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Introduction: Proactive surveillance by a critical care outreach team (CCOT) can promote early recognition of deterioration in hospitalized patients but is uncommon in pediatric rapid response systems (RRSs). After our children’s hospital introduced a CCOT in 2019, we aimed to characterize early implementation outcomes. We hypothesized that CCOT rounding would identify additional children at risk for deterioration. Methods: The CCOT, staffed by a dedicated critical care nurse (RN), respiratory therapist, and attending, conducts daily in-person rounds with charge RNs on medical-surgical units, to screen RRS-identified high-risk patients for deterioration. In this prospective study, observers tracked rounds discussion content, participation, and identification of new high-risk patients. We compared ‘identified-patient-discussions’ (IPD) about RRS-identified patients, and ‘new-patient-discussions’ (NPD) about new patients with Fisher’s exact test. For new patients, we performed thematic analysis of clinical data to identify deterioration related themes. Results: During 348 unit-rounds over 20 days, we observed 383 discussions − 35 (9%) were NPD. Frequent topics were screening for clinical concerns (374/383, 98%), active clinical concerns (147/383, 39%), and watcher activation (66/383, 17%). Most discussions only included standard participants (353/383, 92%). Compared to IPD, NPD more often addressed active concerns (74.3% vs 34.8%, p

In early 2017, the Canadian Partnership Against Cancer and CancerCare Manitoba undertook a comprehensive knowledge translation (KT) campaign to improve the utilization of single fraction radiotherapy (SFRT) over multiple fraction radiotherapy (MFRT) for palliative management of bone metastases. The campaign significantly increased short-term SFRT utilization. We assess the time-dependent effects of KT-derived SFRT utilization 12–24 months removed from the KT campaign in a Provincial Cancer Program. This study identified patients receiving palliative radiotherapy for bone metastases in Manitoba in the 2018 calendar year using the provincial radiotherapy database. The proportion of patients treated with SFRT in 2018 was compared to 2017. Logistic regression analyses identified risk factors associated with MFRT receipt. In 2018, 1008 patients received palliative radiotherapy for bone metastasis, of which 63.3% received SFRT, a small overall increase in SFRT use over 2017 (59.1%). However, 41.1% of ROs demonstrated year-over-year decreases in SFRT utilization, indicative of a time-dependent loss of SFRT prescription habits derived from KT. Although SFRT use increased slightly overall in 2018, evidence of compliance fatigue was observed, suggestive of a time-perishing property of RO prescription behaviours derived from KT methodologies. Verification of the study’s findings in larger cohorts would be beneficial. These findings highlight the need for additional longitudinal KT reinforcement practices in the years following KT campaigns.

Numerical models that calculate bed change are becoming increasingly popular because of their longterm forecast projections and their ability to identify causes of bed change. However, the reliability of the simulation results depends on the length of the data series and the algorithms in the model, in which the boundary condition method plays a critical role. The aim of this study is to assess the effectiveness of the HYDIST model to update wet and dry fronts as well as recalculate the wet boundaries of the hydraulic model before its input into the sediment transport model. The moving boundary theories (wet and dry fronts) of Zhao (1994) and Sleigh (1998) were applied. The velocity distribution of the wet boundaries was recalculated after every time step, then the outcomes of the hydraulic model were used as input for the sediment transport model. The results showed good agreement between the simulated and measured data in term of discharge, water level, and sediment concentration. At the same time, the HYDIST model can be successfully used to simulate sediment deposition and riverbank movement.

We investigate the epidemiology and outcomes of squamous cell carcinoma (SCC) in recessive dystrophic epidermolysis bullosa (RDEB) from the Australasian EB registry cohort. Seventeen out of 49 (34.6%) RDEB patients developed at least one SCC. Data detailing SCC was obtainable from 16/17 RDEB-SCC patients. A total number of 161 primary SCCs occurred in 16 RDEB-SCC patients with a mean of 10 SCCs per person. The earliest age of first SCC development was 16 years. Eleven out of 16 RDEB-SCC patients eventually developed metastatic SCCs. The majority of the tumours were well and moderately differentiated. The cumulative risk of SCC development by age 35 was 76.1% for RDEB-Generalized Severe (RDEB-GS) and 10% for RDEB-Generalized Intermediate (RDEB-GI). Amongst those who developed SCCs, their median time to death after first SCC was 5 years for RDEB-GI and 4 years for RDEB-GS. This is the first retrospective study of RDEB-SCC in Australasia.

In this study, we propose a new approach to determine intrusions of network in real-time based on statisticalprocess control technique and kernel null space method. The training samples in a class are mapped to a single point using the Kernel Null Foley-Sammon Transform. The Novelty Score are computed from testing samples in order to determine the threshold for the real-time detection of anomaly. The efficiency of theproposed method is illustrated over the KDD99 data set. The experimental results show that our new method outperforms the OCSVM and the original Kernel Null Space method by 1.53% and 3.86% respectively in terms of accuracy.

