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Immunohistochemistry (IHC) and/or MSI-PCR (microsatellite instability-polymerase chain reaction) tests are performed routinely to detect mismatch repair deficiency (MMR-D). Classical MMR-D tumors present a loss of MLH1/PMS2 or MSH2/MSH6 with MSI-High. Other profiles of MMR-D tumors have been described but have been rarely studied. In this study, we established a classification of unusual MMR-D tumors and determined their frequency and clinical impact. All MMR-D tumors identified between 2007 and 2017 were selected. Any profile besides the classical MMR-D phenotype was defined as unusual. For patients with unusual MMR-D tumors, IHC, and PCR data were reviewed, the tumor mutation burden (TMB) was evaluated and clinical and genetic features were collected. Of the 4948 cases of MMR testing, 3800 had both the available IHC and MSI-PCR results and 585 of these had MMR-D. After reviewing the IHC and PCR, 21% of the cases initially identified as unusual MMR-D were reclassified, which resulted in a final identification of 89 unusual MMR-D tumors (15%). Unusual MMR-D tumors were more often associated with non-CRC than classical MMR-D tumors. Unusual MMR-D tumors were classified into four sub-groups: i) isolated loss of PMS2 or MSH6, ii) classical loss of MLH1/PMS2 or MSH2/MSH6 without MSI, iii) four MMR proteins retained with MSI and, iv) complex loss of MMR proteins, with clinical characteristics for each sub-group. TMB-high or -intermediate was shown in 96% of the cancers studied (24/25), which confirmed MMR deficiency. Genetic syndromes were identified in 44.9% (40/89) and 21.4% (106/496) of patients with unusual and classical MMR-D tumors, respectively (P

Objetivo: Evaluar la anemia y la parasitosis en niños de 6 a 60 meses de edad, atendidos en un Centro de Salud Alto andina de Perú, durante periodo 2015 al 2020. Método: El estudio fue descriptivo – retrospectivo, se aplicó el método científico, con un diseño no experimental, la población y la muestra fueron compuestos por 1097 niños atendidos en el Centro de Salud de Ascensión, durante los años 2015 al 2020, se incluyó todo niño que padezca anemia y/o parasitosis. Resultado: 515 niñas que componen un 46.9%, y 582 niños que componen 53.1 % padecen de anemia, de los cuales el 83% padecen anemia leve, y un 17 % padecen de anemia moderada; en cuanto a género 83,7% niñas y 82,3% niños presentan anemia, en relación a edad los de 6 a 12 mes presentaron anemia leve en un 37.5% y moderado 48.1% ; Por otro lado de un total de 240 niños, un 53.3 % fueron niñas y un 46.7 fueron niños que padecen parasitosis intestinal. Conclusión: En las zonas alto andinas de Perú, de niños y niñas que presentan anemia, predomina la anemia leve, así mismo este problema de salud no diferencia en su afección al género; en relación a la edad predomina de 6 a 12 meses con anemia leve y moderado. Por otro lado, se evidencia un porcentaje considerable de parasitosis intestinal, de igual forma esta enfermedad en cuanto al género no diferencia; sin embargo en cuanto a la edad se evidencia mayor parasitosis intestinal en niños y niñas de 24, 36 y 60 meses; lo que implica que la parasitosis intestinal no necesariamente es un factor predominante para la anemia.

To reduce sleep-related infant deaths, the American Academy of Pediatrics (AAP) has identified safe infant sleep recommendations; however, it is unclear which training strategies to teach safe infant sleep practices are most effective. Since the AAP released updated safe sleep recommendations in 2016, no analysis of the safe infant sleep training literature has been conducted. The purpose of the present review was to evaluate the safe infant sleep training literature of relevant populations such as caregivers and medical personnel, and provide recommendations for future research. The overall efficacy of training strategies was found to be positive or mixed where experiments most commonly implemented an educational session, followed by use of instructional materials, distribution of safe materials, and hospital-wide policy change. Methodological limitations were also identified.

Purpose: Depression is a major mental disorder and has drastic effects on people suffering from other terminal illnesses like cancer. Many patients struggling with chronic or fatal illnesses rely on spirituality to cope. Spirituality in Indian culture has always been a vital component in indigenous health systems.Objective: To determine the relationship between spirituality and depression among patients with cancer visiting a tertiary care institute of Uttarakhand State in northern India. Design: A descriptive cross-sectional survey.Sample: A total of 103 cancer patients visiting inpatient and outpatient departments of a selected tertiary care institute of Uttarakhand state of northern India. Methods: Participants were administered the socio-demographic proforma, Patient Health Questionnaire (PHQ-9) (Kroenke, Spitzer, and Williams, 2001), System of Belief Inventory (SBI-15R). Findings: The mean score of depression among cancer patients was 9.12±6.537 (CI, 7.84-10.39). Patients with high spirituality have minimal or no depression. We found a statistically significant negative correlation between depression and spirituality (r=-0.209, p=0.05).Conclusions: Health care professionals can incorporate spirituality in caring for cancer patients to develop a positive outlook on living despite the illness. Implications for Psychosocial Providers Or Policy: Establishing a spiritual support program as an integral part of a multidisciplinary approach can better cancer treatment in the Indian setting.

The problem in this study is how the effect of work conflict, work environment and work stress on employee job satisfaction at the Representative Office of the Population and Family Planning Agency (BKKBN) North Sumatra. This study aims to determine partially the variables of work conflict, work environment and work stress affect employee job satisfaction and the effect of work conflict, work environment, and job stress simultaneously on employee job satisfaction. associative and quantitative. The sampling technique used a saturated sample to 84 permanent employees. The data collection technique used interviews, documentation studies and questionnaires. The data analysis technique of this research uses classical assumption test and multiple linear regression analysis. Data processing in this study used statistical software SPPS 20. The results showed that based on the results of the t test, the conflict variable partially had a negative and insignificant effect on job satisfaction. The work environment variable partially has a positive and significant effect on employee job satisfaction. Job stress variable has a positive and insignificant effect on employee job satisfaction. In the results of the f test in this study, simultaneously the variables of work conflict, work environment and work stress have an effect on employee job satisfaction. The results showed that based on the results of the t test, the conflict variable partially had a negative and insignificant effect on job satisfaction. The work environment variable partially has a positive and significant effect on employee job satisfaction. Job stress variable has a positive and insignificant effect on employee job satisfaction. In the results of the f test in this study, simultaneously the variables of work conflict, work environment and work stress have an effect on employee job satisfaction. The results showed that based on the results of the t test, the conflict variable partially had a negative and insignificant effect on job satisfaction. The work environment variable partially has a positive and significant effect on employee job satisfaction. Job stress variable has a positive and insignificant effect on employee job satisfaction. In the results of the f test in this study, simultaneously the variables of work conflict, work environment and work stress have an effect on employee job satisfaction.

