Trends In Usage Research Articles

Dynamic recommendation for anticoagulant treatment in patients with atrial fibrillation using deep reinforcement learning method

Abstract Background Recent evidence suggests that the guideline-directed anticoagulant therapy for atrial fibrillation (AF) remains controversial. Widely-used CHA2DS2-VASc score is solely based on limited traditional cardiovascular risk factors, omitting AF characteristics and other markers of thromboembolic risk. A more efficient, safer and more personalized anticoagulant approach is warranted. Purpose To develop a data-driven deep reinforcement learning (DRL) model for guiding dynamic anticoagulant treatment in AF patients to improve cardiovascular outcomes. Methods Participants of this study were enrolled from the multicentred China Atrial Fibrillation (China-AF) Registry between August 2011 and December 2022, who were with regular follow-up every 6 months. We excluded patients on warfarin at baseline due to its declining usage trend in non-valvular AF patients in China. The DRL model was trained in 70% randomly selected patients for optimal dynamic decision-making, and then subsequently tested in the remaining 30%. Data of sociodemographic characteristics, AF characteristics, medical history, lifestyle factors, laboratory examination, and medications were input for model training. Concordance rate between DRL model’s recommendations and physicians’ actual decisions of non-vitamin-K-antagonist oral anticoagulant (NOAC) prescription among all visits before censoring was calculated for each patient. Primary outcome was the composite of cardiovascular death, ischemic stroke, transient ischemic attack or systemic embolism (SSE), and major bleeding. Shapley additive explanation analysis ranked the most important factors affecting decision-making of the DRL model. Results A total of 20068 patients (mean age: 63.0±12.0 years; 36.2% female) were randomly divided into a training cohort of 14050 patients and a testing cohort of 6018 patients. The model’s NOAC recommendations were mostly affected by age, prior NOAC prescription, body mass index, hypertension history and prior statin prescription (Figure 1). Patients with concordance rates of 50.1%-75% and 75.1%-100% had significant risk reductions for the primary outcome (adjusted HR =0.63; 95% CI, 0.46-0.85; P = 0.003 and adjusted HR =0.59; 95% CI, 0.46-0.75; P <0.001, respectively), compared to those with a concordance rate of 0-25%. Similar results were observed for all-cause death, cardiovascular death and SSE outcomes, that patients with the highest concordance rate had a significant lower risk, compared to those with the lowest concordance rate. There was a nonsignificant but similar trend with regard to major bleeding events (Figure 2). Conclusions This modelling study suggests that a data-driven DRL model might provide more efficient, safer and more personalized anticoagulant suggestions, potentially assisting physicians in clinical practice.

Antibiotic Susceptibility among Infective Endocarditis Population: Syndromic Antibiogram Evaluation at Indonesian National Cardiovascular Center

Infective Endocarditis (IE) is a life-threatening disease with a high mortality rate (25%). Laboratory approaches to support the diagnosis of IE especially blood and/or cardiac vegetation culture, are crucial for providing definitive therapy. However, negative culture is frequently observed, therefore empirical use of antibiotics seems unavoidable and may lead to increasing antimicrobial resistance. This study aims to observe the prevalence of antibiotic susceptibility among the IE population using the WISCA approach. This retrospective study observed medical record data of all inpatients diagnosed with IE according to ICD-10 at Cardiovascular Center Harapan Kita Hospital (NCCHK) between January 2018 and December 2022. Patient data were combined with bacterial identification and antibiotic susceptibility test data from the laboratory information system, and evaluated based on period (year). A total of 67,858 inpatients and 1.1% (n=772) were diagnosed with IE. Successful culture growth (blood and/or cardiac vegetation specimen) was between 36.8% and 70% annually. Streptococcus viridans group (82/237, 34.6%) and Coagulase-negative Staphylococci (57/237, 24.1%) were dominantly observed among the IE population. Low susceptibility among Penicillin (34.3%) towards Gram-positive bacteria, as first-line treatment option in IE. Meanwhile, high susceptibility range was observed in Ceftriaxone (95.7%), Gentamicin (80.4%), Rifampicin (84.4%), and Vancomycin (98.7%) as second-line treatment in IE. Despite the low prevalence, the occurrence of antimicrobial resistance in IE has become a priority concern. Continuing the syndromic antibiogram is mandatory to assist the trend of empirical antibiotic usage and refine the established local treatment guidelines.

