Mesh Research Articles

Comparative Analysis of Bariatric Surgery and Non-surgical Therapies: Impact on Obesity-Related Comorbidities.

Obesity is associated with a broad spectrum of comorbidities, including metabolic dysregulation, cardiovascular complications, and socioeconomic impacts. Traditional lifestyle interventions often yield transient results in weight management, while bariatric surgery offers a promising alternative. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and focused on randomized controlled trials comparing bariatric surgery (e.g., Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), and sleeve gastrectomy (SG)) with non-surgical therapies (drug therapy and lifestyle modifications) in the management of obesity-related comorbidities, particularly hypertension and type 2 diabetes mellitus (T2DM). We comprehensively searched databases like PubMed, PMC, and EBSCO using Medical Subject Headings (MeSH) terms related to obesity, bariatric surgery, and non-surgical treatments. We included seven studies involving participants aged 18-64 published within the last six years. We rigorously assessed these studies for quality and extracted data to evaluate outcomes such as weight loss, diabetes remission rates, hypertension management, and renal function. The review found that bariatric surgery consistently resulted in substantial and sustained weight loss compared to non-surgical therapies. Surgical interventions significantly improved hypertension control, reduced cardiovascular risks, and enhanced glycemic control in diabetic patients. The effectiveness of bariatric surgery in promoting diabetes remission was attributed not only to weight loss but also to physiological changes in gastrointestinal anatomy, gut hormones, and energy balance regulation. Limitations identified in the literature included variations in study methodologies, follow-up durations, and patient characteristics, which limited direct comparisons and generalizations. Future research should incorporate more extended follow-up periods and standardized methods to further validate these findings' durability and broad applicability across diverse patient populations. In conclusion, bariatric surgery emerges as an effective treatment option for managing obesity-related comorbidities, particularly hypertension and T2DM. While acknowledging the inherent risks and complexities associated with surgical interventions, ongoing research and clinical innovations are crucial to optimizing patient outcomes and reducing the global burden of obesity-related diseases.

Vision Rehabilitation Using Contact Lenses in Infantile Nystagmus: A Systematic Review

Background and Objectives: Nystagmus has a negative effect on the patient's quality of life (QoL), leading to an increase in their dependence on others and a decrease in self-confidence and social relationships. Therefore, effective treatment and management are crucial in restoring those affected's visual function and social life. To determine whether contact lens (CL) use impairs the vision of infantile nystagmus (IN) patients, this study conducts a systematic review of the relevant literature. Methods: This systematic review adhered to the guidelines of the preferred reporting items for systematic reviews and meta-analyses (PRISMA). We searched databases including PubMed, Scopus, Google Scholar, and the Cochrane Central Register of Controlled Trials for relevant studies published up to May 9, 2022. The search was not limited by study type (except for review articles), publication time, or language. We used medical subject headings (MeSH) and keywords such as “nystagmus,” “CL,” “congenital nystagmus,” “IN,” “rigid gas permeable lenses,” and “soft CLs”. Results: Initially, 102 articles were identified. After removing duplicates, 76 articles remained. Of these, 39 were excluded during screening for irrelevance, and 8 were excluded due to inaccessible abstracts or full texts. Ultimately, 29 articles were included in this review. Conclusion: The majority of studies reviewed reported no significant side effects from using CLs, and most patients achieved similar or improved visual function compared to using glasses. As a result, even if CLs are not superior to glasses, they perform comparably and can be considered a primary treatment option when there are indications for prescribing CLs.

Assessment of Various Archwire Materials and Their Impact on Orthodontic Treatment Outcomes.

