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Objectives Local neighbourhoods have great potential to foster community belonging which can improve health and well-being. In partnership with the City of Toronto, we prioritize and assess the importance of physical and social environmental attributes to community belonging. Using new data linkages, we contribute to Toronto’s community safety and well-being plan, SafeTO. Approach We leverage an individual-level record linkage of respondents from multiple cycles of the Canadian Community Health Survey (CCHS, 2000 to 2017), the Canadian Vital Statistics Death Database (CVSD), and the Discharge Abstract Database (DAD) from the Centre for Population Health Data at Statistics Canada. Environmental data sources include the Census, administrative data, and open-source data. Using postal code information from the CCHS, we connected each respondent with their neighbourhood’s attributes, which include but are not limited to proximity to amenities (such as childcare, libraries and public transit), the Canadian Active Living Environment measure, green space, and air quality. Results Of the 74,000 CCHS respondents from the Toronto census metropolitan area (representing a population of 4 to 5 million annually), an overall rate of 86% agreed to link and share their data, which renders an estimated linked sample of approximately 63,600 respondents. Across the entire linkage, 54% of respondents are linked to a record in the DAD between 1999/00 and 2017/18, and 10% are linked to a death record in the CVSD between 2000 and 2017. In consultation with municipal agencies and community stakeholders, we will prioritize the environmental attributes that are most relevant to community belonging and well-being, and comprehensively model the relationship between these attributes, community belonging and downstream health outcomes using multivariable regression and time-to-event models. Conclusion This on-going work contributes to the development of innovative approaches for using multi-sector data to inform decision making, as per the goals of SafeTO. Results from the analyses will be used to identify environmental attributes potentially important for community belonging and will support municipal city planning and resource allocation.

Background The impacts of the built environment on health is a widely studied international area of research. One area of research is how urban morphology (e.g. active living environments, also known as neighbourhood walkability) may promote healthy behaviour within a population. However urban morphology and data relating to the built environment varies across different countries. Objectives One of the challenges in international studies is producing consistent, comparable measures of the built environment, in this case active living environments. As part of a study which compares the impact of neighbourhood environments on health outcomes for patients with type 2 diabetes (T2D), neighbourhood-level measures for walkable environments were derived for Canada and Wales using Geographic Information Systems (GIS). Methods Using method based upon the Canadian Active Living Environments Database (Can-ALE) we created walkability indicators for Wales, UK. We created GIS models using OpenStreetMap and Office for National Statistics (ONS) Open Data to produce walkability metrics for each Lower Layer Super Output Area (LSOA) in Wales for linkage into the SAIL databank. We compared the GIS generated walkability metrics for Wales with those produced for Canada to evaluate whether the GIS methods are internationally transferable in the context of generating walkability indictors and associations with T2D. Findings This work highlights the challenges in creating internationally comparable environmental exposure metrics. The differences in urban morphology and scale in Canada and Wales are significant, however this work demonstrates how with considered methodological choices these differences can be overcome to generate comparable built environment indicators. Conclusions The generation of comparable walkability indicators for the built environment has allowed subsequent analysis into hospital admissions for people living with T2D in Caranda and Wales. This study has wider implications for international research into the impacts of the built environment on population health and are reproducible on future studies.

ABSTRACT Objectives To demonstrate the methodology and results for linking measures of neighbourhood walking-friendliness or "walkability" to Canadian health surveys and Canadian health surveys linked to administrative health care records. Approach We linked multiple measures of neighbourhood walkability to hundreds of thousands of 6-digit postal codes of respondents to three large Canadian surveys using geographic information systems and anonymized banks of postal codes. Results Long term exposure to walkable neighbourhoods was associated with increased reporting of walking for utilitarian purposes. Moving to a high walkable neighbourhood from a low walkable neighbourhood was associated with a full unit decrease in the body mass index of Canadian men over a 12-year follow-up. In a linkage of walkability measures to respondents who wore biosensors for a one-week period in several Canadian cities, we found that neighbourhood walkability was associated with increased reporting of utilitarian walking but not overall physical activity and step counts as measured by biosensors. Conclusion There is potential for walkable neighbourhoods to influence physical activity and body weight of Canadians which is more evident when individuals are followed for long periods of time.

Background: Pediatric strabismus surgeries have frequently been linked to the occurrence of oculocardiac reflex (OCR). This study aimed to assess the efficacy and safety of peribulbar and sub-tenon blocks on the occurrence of OCR during pediatric strabismus surgeries. Materials and Methods: A randomized, double-blinded trial was conducted with 120 children (ASA I/II) scheduled for strabismus surgery. Patients were randomized into three groups: control (intravenous paracetamol 15 mg/kg), sub-tenon (0.08 mL/kg of 0.5% bupivacaine), and peribulbar (0.25 mL/kg of a 1:1 mixture of 0.5% bupivacaine and 2% lidocaine). The study assessed the incidence rate of OCR as well as the time of occurrence of OCR after induction, hemodynamic variables, postoperative pain and analgesic requirements, the incidence of postoperative vomiting (POV), complications resulting from the orbital regional anesthesia, and total intraoperative atropine requirements. Results: The OCR incidence did not differ significantly between groups. Twenty-three patients (57%) in the sub-tenon group, 14 patients (35%) in the peribulbar group, and 14 patients (35%) in the control group experienced OCR (P = 0.063 and 0.201). All OCR cases were treated with atropine. Pain scores at 4 h post-surgery were significantly higher in the sub-tenon and peribulbar groups compared to the control group (P = 0.001 and 0.041, respectively). The sub-tenon group had one case of POV, whereas the control group had five cases (P = 0.025). Conclusion: Both sub-tenon and peribulbar blocks effectively reduced POV and analgesic requirements in pediatric strabismus surgery, but did not prevent the occurrence of OCR.

Interdisciplinary marine research is pivotal for addressing ocean sustainability challenges but may exclude diverse socio-economic, cultural, or identity groups. Drawing on perspectives of marine Early Career Researchers, we highlight the importance of Diversity, Equity, and Inclusion (DEI) in advancing interdisciplinary marine science and present ten recommendations to enhance DEI. As our ocean faces increasing threats, fostering DEI within this domain is not merely an aspirational goal but an ethical imperative.

Artificial intelligence (AI) has profoundly influenced various sciences, with Chat GPT emerging as a key tool for researchers, programmers, and students. This study explores the attitudes of students from the Departments of Library and Information Science and Media at Alexandria University's Faculty of Arts toward using Chat GPT for academic assignments. It aims to assess the extent of their reliance on the tool, their proficiency in using it to produce accurate and reliable results, and their ability to critically evaluate the outputs generated. Using a descriptive-analytical methodology, the study surveyed a random sample of students during the 2023-2024 academic year, collecting 206 responses (40 of which were excluded for incompleteness). The findings aim to raise awareness of Chat GPT's capabilities, guide university instructors in promoting its effective use, and enhance the integration of AI tools in education for improved academic outcomes.

Introduction The diagnosis of endometriomas in patients with endometriosis is of primary importance because it influences the management and prognosis of infertility and pain. Imaging techniques are evolving constantly. This study aimed to systematically assess the diagnostic accuracy of transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) in detecting endometrioma using the surgical visualisation of lesions with or without histopathological confirmation as reference standards in patients of reproductive age with suspected endometriosis.Methods PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov databases were searched from their inception to 12 October 2022, using a manual search for additional articles. Two authors independently performed title, abstract and full-text screening of the identified records, extracted study details and quantitative data and assessed the quality of the studies using the ‘Quality Assessment of Diagnostic Accuracy Study 2’ tool. Bivariate random-effects models were used to determine the pooled sensitivity and specificity, compare the two imaging modalities and evaluate the sources of heterogeneity.Results Sixteen prospective studies (10 assessing TVUS, 4 assessing MRI and 2 assessing both TVUS and MRI) were included, representing 1976 participants. Pooled TVUS and MRI sensitivities for endometrioma were 0.89 (95% confidence interval ‘CI’, 0.86–0.92) and 0.94 (95% CI, 0.74–0.99), respectively (indirect comparison p-value of 0.47). Pooled TVUS and MRI specificities for endometrioma were 0.95 (95% CI, 0.92–0.97) and 0.94 (95% CI, 0.89–0.97), respectively (indirect comparison p-value of 0.51). These studies had a high or unclear risk of bias. A direct comparison (all participants undergoing TVUS and MRI) of the modalities was available in only two studies.Conclusion TVUS and MRI have high accuracy for diagnosing endometriomas; however, high-quality studies comparing the two modalities are lacking.

