Number Of Days Research Articles

Convolutional LSTM–LSTM model for predicting the daily number of influenza patients in South Korea using satellite images

ObjectivesInfluenza affects a considerable proportion of the global population each year, and meteorological conditions may have a significant impact on its transmission. In this study, we aimed to develop a prediction model for the number of influenza patients at the national level using satellite images and provide a basis for predicting influenza through satellite image data. Study designWe developed an influenza incidence prediction model using satellite images and influenza patient data. MethodsWe collected satellite images and daily influenza patient data from July 2014 to June 2019 and developed a convolutional long short-term memory (LSTM)–LSTM neural network model. The model with the lowest average of mean absolute error (MAE) was selected. ResultsThe final model showed a high correlation between the predicted and actual number of influenza patients, with an average MAE of 5.9010 per million population. The model performed best with a 2-week time sequence. ConclusionsWe developed a national-level prediction model using satellite images to predict influenza incidence. The model offers the advantage of nationwide analysis. These results may reduce the burden of influenza by enabling timely public health interventions.

Evaluating the Acceptability and Feasibility of Collecting Passive Smartphone Data to Estimate Psychological Functioning in U.S. Service Members and Veterans: A Pilot Study.

This study investigated the acceptability and feasibility of digital phenotyping in a military sample with a history of traumatic brain injury and co-occurring psychological and cognitive symptoms. The first aim was to evaluate the acceptability of digital phenotyping by (1a) quantifying the proportion of participants willing to download the app and rates of dropout and app discontinuation and (1b) reviewing the stated reasons for both refusing and discontinuing use of the app. The second aim was to investigate technical feasibility by (2a) characterizing the amount and frequency of transferred data and (2b) documenting technical challenges. Exploratory aim 3 sought to leverage data on phone and keyboard interactions to predict if a participant (a) is depressed and (b) has depression that improves over the course of the study. A passive digital phenotyping app (Mindstrong Discovery) functioned in the background of the participants' smartphones and passively collected phone usage and typing kinematics data. Fifteen out of 16 participants (93.8%) consented to install the app on their personal smartphone devices. Four participants (26.7%) discontinued the use of the app partway through the study, primarily because of keyboard usability and technical issues. Fourteen out of 15 participants (93.3%) had at least one data transfer, and the median number of days with data was 40 out of a possible 57 days. The exploratory machine learning models predicting depression status and improvement in depression performed better than chance. The findings of this pilot study suggest that digital phenotyping is acceptable and feasible in a military sample and provides support for future larger investigations of this technology.

Characterising continental shelf waves and their drivers for the southeast coast of Australia

Low-lying, developed areas in New South Wales (NSW) are susceptible to extended periods of inundation, which cannot be attributed to tides or local synoptic conditions. This inundation is often associated with relatively small water level anomalies but is persistent enough to damage the built environment. Due to their long duration, continental shelf waves (CSWs) are one of the mechanisms of concern associated with extended coastal inundation. These waves are caused by a range of synoptic disturbances occurring along the mid-latitudes and they travel anticlockwise along the coast (in the southern hemisphere), reaching low latitudes of NSW. This study investigates the characteristics of CSWs that travel along the NSW coast, their generation and propagation mechanisms in relation to local synoptic and oceanic conditions, and their potential modulation by two major large-scale climate modes: the El Niño/Southern Oscillation and the Southern Annular Mode (SAM). We used time series of daily tidal residuals from 1994 to 2015 from nine locations along the NSW coast and used a peak over threshold approach to identify 29 waves which had an average amplitude of 0.3 m, mean period of 15 days (ranging from 8 to 20 days), and a highest occurrence in autumn and winter. The generation of CSWs is tightly coupled to the subpolar jet, the belt of westerlies, and the subtropical ridge, confirming that large-scale atmospheric circulation is a key element in the generation and propagation of CSWs. Through analyses of the inverse barometer, we found that CSWs propagate freely up to the north coast of NSW, independent of local weather conditions. We also found that CSWs are more frequent during the positive phase of SAM combined with La Niña and during neutral SAM combined with El Niño events. This study provides the longest database to date of CSWs for NSW, alongside new insights into their characteristics and timing and frequency of occurrence. Importantly, this information can be used to monitor their occurrence and forecast their impact, including the number of days taken for a wave to reach different locations along the NSW coast.

