pellet form by using a swinging bucket centrifuge. It was found that the backscatter power (as measured by the mid-band fit) increased by ~ 3 dB for both cell types in dilute solutions for which the volumetric concentration was doubled for a specific range of cell concentrations (which was dependent on cell size). In pellet form the backscatter power from the prostate cell pellets was ~12-14dB greater than the AML cell pellets. A comparison of the spectral slopes also strongly suggests a change in the scattering source contributions when the cells are in pellets: the spectral slope was negative for all concentrations for prostate cells imaged at 40MHz, but positive when measured in pellets. This is consistent an increased contribution to the backscatter of smaller sized scatterers (such as the cell nucleus) that manifests itself only when the cells are in pellets but not in solution. These data will be compared to theoretical predictions and their significance discussed.

BACKGROUND Various technological interventions have been proposed and studied to address the growing demand for care of residents in assisted living facilities, in which a preexisting shortage of professional caregivers has been exacerbated by the COVID-19 pandemic. Care robots are one such intervention with the potential to improve both the care of older adults and the work life of their professional caregivers. However, concerns about efficacy, ethics, and best practices in the applications of robotic technologies in care settings remain. OBJECTIVE This scoping review aimed to examine the literature on robots used in assisted living facilities and identify gaps in the literature to guide future research. METHODS On February 12, 2022, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) protocol, we searched PubMed, CINAHL Plus with Full Text, PsycINFO, IEEE Xplore digital library, and ACM Digital Library using predetermined search terms. Publications were included if they were written in English and focused on the use of robotics in assisted living facilities. Publications were excluded if they did not provide peer-reviewed empirical data, focused on user needs, or developed an instrument to study human-robot interaction. The study findings were then summarized, coded, and analyzed using the Patterns, Advances, Gaps, Evidence for practice, and Research recommendations framework. RESULTS The final sample included 73 publications from 69 unique studies on the use of robots in assisted living facilities. The findings of studies on older adults were mixed, with some studies suggesting positive impacts of robots, some expressing concerns about robots and barriers to their use, and others being inconclusive. Although many therapeutic benefits of care robots have been identified, methodological limitations have weakened the internal and external validity of the findings of these studies. Few studies (18/69, 26%) considered the context of care: most studies (48/69, 70%) collected data only on recipients of care, 15 studies collected data on staff, and 3 studies collected data on relatives or visitors. Theory-driven, longitudinal, and large sample size study designs were rare. Across the authors’ disciplines, a lack of consistency in methodological quality and reporting makes it difficult to synthesize and assess research on care robotics. CONCLUSIONS The findings of this study call for more systematic research on the feasibility and efficacy of robots in assisted living facilities. In particular, there is a dearth of research on how robots may change geriatric care and the work environment within assisted living facilities. To maximize the benefits and minimize the consequences for older adults and caregivers, future research will require interdisciplinary collaboration among health sciences, computer science, and engineering as well as agreement on methodological standards.

Au cours des dernières années, l’utilisation recommandée du vaccin vivant atténué contre l’influenza (VVAI) pour les enfants a évolué aux États-Unis en réponse aux preuves d’une diminution potentielle de l’efficacité du VVAI basées sur la surveillance post-commercialisation. Ces problèmes n’ont pas été observés au Canada ou ailleurs ; par conséquent, les recommandations du Comité consultatif national de l’immunisation (CCNI) du Canada et du Advisory Committee on Immunization Practices (ACIP) des États-Unis sur l’opportunité d’utiliser le VVAI ont différé pour deux saisons grippales (2016–2017 et 2017–2018). Cette rétrospective décrit comment le CCNI est parvenu à ses recommandations en réponse aux signaux post-commercialisation d’une baisse de performance des VVAI provenant des États-Unis en 2013–2014 et à nouveau en 2015–2016. L’expérience du CCNI avec le VVAI marque la première fois au Canada où une recommandation préférentielle sur l’utilisation d’un vaccin antigrippal dans un programme d’immunisation systématique a été renversée. Cette expérience souligne l’importance d’une surveillance continue des vaccins après leur mise sur le marché, d’une collaboration internationale et d’une prise en compte attentive du contexte local pour étayer les recommandations relatives aux vaccins. La capacité du CCNI à réagir rapidement aux signaux de performance des vaccins après leur mise sur le marché facilitera la réaction à des signaux similaires de surveillance après la mise sur le marché des vaccins contre la maladie à coronavirus 2019 (COVID-19).