Abstract Background PPHN is a common cause of neonatal respiratory failure and is still a serious condition and associated with high mortality. Objectives To compare the demographic variables, clinical characteristics, and treatment outcomes in neonates with PHHN who underwent ECMO and survived compared to neonates with PHHN who underwent ECMO and died. Methods We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature for studies on the development of PPHN in neonates who underwent ECMO, published from January 1, 2010 to May 31, 2023, with English language restriction. Results Of the 5689 papers that were identified, 134 articles were included in the systematic review. Studies involving 1814 neonates with PPHN who were placed on ECMO were analyzed (1218 survived and 594 died). Neonates in the PPHN group who died had lower proportion of normal spontaneous vaginal delivery (6.4% vs 1.8%; p value > 0.05) and lower Apgar scores at 1 min and 5 min [i.e., low Apgar score: 1.5% vs 0.5%, moderately abnormal Apgar score: 10.3% vs 1.2% and reassuring Apgar score: 4% vs 2.3%; p value = 0.039] compared to those who survived. Neonates who had PPHN and died had higher proportion of medical comorbidities such as omphalocele (0.7% vs 4.7%), systemic hypotension (1% vs 2.5%), infection with Herpes simplex virus (0.4% vs 2.2%) or Bordetella pertussis (0.7% vs 2%); p = 0.042. Neonates with PPHN in the death group were more likely to present due to congenital diaphragmatic hernia (25.5% vs 47.3%), neonatal respiratory distress syndrome (4.2% vs 13.5%), meconium aspiration syndrome (8% vs 12.1%), pneumonia (1.6% vs 8.4%), sepsis (1.5% vs 8.2%) and alveolar capillary dysplasia with misalignment of pulmonary veins (0.1% vs 4.4%); p = 0.019. Neonates with PPHN who died needed a longer median time of mechanical ventilation (15 days, IQR 10 to 27 vs. 10 days, IQR 7 to 28; p = 0.024) and ECMO use (9.2 days, IQR 3.9 to 13.5 vs. 6 days, IQR 3 to 12.5; p = 0.033), and a shorter median duration of hospital stay (23 days, IQR 12.5 to 46 vs. 58.5 days, IQR 28.2 to 60.7; p = 0.000) compared to the neonates with PPHN who survived. ECMO-related complications such as chylothorax (1% vs 2.7%), intracranial bleeding (1.2% vs 1.7%) and catheter-related infections (0% vs 0.3%) were more frequent in the group of neonates with PPHN who died (p = 0.031). Conclusion ECMO in the neonates with PPHN who failed supportive cardiorespiratory care and conventional therapies has been successfully utilized with a neonatal survival rate of 67.1%. Mortality in neonates with PPHN who underwent ECMO was highest in cases born via the caesarean delivery mode or neonates who had lower Apgar scores at birth. Fatality rate in neonates with PPHN who underwent ECMO was the highest in patients with higher rate of specific medical comorbidities (omphalocele, systemic hypotension and infection with Herpes simplex virus or Bordetella pertussis) or cases who had PPHN due to higher rate of specific etiologies (congenital diaphragmatic hernia, neonatal respiratory distress syndrome and meconium aspiration syndrome). Neonates with PPHN who died may need a longer time of mechanical ventilation and ECMO use and a shorter duration of hospital stay; and may experience higher frequency of ECMO-related complications (chylothorax, intracranial bleeding and catheter-related infections) in comparison with the neonates with PPHN who survived.

Abstract Background Streptococcus pneumoniae bacteria causes substantial morbidity and mortality worldwide, especially in children under 5 years of age. Prevention of these outcomes by pneumococcal conjugate vaccines (PCV) is an important public health initiative, supported by publicly funded vaccination programs in Canada. While the National Advisory Committee on Immunization (NACI) provides national recommendations for vaccination schedules, decisions on vaccination program delivery are made regionally, creating potential for variability across the country. In addition, defining the groups that are most at risk has become a complex endeavor for provinces and territories in Canada, specifically considering Indigenous children. Methods In this environmental scan, we reviewed policy documents, provincial/territorial and international PCV schedules, and scientific literature, and consulted with vaccination program stakeholders and experts from across the country, in order to understand the evolution of PCV vaccination guidelines and policies in Canada and identify whether and how the needs of Indigenous children are addressed. Results As of March 2023, most regions do not specify particular vaccination requirements for Indigenous children; however, three provinces identify Indigenous children as “high risk” and use varying language to recommend a four dose, rather than the routine three dose, schedule. Our results also draw attention to evidence gaps supporting a differing practice for Indigenous populations. Conclusions Future PCV program innovation requires inclusive and clear policies as well as definitive evidence-based policies and practices in order to improve equitable population health.

Abstract Current methods for therapeutic drug monitoring (TDM) have a long turnaround time as they involve collecting patients' blood samples followed by transferring the samples to medical laboratories where sample processing and analysis are performed. To enable real‐time and minimally invasive TDM, a microneedle (MN) biosensor to monitor the levels of two important antibiotics, vancomycin (VAN) and gentamicin (GEN) is developed. The MN biosensor is composed of a hydrogel MN (HMN), and an aptamer‐functionalized flexible (Flex) electrode, named HMN‐Flex. The HMN extracts dermal interstitial fluid (ISF) and transfers it to the Flex electrode where sensing of the target antibiotics happens. The HMN‐Flex performance is validated ex vivo using skin models as well as in vivo in live rat animal models. Data is leveraged from the HMN‐Flex system to construct pharmacokinetic profiles for VAN and GEN and compare these profiles with conventional blood‐based measurements. Additionally, to track pH and monitor patient's response during antibiotic treatment, an HMN is developed that employs a colorimetric method to detect changes in the pH, named HMN‐pH assay, whose performance has been validated both in vitro and in vivo. Further, multiplexed antibiotic and pH detection is achieved by simultaneously employing the HMN‐pH and HMN‐Flex on live animals.

Abstract: Currently, the economic losses generated by the attack of pests on the storages constitute a severe problem. Conventional grain protection methods based on the application of chemical pesticides to control these undesirable insects have also formed to represent an annoyance since the excessive usage of these compounds is linked to contamination problems and serious harm to consumers' health. This research aims to possibility of creating a means to protect the grain stores from infestation with Rhyzopertha dominica through testing for the efficiency of Trichoderma harzianum with three concentrations (7x104, 7x106, 7x108 and spores /ml) in the protection of grains in jute sacks from infection by this pest after three months of storage period and the effect of T. harzianumon . The results showed that the high efficiency of T. harzianumon in protecting the grain stores from infestation by these insect sacks was measured when treated in the bags with the highest concentration of 7x108 spores/ml of fungi, and the total weight loss was 2.0269. while the control treatment gave 6.4012-gram weight losses. also shows the total weight loss was 4.054 when the grains were treated with the highest concentration of 7x108 spores/ml of fungus. in contrast to 8.0629-gram weight decreases with the control treatment. and treated the bags and grains with 7x108 spores/ml of fungi, the total percentage of weight losses was 1.7033 after three months from storage. while the control treatment gave 11.475 grams of weight loss.