Objetivo. Determinar de qué manera la intervención educativa basado en evidencias fortalece las competencias del agente comunitario de salud alto andinos sobre emergencias materno- neonatal del Huancavelica , Perú – 2019. Métodos. Se realizó un estudio de tipo cuantitativo, diseño pre experimental con un solo grupo en agentes comunitarios de salud de la Microred de Ascensión. La muestra incluye agentes comunitarios (n = 16); de quienes se realizó la recolección de datos sobre las competencias en emergencias materno-neonatal. Resultados. 50,0% de agentes comunitario de salud de la Microred de Ascensión son del género masculino y femenino, respectivamente; 56,3%, de 36 a 45 años y 43,8%, de 26 a 35 años; 43,8%, con primaria completa, y 31,3%, secundaria incompleta; y un mínimo número de otro grado de instrucción. El 62,5%, momento antes de la estrategia presentaban una competencia cognitiva en inicio sobre emergencia materno-neonatal y 37,5%, en proceso; después de la intervención; 75,0%, lograron la competencia cognitiva, y 25,0%; en proceso. El 68,8%, antes de la estrategia presentaban una competencia procedimental en inicio sobre las emergencias materno-neonatal y 31,3%, en proceso; después de la intervención; 75,0%, lograron la competencia procedimental, y 25,0%; en proceso. Un 75,0%, antes de la estrategia presentaban una competencia actitudinal en inicio sobre las emergencias materno-neonatal y 25,0%, en proceso; después de la intervención; 93,8%, lograron la competencia actitudinal, y 6,3%; en proceso. Y, 56,3%, antes de la estrategia presentaban una competencia en inicio sobre emergencia materno-neonatal y 43,8%, en proceso; después de la intervención; 81,3%, lograron la competencia, y 18,8%; en proceso. Conclusiones. Las intervenciones educativas basados en evidencias lograron incrementar las competencias en manejo de emergencia materno-neonatal en agentes comunitarios de salud. Por ello, puede ser implementado en otras instituciones prestadoras de servicios de salud-IPRESS.

This study aims to determine the strengthening of the 21st Century Skills of UPBJJ Pekanbaru and Pangkal Pinang students in dealing with the ASEAN economic community (MEA). The 21st Century Skills strengthening study was motivated by the low competition in economic politics in Indonesia. The study involved 379 students selected based on study programs at the Pekanbaru Open University and Pangkal Pinang. Data in the form of opinions and statements were collected using a questionnaire in the form of a questionnaire and essay. Data obtained were analyzed qualitatively and quantitatively. The results showed that UPBJJ Pekanbaru and Pangkal Pinang students were qualitatively ready to perform 21st-century skills, including digital era literacy, inventive thinking, memorable communication, high productivity, and spiritual norms and values. Based on quantitative data, there is no significant difference in strengthening the 21st Century Skills of UPBJJ Pekanbaru and Pangkal Pinang students.

BACKGROUND: There has been a substantial scarcity of personal protective equipment (PPE) in several countries during the ongoing pandemic of Coronavirus disease-19 (COVID-19). Nurses in Indonesia also experience a shortage of PPE as the number of COVID-19 patients in Indonesia continues to increase. There is no accurate data yet regarding the exact number of PPE scarcity for nurses. AIM: This study aimed to describe the availability of PPE and adverse consequences long-term used off the PPE and examine the relationship between shortage PPE and nurse behavior response in Indonesia. METHODS: An online-based survey was used to collect data on the nurse, regardless of their discipline, training background, or degree of experience, who are directly involved in managing COVID-19 patients. In this study, a total of 211 questionnaires were gathered. The survey was conducted using the Google form. This study employs univariate and bivariate analysis. RESULTS: Most of the mask N95 provision reaches up to 80%. The second is the hazmat (71%) and the lowest in the gloves (30%). Around 71% of respondents generally resist removing their PPE until the shift is complete. Then, 62% of the respondents are ready to propose to the leaders of the PPE, and 51% show that they are modifying the PPE. Nasal blisters are the most prevalent type of injury sustained by nurses while wearing PPE (86%), followed by headaches and dehydration. This study found that most respondents (60.7%) with insufficient PPE had a positive behavior reaction, whereas just 18% had a poor behavior reaction. CONCLUSION: Most nurses have difficulties accessing N95 and experience some adverse effects of prolonging PPE use. Policymakers should take urgent action to tackle these concerns.

The constant advancement in the medical field has allowed for the diagnosis and treatment of several health conditions. It has also contributed to increasing the average human lifespan, which is considered an outstanding achievement in history. Nevertheless, the impact of this in an ever-increasing aged population with chronic diseases and, most of the time, with limited and poor quality of life was not considered. Thus, it is imperative to establish strategies to age successfully. In order to do have a better understanding of this crucial issue, this review will analyze the endocrine changes in the elderly. It will present common conditions found in this population, chronic inflammation, and oxidative stress. Additionally, we will explain aging-related metabolic and physical performance decline related to hormone changes and lifestyle modifications. We will propose the Mediterranean diet and some specific guidelines about physical activity as part of the plan to have an active and successful aging process.

Digital, Introduction: Cardiovascular risk factors have been measured under different conditions, there is some missing information related to specific occupations, such as penitentiary staff which due to their characteristics could have an increased cardiovascular risk. Objective: To determine cardiovascular risk factors on military staff from penitentiary institutions in Santander—Colombia. Methods: Cross-sectional study conducted with 182 workers. Anthropometric parameters, blood pressure, serum lipid profile, and glucose levels were measured. Univariate and bivariate analyses were carried out to establish differences between individuals. Results: Anthropometric and biochemical measures showed that 71.3% participants were overweight or obese, 29.4% presented high blood pressure with increased levels of total cholesterol (27.5%), triglycerides (40.7%), glucose (9.3%), and 84.1% presented low levels of HDL cholesterol. Bivariate analysis found a negative correlation between BMI and HDL cholesterol (p, Ciencias Médicas y de la Salud

Background Serum protein electrophoresis (SPE) is a common clinical laboratory test, mainly indicated for the diagnosis and follow-up of monoclonal gammopathies. A time-consuming and potentially subjective human expertise is required for SPE analysis to detect possible pitfalls and to provide a clinically relevant interpretation. Methods An expert-annotated SPE dataset of 159 969 entries was used to develop SPECTR (serum protein electrophoresis computer-assisted recognition), a deep learning-based artificial intelligence, which analyzes and interprets raw SPE curves produced by an analytical system into text comments that can be used by practitioners. It was designed following academic recommendations for SPE interpretation, using a transparent architecture avoiding the “black box” effect. SPECTR was validated on an external, independent cohort of 70 362 SPEs and challenged by a panel of 9 independent experts from other hospital centers. Results SPECTR was able to identify accurately both quantitative abnormalities (r ≥ 0.98 for fractions quantification) and qualitative abnormalities [receiver operating characteristic–area under curve (ROC–AUC) ≥ 0.90 for M-spikes, restricted heterogeneity of immunoglobulins, and beta-gamma bridging]. Furthermore, it showed highly accurate at both detecting (ROC–AUC ≥ 0.99) and quantifying (r = 0.99) M-spikes. It proved highly reproducible and resilient to minor variations and its agreement with human experts was higher (κ = 0.632) than experts between each other (κ = 0.624). Conclusions SPECTR is an algorithm based on artificial intelligence suitable to high-throughput SPEs analyses and interpretation. It aims at improving SPE reproducibility and reliability. It is freely available in open access through an online tool providing fully editable validation assistance for SPE.

The COVID‐19 pandemic has caused disruptions to national health systems and impacted health outcomes worldwide. However, the extent to which surveillance systems, such as population‐based cancer registration, have been affected was not reported. Here we sought to evaluate the effect of the pandemic on registry operations across different areas and development levels worldwide. We investigated the impact of COVID‐19 on three main areas of cancer registry operations: staffing, financing and data collection. An online survey was administered to 750 member registries of the International Association for Cancer Registries. Among 212 responding registries from 90 countries, 65.6% reported a disruption in operations, ranging between 45% in south‐eastern Asia and 87% in the Latin America and Caribbean. Active data collection was disrupted more than case notifications or hybrid methods. In countries categorized with low Human Development Index (HDI), a greater number of registries reported a negative impact (81.3%) than in very high HDI countries (57.8%). This contrast was highest in term of impact on financing: 9/16 (56%) registries in low HDI countries reported a current or an expected decline in funding, compared to 7/108 (7%) in very high HDI countries. With many cancer registries worldwide reporting disruption to their operations during the early COVID‐19 pandemic, urgent actions are needed to ensure their continuity. Governmental commitment to support future registry operations as an asset to disease control, alongside a move toward electronic reporting systems will help to ensure the sustainability of cancer surveillance worldwide., What's new? The COVID‐19 pandemic has caused disruptions to health systems worldwide. Has it also affected surveillance systems, such as population‐based cancer registries? In this study, the authors found that two‐thirds of analyzed cancer registries reported disruption in staffing, finances, and/or data collection. In countries with a low Human Development Index (HDI), a greater number of registries reported a negative impact (81.3%) than in very high HDI countries (57.8%). These results emphasize the need for actionable, strategic plans to ensure the continuity of registry operations globally.

