Backward Analysis Research Articles

Surviving in scrubs: sexism, sexual harassment, and assault in the primary care workforce

<h3>Summary</h3> <h3>Background and objectives</h3> There is a need for prediction scores that identify individuals at increased risk for developing progressive chronic kidney disease (CKD). Therefore, this study was performed to develop and validate a “renal risk score” for the general population. <h3>Design, setting, participants, &amp; measurements</h3> For this study we used data from the PREVEND (Prevention of Renal and Vascular ENdstage Disease) study, a prospective population-based cohort study with a median follow-up of 6.4 years. Participants with two or three consecutive estimated GFR (eGFR) measurements during follow-up were included. Participants within the group who had the most renal function decline (top 20% of the total population) and had an eGFR value &lt;60 ml/min per 1.73 m² during follow-up were defined as having progressive CKD. Possible predictors for progressive CKD were selected on the basis of univariable logistic regression analyses. <h3>Results</h3> A final prediction model was built using backward logistic regression analysis. Besides baseline eGFR, the model contained age, urinary albumin excretion, systolic BP, C-reactive protein, and known hypertension. The area under the receiver operating characteristic (ROC) curve was 0.84. We performed internal validation by using a bootstrapping procedure. As expected, after the regression coefficients were corrected for optimism, the area under the ROC curve was still 0.84. For clinical use we divided all predictors in meaningful clinical categories to develop a score chart. The area under the ROC curve was 0.83, indicating the high discriminative value of this model. <h3>Conclusions</h3> Given the high internal validity of this renal risk score, this score can be helpful to identify individuals at increased risk for progressive CKD.

Elevated Troponin and Mortality in Patients with COVID-19: A Multicenter Retrospective Cohort Study

Introduction: Myocardial injury, causing elevated troponin levels, have been associated with worse outcomes in coronavirus disease 2019 (COVID-19) disease patients. However, our anecdotal experience did not consistently reflect this pattern. Therefore, we evaluated the outcomes of COVID-19 patients with elevated troponin. Methods: This is a retrospective study of 1,024 COVID-19 patients admitted to two hospitals in Southern California in the United States. We categorized the troponin levels as normal (≤1× upper reference limit (URL)), mildly elevated (&gt;1 to ≤3× URL), and severely elevated (&gt;3× URL). We compared the characteristics of the three troponin groups using chi-square for categorical variables and one-way Anova for the continuous variables. Finally, backward selection Cox regression analysis was carried out using mortality as a dependent variable. Results: Of the COVID-19 1,024 patients included in the study, 944 (92%) had normal troponin, 45 (4.4%) had mild elevation, and 35 (3.4%) had a severe elevation in troponin levels. In the multivariate Cox regression analysis, troponin elevation in patients without ST-elevation on ECG was not independently associated with mortality (hazard ratio 0.92, 95% CI 0.64-1.3). Increased risk of death was independently associated with age as well as serum C-reactive protein and serum creatinine levels. Conclusion: Elevated troponins without ST-elevation on ECG on hospital admission were not independently associated with increased mortality in hospitalized COVID-19 patients. However, further research is needed to fully understand the absence of a relationship between troponin elevation and mortality in our study population.

Interactions between dopamine transporter and N-methyl-d-aspartate receptor-related amino acids on cognitive impairments in schizophrenia

BackgroundCognitive impairments, the main determinants of functional outcomes in schizophrenia, had limited treatment responses and need a better understanding of the mechanisms. Dysfunctions of the dopamine system and N-methyl-d-aspartate receptor (NMDAR), the primary pathophysiologies of schizophrenia, may impair cognition. This study explored the effects and interactions of striatal dopamine transporter (DAT) and plasma NMDAR-related amino acids on cognitive impairments in schizophrenia. MethodsWe recruited 36 schizophrenia patients and 36 age- and sex-matched healthy controls (HC). All participants underwent cognitive assessments of attention, memory, and executive function. Single-photon emission computed tomography with 99mTc-TRODAT and ultra-performance liquid chromatography were applied to determine DAT availability and plasma concentrations of eight amino acids, respectively. ResultsCompared with HC, schizophrenia patients had lower cognitive performance, higher methionine concentrations, decreased concentrations of glutamic acid, cysteine, aspartic acid, arginine, the ratio of glutamic acid to gamma-aminobutyric acid (Glu/GABA), and DAT availability in the left caudate nucleus (CN) and putamen. Regarding memory scores, Glu/GABA and the DAT availability in left CN and putamen exhibited positive relationships, while methionine concentrations showed negative associations in all participants. The DAT availability in left CN mediated the methionine-memory relationship. An exploratory backward stepwise regression analysis for the four biological markers associated with memory indicated that DAT availability in left CN and Glu/GABA remained in the final model. ConclusionsThis study demonstrated the interactions of striatal DAT and NMDAR-related amino acids on cognitive impairments in schizophrenia. Future studies to comprehensively evaluate their complex interactions and treatment implications are warranted.