Assessing Trends of Vehicle Ownership and Use Among Tertiary Students in Kwame Nkrumah University of Science and Technology Campus, Ghana

The study aims to assess trends of car ownership and usage among tertiary students on campus, with an emphasis on Kwame Nkrumah University of Science and Technology (KNUST). The research design employed in this study was descriptive survey, aiming to gather information from a sample population through their responses to specific questions. Data analysis was conducted using descriptive statistics, summarizing the responses quantitatively through bar charts, pie charts, frequencies, percentages as well as means and tables, created using Microsoft Excel. The results revealed that, a majority (70 percent) of the cars being used by students on the KNUST campus are owned by Ghanaian students with foreign students making up the minority of this number. The major challenges faced by students who own or use vehicles on campus are a lack of filling stations on and around campus, lack of student parking lots, and excess traffic. From the findings, it can be concluded that, students' psychological make-up is a major determinant of vehicle ownership among students. Moreover, the findings further revealed that most of the students who have vehicles on the campus exhibit or develop mostly negative habits after vehicle ownership and this in the long run may have negative effects on academic performance which is the sole purpose of being on campus. The study provides insights into the environmental and health impacts of increased vehicle use on university campuses, offering valuable insights for policy decisions, future research, and campus management, thereby enhancing student mobility.

The Good and Bad of AI Tools in Novice Programming Education

As AI coding tools become more prevalent in programming, it is essential to understand how they influence programming education. This study, conducted in a first-semester Introduction to Programming course, aimed to determine the positive and negative effects of these tools on students’ learning experiences and their ability to develop essential programming skills. Using a mixed-methods approach, we collected data from 73 teams of engineering students over a 12-week period. Students completed surveys and reported on their AI tool usage. We analyzed this data quantitatively to identify trends in tool familiarity, usage, and student satisfaction. Additionally, qualitative analysis of student reports provided insights into the specific ways AI tools were used and their perceived benefits and drawbacks. The findings revealed a significant increase in AI tool familiarity (from 28% to 100%) and usage among students. Students’ satisfaction with AI tools improved over time. The most prevalent tasks for which novice programmers used AI tools included creating comments (91.7%), identifying and correcting bugs (80.2%), and seeking information (68.5%), while other tasks were less common. While these tools offered benefits like assisting in learning and enhancing real-world relevance, they also raised concerns about cheating, over-reliance on AI tools, and a limited understanding of core programming concepts.