Aim Orthodontic treatment relies heavily on the mechanical properties and surface characteristics of archwire materials to achieve optimal outcomes. This study aimed to comprehensively evaluate the mechanical properties, including tensile strength, yield strength, and modulus of elasticity, as well as the surface characteristics, such as surface roughness and frictional properties, of different archwire materials. Methods Four types of archwire materials, stainless steel, nickel-titanium (NiTi), beta-titanium, and esthetic archwires, were subjected to mechanical testing and surface analysis, with 31 in each group. Tensile testing was conducted to determine the maximum tensile strength, yield strength, and elastic modulus of each material. Surface roughness analysis was performed using profilometry techniques, and frictional properties were evaluated using an orthodontic friction testing apparatus. Results Stainless steel exhibited the highest tensile strength (900 N), followed by beta-titanium (850 N), NiTi (800 N), and esthetic archwire (750 N). Stainless steel also demonstrated the highest yield strength (780 N), followed by beta-titanium (740 N), NiTi (710 N), and esthetic archwire (650 N). The modulus of elasticity was the highest for stainless steel (200 GPa), followed by beta-titanium (170 GPa), NiTi (150 GPa), and esthetic archwires (120 GPa). Surface roughness was lowest in stainless steel archwires (mean Ra value of 0.25 µm), leading to reduced frictional resistance, whereas esthetic archwires exhibited the highest surface roughness (mean Ra value of 0.40 µm) and frictional forces. Significant differences in the mechanical properties and surface characteristics were observed among the materials (p < 0.05). Conclusions The choice of archwire material significantly influences orthodontic treatment outcomes by affecting the efficiency and effectiveness of tooth movement. Stainless steel and beta-titanium wires are ideal for high-stress applications, providing the robust mechanical strength necessary for complex movements. In contrast, NiTi wires, with their superelasticity, offer consistent and gentle forces, enhancing patient comfort and accelerating the alignment phase. Esthetic archwires, while visually appealing, often compromise mechanical performance, potentially prolonging treatment duration.

Microstructure and mechanical properties of 9 % nickel steel welded joints using a CoCrNi filler wire for cryogenic storage tanks

A medium-entropy alloy of CoCrNi exhibits excellent cryogenic mechanical properties. It is possible to enhance the ductility of weld metal for cryogenic storage tank materials at cryogenic temperatures by employing CoCrNi alloys as filler metal. In this study, a CoCrNi multi-principal filler wire and a 308L stainless steel wire were used for welding 9 % Ni steel. The effects of the CoCrNi filler wire on the microstructure, hardness, mechanical properties, and deformation mechanisms of the weld metals were evaluated and discussed. A remarkable finding was that as the tensile temperature decreased from 298 K to 77 K, the fracture elongation of the CoCrNi joint increased by approximately 34.7 %, rather than decreasing. In contrast, a significant reduction in fracture elongation was observed in the 308L joint. The CoCrNi filler wire could promote the activation of twinning deformation in the weld metal at 77 K, thereby enhancing the ductility of the welded joints at cryogenic temperatures.

The Efficacy of Manual Therapy on Musculoskeletal Pain in Menopause: A Systematic Review.

(1) Background: The aim of this review was to evaluate the effects of manual therapy for musculoskeletal pain in menopausal women. (2) Methods: A comprehensive search of manuscripts published from inception until 29 February 2024 was conducted on PubMed, EBSCO Information Services (EBSCOhost), Physiotherapy Evidence Database (Pedro), Web of Science, Scientific Electronic Library Online (SciELO), Cochrane Central Register of Controlled Clinical Trials, and Scopus using Medical Subject Headings (MeSH) and free terms. Randomized controlled trials (RCT) investigating the effects of manual therapy for musculoskeletal pain in postmenopausal women were included. Articles published in non-English or non-Portuguese languages, case reports, expert opinions, dissertations, conference papers, and gray literature were excluded. Studies were screened for population, musculoskeletal pain, intervention, and pain outcome by two independent reviewers using an ad hoc data extraction form. (3) Results: A total of 5 RCTs (4 with high risk of bias and 1 with low risk of bias) were included (total sample = 245), addressing thumb carpometacarpal osteoarthritis, thoracic kyphosis, chronic neck and backache, knee osteoarthritis, and sternocostal joint pain. The combined results of these studies showed improved musculoskeletal pain in menopausal women; duration of the follow-up was between 4 weeks to 6 months. Conclusions: The majority of studies included in this systematic review were effective in reducing musculoskeletal pain in menopausal women. These results come mainly from studies with a high risk of bias with small sample sizes, and the most representative follow-up period was short-term. Therefore, the results of this systematic review should be interpreted with caution.

Dutasteride for the Treatment of Androgenetic Alopecia: An Updated Review.