Observation on the aerosol and ozone precursors in suburban areas of Shenzhen and analysis of potential source based on MAX-DOAS

Long-term stereoscopic observations of aerosol, NO2, and HCHO were carried out at the Yangmeikeng (YMK) site in Shenzhen. Aerosol optical depths and NO2 vertical column concentration (NO2 VCD) derived from MAX-DOAS were found to be consistent with other datasets. The total NO2 VCD values of the site remained low, varying from 2 × 1015 to 8 × 1015 mol/cm2, while the HCHO VCD was higher than NO2 VCD, varying from 7 × 1015 to 11 × 1015 mol/cm2. HCHO VCD was higher from September to early November than that was from mid-late November to December and during February 2021, in contrast, NO2 VCD did not change much during the same period. In January, NO2 VCD and HCHO VCD were both fluctuating drastically. High temperature and HCHO level in the YMK site is not only driving the ozone production up but also may be driving up the ozone concentration as well, and the O3 production regime in the YMK site tends to be NOx-limited. At various altitudes, backward trajectory clustering analysis and Potential Source Contribution Function (PSCF) were utilized to identify possible NO2 and HCHO source locations. The results suggested that the Huizhou-Shanwei border and the Daya Bay Sea area were the key potential source locations in the lower (200 m) and middle (500 m) atmosphere (WPSCF > 0.6). The WPSCF value was high at the 1000 m altitude which was closer to the YMK site than the near ground, indicating that the pollution transport capability in the upper atmosphere was limited.

The relationship of platelet to lymphocyte ratio with the presence and extent of coronary atherosclerosis detected by coronary computed tomography angiography

Objectives: Platelet-lymphocyte ratio (PLR) combines the predictive risk of platelet and lymphocyte counts into a single risk index. PLR has been studied as a predictive marker in a variety of cardiovascular diseases. However, our understanding of the link between PLR and coronary artery disease (CAD) remains limited. The present study aimed to evaluate the relationship between PLR and intensity of coronary atherosclerosis in patients with suspected CAD. Methods: In this retrospective study, we included 221 patients undergoing dual-source 64-slice coronary computed tomography angiography (CCTA). Total and different types of leukocyte counts were measured with an automatic blood counter. Based on a modified version of the American Heart Association's categorisation, the coronary artery tree was divided into 16 segments. To assess the extent of coronary atherosclerosis, the number of affected coronary segments was counted. Coronary artery plaques were classified into three categories: (1) calcified plaque, (2) non-calcified plaque, and (3) mixed plaque. Results: After multivariable backward stepwise regression analysis, PLR remained as an independent predictor for both the presence and extent of coronary atherosclerosis (OR=2.38, 95% CI: 1.27-4.47 and OR=1.66, 95% CI: 1.10-2.51, respectively). There was no significant relationship between PLR and plaque morphology. Conclusions: Higher PLR was associated with the intensity of coronary atherosclerosis detected by CCTA. Further research is necessary to determine the optimal approach to using PLR in medical practice.