6954 Effect Of The SARS-CoV-2 Pandemic on Metabolic Control In Patients With Type 2 Diabetes: A 5-year Cohort Follow-Up

Abstract Disclosure: D.P. Morales Rodríguez: None. M. Romero Ibarguengoitia: None. A. Garza-Silva: None. A. Rivera-Cavazos: None. I. Fernandez-Chau: None. A. Cepeda Medina: None. A. Gonzalez-Cantú: None. The SARS-CoV-2 pandemic brought a radical shift in the healthcare system and a suboptimal care for vulnerable patients, such as those with Type 2 Diabetes Mellitus (T2DM). Thus, we compared the metabolic control of patients with T2DM before and throughout 3 years of the SARS-CoV-2 pandemic, described the type of consultations and trends in attendance in various specialties, and compared the number of medications prescribed to patients before and during the pandemic. We conducted a retrospective observational cohort study on steelworkers with T2DM from a hospital in northeastern Mexico, who were treated by a multidisciplinary team from 2018 to 2022. We analyzed HbA1C levels, fasting serum glucose (FGS), low-density lipoprotein cholesterol (LDLc), blood pressure (BP) values, microalbuminuria, attendance at consultations across different specialties, and the trend in medication usage. We analyzed 999 subjects, 516 (51.7%) males, with a mean age (SD) of 60.1 (12.7) years. A significant difference was found in the proportion of controlled patients based on HbA1C with 55.5% in 2018 and 70.7% in 2022 (p<0.001). There was an increase of FGS control from 13.8% in 2018 to 56.1% in 2022 (p<0.001). LDL cholesterol control exhibited a decrease from 62.1% in 2018 to 57% in 2022 (p<0.001). Proportion of patients with systolic BP control decreased from 82.7% in 2018 to 80.1% in 2022 (p<0.001). Diastolic BP control was 89.6% in 2018 with an increase to 91.4% in 2022 (p=0.01). Microalbuminuria based control, increased from 80.5% in 2018 to 89% in 2022 (p=0.002). Telephone consultations were introduced in 2020, with 899 (90%) patients using this modality at least once, leading to a 35.8% decrease of in-person consultations (n=541,54.2%) and reaching its lowest point in 2021 (n=2, 0.2%). Throughout the follow-up period, all patients had at least one annual consultation with an internist or geriatrician based on their age group. There was an increase of endocrinology consultations from 8.5% in 2018 to 12.1% in 2022 and in cardiology from 6.9% in 2018 to 10.3% in 2022 (<0.05). There was a rise in the prescription of oral hypoglycemic agents raging from 4.9% to 14.2% between 2018 and 2020, with SGLT2 inhibitors being the highest prescribed and a 2.5% decrease in the prescription of sulfonylureas between 2018 and 2020. Similarly, there was an increase in the prescription of long-acting insulin by 5.9% between 2018 and 2020. There was a higher proportion of patients with controlled glycemic and diastolic blood pressure targets during the SARS-CoV-2 pandemic, this can be attributed to patient’s access to telemedicine and a multidisciplinary team capable of providing an appropriate medication prescription for an optimized management and improvement in patient’s quality of life. Presentation: 6/1/2024

6959 Variation of FIB-4 Classification In A 5-Year Follow-Up Cohort of Patients With Type 2 Diabetes Mellitus Managed By A Multi-Disciplinary Team In A Hospital In Northeastern Mexico

Abstract Disclosure: M. Romero Ibarguengoitia: None. D.P. Morales-Rodríguez: None. A. González-Cantú: None. A. Garza-Silva: None. A. Rivera-Cavazos: None. I. Fernández-Chau: None. A. Cepeda-Medina: None. Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common pathology associated to type 2 diabetes mellitus (T2DM), however the change in its classification over time is unknown in patients with T2DM managed by a multidisciplinary team in a population of Northern Mexico. Therefore, we analyzed the change in the FIB-4 classification for MASLD before and during 3 years of SARS-CoV-2 pandemic. We conducted a retrospective observational cohort study on a population of steelworkers with T2DM from a hospital in Northeastern Mexico from 2018 to 2022 treated by a multidisciplinary team. This team was comprised by an internist or geriatrician based on patient’s age, an endocrinologist, a nutritionist, and other specialties related to T2DM. We analyzed levels of HbA1C, fasting serum glucose (FSG), attendance to various specialties consultations, trends in medication usage and changes in the classification of FIB-4 scale. A total of 999 subjects were studied, with 516 (51.7%) being male, average age (SD) of 60.1 (12.7) years. There was a significant difference in the proportion of patients with controlled HbA1C levels, being 55.5% in 2018 and rising to 64.3% in 2020 and to 70.7% in 2022 (p<0.001). An increase in the proportion of patients in control based on FSG was observed, from 13.8% in 2018 to 54.8% in 2020 and 56.1% in 2022 (p<0.001). Throughout the follow-up period, all patients had at least one annual consultation with an internist or geriatrician according to their age group. Additionally, there was an increase in assistance to endocrinology consultations from 8.5% in 2018 to 9.9% in 2020 and 12.1% in 2022 (p<0.001). There was a rise in the prescription of oral hypoglycemic agents in general from 4.9% in 2018 to 14.2% in 2020, with an increase of GLP-1 analogs from 3.3% in 2018 to 9.3% in 2020 (p<0.001). Regarding the categorization by FIB-4, in 2018, a proportion of 64.8% of patients were observed in the F0-F1 category, 30.2% in the F2 category, and 4.8% in the F3-F4 category (p<0.001). These levels remained similar for 2020, with 62.6% in the F0-F1 category, 32.4% in the F2 category, and 4.9% in the F3-F4 category (p<0.001). In 2022, there is an increase in the proportion of patients in the F0-F1 category, reaching 71.8% of our population, along with a decrease in those classified as F2 to 20.9%, and a slight increase in the proportion of patients in the F3-F4 category to 7.2% (p<0.001). MASLD is a condition that occurs frequently in our population; however, it is possible to stabilize and even decrease its classification through a multidisciplinary and specialized team capable of treating T2DM effectively by optimizing its management with GLP-1 prescription and a prompt referral to endocrinology consultation with the aim of providing a good quality of life for the patients. Presentation: 6/2/2024