Androgenetic alopecia (AGA) is a common skin disease characterized by progressive hair loss, with negative psychological impacts on patients, especially young people. The primary pathogenesis of AGA involves the action of 5α-reductase converting testosterone to dihydrotestosterone, leading to gradual miniaturization of genetically susceptible hair follicles. Finasteride inhibits type II 5α-reductase, while dutasteride simultaneously inhibits type I and type II 5α-reductase. Currently, finasteride is approved by the Food and Drug Administration (FDA) for the treatment of AGA, but its efficacy remains poor in some patients. This article aims to review the treatment of androgenetic alopecia with dutasteride. Oral dutasteride, intradermal injection of dutasteride (mesotherapy) and other related treatment methods are included. We performed a Medical Subject Heading search in the PubMed database using "androgenetic alopecia" and "dutasteride". Compared to finasteride, oral dutasteride has better efficacy and comparable tolerability, and most adverse events are mild and reversible, making it an effective treatment option for AGA. Mesotherapy with dutasteride is a therapeutic option to reduce the systemic adverse effects of the drug, but there are no standardized treatment protocols and large-scale clinical trials. Microneedling combined with dutasteride solution also has its own unique efficacy for treating AGA. Liposomes or nanoparticles of dutasteride are still under development and may become a more optimized topical formulation in the future.

Experimental study on bending fatigue performance of ambient-cured ultra-high-performance concrete thin plate with embedded steel wire mesh

Ambient-cured ultra-high-performance concrete (ACUHPC) with embedded steel wire mesh (SWM) was studied experimentally. ACUHPC-SWM thin plates having different SWM wire ratios and fatigue load stress levels were tested to clarify the effects of SWM on static and fatigue bending behavior. Subsequently, the fatigue equations for ACUHPC-SWM materials (with different failure probabilities) and reinforcement efficiency of the SWM were proposed. Finally, the reinforcement mechanism of the SWM was revealed by comparing it with ACUHPC thin plates. The results show that the inclusion of wire mesh significantly improved the cracking strength, ultimate static strength, energy dissipation performance, and fatigue ultimate strength of ACUHPC, with maximum increases of 23.63 %, 260.32 %, 940.42 %, and 196.34 %, respectively. As the wire mesh ratio increased, the improvement in fatigue ultimate strength initially increased and then decreased once the wire mesh ratio exceeded 1.884 %. The mechanism according to which SWM enhances ACUHPC involves the action of the mesh as a bridge to delay crack development and increase toughness.

Characteristics of Out-of-Hospital Cardiac Arrest Trials Registered in ClinicalTrials.gov.

Background/Objective: Out-of-hospital cardiac arrest (OHCA) poses a substantial public health concern. A collective evaluation of clinical trials is crucial for understanding systemic trends and progress within a specific research area of interest, ultimately shaping future directions. We performed a comprehensive analysis of the characteristics of trials in the adult OHCA population registered on ClinicalTrials.gov. Methods: Aided by medical subject headings (MeSH), we systematically searched the ClinicalTrials.gov database. Trends over time were assessed with the Cochran-Mantel-Haenszel test. The association between publication year and annual number was assessed with the Pearson correlation coefficient. Results: Out of 152 trials spanning the 2003-2023 period, 29.6% were observational and 70.4% were interventional. Compared with the observational trials, interventional trials were more often randomized (RCT) and achieved full publication status in 84% of cases (p = 0.03). The primary focus of interventional trials was "procedures" (43%), "devices" (23%), and "drugs" (21%). Observational studies focused on "biomarkers" (16%) and "diagnostic test" (13%) (p < 0.001). A decrement in the number of interventional trials with a sample size ≥100 patients across three temporal study points was observed. Nevertheless, published studies predominantly had a sample size ≥100 patients (76%), in contrast to unpublished trials (p ≤ 0.001). An increase in the number of interventional studies funded by the "academic/university" sector was also recorded. Conclusions: Clinical trials on OHCA primarily involved interventions aimed at treatment and were more often randomized, single-center, with small (<100) sample sizes, and funded by the "academic/university" sector.