Evaluation of Stages, Treatment Protocols, and Outcomes of Colorectal Cancer among West Bank Patients

Background: Colorectal cancer (CRC) is the second most widespread cancer among Palestinian patients. As cancer care improves in hospitals across the West Bank, services like palliative care, targeted therapy, bone marrow transplantation, and individualized therapy are still limited. This study aimed to assess the CRC stages, treatment protocols, and survival rates of patients in the West Bank. Methodology: This retrospective study collected data from the medical records of Al-Najah University Hospital (NUH), which specializes in the care of cancer patients. Patients with confirmed CRC (stages I–IV) undergoing surgical or medical treatment were included in the study. Data collection was standardized by using a data collection form to gather information from the medical records included in the study. All statistical analyses were performed using SPSS (version v27), and survival was assessed using a regression analysis of the number of days from the time of diagnosis to the most recent visit against the type of treatment (e.g., surgery, chemotherapy, radiotherapy). Results: A sample of 252 patients with CRC from NUH was collected, including 143 males and 109 females aged between 27 and 86 years, with the average age being 60.6 ± 11.4 years. The sample included 183 patients (72.6%) diagnosed with colon cancer only, 29 patients (11.5%) diagnosed with rectal cancer only, and 40 patients (15.9%) diagnosed with both. Diagnosis took place at CRC stage I for 3 patients (1.2%), stage II for 33 patients (13.1%), stage III for 57 patients (22.6%), and stage IV for 159 patients (63.1%). Surgery was the most prevailing mode of treatment for 230 patients (91.3%), while 227 patients (90.1%) received chemotherapy treatment, and 38 patients (15.1%) received radiotherapy. Of the 252 patients, 40 patients (15.8%) received FOLFOX (i.e., folinic acid, fluorouracil, oxaliplatin), and 25 patients (9.9%) received FOLFIRI (i.e., folinic acid, fluorouracil, irinotecan), while the 187 remaining patients (74.2%) were treated with capecitabine, oxaliplatin, bevacizumab, cetuximab, regorafenib, cisplatin, etoposide, gemcitabine, or a combination thereof. The sample was categorized into six outcomes: (1) death, (2) cure, (3) disease progression, (4) disease recurrence, (5) under-treatment, and (6) unknown. Mortality was high, with 104 patients (41.3%) dying within a short time after diagnosis, and may have been attributable to delayed diagnosis. Surgical treatment had a positive impact on increasing the survival years, and it was significant (p = 0.033). Conclusions: A high percentage of patients were diagnosed in advanced CRC stages. The treatment modes were adopted from general international guidelines; however, the cure rates were low, and mortality was high. More studies need to be undertaken to investigate the actual application of chemotherapy protocols, and survival would benefit from the involvement of clinical pharmacists in the chemotherapy protocol selection, dosing, frequency, and follow-up. The present study advocates for greater public awareness of CRC and attests to the merits of screening by primary care professionals, which can help to avoid this serious illness and to promote a better prognosis.

How do grazing beef and dairy cattle respond to virtual fences? A review.

Virtual fencing (VF) is a modern fencing technology that requires the animal to wear a device (e.g. a collar) that emits acoustic signals to replace the visual cue of traditional physical fences (PF) and, if necessary, mild electric signals. The use of devices that provide electric signals leads to concerns regarding the welfare of virtually fenced animals. The objective of this review is to give an overview of the current state of VF research into the welfare and learning behavior of cattle. Therefore, a systematic literature search was conducted using two online databases and reference lists of relevant articles. Studies included were peer-reviewed and written in English, used beef or dairy cattle, and tested neck-mounted VF devices. Further inclusion criteria were a combination of audio and electrical signals and a set-up as a pasture trial, which implied that animals grazed in groups on grassland for four hours minimum while at least one fence side was virtually fenced. The eligible studies (n = 13) were assigned to one or two of the following categories: animal welfare (n studies = 8) or learning behavior (n studies = 9). As data availability for conducting a meta-analysis was not sufficient, a comparison of the means of welfare indicators (daily weight gain, daily lying time, steps per hour, daily number of lying bouts, fecal cortisol metabolites (FCM)) for virtually and physically fenced animals was done instead. In an additional qualitative approach, the results from the welfare-related studies were assembled and discussed. For the learning behavior, the number of acoustic and electric signals and their ratio were used in a linear regression model with duration in days as a numeric predictor to assess the learning trends over time. There were no significant differences between VF and PF for most welfare indicators (except FCM with lower values for VF; P = 0.0165). The duration in days did not have a significant effect on the number of acoustic and electric signals. However, a significant effect of trial duration on the ratio of electric to acoustic signals (P = 0.0014) could be detected, resulting in a decreasing trend of the ratio over time, which suggests successful learning. Overall, we conclude that the VF research done so far is promising but is not yet sufficient to ensure that the technology could not have impacts on the welfare of certain cattle types. More research is necessary to investigate especially possible long-term effects of VF.