Mapping new psychoactive substances: Leveraging GIS technology for advanced global surveillance and policy support

The escalating challenge of New Psychoactive Substances (NPS) necessitates enhanced global monitoring and analysis capabilities. This study introduces an advanced interactive visualization tool that employs Geographic Information System (GIS) technologies to improve the functionality of the UNODC's Early Warning Advisory. The tool enables dynamic observation and analysis of NPS's geographical and temporal distribution, thereby facilitating a comprehensive understanding of their public health impacts. By incorporating detailed choropleth maps and annual and cumulative bar charts, the tool allows policymakers and researchers to visually track and analyze trends in NPS usage and control efforts across different regions. The results demonstrate the tool's effectiveness in providing actionable insights, which support the strategic development of public health policies and interventions to curb the global rise in NPS usage. This initiative illustrates the essential role of digital tools in enhancing public health strategies and responses to emerging drug trends. This rising challenge underscores the urgent need for innovative solutions in monitoring drug trends, a theme explored in this paper. The web tool is available at https://nps-vis.cmdm.tw, and the code is available at https://github.com/CMDM-Lab/nps-vis.

Trends of SGLT2 inhibitors among patients with and without cancer.

113 Background: While initial indications for SGLT2 inhibitors (SGLT2i) were for management of type 2 diabetes mellitus (DM), their use has broadened with cardiovascular and renal protective properties. Given limited studies in cancer patients, we evaluated the trends of SGLT2i usage in patients with or without cancer. Methods: This study is a retrospective cohort analysis that examined electronic medical records from a global health research network, TriNetX. Our study population included patients 18 and older having one of following diagnoses: heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), chronic kidney disease (CKD), and cardiovascular disease (CVD) with DM. Cohorts were separated by cancer status, creating 8 study cohorts. The incidence of SGLT2i use was measured annually, defined as total new patients receiving an SGLT2i divided by total eligible patients for that year. Linear trend plots were created showing incidence percentage from 2016 to 2023 to compare trends in cancer patients and non-cancer patients. Results: Amongst all study cohorts, the observed yearly incidence of SGLT2i use was considerably lower from 2016 and 2019. Measured incidence did not exceed 2%, with no observable differences between cancer and non-cancer patients. From 2020 to 2023, the observed incidence dramatically increased year over year, doubling from the observed 2019 incidence for all groups. Differences in utilization between cancer non-cancer patient cohorts became visible from 2020 onward amongst patients with HFrEF, CKD, and DM with CVD. This is highlighted by differences in 2023 incidence percentages for HFrEF (13.1% Non-Cancer vs. 10.7% Cancer), CKD (10.0% Non-Cancer vs. 3.8% Cancer), and DM with CVD (7.6% Non-Cancer vs. 5.2% Cancer). Conclusions: Since 2020, there has been an uptick in SGLT2i usage across all patient cohorts, indicating increased adoption of this therapy in clinical practice. Observed incidence rates suggest that cancer patients were less likely to be prescribed SGLT2i compared to non-cancer patients. Further research is needed to understand the barriers of use and efficacy of SGLT2is in cancer patients. Yearly incidence percentage of SGLT2 inhibitor use for 8 study cohorts represented in each column; each row represents a year where incidence is reported. HFrEF HFpEF CKD CVD + DM Year Non-Cancer Cancer Non-Cancer Cancer Non-Cancer Cancer Non-Cancer Cancer 2016 0.27 0.32 0.28 0.41 0.31 0.37 0.88 0.8 2017 0.34 0.41 0.36 0.57 0.39 0.52 1.16 1.19 2018 0.45 0.53 0.41 0.5 0.46 0.49 1.28 1.14 2019 0.74 0.77 0.6 0.77 0.82 0.77 1.91 1.7 2020 1.55 1.31 0.83 1.02 1.52 1.04 2.77 2.07 2021 4.2 3.32 1.77 2.11 3.76 1.96 4.25 3.36 2022 8.85 7.02 4.04 3.84 7.3 2.89 5.99 4.36 2023 13.07 10.66 6.38 6.16 10 3.68 7.6 5.24 HFrEF= Heart Failure Reduced Ejection Fraction; HFpEF= Heart Failure Preserved Ejection Fraction; CKD= Chronic Kidney Disease; CVD + DM= Cardiovascular Disease with Diabetes Mellitus.