Abstract Hip fractures exceed 250,000 cases annually in the United States, with the worldwide incidence projected to increase by 240–310% by 2050. Hip fractures are predominantly diagnosed by radiologist review of radiographs. In this study, we developed a deep learning model by extending the VarifocalNet Feature Pyramid Network (FPN) for detection and localization of proximal femur fractures from plain radiography with clinically relevant metrics. We used a dataset of 823 hip radiographs of 150 subjects with proximal femur fractures and 362 controls to develop and evaluate the deep learning model. Our model attained 0.94 specificity and 0.95 sensitivity in fracture detection over the diverse imaging dataset. We compared the performance of our model against five benchmark FPN models, demonstrating 6–14% sensitivity and 1–9% accuracy improvement. In addition, we demonstrated that our model outperforms a state-of-the-art transformer model based on DINO network by 17% sensitivity and 5% accuracy, while taking half the time on average to process a radiograph. The developed model can aid radiologists and support on-premise integration with hospital cloud services to enable automatic, opportunistic screening for hip fractures.

Abstract Background Endometriomas are genetically distinct from other endometriosis lesions and could be associated with a predisposition to excessive inflammation. However, differences in clinical presentation between types of endometriosis lesions have not been fully elucidated. This study aimed to investigate the quality of life and pain scores of patients with endometriomas compared to those with other types of endometriosis lesions. Methods A cross-sectional observational study was conducted between January 2020 and August 2023. Patients diagnosed with endometriosis completed the Endometriosis Health Profile 30 pain subscale questionnaire for their quality of life score and rated their endometriosis-associated pain symptoms using an 11-point numerical rating scale. The data were analyzed for comparison through multivariate linear regression models. Results A total of 248 patients were included and divided into endometrioma (81, 33%) and nonendometrioma (167, 67%) groups. The mean age of the patients was 37.1 ± 7.5 years. Most participants were Canadian or North American (84%). One-third of the patients reported experiencing up to four concurrent pain symptoms. The most reported pain included deep dyspareunia (90%), chronic pelvic pain (84%) and lower back pain (81%). The mean quality of life score was 45.9 ± 25.9. We observed no difference in quality of life scores between patients with and without endometriomas. Patients with endometriomas had lower mean scores for deep dyspareunia (0.8; 95% CI [0 to 1.5]; p = 0.049) and higher mean scores for superficial dyspareunia (1.4; 95% CI [0.2 to 2.6]; p = 0.028). Comorbid infertility (p = 0.049) was a factor that modified superficial dyspareunia intensity in patients with endometriomas. Conclusion In patients with endometriosis, evidence was insufficient to conclude that the presence of endometriomas was not associated with a greater or lesser quality of life, but differences in specific symptoms of dyspareunia were identified.

Abstract Introduction Individuals who have a low socio-economic position (SEP) are more likely to smoke and face greater barriers to quitting tobacco. However, the effectiveness of tailored interventions has been limited probably due to specific challenges relative to this population. We conducted a mixed-method study to better understand health professionals’ perceptions and barriers when implementing a preference-based smoking cessation (SC) intervention among disadvantaged smokers. Methods A self-administered online questionnaire was sent to health professionals (doctors’ and other health professionals specialized in SC) participating in “STOP” a pragmatic multicentre randomized controlled trial. Perceptions regarding patient eligibility, the doctor-patient relationship, general study organization, and satisfaction were measured. Results Twenty-eight STOP study investigators responded. Health professionals prioritize smoking cessation for disadvantaged patients, but face challenges in approaching and following them. A research intervention providing cessation tools based on preference was deemed useful but generally undermined by time constraints. Health professionals’ preconceptions regarding patients in low SEP having other “pressing problems” which might be exacerbated by quitting smoking were also identified. Further, participation in a research intervention was perceived as not satisfactory due to workload and lack of time. Conclusion Our results highlight general barriers inherent to implementing pragmatic trials. They also present specific challenges in smoking cessation trials among disadvantaged population, essential to advance equity in tobacco control.

ObjectivesImmune checkpoint inhibitors (ICIs) are associated with immune-related adverse events (irAEs), of which endocrinopathies are common. We characterized endocrine and non-endocrine irAEs in cancer patients receiving ICIs, identified risk factors for their development and established whether endocrine and non-endocrine irAEs were differentially associated with improved cancer prognosis.Design and methodsSingle-center, retrospective cohort study of patients with advanced or metastatic solid tumors receiving at least one ICI treatment cycle (242 men, 151 women, median age 65 years). Main outcome measures were incidence of any irAE during the study period, overall survival and time to treatment failure.ResultsNon-endocrine irAEs occurred in 32% and endocrine irAEs in 12% of patients. Primary thyroid dysfunction was the most common endocrine irAE (9.5%) and the majority of endocrinopathies required permanent hormone replacement. Women had an increased risk of developing endocrine irAEs (p = 0.017). The biggest survival advantage occurred in patients who developed both endocrine and non-endocrine irAEs (overall survival: HR 0.16, CI 0.09-0.28). Time to treatment failure was also significantly improved in patients who developed endocrine irAEs (HR 0.49, CI 0.34 – 0.71) or both (HR 0.41, CI 0.25 – 0.64) but not in those who only developed non-endocrine irAEs.ConclusionsWomen may have increased risk of endocrine irAEs secondary to ICI treatment. This is the first study to compare the effects of endocrine irAEs with non-endocrine irAEs on survival. Development of endocrine irAEs may confer survival benefit in ICI treatment and future, prospective studies are needed to elucidate this.

Abstract Background Physical activity behavioral interventions to change individual-level drivers of activity, like motivation, attitudes, and self-efficacy, are often not sustained beyond the intervention period. Interventions at both environmental and individual levels might facilitate durable change. This community-based study seeks to test a multilevel, multicomponent intervention to increase moderate intensity physical activity among people with low incomes living in U.S. public housing developments, over a 2 year period. Methods The study design is a prospective, cluster randomized controlled trial, with housing developments (n=12) as the units of randomization. In a four-group, factorial trial, we will compare an environmental intervention (E) alone (3 developments), an individual intervention (I) alone (3 developments), an environmental plus individual (E+I) intervention (3 developments), against an assessment only control group (3 developments). The environmental only intervention consists of community health workers leading walking groups and indoor activities, a walking advocacy program for residents, and provision of walking maps/signage. The individual only intervention consists of a 12-week automated telephone program to increase physical activity motivation and self-efficacy. All residents are invited to participate in the intervention activities being delivered at their development. The primary outcome is change in moderate intensity physical activity measured via an accelerometer-based device among an evaluation cohort (n=50 individuals at each of the 12 developments) from baseline to 24-month follow up. Mediation (e.g., neighborhood walkability, motivation) and moderation (e.g., neighborhood stress) of our interventions will be assessed. Lastly, we will interview key informants to assess factors from the Consolidated Framework for Implementation Research domains to inform future implementation. Discussion We hypothesize participants living in developments in any of the three intervention groups (E only, I only, and E+I combined) will increase minutes of moderate intensity physical activity more than participants in control group developments. We expect delivery of an intervention package targeting environmental and social factors to become active, combined with the individual level intervention, will improve overall physical activity levels to recommended guidelines at the development level. If effective, this trial has the potential for implementation through other federal and state housing authorities. Trial registration Clinical Trails.gov PRS Protocol Registration and Results System, NCT05147298 . Registered 28 November 2021.

