Strict Protocol Research Articles

Passengers’ Intentions to Use Public Transport during the COVID-19 Pandemic: A Case Study of Bangkok and Jakarta

Several problems have arisen due to the COVID-19 pandemic, particularly in the public transportation sector. Data from 2021 show that the number of bus passengers in Bangkok has decreased by 40–60% below normal conditions, and the number of bus passengers in Jakarta has decreased by around 76% compared to June 2019. In the new normal period, public transport is required to implement strict health protocols in its operations. This paper aims to evaluate potential indicators underlying the intention to use public transport during a pandemic. The target groups are public and paratransit buses in Bangkok and Jakarta, two metropolitan areas in ASEAN that have been greatly affected by this pandemic. A total of 400 questionnaires were distributed in each city. The outcome from the structural equation model reveals a relatively similar finding in both cities. Tangibility is one of the five dimensions of service quality that is influential in both cities; this indicator affects the intention to use public transportation in Jakarta (Coeff. = 14.670, p-value < 0.001) and Bangkok (Coeff. = 1.164, p-value < 0.001). In this study, confidence (CO) is significant for the intention to use public transportation in both cities with a coefficient of 0.105 for Bangkok and 0.969 for Jakarta. Furthermore, the health measure indicator (HM) has a significant value on passenger confidence (CO) in using public transportation for both cities (Coeff. = 0.808, p-value = <0.001 in Bangkok and Coeff. = −1.413, p-value = 0.008 in Jakarta). Health measures such as wearing a mask, always washing hands and not traveling if unwell are considered to be the right policies to prevent the spread of the virus during the COVID-19 pandemic. This practical implication can become a core strategy for improving the quality of public transport services in similar cities.

Change of decontamination habits at Moroccan dentaloffices and laboratories during the COVID Pandemic: Anepidemiologicalstudy

The objective of our study was to evaluate the change in the habits of dentists and dental technicians in the city of Casablanca, Morocco, in relation to the decontamination of fixed dental prosthesis works during the pandemic of COVID. A descriptive cross-sectional study was conducted among 106 dentists and 30 dental technicians by using an anonymous questionnaire. 50% of the dentists have adopted strict and precise protocols for decontamination and disinfection of dental works compared to 76.7% of the dental technicians. 31.1% of the dentists decided to use a more virucidal disinfectant product versus 33.3% of the technicians. 32.1% of the dentists did not change their disinfection/decontamination habits for prosthetic works in the COVID-19 era versus 6.7% of dental technicians. 92.5% of the dentists and 93.3% of the dental technicians invested more in disinfectants during the COVID period. Many prosthodontists changed their habits during COVID crisis compared to dentists who disinfected prosthetic pieces even before the pandemic. Dentists like technicians adopted stricter and more precise protocols and invested more in disinfectants products during the pandemic. A standardized decontamination protocol should be established and applied and the use of chair-side computer-aided design and manufacturing (CAD-CAM) helps to control cross-infection.

Optimization of postoperative surveillance protocols in upper tract urothelial cancer: A retrospective cohort study.

Upper tract urothelial carcinoma (UTUC) is an aggressive disease that is managed by radical or organ-sparing surgery. High recurrence rates require early detection and strict follow-up (FU) protocols. Recommendations are assigned to a low level of evidence. Our aim was to identify time-to-tumor recurrence, analyze the temporal relation to recommended FU regimens, and provide a critical proposal for further surveillance. This retrospective study included 54 patients receiving radical nephroureterectomy (RNU) in high-risk UTUC and 14 patients assigned to kidney-sparing surgery (KSS) with low-risk disease. FU surveillance protocols consisted of close intervals irrespective of the received type of surgery. In total, 68 patients were included with a median FU of 23 months. Mean overall survival (OS) was significantly shorter in RNU compared to KSS (P = .027). Recurrence in the bladder and/or upper urinary tract (UUT) was 57.1% in KSS and 38.9% after RNU (P = .241). Mean recurrence-free survival (RFS) was significantly shorter in RNU patients compared to KSS (22.4 vs. 47.9 months, P = .013), and 76.2% of the recurrences in the RNU group occurred in the first postoperative year. UUT recurrence was diagnosed after a median of 3.0 (RNU) and 25.0 (KSS) months. There was a frequent onset of metastases in the RNU group, with 85.7% in the first year compared to the KSS group with 50%. Multivariable regression analysis showed that the tumor stage was the parameter independently related to OS (P = .002), RFS (P = .008), and metastasis-free survival (MFS, P = .002). In conclusion, surveillance of UTUC should be adapted to real-time occurrence patterns. Strict imaging protocols are recommended in the first two years irrespective of the method of surgery. As recurrence is equally distributed over the years after KSS, cystoscopy should be offered regularly for five years and diagnostic URS for three years. After RNU, cystoscopies should be decreased to yearly intervals after year three. Contralateral UUT should also be examined after RNU.