Over the last several years, the recommended use of the live-attenuated influenza vaccine (LAIV) for children has evolved in the United States (US) in response to evidence of a potential decrease in LAIV effectiveness based on post-market monitoring. These issues were not observed in Canada or elsewhere; consequently, recommendations from Canada’s National Advisory Committee on Immunization (NACI) and the US Advisory Committee on Immunization Practices (ACIP) on whether to use LAIV differed for two influenza seasons (2016–2017 and 2017–2018). This retrospective describes how NACI arrived at its recommendations in response to post-market signals of reduced LAIV performance from the US in 2013–2014 and again in 2015–2016. NACI’s experience with LAIV marks the first time in Canada where a preferential recommendation on the use of an influenza vaccine in a routine immunization program was reversed. This experience highlights the importance of ongoing post-market monitoring of vaccines, international collaboration and careful consideration of local context to inform vaccine recommendations. NACI’s capacity for timely responses to post-market vaccine performance signals will facilitate responsiveness to similar post-market monitoring signals from the coronavirus disease 2019 (COVID-19) vaccines.

systematic review protocol

Purple urine bag syndrome (PUBS) is a rare clinical entity. Few cases are described in the literature. It occurs in patients with predisposing factors. Here in, we reported a case of a PUBS in an 85-year-old female patient. She presented to the emergency room with confusion and oliguria over the past five days in a context of fever. Her past medical history was diabetes, hypertension and chronic kidney failure with preserved diuresis. Since two months, the patient was bedridden after a left femur fracture. During her hospitalization, the urinary catheter placement revealed initially hematicurine, which became purplish next day that consisted with PUBS diagnosis. A multi-sensitive Klebsiella pneumoniae was isolated in the urine culture and treated by antibiotics with replacement of an indwelling catheter and urine bag. On the third day of antibiotic therapy, the urine reached gradually the normal color. The outcome was favorable. Purple urine bag syndrome must be recognized by the clinician to ensure an adequate patient management and avoid unnecessary explorations.

BACKGROUND In North America, the first dose of a measles-containing vaccine (MCV1) is administered at ≥12 months of age. However, MCV1 may be given to infants

Background Various technological interventions have been proposed and studied to address the growing demand for care of residents in assisted living facilities, in which a preexisting shortage of professional caregivers has been exacerbated by the COVID-19 pandemic. Care robots are one such intervention with the potential to improve both the care of older adults and the work life of their professional caregivers. However, concerns about efficacy, ethics, and best practices in the applications of robotic technologies in care settings remain. Objective This scoping review aimed to examine the literature on robots used in assisted living facilities and identify gaps in the literature to guide future research. Methods On February 12, 2022, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) protocol, we searched PubMed, CINAHL Plus with Full Text, PsycINFO, IEEE Xplore digital library, and ACM Digital Library using predetermined search terms. Publications were included if they were written in English and focused on the use of robotics in assisted living facilities. Publications were excluded if they did not provide peer-reviewed empirical data, focused on user needs, or developed an instrument to study human-robot interaction. The study findings were then summarized, coded, and analyzed using the Patterns, Advances, Gaps, Evidence for practice, and Research recommendations framework. Results The final sample included 73 publications from 69 unique studies on the use of robots in assisted living facilities. The findings of studies on older adults were mixed, with some studies suggesting positive impacts of robots, some expressing concerns about robots and barriers to their use, and others being inconclusive. Although many therapeutic benefits of care robots have been identified, methodological limitations have weakened the internal and external validity of the findings of these studies. Few studies (18/69, 26%) considered the context of care: most studies (48/69, 70%) collected data only on recipients of care, 15 studies collected data on staff, and 3 studies collected data on relatives or visitors. Theory-driven, longitudinal, and large sample size study designs were rare. Across the authors’ disciplines, a lack of consistency in methodological quality and reporting makes it difficult to synthesize and assess research on care robotics. Conclusions The findings of this study call for more systematic research on the feasibility and efficacy of robots in assisted living facilities. In particular, there is a dearth of research on how robots may change geriatric care and the work environment within assisted living facilities. To maximize the benefits and minimize the consequences for older adults and caregivers, future research will require interdisciplinary collaboration among health sciences, computer science, and engineering as well as agreement on methodological standards.