Too stressed to think? A scoping review of the literature for healthcare educators utilising high acuity clinical scenarios

BackgroundThe practise of paramedicine can be highly stressful particularly where urgent lifesaving decisions need to be made. Traditionally, educators have adopted the approach of placing students in simulated stressful situations as a way of learning to cope with these challenges. It is unclear from the literature whether traditional stress inoculation enhances or hinders learning. This scoping review aims to identify and examine both the peer-reviewed and grey literature reporting physiological stress responses to high-acuity scenarios in paramedicine and cognate healthcare disciplines.MethodsAdhering strictly to JBI Evidence Synthesis Manual for conducting a scoping review, medical subject headings and areas, keywords and all other possible index terms were searched across EBSCOhost (Medline, CINAHL and APA PsycInfo), Scopus and, PubMed. English language articles both published (peer-reviewed academic papers, reports and conference proceedings) and unpublished (grey literature, Google Scholar reports) were included, and publications citing retrieved articles were also checked.ResultsSearches performed across five electronic databases identified 52 articles where abstracts indicated potential inclusion. From this, 22 articles which reported physiological or psychophysiological responses to stressful scenario-based education were included.ConclusionThis review identified that an acceptable level of stress during simulation can be beneficial, however a point can be exceeded where stress becomes a hinderance to learning resulting in underperformance. By identifying strategies to moderate the impact of acute stress, educators of paramedic and other healthcare students can utilise high-acuity clinical scenarios to their andragogical armamentarium which has the potential to improve real-world clinical outcomes.

Preoperative and Postoperative Therapeutic Anticoagulation in Orthopaedic Surgery Increases the Risk of Bleeding: A Systematic Review and Meta-Analysis.

Patients requiring postoperative therapeutic anticoagulation may have increased risk of bleeding complications, infection, and poor wound healing. The purpose of this study was to perform a systematic review and meta-analysis assessing bleeding complication rates among orthopaedic surgery patients receiving perioperative therapeutic anticoagulation. A systematic review and meta-analysis was performed in concordance with the Preferred Reporting Items for Systematic Review and Meta Analysis 2020 guidelines. PubMed was queried for articles related to therapeutic anticoagulation in orthopaedic surgery and complications using keywords and medical subject headings. Inclusion/exclusion criteria were any study reporting bleeding complications after orthopaedic surgery among patients on perioperative therapeutic anticoagulation with a minimum 1-year follow-up. Studies were reviewed for heterogeneity and risk of bias. Pooled analysis was done to determine postoperative complication rates among patients on therapeutic anticoagulation. Thirty-seven studies with 3,990 patients were included. Studies were grouped by their surgical subspecialty with 16 from arthroplasty, one foot and ankle, two spine, one sports, 13 trauma, and four upper extremity. Among patients on therapeutic anticoagulation, the pooled rate and 95% confidence intervals of bleeding complications was 8% (5 to 11%) overall, 10% (5 to 15%) in arthroplasty, 6% (3 to 11%) in trauma, and 5% (1 to 30%) in upper extremity. The overall rates (95% CI) of venous thromboembolism (VTE) were 2% (2 to 4%), infection 5% (3 to 10%), and revision surgery 4% (3 to 6%). Upper extremity VTE rates were 0% (0 to 15%), infection 4% (3 to 6%), and revision surgery 4% (3 to 6%). Trauma VTE rates were 4% (2 to 5%), infection 2% (1 to 6%), and revision surgery 3% (2 to 4%). Arthroplasty VTE rates were 2% (1 to 5%), infection 9% (4 to 18%), and revision surgery 4% (2 to 7%). Therapeutic postoperative anticoagulation may increase the risk of bleeding complications when compared with the general population. Incidence of VTE was similar when compared with historical data.

Evaluation and Comparison of Force Degradation Levels Between Elastomeric Chains and Active Tiebacks With Elastic Modules During Individual Canine Retraction.