Mineral resources are typically quantified by estimating the grade–tonnage curve for different resource categories. Statutory resource assessment reports (e.g., NI-43-101), however, do not include a measure of uncertainty for the disclosed resources despite the major investments required for mining projects. Although conditional simulation can provide confidence intervals (CIs) for resource estimation, it requires a strong stationarity assumption and depends on the variogram model selected, which is often poorly defined with the available data. In order to avoid these limitations, this research proposes the use and comparison of two machine learning (ML) methods, multiple linear regression and a multilayer neural network, to generate tonnage curves and their CIs directly from the data. The classical variogram modeling step is replaced by the specification of intervals for each parameter of the selected variogram model. The learning is carried out in a perfectly controlled environment using simulations with known variograms. Numerous reference deposits are sampled, and for each one, a series of conditional realizations define the mean tonnage and CI curves. Different statistics computed for the entire data set are used as input to predict the tonnage and CI curves by the ML methods. The results indicate that there are no significant differences between the ML methods. In addition, ML resource predictions outperform those obtained with ordinary kriging, constrained kriging, uniform conditioning and indirect lognormal correction, being surpassed only by the discrete Gaussian model. Nevertheless, these predictors were favored by the use of true variogram models. Moreover, the coverage probabilities of different CIs reach the nominal levels indicating adequate resource uncertainty quantification. Finally, two case studies validate the effectiveness of the proposed approach for tonnage prediction and uncertainty quantification.

In the context of noise reduction in diverse applications where a shear grazing flow is present (i.e., engine nacelle, jet pump, landing gear), improved acoustic liner solutions are being sought. This is particularly true in the low-frequency regime, where space constraints currently limit the efficiency of classic liner technology. To perform the required multi-objective optimization of complex meta-surface liner candidates, a software platform called OPAL was developed. Its first goal is to allow the user to assemble a large panel of parallel/serial assembly of unit acoustic elements, including the recent concept of LEONAR materials. Then, the physical properties of this liner can be optimized, relatively to given weighted objectives (noise reduction, total size of the sample, weight), for a given configuration. Alternatively, properties such as the different impedances of liner unit surfaces can be optimized. To accelerate the process, different nested levels of optimization are considered, from 0D analytical coarse designs in order to reduce the parameter space, up to 2D plan or axisymmetric high-order Discontinuous Galerkin resolution of the Linearized Euler Equations. The presentation will focus on the different aspects of liner design considered in OPAL, and present an application on different samples made for a small scale aeroacoustic bench.

People with voice disorders and their problems are always at the centre of attention of several sciences, in particular medicine, pedagogy, psychology, and sociology. The use of quantitative procedures in this paper is mainly ready to lend a hand in sorting out some of the significant issues surrounding speech therapy intervention in both clinical and research contexts. After the removal of the throat, the patient, having the means of communication - the word, but losing one of the components of expressive speech - the voice, has pronounced difficulties in the process of communication. Some patients, realizing their inadequacy due to absence of voice, try to take various measures to overcome the problem, while others become discouraged, frustrated, lose optimism, the desire to overcome the problem and return to a full life. Patients, within the frame of this study, had certain prerequisites for vocal cords, such as verbal breathing and expressive mobility problems.

Indonesia is a developing country with a bank-based country structure. Credit is the largest component of banking assets. Credit growth with the low interest rates and low standard criteria for potential borrowers will have an impact on the credit risk faced by banks. The purpose of this study is to look into the effect of credit growth on the risk and performance of Indonesian conventional banks. This study uses dynamic panel data with the Generalized Method of Moment (GMM) approach. There are 3 hypotheses to be tested: first, the relationship between credit growth and credit risk using a credit loss approach. Second, the relationship between credit growth and bank profitability using a bank interest income approach. Third, the relationship between credit growth and bank solvency using the ratio of capital to assets. The data used in this study is taken from 93 conventional commercial banks registered with the Indonesia Financial Service Authority (Otoritas Jasa Keuangan) in the period of 2009-2019. The results showed that credit growth has a significant negative effect on credit risk and has a significant positive effect on the profitability and solvency of conventional commercial banks in Indonesia.

A presente revisão aborda aspectos históricos do uso da inseminação artificial (IA) como o início de uma nova era nas biotécnicas reprodutivas. No decorrer desta revisão, procurou-se relatar a evolução da IA no sentido de melhorar essa ferramenta de manejo reprodutivo com o advento da inseminação artificial em tempo fixo (IATF). São apresentadas as vantagens do uso dessas biotécnicas no manejo reprodutivo em bovinos de leite e corte, assim como algumas limitações, os ganhos em produtividade de leite e carne, a otimização do trabalho, ganhos genéticos e a contribuição sanitária no que diz respeito à prevenção de doenças da reprodução e daquelas que interferem na reprodução. Diante dos trabalhos apresentados, pode-se concluir que tanto a IA convencional como a IATF constituem ferramentas de manejo reprodutivo que ganham espaço crescente na bovinocultura por proporcionarem ganhos econômicos viáveis além possibilitar uma grande contribuição para organização e planejamento da atividade pecuária.

Objective This work aimed to evaluate the factors associated with Streptococcus pneumoniae nasopharyngeal colonization and antimicrobial susceptibility among pediatric outpatients in southwestern Colombia, 2019. Methods A cross-sectional study was performed using survey-based interviews and the collection of nasopharyngeal-swab specimens for microbiological characterization and antimicrobial susceptibility testing. Logistic regression analyses were performed for factors associated with nasopharyngeal carriage. Results A total of 452 children under the age of 5 years were examined in which 41.8% carried S. pneumoniae. Higher pneumococcal carriage frequencies were observed among participants aged Conclusion The 41.8% of participants carrying S. pneumoniae show a scenario with the presence of multidrug and extensively drug-resistant strains, which constitutes important reservoirs of bacterial transmission by children aged

Epithelioid mesothelioma is the most prevalent subtype of diffuse malignant peritoneal mesothelioma. A recently described nuclear-grading system predicted survival in patients with epithelioid malignant pleural mesothelioma. The present study was undertaken to validate this grading system in epithelioid malignant peritoneal mesothelioma (EMPM) and to compare to combined grade, including nuclear atypia, mitotic count, and tumor necrosis. Cases of EMPM, from 1995 to 2018, were analyzed from 7 French institutions from RENAPE network. Solid growth, tumor necrosis, nuclear atypia, and mitotic count were evaluated by at least 3 pathologists from the RENAPATH group. The predictions in terms of OS and PFS of nuclear grade and combined grade were analyzed. Nuclear grade was computed combining nuclear atypia score and mitotic count into a grade of I–III. Another system combining nuclear atypia score, mitotic score, and tumor necrosis was evaluated and defined as a combined grade I–III. A total of 138 cases were identified. The median follow-up was 38.9 months (range: 1.1–196.6). Nuclear and combined grades III were independently associated with a shorter OS (p