BackgroundHealthy eating during pregnancy has favorable effects on glycemic control and is associated with a lower risk of gestational diabetes mellitus (GDM). According to Diabetes Canada, there is a need for an effective and acceptable intervention that could improve glucose homeostasis and support pregnant individuals at risk for GDM.AimsThis unicentric randomized controlled trial (RCT) aims to evaluate the effects of a nutritional intervention initiated early in pregnancy, on glucose homeostasis in 150 pregnant individuals at risk for GDM, compared to usual care.MethodsPopulation: 150 pregnant individuals ≥18 years old, at ≤14 weeks of pregnancy, and presenting ≥1 risk factor for GDM according to Diabetes Canada guidelines. Intervention: The nutritional intervention initiated in the first trimester is based on the health behavior change theory during pregnancy and on Canada’s Food Guide recommendations. It includes (1) four individual counseling sessions with a registered dietitian using motivational interviewing (12, 18, 24, and 30 weeks), with post-interview phone call follow-ups, aiming to develop and achieve S.M.A.R.T. nutritional objectives (specific, measurable, attainable, relevant, and time-bound); (2) 10 informative video clips on healthy eating during pregnancy developed by our team and based on national guidelines, and (3) a virtual support community via a Facebook group. Control: Usual prenatal care. Protocol: This RCT includes three on-site visits (10–14, 24–26, and 34–36 weeks) during which a 2-h oral glucose tolerance test is done and blood samples are taken. At each trimester and 3 months postpartum, participants complete web-based questionnaires, including three validated 24-h dietary recalls to assess their diet quality using the Healthy Eating Food Index 2019. Primary outcome: Difference in the change in fasting blood glucose (from the first to the third trimester) between groups. This study has been approved by the Ethics Committee of the Centre de recherche du CHU de Québec-Université Laval.DiscussionThis RCT will determine whether a nutritional intervention initiated early in pregnancy can improve glucose homeostasis in individuals at risk for GDM and inform Canadian stakeholders on improving care trajectories and policies for pregnant individuals at risk for GDM.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT05299502, NCT05299502

Objectives This study aimed to examine the prevalence of post-traumatic stress disorder (PTSD) in victims-survivors of intimate partner violence (IPV) consulting at the specialised and original facility ‘Maison des Femmes’ (MdF) or in two close municipal health centres (MHCs).Design A mixed-methods study using a convergent parallel design from July 2020 to June 2021.Setting/participants A questionnaire was proposed to women aged 18 years and over having suffered from IPV, in the MdF and in two MHCs. We also conducted qualitative interviews with a subsample of the women, asking for victim-survivors’ perceptions of the effect of the MdF’s care.Primary and secondary outcome measures The presence of a PTSD using the PTSD self-report checklist of symptoms, possibility of reaching women by phone 6 months after the inclusion visit, level of self-rated global health, number of emergency visits in the past 6 months, substances use, readiness to change and safety behaviours.Results A total of 67 women (mean age: 34 years (SD=9.7)) responded to our questionnaire. PTSD diagnosis was retained for 40 women (59.7%). Around 30% of participants self-rated their global health as bad. Less than 30% (n=18) of women were regular smokers, and only 7.5% of participants had a problematic alcohol use (Alcohol Use Disorders Identification Test-Consumption score ≥4), 19.4% women used psychotropic drugs. Six months after inclusion, half of participants had been reached by phone. Analysis of the qualitative interviews clarified victim-survivors’ perceptions of the MdF’s specific care: social networking, multidisciplinary approach, specialised listening, healthcare facilities, evasion and ‘feeling at home’.Conclusions The high prevalence of PTSD at inclusion was nearly the same between the three centres. This mixed-methods comparison will serve as a pilot study for a larger comparative trial to assess the long-term impact of the MdF’s specialised care on victims-survivors’ mental health, compared with the care of uncoordinated structures.Trial registration number NCT04304469.

Abstract Background The evolution of smoking rates according to migrant status has not been examined in France, despite a recent reduction in overall smoking rates. Methods DePICT is a two waves (2016: n = 4356; 2017: n = 4114) nationwide telephone survey, representative of the French adult population. We compared smoking-related behaviors before and after implementation of tobacco-control measures (2017), according to the geographical region of birth. Results Compared to 2016, individuals originating from Africa or the Middle East had a slightly higher smoking prevalence in 2017 (34.7% vs 31.3%), despite a higher intention to quit or attempt in the preceding year (adjusted OR(ORa) = 2.72[1.90; 3.90]) compared to non-immigrants. They were also less likely to experience an unsuccessful quit attempt (ORa = 1.76[1.18; 2.62]). Conclusion Tobacco-control measures could have widened smoking inequalities related to migrant status. The evolution of smoking-related behaviors among immigrants should be examined when studying the long-term effects of such policies.

The current research was conducted with the aim of identifying and presenting a control model of social harms of teenagers in the use of virtual social networks. The research method was of a mixed method type, which was operationalized and implemented in two qualitative and quantitative parts. The research method in the descriptive quantitative phase was a survey type and the statistical population included all specialists in the field of communication and modern communication media who were selected to participate in the research. The data collection tool in the quantitative part was a researcher-made questionnaire taken from the qualitative phase. The data were analyzed in the quantitative phase using the software package for social sciences and Smart PLS. The findings of the research showed that the convergent and discriminant validity indicators indicate the desirability of the validity of the variables and the values ​​of Cronbach's alpha coefficient and composite reliability indicated the accuracy of measuring the dimensions of all the variables. The estimated values ​​(factor loading, critical values ​​and significance level) indicated that the factor loadings related to the dimensions and items of all variables are in a favorable condition. In fact, the correlation of the variables with the dimensions and items related to these dimensions was high, so the convergent validity related to the dimensions of the variables at the level of the items is established. According to the results, the research model included the dimensions of mental and emotional injuries, weakening of social values, violation of sexual norms, moral injuries and changing behavioral patterns. The findings provide useful implications in the control and prevention of cyberspace harms.

Transboundary cooperation is a priority for the Organisation of Eastern Caribbean States (OECS). For over thirty years since its formation, it has pursued policies of integration and cooperation among its members with the aim of promoting development and reducing social and economic inequalities across the region. Within the last decade, the islands have embarked on ambitious plans for a sustainable Blue Economy, centred on developing the potential of their vast maritime zones. Achieving this requires cooperation across maritime borders for the management of shared natural resources and transnational human activities, as well as for addressing transboundary challenges facing the region such as climate change, marine pollution and Sargassum influxes. Through a literature review and documentary analysis this article provides a first stocktaking of transboundary maritime cooperation in the region through a mapping of regional level policy promoting cooperation and projects among OECS members over the last decade. The analysis reveals great diversity among participating countries, thematic priorities and actors operating across multiple governance levels. The article concludes with a discussion on the drivers for cooperation among OECS members, highlighting transboundary maritime cooperation as a natural and logical approach for capitalising on opportunities and addressing challenges in a capacity constrained region.

Abstract Some rocks contain multiple remanence “components,” each of which preserves a record of a different magnetic field. The temperature ranges over which these remanence components unblock can overlap, making it difficult to determine their directions. We present a data analysis tool called Thermal Resolution Of Unblocking Temperatures (TROUT) that treats the process of thermal demagnetization as a function of temperature (or alternating field demagnetization as a function of coercivity). TROUT models the unblocking temperature/coercivity distributions of components in a demagnetization experiment, allowing these distributions to overlap. TROUT can be used to find the temperatures/coercivities over which paleomagnetic directions change and when two directional components overlap resulting in curved demagnetization trajectories. When applied to specimens given multi‐component Thermoremanent Magnetizations (TRMs) in the laboratory, the TROUT method estimates the temperature at which the partial TRMs were acquired to within one temperature step, even for specimens with significant overlap. TROUT has numerous applications: knowing the temperature at which the direction changes is useful for experiments in which the thermal history of a specimen is of interest (e.g., emplacement temperature of pyroclastic deposits, re‐heating of archaeological artifacts, reconstruction of cooling rates of igneous bodies). The ability to determine whether a single component or multiple components are demagnetizing at a given temperature is useful for choosing appropriate ranges of temperatures to use in paleodirection/intensity experiments. Finally, the width of the range of temperature overlap may be useful for inferring the composition, grain size and domain state of magnetic mineral assemblages.