Smart Tourism Spillover Effects: Analysis Using an Inter-Regional Input-Output Model

The pandemic crisis in 2020 has significantly impacted the tourism sector. Besides, the tourism sector is a sector that has great potential in the economy and is an alternative to replacing the extractive sector, such as coal mining. Furthermore, new concepts related to smart tourism are also starting to emerge, which is expected to help accelerate economic recovery. Based on this, this study aims to evaluate the economic effects of smart tourism, both intra- and inter-regional effects, using inter-regional input-output. This is the first study to discuss the regional linkages to smart tourism. The result shows that smart tourism in Indonesia has a spillover effect to other regions, which can help regional integration. The smart tourism industry has a larger total effect on value-added than other industries. In intraregional, the multiplier effect on output, income, and value-added is greater than other industries. The biggest spillover effect of smart tourism is Java and Nusa Tenggara. Based on forward and backward linkage analysis, smart tourism in Bali is classified as "dependent on inter-industrial demand as an intermediate primary production." In addition, smart tourism can be categorized as a key sector in intra regional Bali. With the investment simulation in the smart tourism industry, it can be forecasted that Indonesia's economic growth in 2022 will increase by 0.035 percent; Bali by 2.2 percent; and other provinces by 0.006 percent, given the improvement of other industries.

Spatial distribution, driving factors and health risks of fine particle-bound polycyclic aromatic hydrocarbons (PAHs) from indoors and outdoors in Hefei, China

Atmospheric particulate matter, especially in urban and industrial environments, can act as a source of different organic pollutants that can pose significant health impacts to residents. However, the pollution status and transport mechanisms of fine particle-bound polycyclic aromatic hydrocarbons (PAHs) in indoor and outdoor environments are uncertain. This study aimed to determine the spatial distribution and morphological characteristics of fine particle-bound PAHs and analyze the factors (source contributions and backward trajectories) that influence their concentrations. The results showed that mean concentrations of 16 PAHs were higher in indoor dust as compared to outdoor dust. In addition, the lowest concentrations of the 16 PAHs were found on the 11-20th floor, with smoking households > nonsmoking households (except Nap, Acy, and Ace). The 2–3 ring PAHs were more prominent in households with cooking activities. The particle size distribution showed that most of the particles were <62 μm in diameter, indicating that the indoor particles were smaller in size. Furthermore, the range of δ13C values in the outdoor dust (−30.17 ~ −28.63 ‰) samples was significantly lower than in indoor dust (−28.29 ~ −22.53 ‰). The results based on diagnostic ratios, positive matrix factorization (PMF) analysis and backward trajectory model analysis suggested that the sources of PAHs in indoor and outdoor dust were mixed, originated both locally and from neighboring provinces transported over long distances, especially concentrated in the Yangtze River Delta area. Finally, carcinogenic risk values for indoor dust were greater than those for outdoor dust. Therefore, it is recommended that local governments and industries with high PAH emissions should implement proper protocols to monitor and minimize the pollution levels of PAHs in the urban industrial environment in order to mitigate their health risks.

Understanding drivers of vaccine hesitancy among pregnant women in Nigeria: A longitudinal study

Vaccine-preventable-diseases are major contributors to disease burden in Sub-Saharan Africa. There is dearth of knowledge on the drivers of childhood vaccine hesitancy in Nigeria and its impact on coverage. Although understudied, pregnant women are a particularly important vulnerable group and very relevant for childhood vaccination decisions. This study’s aims are to adapt Confidence, Complacency, Constraints, Calculation, and Collective Responsibility, also known as the 5C psychological antecedence scale for the Nigerian context and to measure predictors of intention to vaccinate among pregnant women (prenatal) and subsequent vaccination behavior (postnatal). It is a longitudinal study that used multi-stage sampling procedure. One healthcare facility was selected from each district in five regional clusters, from which 255 pregnant women were randomly drawn. A standardized questionnaire was used to collect relevant data, including the 5C and some additional variables. Multiple linear regression using backward elimination analysis was performed to identify intention at prenatal and behavior at postnatal. Pregnant women’s intention to vaccinate unborn children was lower if they were Muslims, had lower confidence in public health system, if husband approval was important, and if they believed in rumor. At postnatal, vaccination behavior was more likely to follow mothers’ religious beliefs, when confidence in vaccine effectiveness was high and when mothers felt responsible for the collective. However, everyday stress (constraints) related to less vaccination behavior, and intention did not predict actual vaccination behavior. The 5C scale needs revision before being widely used in Nigeria. Yet, it is a better tool for measuring vaccination behavior than intention.