Background Current evidence regarding the optimal length of hospital stay (LOS) following myocardial infarction (MI) is limited. This study aimed to examine LOS policy for MI patients and to assess the safety of early discharge. Methods A prospective observational study that included patients with STEMI and NSTEMI enrolled in the Acute Coronary Syndrome Israeli Survey (ACSIS) during the years 2000–2016. Patients were divided into three subgroups according to their LOS: 6 days (long‐LOS). We compared baseline characteristics, management strategies and clinical outcomes at 30 days and 1 year in these groups. Results Ten thousand four hundred and fifty eight patients were enrolled in the study. The LOS of MI patients gradually decreased over time. Short‐LOS and intermediate‐LOS patients had similar clinical characteristics while patients in the long‐LOS group were older with more co‐morbidity. There was no difference in the clinical outcomes, including re‐MI, arrhythmias, 30 days MACE, and 30 days mortality between the short‐LOS and intermediate‐LOS groups. However, the rate of re‐hospitalizations was higher in the short‐LOS group (20.9% vs. 17.8%, p = .004) without evidence of increased cardiovascular events. In multivariate analysis, the LOS did not predict either 30 days mortality (HR: 1.3; CI:0.45–5.48), nor MACE at 30 days (HR: 1.1; CI:0.79–1.56). Conclusion Our study suggests that an early discharge strategy of up to 3 days from admission is safe for low and intermediate‐risk patients after both STEMI and NSTEMI. Nevertheless, this strategy is associated with an increased risk of potential avoidable readmission and there might be psychological and social factors that may warrant a longer stay.

Medically complex children including infants undergoing cardiac surgery are at increased risk for hospital readmissions. Investigation of this population may reveal opportunities to optimize systems and coordination of care. A retrospective study of all infants undergoing cardiac surgery from 2015 through 2016 at a large tertiary institution who were readmitted within 1 year of discharge from cardiac surgical hospitalization was performed. Data specific to patient characteristics, surgical hospitalization, and readmission hospitalization are described. Unplanned readmissions within 1 year of hospital discharge were analyzed with Cox proportional hazard regression to identify factors associated with increased hazard for earlier unplanned readmission. Comparable to previous reports, 12% (78/658) of all surgical hospitalizations were associated with unplanned readmission within 30 days. Infectious etiology, followed by cardiac and gastrointestinal problems, was the most common reasons for unplanned 30-day readmission. Unplanned readmissions within 2 weeks of discharge were multifactorial and less commonly related to cardiac or surgical care. Primary nasogastric tube feeding at the time of discharge was the only significant risk factor for earlier unplanned readmission (p = 0.032) on multivariable analysis. Increased care coordination with particular attention to feeding and comorbidity management may be future targets to effectively mitigate readmissions and improve quality of care in this population.

Ketogenic diets have been used to treat diverse conditions, and there is growing evidence of their benefits for tissue repair and in inflammatory disease treatment. However, their role in infectious diseases has been little studied. Buruli ulcer (Mycobacterium ulcerans infection) is a chronic infectious disease characterized by large skin ulcerations caused by mycolactone, the major virulence factor of the bacillus. In the current study, we investigated the impact of ketogenic diet on this cutaneous disease in an experimental mouse model. This diet prevented ulceration, by modulating bacterial growth and host inflammatory response. β-hydroxybutyrate, the major ketone body produced during ketogenic diet and diffusing in tissues, impeded M. ulcerans growth and mycolactone production in vitro underlying its potential key role in infection. These results pave the way for the development of new patient management strategies involving shorter courses of treatment and improving wound healing, in line with the major objectives of the World Health Organization.

Introduction Assisted reproductive technology including in vitro fertilization (IVF) and oocyte donation (OD) may increase risk for placenta-mediated diseases. Comprehensive analysis of histopathological placental lesions according to source of oocytes used in the IVF procedure – recipient derived (RD-IVF) vs oocyte donation (OD-IVF), has not been conducted in a population with a hypertensive disorder of pregnancy (HDP) and/or intrauterine growth restriction (IUGR). Methods A retrospective cohort study of archived placenta specimens from RD-IVF and OD-IVF pregnancies affected by HDP and/or IUGR was conducted with blinded histopathological placental examination. Three categories of lesions were differentiated and defined as main outcomes: maternal vascular malperfusion (MVM), chronic inflammation, and fetal vascular malperfusion (FVM). To determine the relationship between conception method and placental lesions, multivariable regressions were performed with maternal age, gestational age, HDP, birth and placental weight percentiles as model covariates. Results 115 placentas were included 83 (72.2%) RD-IVF, 32 (27.8%) OD-IVF. Adjusted OR (aOR) for conception method was 5.05 (95%CI 0.58–43.90, p=0.142) for MVM, 1.87 (95%CI 0.68–5.15, p=0.228) for chronic inflammatory and 0.61 (95%CI 0.15–2.37, p=0.471) for FVM lesions. Multiple gestation demonstrated borderline association with MVM (aOR=0.24, 95%CI 0.04–1.51, p=0.129) and total pathology score (aRR=0.79, 95%CI 0.62–1.01, p=0.058). Subgroup analysis suggested greater odds of villitis of unknown etiology (VUE) for OD-IVF (aOR=2.98, 95%CI 1.12–7.93, p=0.029). Discussion Source of oocyte derivation demonstrated no evidence of association with main outcomes in cases of HDP and/or IUGR. Subgroup analysis demonstrated increased rates of inflammatory lesions for OD-IVF. Multiple gestation may be associated with decreased MVM and total lesions.

Epithelioid mesothelioma is the most prevalent subtype of diffuse malignant peritoneal mesothelioma. The relationship between a strong adaptive immune response and a better prognosis in malignant solid tumors is widely known. Due to the low incidence of epithelioid malignant peritoneal mesothelioma (EMPM), very little is known about their immune micro-environment. We encountered several cases of tertiary lymphoid structures in EMPM in a previous study and aimed to investigate in the same series the prevalence, clinicopathological features, and the prognostic impact associated with tertiary lymphoid structures in EMPM (TLS-EMPM). Cases of EMPM, from 1995 to 2018, were retrieved from 7 French institutions from the RENAPE Network. The predictions in terms of overall survival (OS) and progression-free survival (PFS) of TLS-EMPM were analyzed. We report 52 cases of TLS-EMPM among a series of 138 cases of EMPM. TLS-EMPM was significantly associated with neoadjuvant chemotherapy, and was not a prognostic indicator for OS (p = 0.652) and PFS (p = 0.804) in our series. TLS is a component of the host immune response to EMPM significantly associated with neoadjuvant chemotherapy, but was not a predictor of prognosis for overall and progression-free survivals in this series. These findings provide another possible etiology for tertiary lymphoid structures.