Inflammatory breast carcinoma is a rare form of advanced breast cancer which carries a poor prognosis, even with treatment. Diagnosis is reached on clinical and pathological grounds; however, due to its propensity to mimic other conditions, it may often be delayed or missed by attending physicians. This case series describes four patients seen at our institution with a diagnosis of inflammatory breast cancer; 3 patients had a history of previously treated breast malignancy. In these cases, the emergence of a new breast lesion evaded initial diagnosis due to incomplete initial physical examination, falsely reassuring imaging results, lack of recognition that a cellulitis picture can resemble metastatic carcinoma, and inconclusive initial biopsy sections. These obstacles to achieve diagnosis serve to further worsen the prognosis by delaying the initiation of multimodality treatment which can improve survival. The purpose of our paper is to increase awareness among breast cancer specialists of the importance of undressing the patient for basic clinical examination of the breasts, recognition of the appearances of this type of local recurrence of breast cancer, and not to rely purely on ultrasound and mammography due to delay in diagnosis in some of our local cases. Sometimes deeper sections and repeat biopsies are needed to make the diagnosis.

Arterial stiffness is an independent prognostic factor for predicting adverse cardiovascular outcomes in hypertensive patients. This study aimed to investigate the rate of increase in arterial stiffness index and the relationship between the ambulatory arterial stiffness index (AASI) with some cardiovascular risks and the change of AASI after 3 months of treatment with perindopril/indapamide (PER/IND). We conducted this research on 75 untreated hypertensive patients at Can Tho University of medicine and pharmacy, Viet Nam. AASI and pulsepressure (PP) were calculated from 24-hour ambulatory blood pressure results. Our study showed that the mean AASI is 0.44±0.14. Female’s increased AASI is capable of 4.38 times as much as the male. Left ventricular hypertrophy (LVH) can increase arterial stiffness index about 3.93 times as much as the non-hypertrophy group (p

Aim: Healthcare workers have directly provided care for COVID-19 patients, and have faced many additional sources leading to poor mental health. The study aimed to investigate the mental health problems and related factors among healthcare staff in Vietnam. Methods: A descriptive cross-sectional mixed methods study, combining quantitative and qualitative research methods, was performed among 400 healthcare workers working at the National Hospital for Tropical Diseases and Ninh Binh General Hospital from the first day of treatment for COVID-19 patients to May 01, 2020. Results: The results showed that 8.0% of participants had stress, 17.5% of participants had anxiety, and 14.8% of participants had depression. Approximately 50% of participants reported that they had at least one of these symptoms. The findings illustrated that stress, anxiety, and depression were associated with the position in a hospital, health status during the COVID-19 pandemic, family members/relatives infected with COVID-19, physical and mental support from friends, family, and community, department, years of working, and the average work hours per day of healthcare workers exposed to COVID-19. Conclusion: During the COVID-19 pandemic, healthcare workers who worked in the hospital providing treatment and care for COVID-19 patients dealt with mental health problems such as stress, anxiety, and depression. It is necessary to promote mental health among healthcare workers, to contribute to the fight against the COVID-19 outbreak in Vietnam. [ABSTRACT FROM AUTHOR]

The construction of a heterojunction by coupling two semiconductor photocatalysts with appropriate band positions can effectively reduce the recombination of photogenerated charge carriers, thus improving their catalytic efficiency. Recently, ZnO photocatalysts have been highly sought after in the synthesis of semiconductor heterostructures due to their wide band gap and low conduction band position. Particularly, transition metal-doped ZnO nanoparticles are attractive due to the additional charge separation caused by temporary electron trapping by the dopant ions as well as the improved absorption of visible light. In this paper, we compare the effect of doping ZnO nanoparticles with 3d (Co and Mn) and 4d (Ag) transition metals on the structural and optical properties of ZnO/CdZnS heterostructures and their photocatalytic performance. With the help of scanning electron microscopy, the successful anchoring of doped and undoped ZnO nanoparticles onto CdZnS nanostructures was confirmed. Among the different heterostructures, Ag-doped ZnO/CdZnS exhibited the best visible-light-driven degradation of rhodamine B at a rate of 1.0 × 10−2 min−1. The photocurrent density analysis showed that AgZnO/CdZnS has the highest amount of photogenerated charges, leading to the highest photocatalytic performance. The reduction in the photocatalytic performance in the presence of hole scavengers and hydroxyl radical scavengers confirmed that the availability of photogenerated electrons and holes plays a pivotal role in the degradation of rhodamine B. [ABSTRACT FROM AUTHOR]