AbstractGlycopyrronium is an antimuscarinic drug that is available in a moist towelette preparation for the treatment of primary axillary hyperhidrosis, which is characterized by excessive sweating on the palms, soles of feet, and axillary region. Antimuscarinic toxicity is uncommon with therapeutic use. A 25-year-old female presented to the emergency department with urinary retention and visual changes after initiating topical glycopyrronium tosylate therapeutically. She was tachycardic with a heart rate of 115 beats/min and required a Foley catheter for urinary retention of over 1200 mL. She received 1.5 mg physostigmine for antimuscarinic symptoms and her heart rate improved. Despite treatment, she required a Foley catheter for four days with eventual improvement. This case demonstrates side effects of an unusual preparation of glycopyrronium and the need to take a detailed topical medication history in patients with antimuscarinic symptoms.

Background Endometriosis is a common gynecological condition with a wide range of symptoms, including infertility, dyspareunia, intestinal disorders, and pelvic pain. Laparoscopy and laparotomy are used widely for diagnosing and managing endometriosis. We will conduct a systematic review and meta-analysis with the aims of reporting complications rates following each type of surgeries for endometriosis and determinants of complications. Method We will search Medline (via PubMed), Embase, the Cochrane Library, Web of Science, and Google Scholar for both retrospective and prospective cohorts or trials of at least 30 participants reporting perioperative and postoperative complications for endometriosis surgeries. We will restrict the studies to those conducted after 2011, to be representative of current practices, and will exclude studies of surgeries for gynecological cancer, or other concomitant benign gynecologic surgeries such as myomectomy. Two reviewers will independently screen references and select eligible studies. A standardized form will be used to collect data related to the baseline characteristics, potential determinants of complications, types of interventions, and outcomes. Cumulative incidences of complications will be pooled using DerSimonian and Laird random-effects method. The relation between potential determinants and complications will be reported with risk ratios and their 95% of confidence intervals. Subgroup analysis of surgical approach, surgical procedure, superficial and deep infiltrating endometriosis, and the indication of surgery will be conducted. Sensitivity analyses restricted to studies with low risk of bias will be performed. Discussion This systematic review will provide information on the rates of complications for different surgical approaches and procedures for the treatment of endometriosis. It will contribute to inform patients when making decisions regarding their care. Identifying potential determinants of complications will also help to improve care by identifying women being at higher risk of complications. Trial registration Systematic review registration:CRD42021293865.

Background: The 2020 COVID-19 pandemic led to a strict lockdown in France from March 17 to May 11, 2020. After the lockdown, the French strategy to mitigate the impact of SARS-CoV-2 relied partly on investigations of all confirmed cases. Monitoring collective settings is particularly important since SARS-CoV-2 seems prone to superspreading events (SSEs). Methods: Our study is based on data gathered in Paris from May 11 to December 31, 2020, by the Ile-de-France Regional Health Agency (RHA) to investigate cases occurring in collective and high-risk settings. Specific events in high-risk settings were systematically transmitted to the RHA, and screenings were organized by the facilities, while other settings were reported when three cases were identified within a short period. These settings were more difficult to identify through the surveillance system since no systematic screening was organized by the facility, leaving screenings to rely on the national contact-tracing programme. No official superspreading threshold has been set for SARS-CoV-2. We defined a SSE as an event involving ten cases. Results: We analysed 15,706 events associated with 38,670 cases, representing an average of 2.70 cases per event. Most clusters occurred in educational facilities, workplace environments, social care settings, and healthcare facilities. SSEs represented 3.4% but accounted for 28% of all cases reported. The highest number of SSEs occurred in college settings (12.6%), followed by hospitals and retirement homes. Educational facilities had the lowest number of SSEs, with around 1% in preschools and elementary schools. Conclusions: We observed different SSE rates in each setting. Preschools and primary schools represented the majority of events but experiencing very few SSEs. Colleges were prone to SSEs and were associated with a high number of secondary cases. These findings provide some insights on contact tracing activities and SARS-CoV-2 transmission in different settings.

In this work, the synthesis of pure and (Ce, Ag) co-doped ZnO was successfully accomplished using a solvothermal process. The synthesized samples were characterized by ultraviolet–visible spectroscopy, X-ray diffraction, and scanning electron microscopy. The photocatalytic ability of the samples is estimated through degradation of tartrazine in aqueous solution under photocatalytic conditions. The degradation study carried out for a reaction period of 90 min at and a free pH = 6.0 found that dye degradation is 44.82% for pure ZnO and 98.91% for (Ce, Ag) co-doped ZnO samples, indicating its excellent photocatalytic ability. Tartrazine mineralization was also studied by calculating the degradation of chemical oxygen demand. The effect of operating parameters such as catalyst dose, initial concentration of tartrazine, initial reaction pH, and nature of light source has been optimized for tartrazine degradation as a function of time. The reusability of ZnO and (Ce, Ag) co-doped ZnO catalysts was studied and its photocatalytic efficiency was found to be unchanged, even after six cycles of use. The mechanism of photocatalytic activity was also proposed. HIGHLIGHTS The (Ce, Ag)/ZnO catalyst exhibited outstanding photocatalytic activity.; The effect of tartrazine concentration on photocatalysis performance was studied.; The degradation time of tartrazine using (Ce, Ag)/ZnO catalyst is 90 min.; The reusability of our catalysts ZnO and (Ce, Ag)/ZnO was also explored.;

Tujuan dari penelitian ini mengevaluasi, menganalisa serta membuktikan bahwa varietas beras merah (Oryza nivara. L) dan teknik pemasakan berpengaruh dan dengan metode pengeringan beku (Freeze drying) dapat menjaga stabilitas antosianin nasi merah (Oryza nivara. L) instan. Metode penelitian terdiri dari penelitian tahap pertama meliputi analisis bahan baku : analisis kadar antosianin, protein dan serat pangan (dietary fiber), penelitian tahap kedua menggunakan rancangan analisis Rancangan Acak Kelompok (RAK) 2 faktor meliputi varietas beras merah Inpari 24, Inpara 7, dan Inpago 7 dan teknik pemasakan Dimasak Matang dan Dimasak Setengah Matang. Terdapat 6 perlakuan, 4 kali ulangan, 24 satuan percobaan. Respon pada penelitian tahap kedua meliputi respon kimia (kadar antosianin), respon fisik (waktu rehidrasi), dan respon organoleptik (warna, aroma, rasa, dan tekstur). Olah data menggunakan metode statistik SPSS 21.0 Post Hoc Dunnet’s. Penelitian tahap ketiga analisis sampel terpilih dari penelitian tahap kedua dengan dua metode pengeringan yaitu metode pengeringan beku (freeze drying) dan pengeringan panas (tunnel drying). Hasil penelitian menunjukkan adanya interaksi antara varietas beras merah dan teknik pemasakan. Hasil penelitian tahap pertama menunjukkan hasil uji kadar antosianin, protein dan serat pangan (dietary fiber) dengan nilai tertinggi pada varietas Inpari 24 adalah 5,35 mg/l, 7,15%, dan 16,34%. Hasil penelitian tahap kedua dengan olah data statistik SPSS 21.0 Two Way Anova Post Hoc Dunnet’s diperoleh hasil sampel a1b2 unggul berdasarkan respon kimia kadar antosianin (5,13 mg/l) dan respon organoleptik berdasarkan atribut warna (4,72), rasa (4,12), dan tekstur (4,20). Hasil penelitian tahap ketiga analisis sampel a1b2 perbandingan dengan dua metode pengeringan yaitu metode pengeringan beku (freeze drying) dan metode pengeringan panas (tunnel drying) terhadap stabilitas nutrisi nasi merah instan secara kimia dan fisik yaitu sampel dengan metode pengeringan beku (freeze drying) memiliki nilai terbaik pada kadar antosianin (5,13 mg/l), protein (4,181%), serat pangan (dietary fiber) (12,01%) dan waktu rehidrasi (4 menit 19 detik).