Canine retraction is critical in orthodontic treatment, requiring precise force application. Elastomeric chains and active tiebacks are commonly used materials, but their efficacy in maintaining the force over time needs further evaluation. The study aimed tocompare the rate of force degradation of elastomeric chains vs. active tiebacks during canine retraction overa duration of six weeks in patients undergoing fixed orthodontic therapy. This study involved 20 patients, aged between 16 and 25 years. All the subjects were treated with the 0.018" McLaughlin-Bennett-Trevisi (MBT) prescription. Following the initial leveling and alignment, the canines were retracted on 0.016 x 0.022" stainless steel wire, using an elastomeric chain (ORMCO) on one side and an active tieback (ORMCO)on the contralateral side, each exerting a force of 150 g. Force values were measured using a tension gauge (TECLOCK; DT- 300) at intervals of 48 hours, two weeks, four weeks, and six weeks by a single observer and documented accordingly. The elastomeric chainandactive tieback sides demonstrated substantial force degradation oversix weeks, with a marked reduction of force at given intervals. However, no statistically significant difference in force degradation rates was observed between the two methods (p> 0.05), indicating similar force degradation patterns. The elastomeric chainand active tieback methods demonstrated substantial force degradation over six weeks, with no statistically significant difference between the two. Thus, both materials can be effectively utilized for canine retraction in orthodontic treatmentas they exhibit similar patterns of force degradation.

Diagnostic Accuracy of Magnetic Resonance Imaging in the Diagnosis of Placenta Accreta Spectrum: A Systematic Review and Meta-analysis

Abstract Objective To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in diagnosing placenta accreta spectrum (PAS). Methods We conducted a comprehensive literature search from database inception to November 2023 using terms such as placenta creta, increta, percreta, PAS, MRI, and their respective Medical Subject Headings terms. All prospective and retrospective cohort, case-control, and cross-sectional studies involving prenatal magnetic resonance imaging diagnosis of PAS with subsequent pathological confirmation were included. Results A total of 40 studies encompassing 3664 women met the inclusion criteria, with 1894 cases confirmed pathologically as PAS. The overall sensitivity of MRI was 0.867 (95% confidence interval, 0.807–0.910), and the specificity was 0.860 (95% confidence interval, 0.799–0.905), with a correlation of 0.693 between sensitivity and specificity. The estimated odds ratio was 28.693 (95% confidence interval (CI): 14.463–56.924), the negative likelihood ratio was 0.178 (95% CI: 0.122–0.258), and the positive likelihood ratio was 4.316 (95% CI: 3.186–5.846). Analysis of individual MRI criteria revealed estimates of sensitivity, specificity, odds ratio, negative likelihood ratio, and positive likelihood ratio for abnormal placental bed vascularization as 0.500, 0.740, 2.788, 0.571, and 1.645 respectively; 0.384, 0.985, 6.270, 0.471, and 2.720 for bladder wall interruption; 0.766, 0.818, 13.638, 0.262, and 3.375 for the presence of dark intraplacental bands; 0.691, 0.913, 10.828, 0.352, and 3.361 for heterogeneous placenta; 0.688, 0.984, 34.886, 0.254, and 7.164 for indistinctive myometrium; 0.757, 0.864, 8.496, 0.362, and 2.778 for loss of retroplacental dark zone; 0.828, 0.593, 5.829, 0.329, and 1.766 for myometrial thinning; and 0.518, 0.916, 9.473, 0.411, and 3.526 for placental bulge, respectively. Conclusion MRI demonstrates significant utility in diagnosing PAS and its severity. It is recommended for use in all cases with inconclusive ultrasonographic findings. Registration Registration number CRD42021267501

Solar air heater energy and exergy enhancement using a v-corrugated wire mesh absorber: An experimental comparison

In this paper, the energy and exergy performance of a double-pass solar air heater (SAH) using a novel model of a v-corrugated wire mesh absorber (CM-SAH) is investigated experimentally. The v-corrugated wires are adjacent to each other in one layer along the airflow direction to reduce the hydraulic resistance. Simultaneously, this arrangement increases the surface absorptance rate of solar radiation and expands the heat exchange area. To evaluate the performance of CM-SAH, a standard SAH having a v-corrugated absorber plate (CP-SAH) and the same configuration dimensions is compared with CM-SAH. The comparison is achieved under the same operating conditions and using different air mass flow rates of (0.01, 0.02, and 0.03 kg/s). The results show that the CM-SAH outperformed the CP-SAH in terms of thermal efficiency, exergy efficiency, and output air temperature. The maximum thermal efficiencies reach 87.3 % and 65.1 %, while the maximum exergy efficiencies reach 4.4 % and 3.4 %, for CM-SAH and CP-SAH, respectively. In addition, the thermal efficiency of CP-SAH decreased after midday while that of CM-SAH continuously increased.