Capacity at All-Way Stop Control Intersections: Case Study

This paper presents an empirical investigation into the capacity of all-way stop-controlled (AWSC) intersections. Video data was collected over four days at an AWSC intersection site in Bozeman, Montana. The site is characterized by single-lane approaches and high level of vehicular and pedestrian traffic. Using strict protocols, video records were processed at the individual vehicle level and several information metrics were extracted for each vehicle in the data set on all approaches. Study results indicate that the total intersection capacity at the study site varied between 400 and 1,400 vehicles per hour. The study suggests that the wide range of capacity observations is largely associated with the pedestrian crossing activity at the study site. Statistical tests confirmed that both pedestrian crossing activity and the level of conflict have significant effects on intersection capacity at the 95% confidence level. For movement type, the right-turn movement was not found to have a significant effect on intersection capacity while left-turn movement was found to negatively affect the intersection capacity. The results presented in this paper offer valuable information on AWSC intersection capacity, given the limited amount of information in the literature and the dated nature of those empirical observations.

SARS-Cov-2 Infection and Seroconversion Rates in Healthcare Providers Prior to COVID-19 Vaccine Rollout.

A 6-month longitudinal surveillance study of asymptomatic healthcare providers (HCP) was carried out at a large urban academic medical center in the United States to assess whether their job occupation with higher exposure risks to SARS-CoV-2 would equate with higher risk of contracting COVID-19 at the beginning of the pandemic before COVID-19 vaccines were available. A longitudinal cohort study design was used to collect and analyze immunological and virological monitoring data and self-report survey assessments of personal protective equipment (PPE) availability, adherence to infection control guidelines, and time spent on COVID-19 wards. Among 289 eligible participants, SARS-CoV-2 exposure risk was high with 48-69% participants working in COVID-19 units and more than 30% of them caring for COVID-19 patients. However, the seroconversion rate was low with only 2.1% of participants developing humoral or cellular immunity against SARS-CoV-2. Our study findings suggest that, for this HCP cohort working at a large urban academic medical center, a low incidence of SARS-CoV-2 infection could be maintained under conditions of strict infection prevention protocols and reliable PPE availability.

The test-retest reproducibility of the multiple array probe Leiden in men with lower urinary tract symptoms.

We aimed to study the test-retest reliability of the Multiple Array Probe Leiden (MAPLe), a multiple electrode probe designed to acquire and discriminate electromyography signals in the pelvic floor muscles, in men with lower urinary tract symptoms (LUTS). Adult male patients with LUTS with sufficient knowledge of Dutch language, but without complications (e.g., urinary tract infection), or previous urologic cancer and/or urologic surgery were enrolled. In the initial study, next to physical examination and uroflowmetry, all men underwent MAPLe assessment at baseline and after 6 weeks. Second, participants were reinvited for a new assessment using a stricter protocol. A time interval of 2 h (M2) and 1 week (M3) after baseline (M1) allowed the calculation of the intraday agreement (M1 vs. M2), and the interday agreement (M1 vs. M3) for all 13 MAPLe variables. The outcomes of the initial study in 21 men suggested a poor test-retest reliability. The second study in 23 men showed a good test-retest reliability with intraclass correlations ranging from 0.61 (0.12-0.86) to 0.91 (0.81-0.96). The agreement was generally higher for the intraday determinations than for the interday determinations. This study revealed a good test-retest reliability of the MAPLe device in men with LUTS, when using a strict protocol. With a less strict protocol, the test-retest reliability of MAPLe was poor in this sample. To make valid interpretations of this device in a clinical or research setting, a strict protocol is needed.