Anne-Claire Fougerousse,1 Laure Mery-Bossard,2 Josiane Parier,3 Charles Taieb,4 Antoine Bertolotti,5,6 Francois Maccari3 On behalf of GEM ResoPso1Dermatology Department, Hôpital d’Instruction des Armées Bégin, Saint Mandé, 94160, France; 2Dermatology Department, Centre Hospitalier Intercommunal Poissy Sant Germain en Laye, Saint-Germain-en-Laye, 78100, France; 3Private Practice, La Varenne Saint Hilaire, Saint-Maur-des-Fossés, 94210, France; 4European Market Maintenance Assessment, Patients Priority Department, Fontenay sous-Bois, France; 5Infectious Diseases and Dermatology Department, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, La Réunion, France; 6Inserm CIC1410, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, La Réunion, FranceCorrespondence: Anne-Claire FougerousseDermatology Department, Hôpital d’Instruction des Armées Bégin, 69 Avenue de Paris, Saint Mandé, 94160, FranceTel + 331 43 98 50 00Fax + 331 43 98 49 15Email ac.fougerousse@gmail.comPurpose: To evaluate the modalities of methotrexate prescription for moderate to severe psoriasis by dermatologists in France.Patients and Methods: We performed a national online practice survey between October and December 2020.Results: A total of 254 dermatologists responded, 237 reported prescribing methotrexate for moderate to severe psoriasis in adults, of which 57% as a first line systemic treatment. Nineteen percent reported performing a test dose at the initiation of treatment. Methotrexate was prescribed orally in 54.7% of cases, subcutaneously in 44.8% of cases and intramuscularly in 0.4% of cases. The initial weekly dose of methotrexate was < 15 mg for 30% of the dermatologists and ≥ 15 mg for 70% of them. Two hundred and three dermatologists had already change the route of administration for methotrexate from the oral to injectable form due to poor tolerance (48.3%), lack of efficacy (35%) or lack of compliance (16.7%). Two hundred thirty-four dermatologists (98.7%) reported prescribing folic acid with methotrexate, and 79.3% reported prescribing tests evaluating the risk of hepatic fibrosis. Forty-three percent of dermatologists have not initiated or have reduced their prescriptions since the beginning of the pandemic of COVID-19. Prescribing patterns were different according to the type of practice (private practice versus hospital/mixed practice).Conclusion: Methotrexate is used by the majority of dermatologists interviewed for moderate to severe psoriasis in adults, with heterogeneity of practices.Keywords: psoriasis, methotrexate, practice survey, dermatologists

SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function.

Resumen Introducción: El sobrepeso y la obesidad constituyen una de las principales preocupaciones sanitarias en los adolescentes. Tener los conocimientos suficientes representa una opción para disminuir los riesgos. El objetivo del estudio fue evaluar la correlación entre conocimientos, actitudes y prácticas e índice de masa corporal (IMC) en adolescentes peruanos. Material y Métodos: Se realizó un estudio no experimental de tipo transversal en 242 adolescentes de edades comprendidas entre 11 a 18 años. Para determinar los conocimientos, actitudes y prácticas sobre alimentación saludable, se desarrolló un cuestionario según los criterios propuestos por la Organización de las Naciones Unidas para la Agricultura y Alimentación (FAO, por sus siglas en inglés). Además, se calculó el índice de masa corporal para la edad (IMC/Edad) de acuerdo con las recomendaciones de la Organización Mundial de Salud (OMS). El análisis de los datos se hizo mediante el software estadístico IBM SPSS versión 24. Resultados: La proporción de mujeres que demostraron conocimientos altos, actitudes favorables y prácticas adecuadas, fue superior en relación con los varones (76,5% vs. 75,0%), (75,5% vs. 70,7%) y 72,5% vs. 67,9%, respectivamente. Sin embargo, no hubo diferencias significativas (p>0,05). La proporción de varones que presentaron sobrepeso y obesidad fue 25,7% y 12,1%, respectivamente. Finalmente, se encontró correlación positiva estadísticamente significativa entre el IMC/Edad con los conocimiento, actitudes y prácticas acerca de alimentación saludable en los adolescentes (ρ=0,137; p=0,033), (ρ=0,160; p=0,013) y (ρ=0,133; p=0,039), respectivamente. Conclusiones: Los hallazgos sugieren que los adolescentes, especialmente los varones, deben ser el foco de programas de intervención nutricional integrados, con el propósito de disminuir la prevalencia de sobrepeso y obesidad.

Social media was born as a derivative of information and communication technology (ICT) development. It is stimulating new habits for people to produce, consumption, and distribution information in online interaction. Although many researchers have studied social media, no one has provided attention to social media and ulama (Islamic scholar). This article aims to describe patterns of ownership, access, perceived usefulness, and ease of use of social media among ulama. Based on qualitative research in Ogan Ilir District, South Sumatera Province, we found that the acceptability of social media among ulama in Ogan Ilir District is positive. Online life has become the new identity of ulama in this area. They use social media for broadcasting da’wah message and selling or buying goods and service. However, no ulama are producing their messages of da'wah. Facebook is the most popular social media among ulama. We also find that feeling safe and comfortable, get the real benefits from social media, network quality, and jihad in cyberspace have positive contributions to social media adoption within ulama. We identify the availability of time, audience response, negative content, addictive situations, and internet cost as the inhibiting factor of social media adoption among ulama. We discussed these findings and suggested practical recommendations and agenda for further research.

Morphological features including interarterial course, intramural course, high ostial location and slit-like ostium are presumed risk factors for sudden cardiac death in children with anomalous aortic origin of the coronary artery (AAOCA). To facilitate clinical risk stratification, the diagnostic accuracy of CT angiography for individual risk factors in the setting of AAOCA must be established. We assessed diagnostic accuracy of standardized CT angiography interpretation for morphological characteristics that might determine risk in children with AAOCA by comparing them to surgical findings. We created a standardized protocol for CT angiography of AAOCA and retrospectively evaluated diagnostic performance in 25 consecutive surgical patients. Relevant morphological variables in AAOCA were assessed by three independent blinded readers, with surgery as the reference standard. We used Cohen kappa coefficients and accuracies to assess agreement between readers and surgical findings, and we calculated intraclass correlation coefficients to compare length of the intramural course. CT angiography correctly identified AAOCA in all patients. For the three readers, accuracies for detecting ostial stenosis were 84%, 94% and 96%; for high ostial origin, accuracies were 76%, 78% 82%; for intramurality using the peri-coronary fat sign, accuracies were 98%, 96% and 92%; and for intramurality using oval shape of coronary artery, accuracies were 98%, 94% and 92%. The intraclass correlation coefficients (ICCs) for predicting intramural length among the three readers were 0.67, 0.75 and 0.81 using peri-coronary fat, and 0.69, 0.50 and 0.81 using oval shape, respectively. CT angiography reliably identified AAOCA in all children and detected the presence of intramurality with high accuracy.

Background Aneurysm clipping requires the proficiency of several skills, yet the traditional way of practicing them has been recently challenged, especially by the growth of endovascular techniques. The use of simulators could be an alternative educational tool, but some of them are cumbersome, expensive to implement, or lacking in realism. The aim of this study is to evaluate a reusable low-cost 3-dimensional printed training model we developed for aneurysm clipping. Methods The simulator was designed to replicate the bone structure, arteries, and targeted aneurysms. Thirty-two neurosurgery residents performed a craniotomy and aneurysm clipping using the model and then filled out a survey. They were divided into Junior and Senior groups. Descriptive, exploratory, and confirmatory factor analysis was performed using IBM SPSS statistical software. Results The overall residents' response was positive, with high scores to face validity and content validity questions. There was no significant statistical difference between the Junior and Senior groups. The confirmatory factor and internal consistency analysis confirmed that the evaluation was highly reliable. Globally, 97% of the residents found the model was useful and would repeat the simulator experience. The financial cost is $2500 USD for implementation and only $180 USD if further training sessions are required. Conclusions The main strengths of our training model are its highlighted realism, adaptability to trainees of different levels of expertise, sustainability, and low cost. Our data support the concept that it can be incorporated as a new training opportunity during professional specialty meetings and/or within residency academic programs.