Trends in volatile anesthetic sevoflurane and desflurane usage and its impact on carbon emissions: A six-year audit at National Taiwan University Hospital (2018–2023)

This short communication presents an audit of anesthetic gas usage at National Taiwan University Hospital from 2018 to 2023. Using descriptive statistics and trend analysis, the data reveals trends in the consumption of sevoflurane and desflurane, associated costs, and their corresponding carbon emissions. A significant decrease in desflurane usage contributed to a 42.4% reduction in carbon dioxide equivalent (CO2e) emissions per general anesthesia case from 2018 to 2023. The findings underscore the importance of sustainable practices in anesthesia to align with global efforts to reduce carbon emissions.

Comparing the trends of MBS telepsychiatry and consultant physician telehealth services from 2017 to 2022: A retrospective study.

The Medicare Benefit Schedule (MBS) telehealth items were expanded in March 2020 during the COVID-19 pandemic. We measured the use of MBS telepsychiatry items compared to consultant physician telehealth items within the context of these item changes, to understand differences in telepsychiatry and physician telehealth utilisation. Monthly counts of face-to-face and telehealth (videoconferencing and telephone) MBS items for psychiatrists and physicians from January 2017 to December 2022 were compiled from Services Australia MBS Item Reports. Usage levels were compared before and after telehealth item expansion. Usage trends for MBS telepsychiatry and physician telehealth items were compared in time-series plots. Telehealth item expansion resulted in a greater rise of telepsychiatry services from 3.8% beforehand to 43.8% of total services subsequently, compared with physician telehealth services (from 0.6% to 20.0%). More physician telehealth services were by telephone compared with telepsychiatry services. Time-series of both telehealth services displayed similar patterns until mid-2022, when physician telehealth services declined as telephone items were restricted. Telepsychiatry services consistently comprised a greater proportion of total services than physician telehealth services. MBS psychiatrist services showed a more substantial and persistent shift to telehealth than physician services, suggesting a greater preference and use of telepsychiatry.

Unravelling Prokaryotic Codon Usage: Insights from Phylogeny, Influencing Factors and Pathogenicity

Analyzing prokaryotic codon usage trends has become a crucial topic of study with significant ramifications for comprehending microbial genetics, classification, evolution, and the control of gene expression. This review study explores the numerous facets of prokaryotic codon usage patterns, looking at different parameters like habitat and lifestyle across broad groups of prokaryotes by emphasizing the role of codon reprogramming in adaptive strategies and its integration into systems biology. We also explored the numerous variables driving codon usage bias, including natural selection, mutation, horizontal gene transfer, codon-anticodon interaction, and genomic composition in prokaryotes through a thorough study of current literature. Furthermore, a special session on codon usage on pathogenic prokaryotes and the role of codon usage in the phylogeny of prokaryotes has been discussed. We also looked at the various software and indices that have been recently applied to prokaryotic genomes. The promising directions that lay ahead to map the future of codon usage research on prokaryotes have been emphasized. Codon usage variations across prokaryotic communities could be better understood by combining environmental, metagenomic, and system biology approaches.