WITHDRAWN: Recurrent UPJ obstruction following paediatric pyeloplasty is associated with an initial

To determine the risk factors that affect surgical outcomes for pediatric pyeloplasty, and whether this may be related to the choice of operative approach. A retrospective cohort study was performed to evaluate clinicodemographic and operative characteristics of children undergoing dismemberment pyeloplasty by 2 senior pediatric urologists in our tertiary institution between Jan 2008 - Dec 2017. Outcomes included overall complications, re-stenosis, and revision pyeloplasty based on clinic-radiological parameters. Bivariate analysis with Chi-square and Mann-Whitney U test followed by multivariate logistic regression with backward likelihood analysis determined an adjusted effect estimate of the identified significant indicators for inferior peri-operative outcomes related to management. A total of 185 (93 open, 92 Laparoscopic) cases with an average follow-up of 31.3±27.4 months were analyzed. Complications occurred in 21 (11.4%) patients. 12 (6.5%) experienced recurrent UPJ obstruction with 10 (5.4%) undergoing redo-pyeloplasty. Of these, 9 were performed open and 1 laparoscopically. Multivariate logistic regression identified open pyeloplasty as an independent predictor for overall complications (HR 3.29, 95%CI 1.14, 9.51), recurrent UPJ obstruction (HR 49.8, 95%CI 3.09, 803.2) and redo-pyeloplasty (HR 9.75, 95%CI 1.21, 78.6) compared to a laparoscopic approach. Missed crossing vessels were identified in seven redo-cases, which all were from prior open pyeloplasty. An initial open approach was identified as an independent predictor of future complications due to a higher incidence missed crossing vessels at initial repair. Surgeons need to remain especially mindful of this phenomenon when working in a confined open field.

Children’s rates of COVID-19 vaccination as reported by parents, vaccine hesitancy, and determinants of COVID-19 vaccine uptake among children: a multi-country study from the Eastern Mediterranean Region

BackgroundHuge efforts are being made to control the spread and impacts of the coronavirus pandemic using vaccines. However, willingness to be vaccinated depends on factors beyond the availability of vaccines. The aim of this study was three-folded: to assess children’s rates of COVID-19 Vaccination as reported by parents, to explore parents’ attitudes towards children’s COVID-19 vaccination, and to examine the factors associated with parents’ hesitancy towards children’s vaccination in several countries in the Eastern Mediterranean Region (EMR).MethodsThis study utilized a cross-sectional descriptive design. A sample of 3744 parents from eight countries, namely, Iraq, Jordan, Kuwait, Lebanon, Palestine, Qatar, Saudi Arabia (KSA), and the United Arab Emirates (UAE), was conveniently approached and surveyed using Google forms from November to December 2021. The participants have responded to a 42-item questionnaire pertaining to socio-demographics, children vaccination status, knowledge about COVID-19 vaccines, and attitudes towards vaccinating children and the vaccine itself. The Statistical Package for Social Sciences (SPSS- IBM, Chicago, IL, USA) was used to analyze the data. A cross-tabulation analysis using the chi-square test was employed to assess significant differences between categorical variables and a backward Wald stepwise binary logistic regression analysis was performed to assess the independent effect of each factor after controlling for potential confounders.ResultsThe prevalence of vaccinated children against COVID-19 was 32% as reported by the parents. Concerning parents’ attitudes towards vaccines safety, about one third of participants (32.5%) believe that all vaccines are not safe. In the regression analysis, children’s vaccination was significantly correlated with parents’ age, education, occupation, parents’ previous COVID-19 infection, and their vaccination status. Participants aged ≥50 years and those aged 40-50 years had an odds ratio of 17.9 (OR = 17.9, CI: 11.16-28.97) and 13.2 (OR = 13.2, CI: 8.42-20.88); respectively, for vaccinating their children compared to those aged 18-29 years. Parents who had COVID-19 vaccine were about five folds more likely to vaccinate their children compared with parents who did not receive the vaccine (OR = 4.9, CI: 3.12-7.70). The prevalence of children’s vaccination in the participating Arab countries is still not promising.ConclusionTo encourage parents, vaccinate their children against COVID-19, Arab governments should strategize accordingly. Reassurance of the efficacy and effectiveness of the vaccine should target the general population using educational campaigns, social media, and official TV and radio channels.

Self-Reported Measures Have a Stronger Association With Dizziness-Related Handicap Compared With Physical Tests in Persons With Persistent Dizziness.