Background: Anomalous aortic origin of a coronary artery (AAOCA) is associated with sudden death in the young. We sought to determine quality of life (QOL) in patients/families affected by AAOCA. Methods: Patients with AAOCA (8-18 years) were prospectively included from January 2016 to May 2017. Parent proxy and patient Pediatric Cardiac Quality of Life Inventory (PCQLI) were used to evaluate QOL and Pediatric Quality of Life Inventory (PedsQL) Family Impact Module to assess the impact of AAOCA on families, as primary outcomes. Secondary outcomes included peer relationship, anxiety, and depression assessed using patient-reported outcomes measurement information system. Patients deemed high-risk were offered surgery/exercise restriction. Generalized linear mixed regression models were used to determine significant predictors of outcomes. Results: Fifty-three patients, the majority (n = 31, 59%) unrepaired, and 49 caregivers were included. Using PCQLI, patient and parent proxy QOL scores were similar to published scores for children with long-QT syndrome. Patients’ QOL score was associated with exertional symptoms, perceived chronic disease, and altered parent’s concentration ability. Likewise, parent proxy QOL scores were associated with mother’s living situation, exertional symptoms, parent missing work for ≥1 day, and disturbed parental functioning at work. Family impact scores were associated with lower maternal education, among other measures. Risk categories or surgical status did not impact patient, parent proxy reported, or family impact QOL. Conclusion: Anomalous aortic origin of a coronary artery is associated with decreased QOL as perceived by patients and caregiver and is associated with numerous facets of family functioning. These findings are independent of risk categorization or surgical status.

Machine learning has achieved an important role in the automatic classification of variable stars, and several classifiers have been proposed over the last decade. These classifiers have achieved impressive performance in several astronomical catalogues. However, some scientific articles have also shown that the training data therein contain multiple sources of bias. Hence, the performance of those classifiers on objects not belonging to the training data is uncertain, potentially resulting in the selection of incorrect models. Besides, it gives rise to the deployment of misleading classifiers. An example of the latter is the creation of open-source labelled catalogues with biased predictions. In this paper, we develop a method based on an informative marginal likelihood to evaluate variable star classifiers. We collect deterministic rules that are based on physical descriptors of RR Lyrae stars, and then, to mitigate the biases, we introduce those rules into the marginal likelihood estimation. We perform experiments with a set of Bayesian logistic regressions, which are trained to classify RR Lyraes, and we found that our method outperforms traditional non-informative cross-validation strategies, even when penalized models are assessed. Our methodology provides a more rigorous alternative to assess machine learning models using astronomical knowledge. From this approach, applications to other classes of variable stars and algorithmic improvements can be developed.

espanolObjetivo Adaptar transculturalmente y validar la metodologia COPCORD en poblacion indigena Wayuu del estado Zulia, Venezuela. Metodologia Se realizo un estudio de corte transversal en indigenas Wayuu de los municipios Mara y Guajira del estado Zulia, Venezuela, se adapto transculturalmente la version venezolana del cuestionario COPCORD y se tradujo del espanol venezolano al wayuunaiki (idioma Wayuu). Cien indigenas Wayuu aceptaron participar y se les administro el instrumento, casa por casa, por personal de salud bilingue capacitado. Los individuos COPCORD positivos fueron evaluados por reumatologos. Se realizo analisis descriptivo de variables, se midieron alfa de Cronbach, correlacion de Spearman, analisis de prueba de cribado (sensibilidad, especificidad, VPP y RVs+). Resultados El 66% fueron mujeres, edad promedio 41,4 anos, el 20% monolingues, el 21% analfabetos, el 69% unidos/casados, el 57% con trabajo informal. El 62% reportaron dolor, el 56% con criterios de enfermedades reumaticas; las mas frecuentes fueron: osteoartritis (32,3%), lumbalgia mecanica (13,9%) y sindrome doloroso regional reumatico (12,3%). Cinco dimensiones del instrumento presentaron alfa de Cronbach > 0,7. La sensibilidad fue del 100% y la especificidad del 11,1%, VPP 14,3%, RVs+ 1,13%. Conclusion El COPCORD es valido y util como herramienta de cribado para la deteccion de malestares musculoesqueleticos y enfermedades reumaticas en la poblacion indigena Wayuu. EnglishObjective To adapt cross-culturally and validate the COPCORD methodology in the indigenous Wayuu population of Zulia state, Venezuela. Methodology A cross-sectional study was conducted on Wayuu indigenous people from the Mara and Guajira municipalities of the state of Zulia, Venezuela. The Venezuelan version of the COPCORD questionnaire was transculturally adapted and translated from Venezuelan Spanish to Wayuunaiki (Wayuu language). One hundred indigenous Wayuu, agreed to participate, they were administered the instrument, house by house, by health personnel, who were bilingual and previously trained. Positive COPCORD individuals were evaluated by rheumatologists. A descriptive analysis of variables was performed, Cronbach's alpha was measured, Spearman's correlation, screening test analysis (sensitivity, specificity, VPP and SVR+). Results 66% were women, average age 41.4 years, 20% monolingual, 21% illiterate, 69% in a couple/married, 57% with informal work. Sixty-two percent reported pain, 56% with criteria of rheumatic diseases, the most frequent were: osteoarthritis (32.3%), mechanical lower back pain (13.9%), and regional rheumatic pain syndrome (12.3%). Five dimensions of the instrument presented Cronbach's alpha > 0.7. The sensitivity was 100% and specificity 11.1%, VPP 14.3%, SVR+ 1.13%. Conclusion The COPCORD is valid and useful as a screening tool for the detection of musculoskeletal complaints and rheumatic diseases in the indigenous Wayuu population.

Isolated pulmonary artery (PA) of ductal origin (IPADO) is a rare cardiac defect which requires surgical repair, with or without preceding palliation. We sought to determine the impact of treatment strategy on outcomes. Retrospective study of consecutive patients with IPADO that underwent staged or primary repair from 1/05 to 9/16 at 6 Congenital Cardiac Research Collaborative centers. Patients with single ventricle physiology, major aortopulmonary collaterals, or bilateral IPADO were excluded. Primary outcome was isolated PA z-score at late follow-up. Secondary outcomes included PA symmetry index (isolated:confluent PA diameter) and reintervention burden. Propensity score adjustment was used to account for baseline differences. Of 60 patients in the study cohort, 26 (43%) underwent staged and 34 (57%) primary repair. The staged and primary repair groups differed in weight at diagnosis and presence of other heart disease but not in baseline PA dimensions. Staged patients underwent ductal stent (n = 16) or surgical shunt (n = 10) placement followed by repair at 210 vs. 21 days in the primary repair group (p < 0.001). At median follow-up of 4.5 years post-repair, after adjustment, isolated PA z-score (− 0.74 [− 1.75, − 0.26] vs. − 1.95 [− 2.91, − 1.59], p = 0.012) and PA symmetry index (0.81 [0.49, 1.0] vs. 0.55 [0.48, 0.69], p = 0.042) significantly favored the staged repair group. Freedom from PA reintervention was not different between groups (adjusted HR 0.78 [0.41, 1.48]; p = 0.445). A staged approach to repair of IPADO is associated with superior isolated PA size and symmetry at late follow-up. Consideration should be given to initial palliation in IPADO patients, when feasible.