Bibliometric Analysis of Virtual Reality in Science Education over the Three Decades (1993-2023)

This study aims to conduct a bibliometric analysis of the use of virtual reality in science education over three decades (1993–2023). The method involved data from Google Scholar-indexed publications using Publish or Perish with keywords related to “virtual reality” and “education” over the past 3 decades. Nine hundred and eighty-six publications were obtained with a total of 131,130 citations with an average of 133 citations/paper and 4371 citations/year. The collected data were then screened to ensure its quality. Next, VOSviewer software was conducted to perform co-authorship and co-occurrence analysis. The results of the co-authorship analysis showed that there were 164 authors eligible to be visualized and divided into 88 clusters, indicating a high level of collaboration among authors in this field. Co-occurrence analysis shows that “virtual reality” has an occurrence of 696 in cluster 5 and “science education” is only 16 in cluster 2 with word networks formed only on the words “virtual reality,” “education,” and “field.” This study emphasizes the need for better VR in science education and more research on its impact on students’ science literacy. It outlines VR usage trends in scienceeducation, informing future studies. The findings particularly highlight the importance of investigating VR’s effectiveness in formal educational settings.

Assessing the reliability and readability of migraine treatment information on Turkish websites

BackgroundThe quality and safety of information provided on online platforms for migraine treatment remains uncertain. We evaluated the top 10 trending websites accessed annually by Turkish patients seeking solutions for migraine treatment and assessed information quality, security, and readability in this cross-sectional study.MethodsA comprehensive search strategy was conducted using Google starting in 2015, considering Türkiye’s internet usage trends. Websites were evaluated using the DISCERN measurement tool and Ateşman Turkish readability index.ResultsNinety websites were evaluated between 2015 and 2024. According to the DISCERN measurement tool, most websites exhibited low quality and security levels. Readability analysis showed that half of the websites were understandable by readers with 9th − 10th grade educational levels. The author distribution varied, with neurologists being the most common. A significant proportion of the websites were for profit. Treatment of attacks and preventive measures were frequently mentioned, but some important treatments, such as greater occipital nerve blockade, were rarely discussed.ConclusionThis study highlights the low quality and reliability of online information websites on migraine treatment in Türkiye. These websites’ readability level remains a concern, potentially hindering patients’ access to accurate information. This can be a barrier to migraine care for both patients with migraine and the physician. Better supervision and cooperation with reputable medical associations are needed to ensure the dissemination of reliable information to the public.

Trends in pre-biopsy MRI usage for prostate cancer detection, 2007-2022.

Clinical guidelines favor MRI before prostate biopsy due to proven benefits. However, adoption patterns across the US are unclear. This study used the Merative™ Marketscan® Commercial & Medicare Databases to analyze 872,829 prostate biopsies in 726,663 men from 2007-2022. Pre-biopsy pelvic MRI within 90 days was the primary outcome. Descriptive statistics and generalized estimating equations assessed changes over time, urban-rural differences, and state-level variation. Pre-biopsy MRI utilization increased significantly from 0.5% in 2007 to 35.5% in 2022, with faster adoption in urban areas (36.1% in 2022) versus rural areas (28.3% in 2022). Geographic disparities were notable, with higher utilization in California, New York, and Minnesota, and lower rates in the Southeast and Mountain West. The study reveals a paradigm shift in prostate cancer diagnostics towards MRI-guided approaches, influenced by evolving guidelines and clinical evidence. Disparities in access, particularly in rural areas and specific regions, highlight the need for targeted interventions to ensure equitable access to advanced diagnostic techniques.