BackgroundAssociations between dizziness-related handicap and a variety of self-reported measures have been reported. However, research regarding associations between dizziness-related handicap and aspects of functioning that includes both physical tests and self-reported measures is scarce.ObjectiveThe purpose of the study was to describe the variations in signs and symptoms in people with persistent dizziness using physical tests and self-reported outcomes across three severity levels of the Dizziness Handicap Inventory (DHI) and investigate their associations with the DHI.MethodParticipants with persistent dizziness (n = 107) were included in this cross-sectional study. The participants underwent (1) physical tests (gait tests, grip strength, body flexibility, and movement-induced dizziness) and completed questionnaires regarding (2) psychological measures (Mobility Inventory of Agoraphobia, Body Sensation Questionnaire, Agoraphobic Cognitions Questionnaire, and Hospital Depression and Anxiety Questionnaire), and (3) fatigue, dizziness severity, and quality of life (Chalders Fatigue Scale, Vertigo Symptom Scale-Short Form, and EQ visual analog scale), in addition to the DHI. Data were presented by descriptive statistics for three DHI severity levels (mild, moderate, and severe). A multiple linear backward regression analysis was conducted for each group of measures in relation to the DHI total score, with additional analyses adjusting for age and sex. Based on these results, significant associations were tested in a final regression model.ResultsWith increasing severity levels of DHI, the participants demonstrated worse performance on most of the physical tests (preferred and fast gait velocity, dizziness intensity after head movements), presented with worse scores on the self-reported measures (avoidance behavior, fear of bodily sensation, fear of fear itself, psychological distress, fatigue, dizziness severity, quality of life). After adjusting for age and sex, significant associations were found between total DHI and avoidance behavior, psychological distress, dizziness severity, and quality of life, but not with any of the physical tests, explaining almost 56% of the variance of the DHI total score.ConclusionThere was a trend toward worse scores on physical tests and self-reported measurements with increasing DHI severity level. The DHI seems to be a valuable tool in relation to several self-reported outcomes; however, several signs and symptoms may not be detected by the DHI, and thus, a combination of outcomes should be utilized when examining patients with persistent dizziness.

Human-Related Hazardous Events Assessment for Suffocation on Ships by Integrating Bayesian Network and Complex Network

To investigate the human-related factors associated with suffocation on ships during docking repair, a comprehensive analysis model composed of a Bayesian network (BN) and a complex network (CN) is proposed in the present study. The principle of event tree analysis (ETA) is firstly applied to identify the hazardous events involved in the accident according to the accident report, based on which the CN would then be developed with the logic relationships among the hazardous events. The improved K-shell decomposition algorithm is utilized to determine the criticality of nodes in the CN, the results of which are then used to develop the BN model within the framework of a human factor analysis classification system (HFACS). Then, the developed BN model can be simulated with the probability distribution of all the nodes within the BN, which are obtained on the basis of node criticality. Finally, the results of the BN simulation are interpreted from the perspectives of a brief analysis, backward analysis and sensitivity analysis. The results are verified with existing studies and the accident investigation report issued by authority, which are presented as evidence to verify the effectiveness of the proposed methodology to evaluate the human-related risk involved in the suffocation on ships. The methodology proposed in this study integrates the advantages of BN and CN to investigate the human-related hazardous events involved in maritime accidents, which can be seen as the main innovation of this work.

TOURISM FOR ECONOMIC RECOVERY IN CENTRAL KALIMANTAN : SIMULATION USING INPUT-OUTPUT TABLE

&#x0D; &#x0D; &#x0D; &#x0D; Abstract&#x0D; The Covid-19 pandemic has had a negative impact on Central Kalimantan's economic growth with a contraction of 1.40 percent in 2020. Central Kalimantan's economic is still highly dependent on natural resource-based sectors, and it will be very vulnerable because the movement of the economy will be greatly influenced by global price volatility and its uncertainty. The tourism sector, therefore, is an important sector that is expected to be an alternative driver sector of economic recovery. This study aims to measure and analyze the relationship between the tourism sector and other sectors, as well as to simulate investment policies in Central Kalimantan. Limited studies that focus on the tourism sector as planning for economic recovery after the pandemic, especially in Central Kalimantan, can make this research as a reference for policy makers in economic planning. The Input Output table released in May 2021 becomes secondary data used in research with forward and backward linkage analysis and investment simulations in the tourism sector. The results showed that the tourism sector is the sector that has the highest forward linkage in Central Kalimantan. Furthermore, if investment is given to the sector of accommodation and food service activities, it will provide the greatest boost to the total economy compared to other tourism sectors. However, the transportation sector which is the infrastructure in tourism also has an important role as a leading sector with more than one forward and backward linkage index.&#x0D; &#x0D; Keywords: Pandemic, Tourism Sector, Economic Recovery, Input Output Table&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