Objective: The objective of this study was to establish the frequency of anxiety and depressive symptoms among women diagnosed with unexplained infertility and to identify risk factors. Methods: We conducted a descriptive cross-sectional study. Forty-two women from the CHU de Quebec fertility clinic were recruited. Women completed the ‘Hospital Anxiety and Depression Scale’ (HADS) self-administered questionnaire, used to estimate prevalence of anxiety and depressive symptoms (score ≥ 8). Results: Overall, 55% ( n = 23) of participants were identified with anxiety or depressive symptoms according to the HADS questionnaire. Anxiety symptoms were more frequent (55%) compared with depressive symptoms (10%). According to a logistic regression model, being under 35 years old [odds ratio (OR) = 16.6, confidence interval (CI): 1.9–25.0], never had a previous spontaneous abortion (OR = 5.6, CI: 1.1–43.5) and never sought fertility treatment (OR = 5.5, CI: 1.1–45.4) were associated with a higher risk of anxiety and depressive symptoms. Conclusion: Anxiety and depressive symptoms are common among women with unexplained infertility, and strategies should be developed to better support and treat this high-risk population.

Background: Tixagevimab/cilgavimab (TGM/CGM) are neutralizing monoclonal antibodies (mAbs) directed against different epitopes of the receptor-binding domain of the SARS-CoV-2 spike protein that have been considered as pre-exposure prophylaxis (PrEP). Objectives: This study seeks to assess the efficacy and safety of TGM/CGM to prevent COVID-19 in patients at high risk for breakthrough and severe SARS-CoV-2 infection who never benefited maximally from SARS-CoV-2 vaccination and for those who have a contraindication to SARS-CoV-2 vaccines. Design: This study is a systematic review and meta-analysis. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was followed. Methods: Electronic databases (PubMed, CINAHL, Embase, medRxiv, ProQuest, Wiley online library, Medline, and Nature) were searched from 1 December 2021 to 30 November 2022 in the English language using the following keywords alone or in combination: 2019-nCoV, 2019 novel coronavirus, COVID-19, coronavirus disease 2019, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, tixagevimab, cilgavimab, combination, monoclonal, passive, immunization, antibody, efficacy, clinical trial, cohort, pre-exposure, prophylaxis, and prevention. We included studies in moderate to severe immunocompromised adults (aged ≥18 years) and children (aged ≥12 years) who cannot be vaccinated against COVID-19 or may have an inadequate response to SARS-CoV-2 vaccination. The effect sizes of the outcome of measures were pooled with 95% confidence intervals (CIs) and risk ratios (RRs). Results: Of the 76 papers that were identified, 30 articles were included in the qualitative analysis and 13 articles were included in the quantitative analysis (23 cohorts, 5 case series, 1 care report, and 1 randomized clinical trial). Studies involving 27,932 patients with high risk for breakthrough and severe COVID-19 that reported use of TGM/CGM combination were analyzed (all were adults (100%), 62.8% were men, and patients were mainly immunocompromised (66.6%)). The patients’ ages ranged from 19.7 years to 79.8 years across studies. TGM/CGM use was associated with lower COVID-19-related hospitalization rate (0.54% vs. 1.2%, p = 0.27), lower ICU admission rate (0.6% vs. 5.2%, p = 0.68), lower mortality rate (0.2% vs. 1.2%, p = 0.67), higher neutralization of COVID-19 Omicron variant rate (12.9% vs. 6%, p = 0.60), lower proportion of patients who needed oxygen therapy (8% vs. 41.2%, p = 0.27), lower RT-PCR SARS-CoV-2 positivity rate (2.1% vs. 5.8%, p < 0.01), lower proportion of patients who had severe COVID-19 (0% vs. 0.5%, p = 0.79), lower proportion of patients who had symptomatic COVID-19 (1.8% vs. 6%, p = 0.22), and higher adverse effects rate (11.1% vs. 10.7%, p = 0.0066) than no treatment or other alternative treatment in the prevention of COVID-19. Conclusion: For PrEP, TGM/CGM-based treatment can be associated with a better clinical outcome than no treatment or other alternative treatment. However, more randomized control trials are warranted to confirm our findings and investigate the efficacy and safety of TGM/CGM to prevent COVID-19 in patients at risk for breakthrough or severe SARS-CoV-2 infection.

Introduction: Cervical myomectomy can compromise cervical integrity and the risk of subsequent cervical incompetence is unclear. In this case report, the literature on cervical myomectomies is reviewed as well as that on the potential benefits of cervical cerclage. Case presentation: A 30-year-old woman, nulligravida, with a 12 cm cervical leiomyoma consulted for heavy menstrual bleeding and pelvic pain. After failure of multiple medical therapies, a laparoscopic cervical myomectomy was successfully performed after pre-operative uterine artery embolization using absorbable gelatin sponges to reduce surgical blood loss. Discussion: A concomitant laparoscopic cerclage was achieved in order to prevent cervical incompetence, given that the full thickness of the anterior cervix was penetrated during the myomectomy.

Background: Intussusception (ISN) post-COVID-19 infection in children is rare but can occur. SARS-CoV-2 may play a role in the pathogenesis of ISN and trigger immune activation and mesenteric adenitis, which predispose peristaltic activity to “telescope” a proximal bowel segment into the distal bowel lumen. Objectives: To estimate the prevalence of SARS-CoV-2 infection in ISN children and analyze the demographic parameters, clinical characteristics and treatment outcomes in ISN pediatric patients with COVID-19 illness. Methods: We performed this systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies reporting on the incidence of ISN post-SARS-CoV-2 infection in children, published from 1 December 2019 until 1 October 2022, in PROQUEST, MEDLINE, EMBASE, PUBMED, CINAHL, WILEY ONLINE LIBRARY, SCOPUS and NATURE, with a restriction to articles available in the English language, were included. Results: Of the 169 papers that were identified, 34 articles were included in the systematic review and meta-analysis (28 case report, 5 cohort and 1 case-series studies). Studies involving 64 ISN patients with confirmed COVID-19 (all patients were children) were analyzed. The overall pooled proportions of the ISN patients who had PCR-confirmed SARS-CoV-2 infection was 0.06% (95% CI 0.03 to 0.09, n = 1790, four studies, I2 0%, p = 0.64), while 0.07% (95% CI 0.03 to 0.12, n = 1552, three studies, I2 0%, p = 0.47) had success to ISN pneumatic, hydrostatic and surgical reduction treatment and 0.04% (95% CI 0.00 to 0.09, n = 923, two studies, I2 0%, p = 0.97) had failure to ISN pneumatic, hydrostatic and surgical reduction treatment. The median patient age ranged from 1 to 132 months across studies, and most of the patients were in the 1–12 month age group (n = 32, 50%), p = 0.001. The majority of the patients were male (n = 41, 64.1%, p = 0.000) and belonged to White (Caucasian) (n = 25, 39.1%), Hispanic (n = 13, 20.3%) and Asian (n = 5, 7.8%) ethnicity, p = 0.000. The reported ISN classifications by location were mostly ileocolic (n = 35, 54.7%), and few children experienced ileo-ileal ISN (n = 4, 6.2%), p = 0.001. The most common symptoms from ISN were vomiting (n = 36, 56.2%), abdominal pain (n = 29, 45.3%), red currant jelly stools (n = 25, 39.1%) and blood in stool (n = 15, 23.4%). Half of the patients never had any medical comorbidities (n = 32, 50%), p = 0.036. The approaches and treatments commonly used to manage ISN included surgical reduction of the ISN (n = 17, 26.6%), pneumatic reduction of the ISN (n = 13, 20.2%), antibiotics (n = 12, 18.7%), hydrostatic reduction of the ISN (n = 11, 17.2%), laparotomy (n = 10, 15.6%), intravenous fluids (n = 8, 12.5%) and surgical resection (n = 5, 7.8%), p = 0.051. ISN was recurrent in two cases only (n = 2, 3.1%). The patients experienced failure to pneumatic (n = 7, 10.9%), hydrostatic (n = 6, 9.4%) and surgical (n = 1, 1.5%) ISN treatment, p = 0.002. The odds ratios of death were significantly higher in patients with a female gender (OR 1.13, 95% CI 0.31–0.79, p = 0.045), Asian ethnicity (OR 0.38, 95% CI 0.28–0.48, p < 0.001), failure to pneumatic or surgical ISN reduction treatment (OR 0.11, 95% CI 0.05–0.21, p = 0.036), admission to ICU (OR 0.71, 95% CI 0.83–1.18, p = 0.03), intubation and placement of mechanical ventilation (OR 0.68, 95% CI 0.51–1.41, p = 0.01) or suffering from ARDS (OR 0.88, 95% CI 0.93–1.88, p = 0.01) compared to those who survived. Conclusion: Children with SARS-CoV-2 infection are at low risk to develop ISN. A female gender, Asian ethnicity, failure to ISN reduction treatment (pneumatic or surgical), admission to ICU, mechanical ventilation and suffering from ARDS were significantly associated with death following ISN in pediatric COVID-19 patients.