ZnO-CdO nanocomposites (CZ1, CZ2 and CZ3) were prepared by sol–gel (pyrolysis) technique on the polyvinyl alcohol (PVA) polymeric network for used as thin films coated glass substrate via screen printing as NO2 gas sensitivity agent. The as-synthesized composite samples were analyzed by using X-ray diffraction (XRD), Fourier transforms infrared spectroscopy (FTIR), Ultraviolet spectroscopy (UV–vis) and scanning electron microscope (SEM). The results from XRD and FTIR are showed that the formation of the ZnO-CdO nanocomposite. The SEM images are showed that the ZnO-CdO nanocomposites comprise of spherical particles in the size range of 20–30 nm. The optical absorption results revealed that the optical properties of prepared ZnO-CdO nanocomposites. The CZ1 nanocomposite displays perfect capability to discover NO2 gas.

Background and Objectives Outcome measures can be defined as the quality and cost targets health care organizations are trying to improve. Health-related outcomes are used to assess the effect, both positive and negative, of an intervention or treatment. To be meaningful and relevant, outcomes should ideally focus on what matters to the population to whom an intervention is applied and who may experience the outcomes. In this commentary, with a GRADE perspective in mind, we will introduce a conceptual model to address the many health care stakeholders, for example, in health technology assessment (HTA), quality assurance, systematic reviews, guidelines, and coverage decisions, who are involved in making different types of health decisions based on the same health outcomes. We will also propose and describe a method of defining core outcomes that will support reconciliation as well as harmonization across these different fields. Study Design and Setting The main focus here is on outcomes that matter most to people including patients, family members, and caregivers. We describe the hub and spokes model for core outcome sets that allows for communication and integration across different disciplines and decision makers. Ideally, the core outcomes, also called main outcomes, would be identical across these fields, including, for instance, a systematic review, an HTA, and a clinical or public health guideline. We illustrate this challenge using examples. Results We present the hub and spokes model for direct core outcome sets and describe the challenge and solution in what we call the Standardized Outcomes Linking Across StakeholdeRs (SOLAR) system approach. Judgments will have to be made regarding how directly the outcome of interest for decision makers corresponds to the intended outcome and GRADE offers it through its indirectness domain. Health outcome descriptors (HODs) provide a solution to this. Conclusion Relevant stakeholders should strive to harmonize outcome assessment for the different decision-making contexts and describe how the outcomes they use, optimally informed by systematic reviews of the importance of outcomes, relate to harmonized HODs. In the ideal world, decision makers would use the same harmonized HODs and transparently rate the degree of indirectness of the actual outcomes addressed.

Natural language processing (NLP) is a subfield of artificial intelligence devoted to understanding and generation of language. The recent advances in NLP technologies are enabling rapid analysis of vast amounts of text, thereby creating opportunities for health research and evidence-informed decision making. The analysis and data extraction from scientific literature, technical reports, health records, social media, surveys, registries and other documents can support core public health functions including the enhancement of existing surveillance systems (e.g. through faster identification of diseases and risk factors/at-risk populations), disease prevention strategies (e.g. through more efficient evaluation of the safety and effectiveness of interventions) and health promotion efforts (e.g. by providing the ability to obtain expert-level answers to any health related question). NLP is emerging as an important tool that can assist public health authorities in decreasing the burden of health inequality/inequity in the population. The purpose of this paper is to provide some notable examples of both the potential applications and challenges of NLP use in public health.