Gas Chromatography–Mass Spectrometry Chemical Profiling of Commiphora myrrha Resin Extracts and Evaluation of Larvicidal, Antioxidant, and Cytotoxic Activities

Plant extracts and essential oils can be alternative environmentally friendly agents to combat pathogenic microbes and malaria vectors. Myrrh is an aromatic oligum resin that is extracted from the stem of Commiphora spp. It is used in medicine as an insecticide, cytotoxic, and aromatic. The current study assessed the effect of Commiphora myrrha resin extracts on the biological potency of the third larval stage of Aedes aegypti, as well as its antioxidant and cytotoxic properties against two types of tumor cells (HepG-2 and Hela cell lines). It also used GC–MS to determine the chemical composition of the C. myrrha resin extracts. Fifty components from the extracted plant were tentatively identified using the GC–MS method, with curzerene (33.57%) typically listed as the primary ingredient, but other compounds also make up a significant portion of the mixture, including 1-Methoxy-3,4,5,7-tetramethylnaphthalene (15.50%), β-Elemene (5.80%), 2-Methoxyfuranodiene (5.42%), 2-Isopropyl-4,7-Dimethyl-1-Naphthol (4.71%), and germacrene B (4.35%). The resin extracts obtained from C. myrrha exhibited significant efficacy in DPPH antioxidant activity, as evidenced by an IC50 value of 26.86 mg/L and a radical scavenging activity percentage of 75.06%. The 50% methanol extract derived from C. myrrha resins exhibited heightened potential for anticancer activity. It demonstrated substantial cytotoxicity against HepG-2 and Hela cells, with IC50 values of 39.73 and 29.41 µg mL−1, respectively. Notably, the extract showed non-cytotoxic activity against WI-38 normal cells, with an IC50 value exceeding 100 µg mL−1. Moreover, the selectivity index for HepG-2 cancer cells (2.52) was lower compared to Hela cancer cells (3.40). Additionally, MeOH resin extracts were more efficient against the different growth stages of the mosquito A. aegypti, with lower LC50, LC90, and LC95 values of 251.83, 923.76, and 1293.35 mg/L, respectively. In comparison to untreated groups (1454 eggs/10 females), the average daily number of eggs deposited (424 eggs/L) decreases at higher doses (1000 mg/L). Finally, we advise continued study into the possible use of C. myrrha resins against additional pests that have medical and veterinary value, and novel chemicals from this extract should be isolated and purified for use in medicines.

Novel Approach for Detecting Respiratory Syncytial Virus in Pediatric Patients Using Machine Learning Models Based on Patient-Reported Symptoms: Model Development and Validation Study.

Respiratory syncytial virus (RSV) affects children, causing serious infections, particularly in high-risk groups. Given the seasonality of RSV and the importance of rapid isolation of infected individuals, there is an urgent need for more efficient diagnostic methods to expedite this process. This study aimed to investigate the performance of a machine learning model that leverages the temporal diversity of symptom onset for detecting RSV infections and elucidate its discriminatory ability. The study was conducted in pediatric and emergency outpatient settings in Japan. We developed a detection model that remotely confirms RSV infection based on patient-reported symptom information obtained using a structured electronic template incorporating the differential points of skilled pediatricians. An extreme gradient boosting-based machine learning model was developed using the data of 4174 patients aged ≤24 months who underwent RSV rapid antigen testing. These patients visited either the pediatric or emergency department of Yokohama City Municipal Hospital between January 1, 2009, and December 31, 2015. The primary outcome was the diagnostic accuracy of the machine learning model for RSV infection, as determined by rapid antigen testing, measured using the area under the receiver operating characteristic curve. The clinical efficacy was evaluated by calculating the discriminative performance based on the number of days elapsed since the onset of the first symptom and exclusion rates based on thresholds of reasonable sensitivity and specificity. Our model demonstrated an area under the receiver operating characteristic curve of 0.811 (95% CI 0.784-0.833) with good calibration and 0.746 (95% CI 0.694-0.794) for patients within 3 days of onset. It accurately captured the temporal evolution of symptoms; based on adjusted thresholds equivalent to those of a rapid antigen test, our model predicted that 6.9% (95% CI 5.4%-8.5%) of patients in the entire cohort would be positive and 68.7% (95% CI 65.4%-71.9%) would be negative. Our model could eliminate the need for additional testing in approximately three-quarters of all patients. Our model may facilitate the immediate detection of RSV infection in outpatient settings and, potentially, in home environments. This approach could streamline the diagnostic process, reduce discomfort caused by invasive tests in children, and allow rapid implementation of appropriate treatments and isolation at home. The findings underscore the potential of machine learning in augmenting clinical decision-making in the early detection of RSV infection.