Why do inverse models disagree? A case study with two European CO2 inversions

Abstract. We present an analysis of atmospheric transport impact on estimating CO2 fluxes using two atmospheric inversion systems (CarboScope-Regional (CSR) and Lund University Modular Inversion Algorithm (LUMIA)) over Europe in 2018. The main focus of this study is to quantify the dominant drivers of spread amid CO2 estimates derived from atmospheric tracer inversions. The Lagrangian transport models STILT (Stochastic Time-Inverted Lagrangian Transport) and FLEXPART (FLEXible PARTicle) were used to assess the impact of mesoscale transport. The impact of lateral boundary conditions for CO2 was assessed by using two different estimates from the global inversion systems CarboScope (TM3) and TM5-4DVAR. CO2 estimates calculated with an ensemble of eight inversions differing in the regional and global transport models, as well as the inversion systems, show a relatively large spread for the annual fluxes, ranging between −0.72 and 0.20 PgC yr−1, which is larger than the a priori uncertainty of 0.47 PgC yr−1. The discrepancies in annual budget are primarily caused by differences in the mesoscale transport model (0.51 PgC yr−1), in comparison with 0.23 and 0.10 PgC yr−1 that resulted from the far-field contributions and the inversion systems, respectively. Additionally, varying the mesoscale transport caused large discrepancies in spatial and temporal patterns, while changing the lateral boundary conditions led to more homogeneous spatial and temporal impact. We further investigated the origin of the discrepancies between transport models. The meteorological forcing parameters (forecasts versus reanalysis obtained from ECMWF data products) used to drive the transport models are responsible for a small part of the differences in CO2 estimates, but the largest impact seems to come from the transport model schemes. Although a good convergence in the differences between the inversion systems was achieved by applying a strict protocol of using identical prior fluxes and atmospheric datasets, there was a non-negligible impact arising from applying a different inversion system. Specifically, the choice of prior error structure accounted for a large part of system-to-system differences.

Case Report: Contrast Imaging in the Setting of Cerebral Venous Thrombosis

Disruption to contrast agent supply chains for radiology investigations has become an additional consequence of the COVID-19 pandemic. Various recommendations, including dose reductions and choices of alternative agents, have been made to help account for this limited availability. This case demonstrated how two separate computed tomography (CT) venograms with different contrast agents and similar timing, undertaken on the same day for the same patient, yielded different results; cerebral venous thromboses were more prominent in the subsequent scan. Although there were features suggestive of thrombosis on the first scan, repeat imaging was required to further characterize the lesions identified. The case exemplifies the notion that diagnostic imaging should always be guided by a detailed history and examination. It also raises the discussion point of whether more strict or uniform protocols should be developed to facilitate contrast administration for radiology investigations. It is important that appropriate doses are always administered to maximize diagnostic yield.

Abstract MP42: Associations Between Psychological Resilience and Lifestyle Behaviors Among Adults in Puerto Rico Affected by Repeated Adverse Events

Residents of Puerto Rico have repeatedly experienced adverse events over the past five years including Hurricanes Irma and Maria in 2017, earthquakes in 2019-2020, Hurricane Fiona in 2022, sociopolitical unrest, a deep economic crisis, and the COVID-19 pandemic (including strict lockdown protocols). Higher psychological resilience, or the ability to “bounce back” after adversity, has been associated with better cardiovascular health in other contexts. One potential mechanism for this relationship is that higher resilience may contribute to engaging in healthier behaviors, such as higher diet quality, more physical activity, and healthier sleep duration and quality, as well as less smoking and drinking. However, such relationships have not yet been explored in this population. We cross-sectionally surveyed 1,240 adults in Puerto Rico in 2019-2022, with recruitment both before and during the COVID-19 pandemic, as part of the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT). Participants responded to the Brief Resilience Scale (BRS) and Brief Resilient Coping Scale (BCS). Diet was assessed with a food frequency questionnaire and diet quality was defined by the Alternate Healthy Eating Index (AHEI). Physical activity was measured via the Harvard Alumni Activity Survey. We also collected data on average hours of sleep, quality of sleep, alcohol intake, and tobacco use. Logistic regression models estimated the odds ratios (OR, 95% CI) for following each healthy behavior by established categories of resilience (high and medium vs. low), adjusted for sociodemographic factors and co-morbidities. Of the sample, 39% (452 out of 1175) and 73% (851 out of 1170) were classified with high resilience and coping using the BRS and BCS, respectively. Adults with high resilience (vs. low) on the BRS had twice the odds [OR: 2.01, 95% CI: 1.22, 3.29] of reporting healthy sleep hours (7-8 hours/night compared to either 6 or fewer/night or 9 or more/night). High resilience was also associated with higher odds of being in the upper AHEI tertile (better diet quality) [OR: 1.61 (0.97, 2.68)], and having moderate or heavy physical activity [OR: 1.54 (1.04, 2.29) compared to sedentary or light activity]. These associations persisted when further adjusting for mental health disorders, perceived stress, and social support. Moreover, the relationships were stronger among participants interviewed during the COVID-19 pandemic, suggesting that psychological resilience may be particularly relevant during an ongoing stressor. No significant associations were noted between resilience and tobacco or alcohol use. Given Puerto Rico’s susceptibility to adverse events, seeking to improve population resilience in this and similarly vulnerable populations may lead to better health over the life course.