The objective of this study was to determine the demographics and subjective rationale for failure to present for retrieval of patients who had an inferior vena cava (IVC) filter placed.Between January 1, 2010, and September 12, 2017, there were 242 patients who had retrievable IVC filters placed. Demographics and indications for filter placement were retrospectively analyzed. All patients who failed to have the filter retrieved were contacted by Institutional Review Board-approved telephone survey to delineate the reason that the filter was not removed.Of 242 patients with IVC filters placed, 53 (22%) patients presented for filter retrieval at Abington-Jefferson Health. Patients who presented for filter retrieval were statistically younger (46 years vs 65 years; P .001). The most common indication for filter placement in both groups was preoperative placement for bariatric surgery, but this percentage was higher in the group that presented for filter retrieval (70% [37/53] in the retrieved group vs 47% [88/189] in the nonretrieved group; P = .018). After telephone survey that reached 146 patients, it was determined that 46 (32%) patients who did not return for filter retrieval were told to keep the filter in place secondary to comorbidities, 28 (19%) did not remember being instructed to follow up for retrieval, and 18 (12%) did not want another procedure. Twenty-four patients were deceased at the time of telephone survey (16%). The remainder of the patients had the filter removed at an outside institution or gave another reason.Our study documented a disappointingly low rate of filter retrieval. Patients with IVC filters who failed to present for retrieval were more likely to be older and frequently did not understand the complications of leaving a filter in place and the need to have the filter retrieved. Patient education should be increased to better capture patients with IVC filters and to improve retrieval rates, but our study showed that a significant percentage of patients do not have filters retrieved because of comorbidities or they do not want another procedure.

A vaccine for respiratory syncytial virus (RSV) has been actively sought for over 60 years due to the health impacts of RSV disease in infants, but currently the only available preventive measure in Canada and elsewhere is limited to passive immunization for high-risk infants and children with a monoclonal antibody. RSV vaccine development has faced many challenges, including vaccine-induced enhancement of RSV disease in infants. Several key developments in the last decade in the fields of cellular immunology and protein structure have led to new products entering late-stage clinical development. As of July 2019, RSV vaccine development is being pursued by 16 organizations in 121 clinical trials. Five technologies dominate the field of RSV vaccine development, four active immunizing agents (live-attenuated, particle-based, subunit-based and vector-based vaccines) and one new passive immunizing agent (monoclonal antibody). Phase 3 clinical trials of vaccine candidates for pregnant women, infants, children and older adults are under way. The next decade will see a dramatic transformation of the RSV prevention landscape.

Background: Few studies have explored the relative burden and trends in pulmonary (PTB) vs. extra-pulmonary (EPTB) tuberculosis in the United States using a nationally representative sample. Methods: This study examined trends in hospitalization rates, length-of-stay (LOS), in-hospital mortality and inflation-adjusted charges, for PTB vs. EPTB using the Nationwide/National Inpatient Sample (NIS) from 1998 to 2014. Descriptive and multivariable analyses (linear, negative binomial and logistic) were utilized adjusting for demographics, co-morbidity and hospital characteristics. Results: During the study period there were a survey-adjusted, estimated 258,631 PTB (75.5%), 76,476 EPTB (22.3%) and 7552 concurrent PTB and EPTB (2.2%) discharges. Whites accounted for 27.6% of PTB, 21.9% of EPTB and 17.6% of concurrent discharges; and self-pay or no insurance accounted for 22.2%, 18.4%, and 25.9%, respectively. EPTB was more common among blacks (22.5%), and combined TB more common among Hispanics (24.8%). Mean LOS was 11.4 days, 13.2 days, and 19.5 days; with mean nominal charges of $48,031, $62,255, and $89,364 for PTB, EPTB and combined TB respectively. Inpatient mortality for all three groups was approximately 5.7%. Miliary TB and TB of meninges and central nervous system were positively associated with mortality (odds ratios of 2.44 and 2.11, respectively), as was alcohol abuse (OR 1.21). Trend analyses showed decreased hospitalizations for all TB types, no change in LOS trends, decreased mortality for PTB and ETB and increased charges for PTB and ETB from 1998 to 2014. Increased utilization, higher charges and higher risk of mortality (to some extent) among the EPTB cases warrant improved methods for screening, diagnosis and treatment. Conclusion: Though rates of TB hospitalization are declining, EPTB is becoming relatively more common and is more costly compared to pulmonary TB. Screening methods that focus on identification of ETB contrary to current practice guidelines are needed to aid ETB case finding. Keywords: Tuberculosis, Epidemiology, Health care utilization, Alcohol, Health care disparities