A Monograph on Anatomy and Variants of Hepatic Resectional Surgery

BACKGROUND: The liver anatomy appears to be very complex due to the enormous number of vascular and biliary branches as well as the fact that the underlying pathology frequently distorts the anatomy. To prevent damage during surgical or invasive procedures, it is advised to be aware of the arteries’ typical structure and variations. Hepatic surgeons, general surgeons, transplant surgeons, interventional radiologists, and other medical specialists who treat liver problems must have this knowledge. MATERIALS AND METHODS: We have retrospectively evaluated the PubMed databases, Embase, and the Cochrane Library by applying various combinations of subject-related terms. The search terms identified with the medical subject heading were “Anatomy, right hepatectomy, resection, variants.” The databases were used to collect the literature published since 1991. RESULTS: Results delineated that 91.6% of patients had a single right hepatic vein, 81% shared a trunk with their middle hepatic vein (MHV) and left hepatic vein (LHV), and 19% had separate MHV and LHV drainage into the inferior vena cava. Overall prevalences of the abnormal hepatic artery, abnormal right hepatic artery (aRHA), abnormal left hepatic artery (aLHA), and combined aRHA/aLHA were found to be 27.41%, 15.63%, 16.32%, and 4.53%, respectively. The most common variation (type 2) is the so-called “portal vein (PV) trifurcation,” in which the main PV divides into the left PV, the right anterior PV, and the right posterior PV. The right posterior sectoral duct joins the left hepatic duct with a supraportal course, the right posterior sectoral duct joins the right anterior sectoral duct with an infraportal course, the trifurcation variation of the biliary tree, retroportal course, and the left lateral segmental ducts caudal to the umbilical portion of the PV are examples of variant biliary anatomy encountered in PV variations. Duplication of the common bile duct is a very uncommon congenital biliary system defect. CONCLUSION: It is very crucial for surgeon to have abreast knowledge of the tributaries, their anatomy, and variations to limit blood loss and operative morbidities.

Delamination free forming of novel high interface strength metal-polymer laminates

A new class of metal-polymer-laminates, fabricated using wire mesh and “steel-chips” interlayer, is shown to have significantly high interface strength. A finite element model, calibrated using tensile, lap shear, and peel tests, is used to predict the deformation and failure of the laminates. Formability of the developed laminates is studied using the limiting-dome-height tests. The metal-polymer-laminates do not delaminate in any of the tests. A complete shift of forming-limit-curve towards biaxial-tension region is observed in strain-based forming limit diagram for the polymer side. Strain-path independent forming-limits are plotted in stress space, to negative the effect of non-proportional strain histories.

Is artificial intelligence for medical professionals serving the patients?

BackgroundAlgorithmic decision-making (ADM) utilises algorithms to collect and process data and develop models to make or support decisions. Advances in artificial intelligence (AI) have led to the development of support systems that can be superior to medical professionals without AI support in certain tasks. However, whether patients can benefit from this remains unclear. The aim of this systematic review is to assess the current evidence on patient-relevant benefits and harms, such as improved survival rates and reduced treatment-related complications, when healthcare professionals use ADM systems (developed using or working with AI) compared to healthcare professionals without AI-related ADM (standard care)—regardless of the clinical issues.MethodsFollowing the PRISMA statement, MEDLINE and PubMed (via PubMed), Embase (via Elsevier) and IEEE Xplore will be searched using English free text terms in title/abstract, Medical Subject Headings (MeSH) terms and Embase Subject Headings (Emtree fields). Additional studies will be identified by contacting authors of included studies and through reference lists of included studies. Grey literature searches will be conducted in Google Scholar. Risk of bias will be assessed by using Cochrane’s RoB 2 for randomised trials and ROBINS-I for non-randomised trials. Transparent reporting of the included studies will be assessed using the CONSORT-AI extension statement. Two researchers will screen, assess and extract from the studies independently, with a third in case of conflicts that cannot be resolved by discussion.DiscussionIt is expected that there will be a substantial shortage of suitable studies that compare healthcare professionals with and without ADM systems concerning patient-relevant endpoints. This can be attributed to the prioritisation of technical quality criteria and, in some cases, clinical parameters over patient-relevant endpoints in the development of study designs. Furthermore, it is anticipated that a significant portion of the identified studies will exhibit relatively poor methodological quality and provide only limited generalisable results.Systematic review registrationThis study is registered within PROSPERO (CRD42023412156).