Strong restructuration of skin microbiota during captivity challenges ex-situ conservation of amphibians.

In response to the current worldwide amphibian extinction crisis, conservation instances have encouraged the establishment of ex-situ collections for endangered species. The resulting assurance populations are managed under strict biosecure protocols, often involving artificial cycles of temperature and humidity to induce active and overwintering phases, which likely affect the bacterial symbionts living on the amphibian skin. However, the skin microbiota is an important first line of defense against pathogens that can cause amphibian declines, such as the chytrid Batrachochytrium dendrobatidis (Bd). Determining whether current husbandry practices for assurance populations might deplete amphibians from their symbionts is therefore essential to conservation success. Here, we characterize the effect of the transitions from the wild to captivity, and between aquatic and overwintering phases, on the skin microbiota of two newt species. While our results confirm differential selectivity of skin microbiota between species, they underscore that captivity and phase-shifts similarly affect their community structure. More specifically, the translocation ex-situ is associated with rapid impoverishment, decrease in alpha diversity and strong species turnover of bacterial communities. Shifts between active and overwintering phases also cause changes in the diversity and composition of the microbiota, and on the prevalence of Bd-inhibitory phylotypes. Altogether, our results suggest that current husbandry practices strongly restructure the amphibian skin microbiota. Although it remains to be determined whether these changes are reversible or have deleterious effects on their hosts, we discuss methods to limit microbial diversity loss ex-situ and emphasize the importance of integrating bacterial communities to applied amphibian conservation.

Biological variation estimates for spot urine analytes and analyte/creatinine ratios in 33 healthy subjects.

Urine samples are frequently used in the clinical practice. In our study, we aimed to calculate the biological variations (BV) of analytes and analyte/creatinine ratios measured in spot urine. Second-morning spot urine samples were collected from 33 (16 female, 17 male) healthy volunteers once weekly for 10weeks and analyzed in the Roche Cobas 6,000 instrument. Statistical analyzes were performed using BioVar, an online BV calculation software. The data were evaluated in terms of normality, outliers, steady state, homogeneity of the data, and BV values were obtained by analysis of variance (ANOVA). A strict protocol was established for within-subject (CVI) and between-subject (CVG) estimates for both genders. There was a significant difference between female/male CVI estimates of all analytes except potassium, calcium and magnesium. No difference was found in CVG estimates. When the analytes that had a significant difference in CVI estimates in spot urine analytes were compared to creatinine, it was observed that the significant difference between the genders disappeared. There was no significant difference between female/male CVI and CVG estimates in all spot urine analyte/creatinine ratios. Since the CVI estimates of analyte/creatinine ratios are lower, it would be more reasonable to use them inresult reporting. Reference ranges should be used with caution, since II values of almost all parameters are between 0.6 and 1.4. The CVI detection power of our study is 1, which is the highest value.