Minimal clinically important difference in physical activity in patients with stroke

Background Estimates of the minimal clinically important difference (MCID) for stroke-related outcomes are needed, but the MCID for physical activity is unknown. Objective To provide an anchor-based estimate of the MCID for physical activity in patients with stroke. Methods This study included 31 patients with stroke admitted to a hospital and discharged home. Physical activity, including the daily number of steps and metabolic equivalents (METs), was evaluated shortly after informed consent was obtained following admission (baseline) and discharge using an Active-style Pro HJA-750C with a triaxial accelerometer. We calculated the number of steps and time rate (%) of sedentary behavior (SB), light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) per day. After discharge, the physical therapist rated each participant’s perceived amount of physical activity recovery on the Global Rating of Change scale (GRC). The mean change in each physical activity data point from baseline to after discharge in the group of participants who answered “a little better, meaningful” in the GRC was considered the MCID. Results Eighteen participants were included in the analysis. Participants’ physical function improved from baseline to at discharge during hospitalization, although mild motor paralysis persisted. MCID values for the step activity, SB, LPA, and MVPA were 1828 steps, -11.2%, 6.9%, 4.3% per day, respectively. Conclusion For researchers and clinicians, this study’s MCIDs provide a benchmark for interpreting changes in the effects of intervention studies, and specific guidelines for interventions in clinical practice. Further research with larger sample sizes is required to confirm these findings.

Availability, pricing, and affordability of essential medicines for pediatric population in Malawi

Objective:Lack of access to essential medicines negatively impacts on the quality of healthcare delivery and increases morbidity and mortality, especially to the vulnerable pediatric population. We assessed the availability, pricing, and affordability of pediatric formulations in Malawi.Methodology:The study was conducted in 76 health facilities (public, faith-based and private pharmacies, and clinics) from the northern and southern regions of Malawi from March to May 2023. We adapted the WHO/HAI method for the assessment of both availability and pricing of medicines. Data on availability were collected from stock card records using a WHO/HAI template and medicine prices were provided by the pharmacy personnel who were managing the facilities. Availability of medicines was calculated as the percentage of facilities which had a stock of the respective medicine at the time of data collection while medicine prices was assessed by calculating the median prices of each medicine. To assess the affordability of the medicines, we calculated the number of days it takes for a person who is receiving the government-set minimum wage to work to pay for a treatment course of common indications. The study was approved by the KUHES ethics committee under the numbers U.12/22/3900 and U.12/22/3903.Results and conclusion:The overall availability of pediatric medicines was 38.1% for public health facilities, 53.7% for private retail pharmacies and drug stores, 49.5% for private clinics and 48.3% for Christian Health Association of Malawi (CHAM) facilities. We found the illegal availability of prescription-only medicines of up to 54% in medicine stores. Medicine median prices were higher in the private clinics followed by retail pharmacies and drugs stores. CHAM had the lowest median prices for medicines of all the sectors. More than 50% of medicines were found to be affordable as less than a day’s wage was required to purchase the treatment. We found poor availability of pediatric formulation among public, CHAM, and private sectors in Malawi. This may affect the quality of care among pediatric patients and therefore contribute to morbidity and mortality in Malawi. The supply of medicines and health commodities needs to consider needs of special populations such as children to achieve universal health coverage.

Improving COVID-19 vaccination centre operation through computer modelling and simulation

ABSTRACT Mass vaccination has provided a route out of the COVID-19 pandemic in a way that social restrictions can be safely eased. For many countries, dedicated vaccination centres have been key to that effort. However, with no directly comparable historical experience there has been little information to guide the operational management and initial configuration of these sites. This paper provides an account of how, early in the mass vaccination effort, Operational Research has been a valuable asset in supporting management decisions at two major vaccination centres in the UK. We first describe a conceptual pathway model representing the key stages of the vaccination process, from registration to clinical assessment, vaccination, and observation. An approximation using discrete event simulation is then presented. On application, we report on its use in influencing the initial setup of one site, with model outputs directly setting the daily number of patient bookings. For the same site, we reveal how analysis has informed a significant operational shift in combining two key activities on the vaccination pathway (clinical assessment and vaccination). Finally, we describe how, at a second site, modelling has examined pathway stability, in terms of resilience to unforeseen “shocks” such as delayed arrivals and staff unavailability.