Background: Coinfection with bacteria, fungi, and respiratory viruses has been described as a factor associated with more severe clinical outcomes in children with COVID-19. Such coinfections in children with COVID-19 have been reported to increase morbidity and mortality. Objectives: To identify the type and proportion of coinfections with SARS-CoV-2 and bacteria, fungi, and/or respiratory viruses, and investigate the severity of COVID-19 in children. Methods: For this systematic review and meta-analysis, we searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus, and Nature through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies on the incidence of COVID-19 in children with bacterial, fungal, and/or respiratory coinfections, published from 1 December 2019 to 1 October 2022, with English language restriction. Results: Of the 169 papers that were identified, 130 articles were included in the systematic review (57 cohort, 52 case report, and 21 case series studies) and 34 articles (23 cohort, eight case series, and three case report studies) were included in the meta-analysis. Of the 17,588 COVID-19 children who were tested for co-pathogens, bacterial, fungal, and/or respiratory viral coinfections were reported (n = 1633, 9.3%). The median patient age ranged from 1.4 months to 144 months across studies. There was an increased male predominance in pediatric COVID-19 patients diagnosed with bacterial, fungal, and/or viral coinfections in most of the studies (male gender: n = 204, 59.1% compared to female gender: n = 141, 40.9%). The majority of the cases belonged to White (Caucasian) (n = 441, 53.3%), Asian (n = 205, 24.8%), Indian (n = 71, 8.6%), and Black (n = 51, 6.2%) ethnicities. The overall pooled proportions of children with laboratory-confirmed COVID-19 who had bacterial, fungal, and respiratory viral coinfections were 4.73% (95% CI 3.86 to 5.60, n = 445, 34 studies, I2 85%, p < 0.01), 0.98% (95% CI 0.13 to 1.83, n = 17, six studies, I2 49%, p < 0.08), and 5.41% (95% CI 4.48 to 6.34, n = 441, 32 studies, I2 87%, p < 0.01), respectively. Children with COVID-19 in the ICU had higher coinfections compared to ICU and non-ICU patients, as follows: respiratory viral (6.61%, 95% CI 5.06–8.17, I2 = 0% versus 5.31%, 95% CI 4.31–6.30, I2 = 88%) and fungal (1.72%, 95% CI 0.45–2.99, I2 = 0% versus 0.62%, 95% CI 0.00–1.55, I2 = 54%); however, COVID-19 children admitted to the ICU had a lower bacterial coinfection compared to the COVID-19 children in the ICU and non-ICU group (3.02%, 95% CI 1.70–4.34, I2 = 0% versus 4.91%, 95% CI 3.97–5.84, I2 = 87%). The most common identified virus and bacterium in children with COVID-19 were RSV (n = 342, 31.4%) and Mycoplasma pneumonia (n = 120, 23.1%). Conclusion: Children with COVID-19 seem to have distinctly lower rates of bacterial, fungal, and/or respiratory viral coinfections than adults. RSV and Mycoplasma pneumonia were the most common identified virus and bacterium in children infected with SARS-CoV-2. Knowledge of bacterial, fungal, and/or respiratory viral confections has potential diagnostic and treatment implications in COVID-19 children.

Introduction A therapeutic option frequently proposed for infertility is to proceed first with intrauterine insemination (IUI) cycles. Little is known on the effect of uterine contractions on IUI success rates. We postulated that uterine contractions may help with sperm migration in the women’s genital tract. Our objective is to compare the efficacy of IUI when performed with and without a tenaculum forceps on the cervix.Methods and analysis We are conducting a randomised controlled trial with women aged 18–40 years old, diagnosed with primary or secondary infertility due to endometriosis, mild to moderate male factor, unexplained infertility or ovulatory dysfunction, receiving IUI treatments. On the day of their IUI, women will receive standard care treatment plus or minus the planned use of a Pozzi tenaculum forceps on the cervix. Each of the 800 women will be randomised only once for their first three IUI. They will be randomised in one of the following sequences: tenaculum—no tenaculum—tenaculum or, no tenaculum—tenaculum—no tenaculum. We will compare the live birth rate (primary outcome) and the clinical pregnancy rate (secondary outcome) after IUI treatment. We also plan on assessing global satisfaction of women, pain levels felt during IUI and discrepancies in primary and secondary outcomes in interventions performed by attendings compared with trainees.Ethics and dissemination This research project was approved by the Centre Hospitalier Universitaire de Québec’s ethics review board (no 2018–4084). Pozzi tenaculum application is associated with mild pain, estimated at 33 on a Visual Analogue Scale ranging from 0 to 100. We plan on publishing an article to present our findings in a peer-reviewed journal as well as presenting the research abstract at conferences.Trial registration number NCT03435809.

Emphysematous cystitis is an unusual urological emergency in clinical practice. The disease characteristics are still underreported. It is characterized by the presence of gas in the urinary bladder wall secondary to gas forming organism. We report an incidental finding of emphysematous cystitis in a 35-year-old secondary to a huge liver abscess in a poorly controlled blood sugar. The infection spread hematogenously to the urinary bladder wall that was managed conservatively by urethral catheter drainage and hepatic abscess drainage in adjunct with antimicrobial therapy. The patient had no urinary symptoms. The bladder wall gas disappeared during follow-up in 2 weeks.