Public Service Innovation in the Era of the Covid-19 Pandemi in Tangerang District, Banten

The government has a big responsibility for the best and quality services in all public service sectors to the community. However, during COVID-19, the government imposed strict health protocols that affected the quality of service. This condition requires the Tangerang Regency Government to innovate digital-based public services or information and communication technology. The theory of innovation in research uses the theory developed by Rogers, Everett M in his book Diffusion of Innovations, which looks at innovation from the dimensions of Relative Advantages, Compatibility, Complexity, Trialability and Observability. The research design used is qualitative with a narrative or descriptive study approach. Data collection techniques used triangulation techniques by means of observation, interviews and document review. Meanwhile, data analysis used techniques developed by Miles and Huberman, namely data reduction, data display, and conclusion drawing/verification. The results of the study show that during COVID-19, the Tangerang Regency Government has developed e-government-based public service innovations, including; the Population Administration Service Information System application (SIPENDUK), the Integrated Licensing Service Information System application (SIPINTER), the Integrated Online PBB Print Information System application (siCEPOT) and the Online Medical Check-Up Booking Information System application (Si BOMCU). Public service innovation development strategies that need to be used are; compiling and establishing a blueprint for an integrated e-government application system and creating an ideal institutional model in e-government management.

Benign in radiology bombshell in cytology

Smooth muscle tumor of uncertain malignant potential is a surprise post-operative histopathological finding after myomectomy or hysterectomy. These are aligned between benign and malignant which shares but does not fulfil the complete diagnostic criteria of leiomyosarcoma. Preoperative diagnosis by clinical or radiological examination is uncertain and the diagnosis is only by histopathology. Among women undergoing myomectomy or hysterectomy for a presumed diagnosis of leiomyoma, 0.01% receive a diagnosis of STUMP. Once diagnosed as STUMP, the gold standard treatment option is surgical removal of uterus. As there are no strict accurate protocols for the management of STUMP, the treatment choices should be based on the age of the patient, status and desire to preserve fertility, location of the tumor, metastases, recurrences and pathologic types. Here with we are presenting a case of nulligravida admitted for abnormal uterine bleeding with severe anaemia diagnosed as STUMP on histopathological examination, managed by myomectomy followed by regular follow up for the sake of fertility status. Post operative regular clinical and radiological follow up is mandatory for early pick up of recurrence or metastases.

This Month in Adult Urology.

This Month in Adult Urology.

Cryotherapy for partial gland ablation of prostate cancer: Oncologic and safety outcomes.

Partial gland ablation (PGA) is a new option for treatment of prostate cancer (PCa). Cryotherapy, an early method of PGA, has had favorable evaluations, but few studies have employed a strict protocol using biopsy endpoints in men with clinically significant prostate cancer (csPCa). 143 men with unilateral csPCa were enrolled in a prospective, observational trial of outpatient PGA-cryotherapy. Treatment was a 2-cycle freeze of the affected prostate part. Participants were evaluated with MRI-guided biopsy (MRGB) at baseline and at 6 months and 18 months after treatment. Absence of csPCa upon MRGB was the primary endpoint; quality-of-life at baseline and at 6 months after treatment was assessed by EPIC-CP questionnaires in the domains of urinary and sexual function. Of the 143 participants, 136 (95%) completed MRGB at 6 months after treatment. In 103/136 (76%), the biopsy revealed no csPCa. Of the 103, 71 subsequently had an 18-month comprehensive biopsy; of the 71 with 18-month biopsies, 46 (65%) were found to have no csPCa. MRI lesions became undetectable in 96/130 (74%); declines in median serum PSA levels (6.9 to 2.5 ng/mL), PSA density (0.15 to 0.07), and prostate volume (42 to 34cc) were observed (all p< 0.01). Neither lesion disappearance on MRI nor PSA decline correlated with biopsy outcome. Urinary function was affected only slightly and sexual function moderately. In the near to intermediate term, partial gland ablation with cryotherapy was found to be a safe and moderately effective treatment of intermediate-risk prostate cancer. Eradication of cancer was better determined by MRI-guided biopsy than by MRI or PSA.

Pengaruh Protokol Kesehatan dan Penerapan E-Ticketing terhadap Kepuasan Penumpang Kereta Api Sumatera Barat pada Masa New Normal

The research purposes to examine the effect of health protocols and the implementation of e-ticketing on passenger satisfaction in West Sumatra train service during the new normal.This study uses an associative quantitative method. The data was collected through a survey questionnaire via google fromand quantitative data were got using a scale of Likert that had been tried for validity and reliability. Where the writer studied there was a population of 97 respondents, the sample obtained in this study was 56 respondents using the Slovin formula although a rate of error of 5% and the analysis in the research used multiple linear regression tests. The results showed that both health protocols and e-ticketing have a effect in significant and positive on passenger satisfaction. The findings suggest that the implementation of strict health protocols and efficient e-ticketing system is crucial in ensuring passenger satisfaction in the train service during the new normal. The study provides valuable insights for the railway industry in improving their services to meet the needs and passengers expectations in the current pandemic situation.