BACKGROUND High COVID-19 vaccine uptake is crucial to containing the pandemic and reducing hospitalizations and deaths. Younger adults (aged 20-39 years) have demonstrated lower levels of vaccine uptake compared to older adults, while being more likely to transmit the virus due to a higher number of social contacts. Consequently, this age group has been identified by public health authorities as a key target for vaccine uptake. Previous research has demonstrated that altruistic messaging and motivation is associated with vaccine acceptance. OBJECTIVE This study had 2 objectives: (1) to evaluate the within-group efficacy of an altruism-eliciting short, animated video intervention in increasing COVID-19 vaccination intentions amongst unvaccinated Canadian younger adults and (2) to examine the video’s efficacy compared to a text-based intervention focused exclusively on non-vaccine-related COVID-19 preventive health measures. METHODS Using a web-based survey in a pre-post randomized control trial (RCT) design, we recruited Canadians aged 20-39 years who were not yet vaccinated against COVID-19 and randomized them in a 1:1 ratio to receive either the video intervention or an active text control. The video intervention was developed by our team in collaboration with a digital media company. The measurement of COVID-19 vaccination intentions before and after completing their assigned intervention was informed by the multistage Precaution Adoption Process Model (PAPM). The McNemar chi-square test was performed to evaluate within-group changes of vaccine intentions. Exact tests of symmetry using pairwise McNemar tests were applied to evaluate changes in multistaged intentions. Between-group vaccine intentions were assessed using the Pearson chi-square test postintervention. RESULTS Analyses were performed on 1373 participants (n=686, 50%, in the video arm, n=687, 50%, in the text arm). Within-group results for the video intervention arm showed that there was a significant change in the intention to receive the vaccine (χ21=20.55, Pχ23=1.70, P=.64) was not significant. When administered the video intervention, we found that participants who had not thought about or were undecided about receiving a COVID-19 vaccine were more amenable to change than participants who had already decided not to vaccinate. CONCLUSIONS Although the video intervention was limited in its effect on those who had firmly decided not to vaccinate, our study demonstrates that prosocial and altruistic messages could increase COVID-19 vaccine uptake, especially when targeted to younger adults who are undecided or unengaged regarding vaccination. This might indicate that altruistic messaging provides a “push” for those who are tentative toward, or removed from, the decision to receive the vaccine. The results of our study could also be applied to more current COVID-19 vaccination recommendations (eg, booster shots) and for other vaccine-preventable diseases. CLINICALTRIAL ClinicalTrials.gov NCT04960228; https://clinicaltrials.gov/ct2/show/NCT04960228

The current study aimed to characterize the activity in orthodontic clinics during the COVID-19-induced lockdown and the inter-lockdown periods, as well as to evaluate patients’ perspectives with respect to their fears, their extent of cooperation with treatment, and their emergency needs during the lockdown. The data were gathered from 11 private orthodontic clinics from 1 January 2020 to 8 March 2021, which included three lockdowns and inter-lockdowns. Information specifying the number of admissions, missed appointments, and emergency visits was gathered. Four hundred and twenty-nine orthodontic patients treated in those clinics agreed to complete a questionnaire that evaluated their concerns and expectations, the treatment emergency issues, implementation of the orthodontist’s instructions, and contact with the clinical staff during lockdowns. There was a significant increase in the number of scheduled appointments during the inter-lockdown periods, compared with the pre-pandemic period (p = 0.001). No difference in the number of missed/canceled or emergency appointments was found between the different periods (p > 0.420). The majority (89.6%) of the emergency visits involved issues with appliances; 68.7% of the subjects were advised to present themselves at clinics. During the peaks of the waves of the COVID-19 pandemic, a sharp rise in the number of missed and urgent appointments was not found. Reducing the number of orthodontic emergencies may assist in reducing patient fears.