Research on Construction of Offline Data Warehouse for Ship Shore Power based on DolphinScheduler and Hive

In today's networked, intelligent, and data-driven era, the shore power industry is facing the challenge of rapidly growing data. This paper presents the construction of a professional offline data warehouse system for shore power based on DolphinScheduler and Hive. Firstly, MySQL is adopted as the backend database, combined with Sqoop to synchronize business data to HDFS, ensuring data reliability and integrity. Secondly, the Flume-Kafka-Flume architecture is utilized to achieve real-time collection and caching of user behavior data, providing data support for subsequent analysis. Thirdly, HQL statements are written in Hive to clean, merge, and analyze shore power data, calculating key indicators such as electricity consumption and usage trends. Fourthly, data visualization is achieved through the integration of Superset, displaying data analysis results via a web interface. Fifthly, DolphinScheduler is employed for timed scheduling, ensuring dependency control among various tasks and the smooth operation of the project. This system fully leverages the replication mechanism of HDFS to enhance reliability, dynamically adds nodes to achieve system scalability, and fully utilizes the fault tolerance of the Yarn scheduler. It saves time and computational costs for the shore power industry, realizing higher value and benefits.

The development and validation of a knowledge, attitude, and practice questionnaire of methamphetamine use

Methamphetamine is a synthetic psychostimulant that is showing a rising trend of usage among adolescents and youths. Its harmful side effects and high risk of developing addiction is a public health problem. Recognizing the knowledge, attitudes, and practices (KAP) on methamphetamine is critical in the planning of an intervention strategy. Currently there is a lack of KAP questionnaires on methamphetamine. The study aims to develop and validate a KAP questionnaire on methamphetamine-use for use among Malaysian adolescents. Following an extensive literature review, face and content validity were carried out among healthcare workers, the public, students, and local subject matter experts. A pilot study was conducted amongst 50 students to assess the test-retest reliability. The questionnaire was then distributed to two groups of 269 and 331 individuals for the Exploratory (EFA) and Confirmatory Factor Analysis (CFA), respectively. The internal reliability was also assessed among these groups. The content validation consisting of Item Content Validity Index (I-CVI, ranging from 0.875 to 1.00), and Scale Content Validity Index (S-CVI/Ave = 0.941) both showed good validation scores. Test-retest reliability showcased an Intraclass Correlation Coefficient (ICC) of > 0.7, indicating its reliability. The model was constructed via the EFA resulting in four constructs, and the model’s goodness of fit was confirmed with CFA. An internal reliability was calculated with Cronbach’s Alpha and showed acceptable reliability (α-values > 0.6) for all constructs. The KAP questionnaire of methamphetamine use is a valid and reliable tool that can be used among Malaysian adolescents. The model arising from this study, can also be used as a guide for future intervention models for adolescent methamphetamine-use disorder.

Minimum intraoperative testing battery for cochlear implantation: the international practice trend.

In cochlear implantation (CI) surgery, there are a wide variety of intraoperative tests available. However, no clear guide exists on which tests must be performed as the minimum intraoperative testing battery. Toward this end, we studied the usage patterns, recommendations, and attitudes of practitioners toward intraoperative testing. This study is a multicentric international survey of tertiary referral CI centers. A survey was developed and administered to a group of CI practitioners (n = 34) including otologists, audiologists and biomedical engineers. Thirty six participants were invited to participate in this study based on a their scientific outputs to the literature on the intraoperative testing in CI field and based on their high load of CI surgeries. Thirty four, from 15 countries have accepted the invitation to participate. The participants were asked to indicate the usage trends, perceived value, influence on decision making and duration of each intraoperative test. They were also asked to indicate which tests they believe should be included in a minimum test battery for routine cases. Thirty-two (94%) experts provided responses. The most frequently recommended tests for a minimum battery were facial nerve monitoring, electrode impedance measurements, and measurements of electrically evoked compound action potentials (ECAPs). The perceived value and influence on surgical decision-making also varied, with high-resolution CT being rated the highest on both measures. Facial nerve monitoring, electrode impedance measurements, and ECAP measurements are currently the core tests of the intraoperative test battery for CI surgery.

Trends in Antimicrobial Usage on Swiss Pig Farms from 2018 to 2021: Based on an Electronic Treatment Journal.