Upaya Pemulihan Kesehatan Penderita Tuberkulosis pada Masa Pandemi COVID-19

This study aims to analyze efforts to restore the health of tuberculosis sufferers during the COVID-19 Pandemic in Cibiru Wetan Village, Cileunyi District, Bandung Regency. The method used is qualitative with a phenomenological approach through in-depth interview techniques. The study results a show that tuberculosis sufferers are still receiving treatment during the COVID-19 pandemic by implementing strict health protocols. In conclusion, efforts to restore the health of tuberculosis sufferers during the COVID-19 pandemic in Cibiru Wetan Village, Cileunyi District, Bandung Regency, are carried out through taking the medication regularly, checking themselves regularly at health care facilities and being accompanied by drug swallowing supervisors (PMO) from their family members.&#x0D; Keywords: COVID-19, Health Recovery, Tuberculosis Patients

The LipoDerm Method for Regeneration and Reconstruction in Plastic Surgery: A Technical Experimental Ex Vivo Note

The combination of adipose-derived stem cells (ASCs) and dermal scaffolds has been shown to be an approach with high potential in soft tissue reconstruction. The addition of dermal templates to skin grafts can increase graft survival through angiogenesis, improve regeneration and healing time, and enhance the overall appearance. However, it remains unknown whether the addition of nanofat-containing ASCs to this construct could effectively facilitate the creation of a multi-layer biological regenerative graft, which could possibly be used for soft tissue reconstruction in the future in a single operation. Initially, microfat was harvested using Coleman's technique, then isolated through the strict protocol using Tonnard's technique. Finally, centrifugation, emulsification, and filtration were conducted to seed the filtered nanofat-containing ASCs onto Matriderm for sterile ex vivo cellular enrichment. After seeding, a resazurin-based reagent was added, and the construct was visualized using two-photon microscopy. Within 1 h of incubation, viable ASCs were detected and attached to the top layer of the scaffold. This experimental ex vivo note opens more dimensions and horizons towards the combination of ASCs and collagen-elastin matrices (i.e., dermal scaffolds) as an effective approach in soft tissue regeneration. The proposed multi-layered structure containing nanofat and dermal template (Lipoderm) may be used, in the future, as a biological regenerative graft for wound defect reconstruction and regeneration in a single operation and can also be combined with skin grafts. Such protocols may optimize the skin graft results by creating a multi-layer soft tissue reconstruction template, leading to more optimal regeneration and aesthetic outcomes.

So far, no novel SARS-CoV-2 variants from Beijing—and hopefully better scientific cooperation going forward

In early December, 2022, China abandoned what until then had been among the most stringent policies against the COVID-19 pandemic globally.1 Termed the “dynamic zero-COVID policy”, mass testing, strict quarantine protocols, and movement controls had aimed to bring COVID-19 outbreaks under control before they could spread.2 This approach proved highly effective: from Jan 22, 2020, until Nov 1, 2022, per million population, China recorded a cumulative 726 COVID-19 cases and 3·9 deaths, compared with 288 384 cases and 3166 deaths in the USA.

The Impact of Community Dental and Oral Health Services During the Covid-19 Pandemic in Indonesia

Based on WHO data, the number of doctors who died from COVID-19 was 545 people, while there were 46 dentists. As a result, dental practice has become a problem during the COVID-19 pandemic. Several solutions were produced to solve this problem, namely switching to non-aerosol procedures. Purpose: to conduct a literature review that examines the impact of community dental and oral health services during the COVID-19 pandemic. Method: this literature study uses the narrative review method by analyzing various journals from the PubMed, EBSCO and Google Scholar online databases related to community dental and oral health services during the COVID-19 pandemic. Conclusion: During the COVID-19 pandemic, treatment at the dentist's clinic was carried out with very strict health protocols to prevent the spread of the virus