Ao longo dos anos, fica cada vez mais perceptível a valorização de técnicas de planejamento e gestão de obras visando melhorar a confiabilidade de cronogramas, prazos e estimativas de resultado dos projetos. Com a competitividade acentuada em que o mercado da construção se encontra, a precisão e a utilização desses recursos fazem-se fundamentais e necessárias para a sobrevivência e a diferenciação das empresas. No desenvolvimento do orçamento e planejamento dos projetos, são calculados os custos diretos e indiretos que totalizam o projeto. Os custos diretos são aqueles que estão diretamente ligados aos serviços em si. Já os indiretos, não, são os custos necessários na empresa para o desenvolvimento e o apoio das atividades em geral. O ponto-chave é que qualquer um desses custos é variável, dependente do fator tempo. Os custos indiretos possuem a característica de variar proporcionalmente ao tempo; e os diretos, de variar inversamente. Desta maneira, sabendo destas características específicas, pode-se chegar à conclusão de que, em um determinado tempo tempo ou prazo ótimo, os custos totais do projeto podem totalizar o menor valor possível, e é em torno da estimativa deste tempo ótimo que o trabalho pretende ser desenvolvido. Elaborando um método para que empresas e orçamentistas possam ter um ponto de partida para o cálculo do tempo ótimo e ferramentas para analisar as características de variabilidade dos custos-prazos para cada um de seus projetos de construção. A metodologia de pesquisa será balizada inicialmente no desenvolvimento de um método teórico que posteriormente será validado através da aplicação em dois projetos reais. Over the years, the valorization of construction planning and management techniques in order to improve the reliability of project schedules, deadlines and result estimates, is increasingly noticeable. The increased competitiveness that the construction market is facing makes that the precision and use of these resources be essential and necessary for the survival and differentiation of companies.In the development of the budget and planning of the projects, the direct and indirect costs are calculated and make up the final value of the project. Direct costs are those that are directly linked to the services themselves, while indirect costs are the costs necessary in the company for the development and support of activities in general.The key point is that any of these costs are time dependent variables, indirect costs have the characteristic of varying proportionally to time and direct costs of varying inversely. Thus, knowing these specific characteristics, it can be concluded that in a given time - optimal time or deadline, the total costs of the project can result the lowest possible value, and it is around the estimate of this optimum time that the work it intends to be developed. Thus developing a method so that companies and budgeters can have a starting point for calculating the optimum time and resources to analyze the characteristics of cost-term variability for each of their projects. The validation and explanation of the application of the method will be done through application in two real construction projects. The research methodology will initially be guided by the development of a theoretical method that will later be validated through the application in two real projects.

Additional file 1. Study protocol.

Supplemental Material sj-pdf-1-caj-10.1177_08465371221105532 for Canadian Association of Radiologists Prostate MRI White Paper by Silvia D. Chang, Caroline Reinhold, Iain D. C. Kirkpatrick, Sharon E. Clarke, Nicola Schieda, Casey Hurrell, Derek W. Cool, Adam S. Tunis, Abdullah Alabousi, Brendan J. Diederichs and Masoom A. Haider in Canadian Association of Radiologists Journal

Additional file 2. Search strategy.

Additional file 3. List of excluded studies.

Additional file 4. Characteristics of included SRs.