A Cross-Cultural Study on the Effects of Government Control Policies on Mobility in COVID-19

This study sought to explore the impact of government policies aimed at reducing the spread of COVID-19, such as social distancing and quarantine, on the reduction in the mobility of people and the role of national culture in moderating this effect. To test this hypothesis, this study collected 21,150 sets of data from 57 countries worldwide and analyzed them using a multilevel growth model. In addition, the number of COVID-19-infected people, the number of people vaccinated, number of days since the first COVID-19, median age by country, population density, total population, and GDP per capita, which can affect mobility, were added as control variables in the study model. Notably, the results of our analysis revealed that the stringency of government policies had a negative effect on mobility and that this effect differed according to cultural characteristics. The findings of the current study have the following implications. First, differences between countries were explained by exploring the effectiveness of government policies in preventing the increase in infectious diseases based on a cultural perspective. Second, the results of this study provide policy implications that international policy makers can refer to apart from the context of the COVID-19 epidemic by presenting country-specific differences in government policies.

Efficacy of intra-ovarian injection of autologous platelet-rich plasma in women with poor responders: a systematic review and meta-analysis.

The effect of platelet-rich plasma (PRP) on ovarian reserve markers in poor ovarian response (POR) is challenging. This systematic review and meta-analysis was, therefore, designed to evaluate the effectiveness of intra-ovarian injection of autologous PRP on improving ovarian reserve markers and assisted reproductive technology (ART) outcomes in infertile women with POR. A systematic search was conducted for the efficacy of intra-ovarian injection of autologous PRP on the improvement of ovarian reserve markers and ART outcomes in infertile women with POR. The methodological quality of the included studies was checked and eligible studies were included in the meta-analysis to find pooled results. Keywords were primary ovarian insufficiency, premature menopause, poor responder, poor ovarian response, diminished/decreased ovarian reserve, platelet-rich plasma, and intra-ovarian or a combination of them. The effect of PRP on fertility indices was evaluated using the standardized mean difference (SMD). The analysis was performed through STATA version 13. 13 studies containing 1289 patients were included. Mean age, body mass index (BMI) and duration of infertility was 37.63 ± 2.66years, 24 ± 1.23kg/m2 and 4.79 ± 1.64years, respectively. Most of the studies measured the outcomes 2-3/3months after intra-ovarian injection of autologous PRP. The antral follicular count (AFC) after treatment by PRP is higher with an SMD of 0.95 compared to before treatment. The day 3 follicle-stimulating hormone (FSH) after treatment by PRP is lower with an SMD of - 0.25 compared to before treatment. The day 3 estradiol (E2) after treatment by PRP is higher with an SMD of 0.17 compared to before treatment. The anti-Mullerian hormone (AMH) after treatment by PRP is higher with an SMD of 0.44 compared to before treatment. The total oocytes number after treatment by PRP is higher with an SMD of 0.73 compared to before treatment. The number of MII oocytes after treatment by PRP is higher with an SMD of 0.63 compared to before treatment. The number of cleavage-stage embryos after treatment by PRP is higher with an SMD of 1.31 compared to before treatment. The number of day 5 embryo after treatment by PRP is higher with an SMD of 1.28 compared to before treatment. Pooled estimation of a meta-analysis of prevalence studies reported a prevalence of 22% for clinical pregnancy, 5% for spontaneous pregnancy and 21% for ongoing pregnancy following PRP therapy. Intra-ovarian injection of PRP improved ovarian reserve markers with increasing AFC, serum level of AMH and day 3 E2 and decreasing serum level of day 3 FSH. In addition, this treatment improved ART outcomes through the increasing of number total oocytes, number of MII oocytes, number of cleavage-stage embryos and number of day 5 embryos in POR women. Although treatment of POR women remains challenging, the use of intra-ovarian injection of autologous PRP in POR patients prior to IVF/ICSI cycles is a sign of new hope for increasing the success of IVF/ICSI. However, further well-organized, randomized controlled trials should be conducted to substantiate this result and recommend intra-ovarian injection of PRP as part of routine treatment in women with POR.