In essential hypertension, a change in the renal resistive index is associated with a change in the ratio of 24-hour diastolic to systolic blood pressure.

An increase in the renal resistive index (RRI) in patients with essential hypertension (EH) predicts deterioration in renal function. In patients with EH, changes in hemodynamic parameters significantly affect the RRI. This study aimed to define changes in Ambulatory Blood Pressure Monitoring (ABPM) parameters that are significantly associated with a change in RRI in patients with EH. We evaluated ABPM and the RRI in 96 patients with EH without organ extrarenal changes at baseline and after two years of follow-up. The relationships between changes in ABPM parameters and the RRI over the period were evaluated. After two years of follow-up, the increase in RRI was consequential. Simultaneously, 24-h systolic blood pressure increased significantly and 24-h diastolic blood pressure decreased. In the whole group and in the group with calculated cystatin C clearance (eGFRcyst) >/=90 ml/min/1.73 m2, the change in RRI significantly negatively correlated with the change in the ratio of 24-h diastolic to systolic blood pressure (D/S ratio), but also with the change in 24-h pulse blood pressure. However, in patients with eGFRcyst>90 ml/min/1.73 m2, only the change in the 24-h D/S ratio significantly correlated with the change in RRI. Based on the backward stepwise regression analysis, the change in RRI was significantly dependent only on the change in 24-h D/S ratio and not on the change in 24-h pulse pressure. A change in the ratio of diastolic to systolic pressure better reflects a change in RRI than a change in pulse pressure.

Baseline Serum Estradiol Level Is Associated with Acute Kidney Injury in Patients with Moderately Severe and Severe Acute Pancreatitis.

Background Sexual dimorphism with critical diseases has been documented. However, the role of serum sex hormones for the presence of acute kidney injury (AKI) in moderately or severe acute pancreatitis (MSAP and SAP) patients remains controversial. Here we set out to evaluate whether early (first 48 h) serum estradiol level is associated with AKI in patients with MSAP and SAP. Patients and Methods. We retrospectively collected data from patients with preliminary diagnosis of MSAP and SAP from the Affiliated Hospital of Yangzhou University between January 2014 and June 2018. Serum sex hormones were extracted for further assessment within first 48 h following admission. Logistic regression analysis and the receiving operating characteristic (ROC) curve were applied to evaluate the association and correlation between serum sex hormones and AKI. Results Data from a total of 122 patients with MSAP or SAP were enrolled in this study. There were no differences in the incidence of AKI between males and females. However, comparing with patients without AKI, those with AKI saw higher estradiol level (p ≤ 0.01) and slight higher progesterone level (p = 0.014) but similar testosterone level (p = 0.668). Interestingly, during both the manual selection and the stepwise backward logistic regression analysis, serum estradiol level was independently associated with AKI in patients with MSAP and SAP (OR 4.699, CI 1.783-12.386, and p = 0.002). Additionally, area under the curve of ROC (AUCROC) showed that serum estradiol level was a proper predictor for AKI (area under the curve 0.875). Specifically, the serum estradiol level of 223.15 pg/mL demonstrated a 92.3% sensitive and a 79.3% specificity in predicting AKI of MSAP and SAP patients, respectively. Conclusions High baseline serum estradiol level appears to be an independent risk factor for AKI in patients with MSAP and SAP. It also tends to be an appropriate indicator for AKI.

Predictors of sacubitril/valsartan high dose tolerability in a real world population with HFrEF.

The angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan (Sac/Val) demonstrated to be superior to enalapril in reducing hospitalizations, cardiovascular and all-cause mortality in patients with ambulatory heart failure and reduced ejection fraction (HFrEF), in particular when it is maximally up-titrated. Unfortunately, the target dose is achieved in less than 50% of HFrEF patients, thus undermining the beneficial effects on the outcomes. In this study, we aimed to evaluate the role of Sac/Val and its titration dose on reverse cardiac remodelling and determine which echocardiographic index best predicts the up-titration success. From January 2020 to June 2021, we retrospectively identified 95 patients (65.6 [59.1-72.8] years; 15.8% females) with chronic HFrEF who were prescribed Sac/Val from the HF Clinics of 5 Italian University Hospitals and evaluated the tolerability of Sac/Val high dose (the ability of the patient to achieve and stably tolerate the maximum dose) as the primary endpoint in the cohort. We used a multivariable logistic regression analysis, with a stepwise backward selection method, to determine the independent predictors of Sac/Val maximum dose tolerability, using, as candidate predictors, only variables with a P-value < 0.1 in the univariate analyses. Candidate predictors identified for the multivariable backward logistic regression analysis were age, sex, body mass index (BMI), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), dyslipidaemia, atrial fibrillation, systolic blood pressure (SBP), baseline tolerability of ACEi/ARBs maximum dose, left ventricle global longitudinal strain (LVgLS), LV ejection fraction (EF), tricuspid annulus plane systolic excursion (TAPSE), right ventricle (RV) fractional area change (FAC), RV global and free wall longitudinal strain (RVgLS and RV-FW-LS). After the multivariable analysis, only one categorical (ACEi/ARBs maximum dose at baseline) and three continuous (younger age, higher SBP, and higher TAPSE), resulted significantly associated with the study outcome variable with a strong discriminatory capacity (area under the curve 0.874, 95% confidence interval (CI) (0.794-0.954) to predict maximum Sac/Val dose tolerability. Our study is the first to analyse the potential role of echocardiography and, in particular, of RV dysfunction, measured by TAPSE, in predicting Sac/Val maximum dose tolerability. Therefore, patients with RV dysfunction (baseline TAPSE <16mm, in our cohort) might benefit from a different strategy to titrate Sac/Val, such as starting from the lowest dose and/or waiting for a more extended period of observation before attempting with the higher doses.

Associations between alloantibodies and multiple red blood cell transfusions in patients with sickle cell anemia

Alloantibodies are popularly transfusion-related and can be formed against many blood components including the red blood cells, white blood cells, and platelets. The formation of alloantibodies which is a common a sequence for repeated red blood cell transfusion has been reported and are clinically crucial in pregnancies, and to identify risk of future transfusion-related adverse hemolytic reactions. The present study was focused at studying the background clinical factors around red blood cell (RBC) transfusion with respect to alloimmunization, effect of Rh-Kell antigen matching units and its impact on sickle cell anemia (SCA) patients to decrease the incidence of alloantibody development. Methodology – Our retrospective study involved data analysis from SCA patients including pregnant women who had undergone antibody screening from Riyadh, Saudi Arabia. Data from the year 2010 up until 2020 was collected from the King Saud Medical City, the regional laboratory and central blood bank in Riyadh and included a total of 246 patients who matched our criteria. Data from indirect antiglobulin test (IAT) done on each patient at two separate time periods was analysed by appropriate statistical tools in SPSS® software platform. Results – A total of 246 SCA patients with a mean age of 11.9 ± 6.7 years were identified to have obtained blood donation in the study period, and 52.4% transfusion recipients were recorded to have undergone phenotype match: Rh-K. Our study also found 17.9% of the alloimmunized patients to have a record of blood transfusions before alloimmunization. Anti-E (40.9%), anti-Kell (34.1%), anti-D (4.5%) were the most popular specificities of alloantibodies defined. No association was found between gender and production of antibodies, and the backward step binary logistic regression analysis predicted recipients of blood transfusions (>7 units) was 3.66 times more exposed to risk of developing alloantibodies (1.23 – 10.85, 95% CI). While among those in the matching phenotype (Rh-K) group was less likely [OR = 0.012 (0.001–0.11, 95% CI)] to develop alloantibodies. The current study showed that advancing age, and multiple transfusion episodes to increase the risk of developing alloantibodies following blood transfusion among SCA patients.