The aim of our study was to assess concordance of staging laparoscopy and cytoreductive surgery (CRS) peritoneal cancer index (PCI) when applying a two-step surgical protocol. We also aimed to evaluate the accuracy of diagnostic laparoscopy to triage patients for complete cytoreduction, and to define optimal time between staging laparoscopy and CRS. We designed a retrospective review of prospectively collected data from patients with advanced ovarian cancer who underwent a diagnostic laparoscopy followed by a CRS a few weeks later (two-step surgical protocol), from January 2010 to April 2019. Only patients selected for complete cytoreduction, and with available PCI score from both surgeries were included. PCI concordance was assessed using intraclass correlation coefficient (ICC). During the study period 543 patients underwent a laparoscopic staging for ovarian carcinomatosis. Among them, 43 patients fulfilled inclusion criteria. ICC between laparoscopic and laparotomic PCI was 0.54. After applying the linear regression equation: laparoscopic PCI + 0.2 x [days between surgeries] + 2, ICC increased to 0.79. Completeness cytoreduction score and laparoscopic PCI were significantly associated (OR 1.27, 95% CI 1.03–1.57, p = 0.03). AUC of laparoscopic PCI to predict complete cytoreduction was 0.90. Concordance between laparoscopic PCI assessment and PCI score at the end of CRS is fair within a two-step surgical management. Laparoscopic assessment underestimates final PCI score by two points, and this difference increases with the delay between both surgeries. Diagnostic laparoscopy can adequately select patients for CRS, and optimal time to perform it is no more than 10 days after laparoscopy.

Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs., Survey data collected across ten low-income and middle-income countries (LMICs) in Asia, Africa and South America compared with surveys from Russia and the United States reveal heterogeneity in vaccine confidence in LMICs, with healthcare providers being trusted sources of information, as well as greater levels of vaccine acceptance in these countries than in Russia and the United States.

To clarify the human health risk of inhalation of gaseous elemental mercury (GEM), we measured GEM concentrations in three artisanal small-scale gold mining (ASGM) areas of Palu (Central Sulawesi, 342 000 residents), Muara Aman (Benkulu in Sumatra, about 1000 residents), and Palangka Raya (Central Kalimantan, 236 000 residents). These sites differed with regard to the scale and method of gold mining (ball mill and dredging systems). Although the scale of ASGM activity at these three sites differed for both the ball mill and dredging methods, gold amalgams were always made during the refining process. The air in these cities was therefore polluted by the mercury used in extracting the gold, although the levels of pollution differed. The highest GEM concentrations were measured at gold shops (5 × 105 ng m−3). In the ASGM activity area, the measured GEM concentrations were high (100–14 000 ng m−3) near grinding drums. GEM concentrations in Palu and Palangka Raya ranged from 2.06 to 375 ng m−3 and 2.04 to 25.3 ng m−3, respectively. GEM concentrations within an ASGM community area in Muara Aman ranged from 4.10 to 11.5 ng m−3. Our results indicated that the health of residents of Palu—not only in the ASGM area but also in the city—may be at risk due to GEM inhalation. In Muara Aman, the health of people who engage in gold refining and of gold shop employees may be at risk, whereas the health of residents of Palangka Raya appears not to be at risk.

The beginning of 2020 is a new challenge for all countries affected by Covid 19, including Indonesia. The number of cases that continues to grow is a public concern. Even so, there are still many people who do not care about the dangers of the virus. Not only physically and psychologically, this global case also affects the economic condition of the community. One of the communities affected by the economy due to the Covid-19 pandemic is the people of Surien Village, Banda Aceh. This service activity aims to disseminate the prevention of Covid-19 transmission and assistance to strengthen the economy of the affected community in Surien Village, Meuraxa District, Banda Aceh City. The method used is to educate the public about health protocols that have been issued by the government to prevent transmission of the corona virus. Socialization was carried out by practicing and distributing brochures containing detailed health protocols such as wearing masks, physical distance from crowds and proper and proper hand washing methods tucked into the basic needs assistance. The results of these activities provide a deeper understanding to the public about the importance of wearing masks and washing hands properly for the early prevention of the spread of Covid-19. Providing basic food assistance is very useful for strengthening the economy of people who tend to be unprivileged during the Covid-19 pandemic issue.

Objetivo: Determinar la relación entre los estilos de vida saludable, glucosa e IMC en adultos del Vallede Amauta – Ate Vitarte – Lima – 2020. Metodología: Diseño no experimental, enfoque cuantitativo,de corte transversal y de tipo correlacional. La muestra está compuesta por a 175 adultos de ambossexos de edades entre 18 a 64 años. Se recolectaron los datos a través de un cuestionario sobre estilode vida; además, se tomaron medidas antropométricas como peso y talla para determinar el Índice demasa corporal (IMC), así mismo, se evaluó el nivel de glucosa. Resultados: El 82.7% de la poblaciónevaluada presentó un estilo de vida saludables y solo el 17.7% una condición poco saludable; asímismo, el 77.2% no realizaba actividad física, encontrando que el 52.6% realiza actividad ligera. Encuanto al consumo de alcohol y otras drogas, el 94.2% es saludable; también, el 76.0% informó tenerun sueño adecuado y el 24.0% tenía una mala calidad de sueño. En cuanto a los hábitos alimentarios,81.2% es saludable, un grupo de 18.9% no tiene hábitos saludables, también el 68.0% no tenía unautocuidado. Se encontró que el 42.3% presentó diabetes. Finalmente, el 34.3% tenía un IMC normal,42.3% presentó sobrepeso y 23.4% presentó obesidad. Conclusión: Existe relación entre el estilo devida, los niveles de glucosa y el IMC de los participantes. Además, el estudio demuestra que la falta deactividad física está relacionado al aumento del IMC, que a la vez se asocia a los niveles de glucosaelevados. Por lo tanto, si se hace una modificación del estilo de vida, condición física y deporte,recreación y manejo del tiempo libre, consumo de alcohol y otras drogas, sueño, hábitos alimentariosy autocuidado, y cuidado médico, puede ser de gran ayuda para la prevención de enfermedadesmetabólicas.

Coronavirus Disease 2019 (COVID-19) adalah penyakit menular yang disebabkan oleh Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). SARS-CoV-2 merupakan coronavirus jenis baru yang belum pernah diidentifikasi sebelumnya pada manusia. Indonesia melaporkan kasus pertama COVID-19 pada tanggal 2 Maret 2020 dan jumlahnya terus bertambah hingga sekarang. Sampai dengan tanggal 15 Oktober 2020 Kementerian Kesehatan melaporkan 349.160 kasus konfirmasi COVID-19 dengan 12.268 kasus meninggal. Aplikasi Self-Assessment COVID-19 dapat membantu skrining mandiri bagi masyarakat dan petugas kesehatan guna mempercepat penemuan kasus dan mempermudah petugas kesehatan memberikan upaya kuratif. Sosialisasi Aplikasi Self-Assessment COVID-19 telah dilaksanakan berkoordinasi dengan Puskesmas Dadok Tunggul Hitam dan Kelurahan Kampung Lapai. Kegiatan meliputi pengenalan aplikasi, instalasi aplikasi, implementasi aplikasi, serta monitoring dan evaluasi penggunaan aplikasi. Peserta mengunduh aplikasi pada perangkat Android dan mengimplementasikan aplikasi dengan antusias. Diharapkan aplikasi ini dapat memudahkan masyarakat mengakses informasi terkait COVID-19 dan melakukan skrining secara mandiri.

The problems of malnutrition among under-five children can be used to determine the need for nutritional surveillance, nutritional care, or appropriate nutritional intervention programmes in a community. The present study was planned to assess prevalence of malnutrition in children of the age group of 0 to 5 years. A village based study was carried out to assess prevalence of malnutrition among under-five children at the rural area of Katol. Data was collected by interview schedule for collection of socio-demographic and physical examination format for assessing malnutrition status from January 2016 to April 2016. A child’s detailed history, sex and weight were recorded and length/height were measured using standard technique. The height and weight were plotted on WHO centiles curves. The malnutrition was graded according to WHO classification. Data analysis was done by using WHO Anthro and SPSS software. Total study subjects age group 0-5yrs. 310 study subjects were in study group and 320 study subjects in control group. As per WHO classification of protein energy malnutrition, 75/320(23.43%) from control group and 59/310 (19, 03%) from study group study subjects were in normal range Significantly higher number no children from study group 80.96% (251/310) showed malnutrition by applying any of the anthropometric parameter than that in control group 76.56% (245/320) (χ2- value=13.43, p-value=0.0038). In conclusion, high percentage of malnutrition was found in under five children in male children. Keywords: Malnutrition, Children, WHO, Rural.