Exploration of factors affecting hemodynamic stability following pheochromocytoma resection - cohort study

PurposeSurgery is the only way to cure pheochromocytoma; however, postoperative hemodynamic instability is one of the main causes of serious complications and even death. This study’s findings provide some guidance for improved clinical management.Patients and methodsThis study was to investigate the factors leading to postoperative hemodynamic instability in the postoperative pathology indicated pheochromocytoma from May 2016 to May 2022. They were divided into two groups according to whether vasoactive drugs were used for a median number of days or more postoperatively. The factors affecting the postoperative hemodynamics in the perioperative period (preoperative, intraoperative, and postoperative) were then evaluated.ResultsThe median number of days requiring vasoactive drug support postoperatively was three in 234 patients, while 118 (50.4%) patients required vasoactive drug support for three days or more postoperatively. The results of the multivariate analysis indicated more preoperative colloid use (odds ratio [OR]=1.834, confidence interval [CI]:1.265–2.659, P=0.001), intraoperative use of vasoactive drug (OR=4.174, CI:1.882–9.258, P<0.001), and more postoperative crystalloid solution input per unit of body weight per day (ml/kg/d) (OR=1.087, CI:1.062–1.112, P<0.001) were risk factors for predicting postoperative hemodynamic instability. The optimal cutoff point of postoperative crystalloid use were 42.37 ml/kg/d.ConclusionHemodynamic instability is a key issue for consideration in the perioperative period of pheochromocytoma. The amount of preoperative colloid use, the need for intraoperative vasoactive drugs, and postoperative crystalloid solution are risk factors for predicting postoperative hemodynamic instability (registration number: ChiCT2300071166).

Trajectories of Health Care Contact Days for Patients With Stage IV Non–Small Cell Lung Cancer

Patients with stage IV non-small cell lung cancer (NSCLC) experience substantial morbidity and mortality. Contact days (ie, the number of days with health care contact outside the home) measure how much of a person's life is consumed by health care, yet little is known about patterns of contact days for patients with NSCLC. To describe the trajectories of contact days in patients with stage IV NSCLC and how trajectories vary by receipt of cancer-directed treatment in routine practice. A retrospective, population-based decedent cohort study was conducted in Ontario, Canada. Participants included adults aged 20 years or older who were diagnosed with stage IV NSCLC (January 1, 2014, to December 31, 2017) and died (January 1, 2014, to December 31, 2019); there was a maximum 2-year follow-up. Data analysis was conducted from February 22 to August 16, 2023. Systemic cancer-directed therapy (yes or no) and type of therapy (chemotherapy vs immunotherapy vs targeted therapy). Contact days (days with health care contact, outpatient or institution-based, outside the home) were identified through administrative data. The weekly percentage of contact days and fitted models with cubic splines were quantified to describe trajectories from diagnosis until death. A total of 5785 decedents with stage IV NSCLC were included (median age, 70 [IQR 62-77] years; 3108 [53.7%] were male, and 1985 [34.3%] received systemic therapy). The median overall survival was 108 (IQR, 49-426) days, median contact days were 36 (IQR, 21-62), and the median percentage that were contact days was 33.3%. A median of 5 (IQR, 2-10) days were spent with specialty palliative care. Patients who did not receive systemic therapy had a median overall survival of 66 (IQR, 34-130) days and median contact days of 28 (IQR, 17-44), of which a median of 5 (IQR, 2-9) days were spent with specialty palliative care. Overall and for subgroups, normalized trajectories followed a U-shaped distribution: contact days were most frequent immediately after diagnosis and before death. Patients who received targeted therapy had the lowest contact day rate during the trough (10.6%; vs immunotherapy, 15.4%; vs chemotherapy, 17.7%). In this cohort study, decedents with stage IV NSCLC had a median survival in the order of 3.5 months and spent 1 in every 3 days alive interacting with the health care system outside the home. These results highlight the need to better support patients and care partners, benchmark appropriateness, and improve care delivery.