In “A Pharmacist’s Role in A Dental Clinic: Establishing a Collaborative and Interprofessional Education Site” written by Kalin L. Johnson, et al., the article discusses the importance of having pharmacists in non-traditional settings, such as a university dental clinic, and the benefits of incorporating them into an interprofessional team. Pharmacists are medication experts who can reduce the burden on dental staff by assisting in disease state and medication counseling, medication reconciliation, medication management services, and identification of medication-related problems in dental settings. From August 2014 to July 2018, a total of 2,773 interventions were made on behalf of the pharmacy team. Integrating a pharmacy team contributed to more robust dentalcare and overall healthcare for patients. Overall, pharmacists were accepted by the dentistry team and patients with very few repercussions.1 The purpose of this commentary is to propose a solution towards multiple issues identified by the author during her experience as an interprofessional pharmacist. We propose telehealth to be the solution to these issues. Our telehealth system will consist of pharmacy residents to foster an engaging learning environment while ultimately keeping costs low. This telehealth system will not only advance the knowledge of pharmacy residents and dental students, but will allow more interventions to be made by the pharmacy team as they will be able to expand virtually. Article Type: Commentary

Background: Knowledge about a vaccine’s side effects and efficacy is important to improving public vaccine acceptance. This study aimed to detect the safety and efficacy of vaccines among the Egyptian population. Methodology and Results: Data was collected using an online survey from participants who took two doses of the BBIBP-CorV, ChAdOx1, or BNT162 vaccines. Pain at the vaccine injection site, muscle pain, fatigue, dizziness, fever, and headache were the most common side effects after the first and second doses. The number pf side effects was higher in ChAdOx1 than in BNT162 and BBIBP-CorV. Most of the side effects started on the first day after vaccination and persisted for 1–2 days. Vaccinated people with past coronavirus infections before vaccination developed better antibodies than those who were only vaccinated. The side-effect severity was greater after the first dose of BBIBP-CorV and ChAdOx1 than after the second dose, but in contrast, the side-effect severity was greater after the second dose of BNT162 vaccine than after the first dose. ChAdOx1 was more effective than BBIBP-CorV, and one dose of ChAdOx1 produced an immune response similar to that of two doses of BBIBP-CorV. Conclusions: Coronavirus vaccines were well-tolerated, safe, and produced an immune response against the virus in most cases. Most postvaccine side effects were mild to moderate, which indicated the building of immunity by the body for protection.

Vaccines are the solution to overcome SARS-CoV-2. This study aimed to determine the post-Sinopharm vaccine safety-profile and immunity through antibody titers. Data were collected using a structured questionnaire from Egyptian participants who received two doses of Sinopharm vaccine. Data were divided into three parts, the first and second parts were to detect participants’ post-first and second dose symptoms and practices, and the third for the results of IgG anti spike protein antibodies test and laboratory tests. Pain, redness, swelling at the injection site, headache, fatigue, and lethargy were the most common post-vaccine symptoms for both first and second doses. Most of the participants felt mild or no symptoms after vaccination. The symptoms started mostly during the first day post-vaccination and lasted for no more than two days. Forty-nine percent of the participants resulted in positive antibodies tests on day 18 post-vaccination. The average antibody level for vaccinated participants with past SARS-CoV-2 infection was much higher than that for non-past infected participants. These vaccines’ administration methods need to be reevaluated by changing the dose, dose interval, adding a third dose, or mixing it with other vaccines with different techniques to improve their protection rates. Further studies are required to validate this finding.

BackgroundHospital procedures have been associated with cognitive change in older patients. This study aimed to document the prevalence of mild cognitive impairment in individuals undergoing left heart catheterization (LHC) before the procedure and the incidence of cognitive decline to 3 months afterwards. Methods and ResultsWe conducted a prospective, observational, clinical investigation of elderly participants undergoing elective LHC. Cognition was assessed using a battery of written tests and a computerized cognitive battery before the LHC and then at 3 months afterwards. The computerized tests were also administered at 24 hours (or discharge) and 7 days after LHC. A control group of 51 community participants was recruited to calculate cognitive decline using the Reliable Change Index. Of 437 participants, mild cognitive impairment was identified in 226 (51.7%) before the procedure. Computerized tests detected an incidence of cognitive decline of 10.0% at 24 hours and 7.5% at 7 days. At 3 months, written tests detected an incidence of cognitive decline of 13.1% and computerized tests detected an incidence of 8.5%. Cognitive decline at 3 months using written tests was associated with increasing age, whereas computerized tests showed cognitive decline was associated with baseline amnestic mild cognitive impairment, diabetes mellitus, and prior coronary stenting. ConclusionsMore than half the patients aged >60 years presenting for LHC have mild cognitive impairment. LHC is followed by cognitive decline in 8% to 13% of individuals at 3 months after the procedure. Subtle cognitive decline both before and after LHC is common and may have important clinical implications. Clinical Trial Registration InformationURL: www.anzctr.org.au. Unique identifier: ACTRN12607000051448.

The chotts in Algeria are temporary salt lakes recognized as important wintering sites of water birds but neglected in terms of the diversity of the insects living on their banks. Around a chott in the wetland complex in the high plains near Constantine (eastern Algeria), more than half of the species of plants are annuals that dry out in summer, a situation that prompted us to sample the vegetation in spring over a period of two years. Three zones were identified based on an analysis of the vegetation and measurements of the salt content of the soils. Surveys carried out at monthly intervals over the course of a year revealed temporal and spatial variations in biodiversity and abundance of grasshoppers. The inner zone is colonized by halophilic plants and only one grasshopper species (Dericorys millierei) occurs there throughout the year. Two polyphagous species of Calliptamus, which can feed on halophilic plants migrate from adjacent areas into the inner zone in August to feed on the plants growing there. The other species of grasshoppers remain in outer zones as they are unable to feed on halophilic plants. The greatest abundance of grasshoppers from August to winter was recorded in the inner zone and in spring and early summer in the outer zones. The dependence of D. millierei on bushes of Amaranthaceae and its moderate flight ability, features of the family Dericorytidae, limit this species ability to colonize neighbouring chotts.

Introduction In vitro fertilisation (IVF) is the treatment of choice for unexplained infertility. Preovulatory uterine flushing could reduce intrauterine debris and inflammatory factors preventing pregnancy and constitute an alternative to IVF. Our objective is to assess the efficacy of preovulatory uterine flushing with physiological saline for the treatment of unexplained infertility.Methods and analysis We will perform a randomised controlled trial based on consecutive women aged between 18 and 37 years consulting for unexplained infertility for at least 1 year. On the day of their luteinising hormone surge, 192 participants will be randomised in two equal groups to either receive 20 mL of physiological saline by an intrauterine catheter or 10 mL of saline intravaginally. We will assess relative risk of live birth (primary outcome), as well as pregnancy (secondary outcome) over one cycle of treatment. We will report the side effects, complications and acceptability of the intervention.Ethics and dissemination This project was approved by the Ethics committee of the Centre Hospitatlier Universitaire de Quebec (no 2015–1146). Uterine flushing is usually well tolerated by women and would constitute a simple, affordable and minimally invasive treatment for unexplained infertility. We plan to communicate the results of the review by presenting research abstracts at conferences and by publishing the results in a peer-reviewed journal.Trial registration number NCT02539290; Pre-results.

An 84 year-old gentleman presented with abdominal distension, anorexia and occasional epigastric pain over a four-week period. Blood parameters revealed a hypochromic microcytic anaemia. Both CT and US scan identified ascites and a mass in the left upper quadrant. An ascitic tap was performed identifying bloody ascites and the presence of reactive mesothelial cells on cytology. A subsequent laparotomy and splenectomy was performed. Histology of the resected spleen revealed a Grade 2 follicular lymphoma (Figure 2). The patient had an uneventful postoperative recovery and was well at 6 months follow up. The spleen is an organ with an important immunological function. Primary splenic involvement occurs in less than 1% of non-hodgkin’s lymphoma. Symptoms of primary splenic lymphoma (PSL) include pyrexia, weight-loss, night sweats, generalised weakness and left upper quadrant pain secondary to spleno - megaly. Ascites is a rare presenting feature of PSL. This report illustrates a case of primary splenic lymphoma which poses diagnostic challenges for the pathologist and clinician and ultimately requires definitive splenectomy to confirm a diagnosis.