Evidence suggests that the antinociceptive activity of various drugs can be increased when administered in combination with B vitamins (BVs). The aim of this study was to examine the potential interaction between statins and BVs to counter nociception, the latter measured by the formalin test. Rats were orally administered atorvastatin (1, 3, 10 and 30 mg/kg), pravastatin (1, 3, 10 and 30 mg/kg), rosuvastatin (1, 3, 10 and 30 mg/kg), BVs (31, 56, 100 and 180 mg/kg) or calculated combinations of BVs with each drug. The effective dose 30 (ED30 ) was calculated for each statin and BVs and subjected to isobolographic analysis, thus finding the ED30 of the combinations. The antinociceptive experimental ED30 values for BVs administered with atorvastatin, pravastatin or rosuvastatin were 1.53 ± 0.38, 6.74 ± 0.04 and 4.26 ± 0.39, respectively, being lower (p < .05) than the corresponding theoretical ED30 : 28.02 ± 2.20, 28.17 ± 2.20 and 29.86 ± 2.21. Since BVs likely boost the antinociceptive effect of statins, these combinations could possibly be advantageous in pain management.

Samoa is not immune to the growing global incidence of cancer, which is disproportionately high in low- and middle-income countries. As a preliminary step to upscale our population-based cancer registry initiatives in Samoa, we conducted a 10-year survey of cancer incidences in Samoa from 2007 to 2016. We reviewed all laboratory and clinically confirmed cases of cancer from 2007 to 2016 covering both government and nongovernment facilities. Cancer incidence increased steadily from 2007 (28.5 per 100 000) to 2012 (67.1 per 100 000). The incidence rate decreased in 2013 (from 67.1 cases in 2012 to 51.4 cases per 100 000 in 2013); and in 2015 (from 65.1 cases in 2014 to 54.3 cases per 100 000 in 2015). From 2012 to 2016, the incidence rate fluctuates between 50 and 65 cases per 100 000. Cancers of female genitalia, breast, and digestive system were the most common types in female and males, respectively.

In this day and age with the internet brings revolution to the way all fields work, especially in the field of business. With the internet technology data became big and known as "Big Data". The development of big data has increased significantly so that it can be utilized in various fields, especially in business areas that have been implemented with internet technology. This electronic buying and selling media have a wide range such as from small to large stores that can utilize media or with a site. This makes users always need this technology, so an E-commerce can also be said to be the largest data-producing media. This study addresses the problem of the extent to which big data generated from E-commerce can affect business and provide benefits for business organizations such as expanding the scope of transactions, supporting decision-making, and others. The research method used in compiling this research is to collect data and information and then conduct processing and analysis of the data. So it is expected from the results of utilization of big data in this E-commerce business that has been processed can provide support especially in making decisions with cluster results that have been obtained for example such as to know the most sales patterns in order to be able to add stock to certain goods and determine promotions based on future sales. The study concluded that based on gift shop sales data, the average item purchased by the store's customers is found in items that are included in cluster group 0 so that the gift shop can increase the stock of items contained in cluster group 0.

In the field of security, baggage-screening with X-rays is used as nondestructive testing for threat object detection. This is a common protocol when inspecting passenger baggage particularly at airports. Unfortunately, the accuracy of such human inspection is around 80–90%, under optimal operator conditions. For this reason, it is quite necessary to assist human inspectors with the aid of computer vision algorithms. This work proposes a deep learning-based methodology designed to detect threat objects in (single spectrum) X-ray baggage scan images. For this purpose, our proposed framework simulates a large number of X-ray images, using a combination of PGGAN (Karras et al. in International conference on learning representations, 2018. https://openreview.net/forum?id=Hk99zCeAb ) and superimposition (Mery and Katsaggelos in 2017 IEEE conference on computer vision and pattern recognition workshops (CVPRW), 2017. https://doi.org/10.1109/CVPRW.2017.37 ) strategies, that are used to train state-of-the-art detection models such as YOLO (Redmon et al. in You only look once: unified, real-time object detection. CoRR abs/1506.02640, 2015. http://arxiv.org/ abs/1506.02640 ), SSD (Liu et al. in SSD: single shot multibox detector. CoRR abs/1512.02325, 2015. http://arxiv. org/abs/1512.02325 ) and RetinaNet (Lin et al. in Focal loss for dense object detection. CoRR abs/1708.02002, 2017. http://arxiv.org/abs/1708.02002 ). Our method has been tested on real X-ray images in the detection of four categories of threat objects: guns, knives, razor blades and shuriken (ninja stars). In our experiments, YOLOv3 (Redmon and Farhadi in Yolov3: An incremental improvement. CoRR abs/1804.02767, 2018. http://arxiv.org/abs/1804.02767 ) obtained the best mean average precision (mAP) with 96.3% for guns, 76.2% for knives, 86.9% for razor blades and 93.7% for shuriken, while the average mAP for all threat objects was 80.0%. We believe the effectiveness of our method in the detection of threat objects makes its use in checkpoints possible. Moreover, our methodology is scalable and can be easily extended to detect other categories automatically.

Background The sentinel lymph node (SLN) biopsy may be an alternative to systematic lymphadenectomy in early cervical cancer. The SLN biopsy is less morbid and has been shown to have high sensitivity for metastasis detection. However, the sensitivity of the SLN technique might be overevaluated because SLNs are examined with ultra-staging, and non-sentinel nodes usually are examined only with routine techniques. This study aimed to validate the negative predictive value (NPV) of the SLN technique by the ultra-staging of SLNs and non-sentinel nodes (NSLNs). Methods The SENTICOL 1 study data published in 2011 were used. All nodes (i.e., SLNs and NSLNs) were secondarily subjected to ultra-staging. The ultra-staging consisted of sectioning every 200 µm, in addition to immunohistochemistry. Moreover, the positive slides and 10% of the negative slides were reviewed. Results The study enrolled 139 patients, and SLNs were detected in 136 (97.8%) of these patiets. Bilateral SLNs were detected in 104 (76.5%) of the 136 patients. A total of 2056 NSLNs were identified (median, 13 NSLNs per patient; range 1–54). Of the 136 patients with SLNs, 23 were shown to have positive SLNs after serial sectioning and immunohistochemical staining. The NSLNs were metastatic in six patients. In the case of bilateral SLN detection, the NPV was 100%, with no false-negatives (FNs). Conclusions The pelvic SLN technique is safe and trustworthy for determining the nodal status of patients with early-stage cervical cancer. In the case of optimal mapping with bilateral detection, the NPV was found to be 100%.

Bekicot (Achatinafulica) is a gastropod class animal consumed by TNS community. It is processed in several ways including fried, boiled, and roasted. This study aims at determining the amount of bacteria found in snails that are processed in accordance with the habits of the community and stored for 3 hours, 6 hours, and 9 hours. This type of research is a descriptive study to see the quality of bicrobiology. This research was conducted in TNS sub-district for sampling and a microbiology test was carried out in the Basic Laboratory of Biology Education at Pattimura University. The results showed that among the three treatments, the lowest number of colonies was 3 hours treatment. The lowest amount of bacteria was found in bekicot meat by roasting with an average of 11.3 Cfu / g. In the storage period of 6 and 9 hours the meat is not safe to be consumed because it contains more than 5x105 Cfu / g bacteria, the highest number of bacteria or cannot be counted (CNbC) is found in meat by boiling.