Access to essential medicines for diabetes care: availability, price, and affordability in central Ethiopia

BackgroundDiabetes is a major global public health burden. Effective diabetes management is highly dependent on the availability of affordable and quality-assured essential medicines (EMs) which is a challenge especially in low-and-middle-income countries such as Ethiopia. This study aimed to assess the accessibility of EMs used for diabetes care in central Ethiopia’s public and private medicine outlets with respect to availability and affordability parameters. MethodsA cross-sectional study was conducted in 60 selected public and private medicine outlets in central Ethiopia from January to February 2022 using the World Health Organization/Health Action International (WHO/HAI) standard tool to assess access to EMs. We included EMs that lower glucose, blood pressure, and cholesterol as these are all critical for diabetes care. Availability was determined as the percentage of surveyed outlets per sector in which the selected lowest-priced generic (LPG) and originator brand (OB) products were found. The number of days’ wages required by the lowest paid government worker (LPGW) to purchase a one month’s supply of medicines was used to measure affordability while median price was determined to assess patient price and price markup difference between public procurement and retail prices.ResultsAcross all facilities, availability of LPG and OB medicines were 34.6% and 2.5% respectively. Only two glucose-lowering (glibenclamide 5 mg and metformin 500 mg) and two blood pressure-lowering medications (nifedipine 20 mg and hydrochlorothiazide 25 mg) surpassed the WHO’s target of 80% availability. The median price based on the least measurable unit of LPG diabetes EMs was 1.6 ETB (0.033 USD) in public and 4.65 ETB (0.095 USD) in private outlets. The cost of one month’s supply of diabetes EMs was equivalent to 0.3 to 3.1 days wages in public and 1.0 to 11.0 days wages in private outlets, respectively, for a typical LPGW. Thus, 58.8% and 84.6% of LPG diabetes EMs included in the price analysis were unaffordable in private and public outlets, respectively.ConclusionsThere are big gaps in availability and affordability of EMs used for diabetes in central Ethiopia. Policy makers should work to improve access to diabetes EMs. It is recommended to increase government attention to availing affordable EMs for diabetes care including at the primary healthcare levels which are more accessible to the majority of the population. Similar studies are also recommended to be conducted in different parts of Ethiopia.

Modeling and Predicting Passenger Load Factor in Air Transportation: A Deep Assessment Methodology with Fractional Calculus Approach Utilizing Reservation Data

This study addresses the challenge of predicting the passenger load factor (PLF) in air transportation to optimize capacity management and revenue maximization. Leveraging historical reservation data from 19 Turkish Airlines market routes and sample flights, we propose a novel approach combining deep assessment methodology (DAM) with fractional calculus theory. By modeling the relationship between PLF and the number of days remaining until a flight, our method yields minimal errors compared to traditional techniques. Through a continuous curve constructed using the least-squares approach, we enable the anticipation of future flight values. Our analysis demonstrates that the DAM model with a first-order derivative outperforms linear techniques and the Fractional Model-3 in both modeling capabilities and prediction accuracy. The proposed approach offers a data-driven solution for efficiently managing air transport capacity, with implications for revenue optimization. Specifically, our modeling findings indicate that the DAM wd model improves prediction accuracy by approximately 0.67 times compared to the DAM model, surpassing the fractional model and regression analysis. For the DAM wd modeling method, the lowest average mean absolute percentage error (AMAPE) value achieved is 0.571, showcasing its effectiveness in forecasting flight outcomes.

Health and Welfare Benefits of Computerized Cognitive Enrichment in California Sea Lions (Zalophus californianus) at the US Navy Marine Mammal Program.

Cognitive enrichment is becoming more prevalent in professional marine mammal facilities. Research with dolphins has suggested that such enrichment provides more welfare benefits than enrichment that does not incorporate cognitive challenge. However, there is little research supporting the use of cognitive enrichment as a means to improve the welfare of sea lions. Recently, a novel form of technological cognitive enrichment, the Enclosure Video Enrichment (EVE) system, was introduced to a population of California sea lions at the US Navy's Marine Mammal Program as a means to enhance welfare. Two of the initial focal animals introduced to EVE were selected based on their health history and the possible benefits of cognitive enrichment in improving health measures. To evaluate this, information regarding the animals' consumption of their offered diet was compared to other animals in the population of similar age and the absence of a similar health history. Subsequently, the total diet consumption of the targeted animals was evaluated in the two years prior to the introduction to EVE and compared to the total diet consumption during the initial 2 years of regular EVE sessions. There was a significant decrease in the number of days in which the sea lions did not consume their entire offered diet in the two years after implementing regular EVE sessions, an increase in participation and performance of voluntary husbandry behaviors, and a reduction in the number of days animals were clinically ill. This study provides evidence of cognitive enrichment as a management tool to improve animal health and welfare as well as performance in training sessions.