In the process of modernization of the global education system, Concepts and categories such as "modernization of education or modern higher education", "education strategy", "internationalization of higher education", "internationalization of higher education", "knowledge society", "education policy", "modern specialist", "education export", "public education", "virtual education", "lifelong learning" remain the main topic of socio-philosophical research. In the increasingly globalized Uzbek society, there is a need to study the problems in the socio-cultural, intellectual sphere, where the modern higher education system is directly transforming the patterns of modernization of the world higher education system. This article analyzes the modernization of the education system, the role of education in the modernization of society. Special attention was paid to the foreign experience, especially Japanese. It will also reveal the interrelated aspects of the education model established in our country and Japan.

We aimed to establish a normative database for the topography of Wharton's duct orifices and to indicate the localization and distances of the orifices against other oral structures.The prospective study involved 3,000 healthy adults. We measured the cranial index, the distances between the mandible gonions and the orifices and between each orifice and the lingual frenulum, the position of the orifices against each other, and against the base of the tongue and the mandibular alveolar ridge. The segments of the cohort were classified by sex and the headform (dolichocephalic, brachycephalic, and mesocephalic).The distance between the orifices varied from 0 mm in the frenulum-attached cases to11.0 ± 2.3 mm in cases of the male brachycephalic skull. The correlation with sex was found for the localization of the frenulum-related orifices (r = 0.64 for females). The orifices were attached to the frenulum (5.9%), were frenulum-related (16.2%), and frenulum-independent (77.9%). The sagittal asymmetry of the orifices was noted in 11.8%, and in 2.1%, the lateral asymmetry was detected.In most of the cases, the Wharton's duct orifices are symmetrical frenulum-independent openings that are usually located in the middle part of the floor of the mouth or close to the mandibular alveolar ridge. The distance between the orifices varies according to sex and the type of the skull. The precise position of the duct orifices must be established prior to sialoendoscopy of the submandibular glands, a botulinum toxin injection around the mandible, tongue traction maneuvers, frenotomy, and other oral surgeries.

The aim of this study was to determine the prevalence of dental anomalies and whethera significant association exists between dental anomalies and consanguinity marriage among Arabic orthodontic patients in Israel. Pretreatment panoramic radiographs of 513 patients (38% males and 62% females) were examined to detect dental anomalies related to number, size, shape, and eruption. A chi-square test was carried out to determine the associations between dental anomalies, gender, and consanguinity marriage. The results indicated that 29% of the subjects manifested at least one dental anomaly. Impacted tooth was found to be the most frequent dental anomaly, with a prevalence of 13.5%, whereas fusion and transmigration were found to be the least common, with a prevalence of 0.2% each. The prevalence of dental anomalies was significantly greater in males (p < 0.001) than in females. In our sample a significant association was found between dental anomalies and consanguinity marriage, and it was found to be greater in subjects with a family history of consanguinity marriage. This association can be attributed to the negative effects of consanguinity marriage, which was also reported in many studies in other fields. This study suggests that consanguinity marriage can be one of the factors involved in the development of dental anomalies in certain at-risk populations.

Introduction: The mass-harvesting of digitized medical data has prompted their use as a clinical and research tool. The purpose of this study was to compare the accuracy and reliability of artificial intelligence derived cephalometric landmark identification with that of human observers. Methods: Ten pre-treatment digital lateral cephalometric radiographs were randomly selected from a university post-graduate clinic. The x- and y-coordinates of 21 (i.e., 42 points) hard and soft tissue landmarks were identified by 6 specialists, 19 residents, 4 imaging technicians, and a commercially available convolutional neural network artificial intelligence platform (CephX, Orca Dental, Hertzylia, Israel). Wilcoxon, Spearman and Bartlett tests were performed to compare agreement of human and AI landmark identification. Results: Six x- or y-coordinates (14.28%) were found to be statistically different, with only one being outside the 2 mm range of acceptable error, and with 97.6% of coordinates found to be within this range. Conclusions: The use of convolutional neural network artificial intelligence as a tool for cephalometric landmark identification was found to be highly accurate and can serve as an aid in orthodontic diagnosis.