당뇨 환자의 삶의 질 관련 요인 : 제 8기 1차년도(2019년) 국민건강영양조사

Objectives: This study aims to examine diabetic patients’ quality of life by using the data of the 8th Korea National Health and Nutrition Examination Survey (1st year, 2019), identify the factors related to this, and utilize the results as basic data for intervention that can improve diabetic patients’ quality of life. Methods: For the research subjects, this study extracted 624 patients who were diagnosed with Diabetes by a doctor from the total sample of 8,110 participants of the 8th Korea National Health and Nutrition Examination Survey. The SPSS(version25.0) program was used for the analysis of the collected data. Then, this study used a backward elimination multiple regression analysis method that applied complex sample, to examine the factors related with the finally estimated quality of life. Results: The results of this study revealed that diabetic patients’ quality of life was related with gender, age, occupation, restriction of activity, subjected health status. The final model explained 35.7% of the variance (Wald F=28.210, p<.001). Conclusions: In order to improve the quality of life of diabetic patients, it would be desirable to provide differentiated management by developing a customized intervention strategy that takes into account gender, age, and occupation. When managing diabetic patients, the state, local governments, and hospitals should include content that prevents and copes with restrictions on activities that may occur due to disease. In addition, it is required to prepare a strategy to induce positive perception of the subject's own health status.

Gender differences in concerns, stress levels and behavior changes in dental academics in Iran during the COVID-19 pandemic: A cross-sectional study.

Coronavirus disease 2019 (COVID-19) has placed a significant psychological burden on the healthcare personnel. Dental academics play a crucial role in the promotion of public oral health and the education of dental students. The aim of the study was to assess COVID-19-related concerns, stress and behavior changes in Iranian dental academics, determine the associated factors, and assess the potential gender differences. In this cross-sectional study, we shared a researcher-developed questionnaire with Iranian dental academics through social media and e-mail. The questionnaire contained 4 sections: Background (8 items and additional 6 knowledge questions); Concerns (18 items); Stress (based on the 15-item Impact of Event Scale (IES)); and Behavior Change (5 items). We divided the concerns by means of the principal component analysis (PCA) into 3 various components of the fear of infection, concerns over professional responsibilities and concerns over restrictions. The backward stepwise multilevel linear and logistic regression analyses served to discover the association of other factors with stress and behavior changes. Out of 274 respondents, 66% were female, and 78% were 45 years old or younger. Approximately half of the respondents demonstrated moderate to severe stress and the median (Me) for behavior change was 46.5 out of 50. The greatest concern expressed by the participants referred to the fear of becoming infected by their patients and spreading the virus to their loved ones. Being female, living with parents and not having any administrative role, along with greater fear of infection, concerns over restrictions and academic experience were associated with higher levels of COVID-19-related stress. Being female and having an administrative role, along with greater fear of infection and knowledge, and more daily patient visits were associated with desirable COVID-19-related behavior changes. The COVID-19 pandemic has significantly affected dental academics' psychological state, leading to various levels of concern, stress and behavior change. Supportive and educational programs must target those with high fear and stress levels to prevent undesirable behaviors.

Post-resonance backward whirl analysis in cracked overhung rotors

Overhung rotors usually exhibit recurrent transitions through critical whirl rotational speeds during startup and coast down operations, which significantly differ from their steady-state whirl responses. The presence of angular acceleration results in a linear-time-varying (LTV) system, which, although technically linear, still presents complexities often evinced by a nonlinear system. In general, backward whirl zones can either precede the critical forward whirl speed (termed as pre-resonance backward whirl, Pr-BW), or immediately follow the critical forward whirl speed (termed as post-resonance backward whirl, Po-BW). The Po-BW in the whirl response of a cracked overhung rotor with a breathing crack is studied here as distinct from that of geometrically symmetric configurations of other rotor systems. The equations of motion from the finite element (FE) model of an overhung rotor system with a breathing crack are numerically integrated to obtain the whirl response. The transient whirl responses with different bearing conditions are thoroughly investigated for excitation of Po-BW. The Po-BW zones of rotational speeds are determined via the wavelet transform method and full spectrum analysis (FSA) and applied to signals with added noise. The results of this work confirm the excitation of the Po-BW in cracked overhung rotors and confirm the robustness of the employed methods.