(1) Background: The aim of this retrospective observational study was to observe the trends in antimicrobial usage (AMU) from 2018 to 2021 in Swiss pigs based on an electronic treatment journal used nationwide by farmers. Thus, for the first time, standardized, longitudinal comparisons of AMU between the years could be analyzed, as well as the influence of targeted interventions, on farms with higher consumption. (2) Methods: The data was evaluated by different indicators, such as the amount of active ingredient in kilograms, treatment days per farm (ATI) and treatment incidence (TI) based either on animal-defined daily doses (TIADD) or used daily doses (TIUDD). Calculations were performed across the following five age categories: suckling piglets, weaners, fattening pigs, and gestating and lactating sows, and the proportions of antimicrobial classes were evaluated for each age category. (3) Results: The highest amount of the active ingredient was administered to the group of fattening pigs, while the suckling piglets received the lowest amount of the active ingredient. In 2021, there was a significant decrease in active ingredient consumption per pig, but a significant increase in ATI, TIADD and TIUDD compared to 2018. The largest proportion of AMU was attributed to penicillins each year, followed by sulfonamides and tetracyclines. The "Highest Priority Critically Important Antimicrobials" represented a proportion of overall usage, declining from 5.2% in 2018 to 3.1% in 2021, while polypeptides were the most used class of critical antimicrobials. Interventions on high-usage farms showed that some farms decreased their AMU in the following year while others did not. (4) Conclusions: This study reveals a decrease in the overall usage measured in kilograms per pig of antimicrobials in Swiss pigs between 2019 and 2021 through the monitoring of AMU, but, at the same time, there was an increase in treatment days or incidence per farm. Critical antimicrobials can be reduced regardless of the indicator. The significance and quality of interventions should be investigated in future studies.

Breaking the silence: The effects of online social movements on gender-based violence

This paper investigates the impact of online social movements against gender-based violence (GBV) on GBV-related crime. Using machine learning techniques, we construct a novel dataset tracking the prevalence of GBV-related social media movements on Twitter from 2014 to 2017. Matching this data with weekly FBI crime reports across U.S. states we estimate the effect of tweets related to GBV on GBV-related reported crime. Our econometric approach aims to mitigate concerns of spurious correlations arising from common trends in Twitter usage and crime. We estimate national level regressions with differential effects on GBV-related and non-GBV-related crimes within the same week, as well as regressions at the state-by-week level controlling for state and month fixed effects. Our main findings reveal that GBV-related tweets led to a small but significant short-term decrease in GBV-related crime reports. Further analysis suggests that the decrease is attributable to a reduction in actual crime rather than in reporting behavior.

Impact of the 2017 revised Japanese obstetric hemorrhage management guidelines on tranexamic acid use in patients undergoing cesarean delivery: an interrupted time series analysis

BackgroundTranexamic acid is one component of a complex management algorithm for postpartum hemorrhage. In Japan, the 2010 obstetric hemorrhage management guidelines was revised in 2017, adding the recommendation for the administration of tranexamic acid for postpartum hemorrhage. This research aims to delineate the temporal trends in tranexamic acid administration in patients undergoing cesarean deliveries and to examine the impact of the obstetric hemorrhage management guidelines implementation. MethodsAn interrupted time series analysis was conducted on data from patients who underwent cesarean deliveries from April 2012 to August 2021, sourced from Japan’s nationwide health insurance claims database. We examined the trends of tranexamic acid usage and blood transfusion use before and after the implementation of the revised guidelines in 2017. ResultsThe study cohort comprised 91 166 cesarean deliveries. Prior to the guideline implementation, the rate of tranexamic acid usage decreased. Post-guidelines implementation, there was a statistically significant increase in the rate of tranexamic acid use, with a quarterly percentage change of 0.48% (95% confidence interval: 0.36 to 0.60; P < 0.001). The guidelines implementation in 2017 was not significantly associated with a change in the rate of transfusions. ConclusionsThis interrupted time series analysis demonstrated a significant increase in the rate of tranexamic acid administration following the implementation of the revised guidelines, reversing the previously observed downward trend. Our findings could reflect the impact of the revised guideline on the use of tranexamic acid for postpartum hemorrhage, but this did not translate to fewer blood transfusions.