A Boatable Days Framework for Quantifying Whitewater Recreation—Insights from Three Appalachian Whitewater Rivers

Outdoor recreation is one of the fastest-growing economic sectors in the United States and is being used by communities to support economic development, social prosperity, and environmental protection. For communities that have whitewater rivers, whitewater recreation provides a powerful economic alternative to ailing extractive and manufacturing industries that have long dominated rural communities. In order to promulgate a whitewater recreation-based economy, stakeholders need information about their whitewater resources, including how often and when they can be paddled. The overall goal of this study, therefore, was to develop an analytical framework that quantifies boatable days, that is, the number of days that streamflow exceeds the minimum boatable flow levels needed to paddle downstream. Importantly, our framework uses publicly available streamflow and minimum boatable flow information that can be used to quantify boatable days for any whitewater run in the country, irrespective of watershed size or river flashiness. We applied the framework to three world-class whitewater rivers in the central Appalachian Mountains, USA, and found abundant and stable boating opportunities throughout the year. Our results underscore the potential for strategically developing whitewater recreation as a means of economic diversification and highlight how boatable days analysis can be used for quantifying whitewater resources.

Association of child abuse and neglect training with filing reports of concern to child welfare services: a cross-sectional study

BackgroundThe aptitude, knowledge, and competence of dental health personnel on child abuse and neglect (CAN) is not optimal for deciding when to file a report of concern to child welfare services (CWS).ObjectivesThe aim of this study was, firstly, to assess the association of the public dental health personnel ‘s (PDHP) training on CAN received in the last three work years, i.e., in 2016 through 2018 with filing reports to the CWS in the same period and secondly to assess the association of expressed need of training on CAN with filing reports to the CWS.MethodsThis cross-sectional study uses data from an electronic survey census of PDHP from Norway (n = 1791) conducted in 2019. The Pearson chi-square test, non-parametric tests, logistic, and negative binomial regression were used for unadjusted and adjusted analysis. Data was reported with proportions, odds ratios (OR), incidence rate ratios and 95% confidence intervals (CIs).ResultsFrom 2016 to 2018, the prevalence estimate of filing reports to CWS was 50%, with a mean (standard deviation) of 1.39 (2.11) reports sent. The logistic regression analysis showed an association between filing reports of concern and CAN training in the last three years. Compared to those that had not received CAN training during the three previous years, the ORs (95% CI) for filing reports to the CWS during the same period was 2.5 (1.6-4.0) for one day CAN work training, 3.2 (2.0-5.1) for 2–4 days CAN training and 4.9 (2.6–9.4) for five or more days CAN training. Compared to workers who did not need training in reporting (routines of CAN), those who expressed the need for a little more and more training were less likely to file a report. The corresponding OR were 0.6 (0.4–0.9) and 0.6 (0.3–0.9), respectively.ConclusionCAN training during the last three years is associated with filing reports of concern to CWS in the same period among PDHP in Norway. The likelihood of filing CAN reports increased with the number of days of CAN training received. Secondly, the PDHP with an expressed need for training on CAN routines were less likely to report suspicions to CWS.

Association Between Opioid-Related Mortality and History of Surgical Procedure: A Population-Based Case-Control Study

Objective: This study examined whether there is an association between opioid-related mortality and surgical procedures. Methods: A case-control study design using deceased controls compared individuals with and without opioid death and their exposure to common surgeries in the preceding 4 years. This population-based study used linked death and hospitalization databases in Canada (excluding Quebec) from January 01, 2008 to December 31, 2017. Cases of opioid death were identified and matched to 5 controls who died of other causes by age (±4 years), sex, province of death, and date of death (±1 year). Patients with HIV infection and alcohol-related deaths were excluded from the control group. Logistic regression was used to determine if there was an association between having surgery and death from an opioid-related cause by estimating the crude and adjusted odds ratios (ORs) with the corresponding 95% confidence interval (CI). Covariates included sociodemographic characteristics, comorbidities, and the number of days of hospitalization in the previous 4 years. Results: We identified 11,865 cases and matched them with 59,345 controls. About 11.2% of cases and 12.5% of controls had surgery in the 4 years before their death, corresponding to a crude OR of 0.89 (95% CI: 0.83–0.94). After adjustment, opioid mortality was associated with surgical procedure with OR of 1.26 (95% CI: 1.17–1.36). Conclusions: After adjusting for comorbidities, patients with opioid mortality were more likely to undergo surgical intervention within 4 years before their death. Clinicians should enhance screening for opioid use and risk factors when considering postoperative opioid prescribing.