Acceptance and uptake of vaccines against tetanus, influenza, pertussis, and COVID-19 among pregnant and postpartum women in low- and middle-income countries: a systematic review and meta-analysis protocol

BackgroundPregnant women, fetuses, and neonates are particularly vulnerable to vaccine-preventable diseases (VPDs). These VPDs are associated with high morbidity and mortality among expectant mothers and their fetuses and neonates. Vaccination during pregnancy can protect the expectant mother from VPDs to which she may be especially vulnerable while pregnant. In addition, the passive transfer of maternal neutralizing immunoglobulin G (IgG) and secretory immunoglobulin A (IgA) also protects the fetus against congenital infections and may further protect the neonate from infection during the first few months of life. Despite this, coverage of recommended maternal vaccines remains suboptimal globally, especially in resource-constrained settings. Determinants of vaccine acceptance and uptake are frequently understudied in low- and middle-income countries (LMICs) and among specific groups such as pregnant and postpartum women. This proposed systematic review will assess the acceptance and uptake of vaccines against tetanus, influenza, pertussis, and COVID-19 among pregnant and postpartum women in LMICs.MethodsA Boolean search strategy employing common and medical subject heading (MeSH) terms for tetanus, influenza, pertussis, and COVID-19 vaccines, as well as vaccine acceptance, hesitancy, together with uptake, pregnancy, and postpartum, will be used to search electronic databases for relevant literature published between 2009 and 2024. Only studies conducted in LMICs that investigated determinants of acceptance, hesitancy, and uptake of tetanus, influenza, pertussis, and COVID-19 vaccines among pregnant and postpartum women will be eligible for inclusion in the review. The quality and the risk of bias of all eligible full-text articles will be assessed using the Joanna Briggs Institute’s (JBI) critical appraisal tools.DiscussionThis protocol proposes a systematic review and meta-analysis that aims to assess the uptake of maternal vaccines and to systematically appraise and quantify determinants of the acceptance and uptake of recommended vaccines during pregnancy and postpartum in LMICs. A better understanding of these factors and how they influence maternal vaccine decision-making will enable public health practitioners as well as global and national policymakers to design more effective interventions as we look towards expanding the scope and reach of maternal immunization programs.

Developing a reference method for indirect measurement of pasture evapotranspiration at sub-meter spatial resolution

To establish an indirect method for estimating and partitioning pasture evapotranspiration, it is vital to develop a direct reference method that aligns with the required temporal and spatial resolution. An evapotranspiration chamber offers an effective solution as it is easy to deploy and operates at an appropriate measurement scale. In this study, we prepared and tested a closed hemispherical chamber for on-site measurements of evaporation and/or transpiration. Advanced data monitoring and logging techniques were integrated to enhance the precision and reliability of direct in-field evapotranspiration measurements. During laboratory testing, vapor accumulation within the chamber was monitored to identify the best representative segment of the vapor accumulation curve. Results indicated that the instrument stabilizes its readings within 5 to 10 s post-deployment in laboratory settings. The subsequent 15 s produce stable readings that best represent actual vapor accumulation. The optimal fan speed, producing an air speed of 5.36 ms−1 at the vicinity of the fan within the chamber, paired with a wire mesh above the vapor-producing surface, yielded the best results. The study established a calibration factor (C) of 1.02 based on the actual water loss and vapor accumulation readings from the sensors at this fan speed. Advanced data analytics were applied to derive the calibration factor and to calculate the values of evapotranspiration from the changing microclimate within the chamber. Direction towards complete automation and the limitations of the chamber in field measurement are provided. The chamber was also tested under field conditions, and the paper examines its practical application and necessary adjustments for field measurements.

Systematic review of adherence to technology-based falls prevention programs for community-dwelling older adults: Reimagining future interventions.

Prevention programs, and specifically exercise, can reduce falls among community-dwelling older adults, but low adherence limits the benefits of effective interventions. Technology may overcome some barriers to improve uptake and engagement in prevention programs, although less is known on adherence for providing them via this delivery mode. We aimed to synthesize evidence for adherence to technology-based falls prevention programs in community-dwelling older adults 60 years and older. We conducted a systematic review following standard guidelines to identify randomized controlled trials for remote delivered (i.e., no or limited in-person sessions) technology-based falls prevention programs for community-dwelling older adults. We searched nine sources using Medical Subject Headings (MeSH) terms and keywords (2007-present). The initial search was conducted in June 2023 and updated in December 2023. We also conducted a forward and backward citation search of included studies. Two reviewers independently conducted screening and study assessment; one author extracted data and a second author confirmed findings. We conducted a random effects meta-analysis for adherence, operationalized as participants' completion of program components, and aimed to conduct meta-regressions to examine factors related to program adherence and the association between adherence and functional mobility. We included 11 studies with 569 intervention participants (average mean age 74.5 years). Studies used a variety of technology, such as apps, exergames, or virtual synchronous classes. Risk of bias was low for eight studies. Five interventions automatically collected data for monitoring and completion of exercise sessions, two studies collected participants' online attendance, and four studies used self-reported diaries or attendance sheets. Studies included some behavior change techniques or strategies alongside the technology. There was substantial variability in the way adherence data were reported. The mean (range) percent of participants who did not complete planned sessions (i.e., dropped out or lost to follow-up) was 14% (0-32%). The pooled estimate of the proportion of participants who were adherent to a technology-based falls prevention program was 0.82 (95% CI 0.68, 0.93) for studies that reported the mean number of completed exercise sessions. Many studies needed to provide access to the internet, training, and/or resources (e.g., tablets) to support participants to take part in the intervention. We were unable to conduct the meta-regression for adherence and functional mobility due to an insufficient number of studies. There were no serious adverse events for studies reporting this information (n = 8). The use of technology may confer some benefits for program delivery and data collection. But better reporting of adherence data is needed, as well as routine integration and measurement of training and skill development to use technology, and behavior change strategies within interventions. There may be an opportunity to rethink or reimagine how technology can be used to support people's adoption and integration of physical activity into daily life routines.

Diaphragm muscle parameters as a predictive tool for weaning critically ill patients from mechanical ventilation: a systematic review and meta-analysis study.

Diaphragmatic ultrasound, valued for its portability and safety, assesses both structural and functional aspects of the diaphragm. While some studies support its predictive value, others conflict. This meta-analysis aims to clarify diaphragmatic ultrasound's role in predicting successful liberation from mechanical ventilation in intensive care settings. A systematic search was performed on Web of Science, Scopus, and PubMed up to March, 2024. The search strategy included a combination of relevant medical subject heading (MeSH) terms and relevant keywords. We defined our eligibility criteria based on the PICO framework. Two authors performed the data extraction using a standardized sheet. The pooled mean difference was calculated using random effects model and Hedges' g along with SD estimation. R and RStudio were used for the statistical analysis and creating forest and funnel plots. The pooled mean difference was 7.25 (95% CI: 4.20, 10.21) for DE among the two groups. We found a statistically significant difference between the two groups indicating that those with successful weaning from intubation had higher means of DE compared to those with failed weaning attempt (p-value<0.01). The mean difference of DTF was also higher among those with successful weaning from intubation compared to those with failed weaning attempt with the pooled mean difference of 14.52 (95% CI: 10.51, 18.54, p-value<0.01). The mean difference of RSBI was lower among those with successful weaning from intubation compared to those with failed weaning attempt with the pooled mean difference of -28.86 (95% CI: -41.82, -15.91, p-value<0.01). Our results suggest that evaluating diaphragmatic excursion and thickening fraction can reliably anticipate successful liberation from mechanical ventilation. However, significant heterogeneity was present among the included studies. High-quality research, particularly randomized clinical trials, is required to further elucidate the role of diaphragmatic ultrasound in predicting weaning from mechanical ventilation.