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The use of gamma glutamyl transpeptidase (GGT) levels as screening test for liver function is controversial. The GGT main utility is in cases in which alkaline phosphatase (ALP) is elevated. We aimed to investigate the request over time for alanine amino transferase (ALT), ALP and GGT, study the effect of a new demand management (DM) intervention for optimal GGT measurement in primary care. Our descriptive study was conducted from January 2010 to December 2020. The intervention was established in November 2019 and consisted of the laboratory information system would automatically remove GGT, if the test had been ordered simultaneously with ALP and there was no prior pathological result on record. We counted the absolute number of measured ALT, ALP and GGT, and calculated the ratios for each of the three markers related to creatinine, and GGT related to ALT in a monthly basis. The number of measured GGT increased slightly and progressively along the study until October 2019, when a decrease was observed. The ALT and ALP request from primary care also increased slightly along years. However, the GGT/ALT ratio never reached the 0.2 goal. Out of the 57,614 GGT requested in primary care patients, 38,167 (66.2%) were not measured. 7633.4€ were saved in reagent. The DM intervention to reduce the measurement of GGT when requested redundantly with ALP in primary care was successful, and the results have been maintained over time as observed by monitoring the GGT/CREA and GGT/ALT indicator results.

SUMMARY OBJECTIVE: This study aims to analyze the level of disability and pain in capoeira practitioners. METHODS: This is a cross-sectional study. Data collection took place at the training sites of participants. The Self-Estimated Functional Inability because of Pain questionnaire for athletes (SEFIP-sport) was used to assess the pain and disability. Descriptive analysis was performed with the presentation of variables through mean and standard deviation (SD) or absolute number and percentage. RESULTS: The sample consisted of 65 capoeira practitioners. Of these, 42 (64.61%) reported pain or discomfort. The total score of the SEFIP-sport presented an average of 2.28 points (SD=2.65). The body regions with the highest reports of pain and disability were the knees, lower back, and wrist/hands. However, we observed a mild degree of disability measured by SEFIP-sport. CONCLUSIONS: The knees, lower back, and wrists/hands were the regions of the body with the highest reports of pain and disability. However, the disability presented by capoeira practitioners was slight.

BACKGROUND: A number of estimates of the infection fatality ratio (IFR) of SARS-CoV-2 in different countries have been published. In Brazil, the fragile political situation, together with socioeconomic and ethnic diversity, could result in substantially different IFR estimates. METHODS: We infer the IFR in Brazil in 2020 by combining three datasets. We compute the prevalence via the population-based seroprevalence survey, EPICOVID19-BR. For the fatalities we obtain the absolute number using the public Painel Coronavirus dataset and the age-relative number using the public SIVEP-Gripe dataset. The time delay between the development of antibodies and subsequent fatality is estimated via the SIVEP-Gripe dataset. We obtain the IFR for each survey stage and 27 federal states. We include the effect of fading IgG antibody levels by marginalizing over the test detectability time window. RESULTS: We infer a country-wide average IFR (maximum posterior and 95% CI) of 1.03% (0.88-1.22%) and age-specific IFRs of 0.032% (0.023-0.041%) [< 30 years], 0.22% (0.18-0.27%) [30-49 years], 1.2% (1.0-1.5%) [50-69 years], and 3.0% (2.4-3.9%) [≥ 70 years]. We find that the fatality ratio in the country increased significantly at the end of June 2020, likely due to the increased strain on the health system. CONCLUSIONS: Our IFR estimate is based on data and does not rely on extrapolating models. This estimate sets a baseline value with which future medications and treatment protocols may be confronted.

The Ontario Renal Network (ORN), a provincial government agency in Ontario, Canada, launched an initiative in 2012 to increase home dialysis use province-wide. The initiative included a new modality-based funding formula, a standard mandatory informatics system, targets for prevalent home dialysis rates, the development of a ‘network’ of renal programmes with commitment to home dialysis and a culture of accountability with frequent meetings between ORN and each renal programme leadership to review their results. It also included funding of home dialysis coordinators, encouragement and funding of assisted peritoneal dialysis (PD), and support for catheter insertion and urgent start PD. Between 2012 and 2017, home dialysis use rose from 21.9% to 26.5% and then between 2017 and 2019 stabilised at 26% to 26.5%. Over 7 years, the absolute number of people on home dialysis increased 40% from 2222 to 3105, while the number on facility haemodialysis grew 11% from 7935 to 8767. PD prevalence rose from 16.6% to 20.9%, a relative increase of 25%. The initiative showed that a sustained multifaceted approach can increase home dialysis utilisation.

One of the most interesting natural tourist destinations in the Czech Republic are sandstone rocks, located mainly in the Bohemian Cretaceous Basin. Sandstones in these areas create a number of aesthetically valuable geomorphological formations, such as rock towers, gates, windows, overhangs etc. In addition, they provide beautiful views. Regions with a concentration of sandstone rocks are thus among the most visited natural areas in the Czech Republic. Unfortunately, mass tourism also brings negative impacts that negatively affect the condition of sandstone rocks—these are mainly engraving in the rocks, painting or spraying on the rocks, vandalism, pollution by garbage or excrements and destruction of natural rock shapes. However, it is not true that a larger number of visitors automatically means a larger number of negative impacts. This paper analyses the factors that influence the occurrence of the above-mentioned negative impacts in areas of sandstone rocks. The basis for the analysis was mapping of negative impacts in the field, data on traffic to individual geosites, GIS database of business entities in the tourism sector in the area of interest and field survey, aimed at explaining the structure of visitors to individual geosites according to their motivation and preferences. First, data on tourists' motivation and preferences were processed using cluster analysis into their typology. Then, the relationship between the intensity of the occurrence of negative impacts and potential factors—the absolute number of visitors, the distance to a major tourist facility and the type of visitor—was analysed. The results showed that damage to geosites is most affected by some types of visitors and little social control.

Purpose To evaluate the effect of a bundled intervention on the number of skin-to-skin (“kangaroo care”) events occurring in a level IV NICU. Design A quality improvement effort centering around the introduction of an intervention bundle intended to safely increase the rate of skin-to-skin holding. Rates of unplanned extubations were recorded as a balancing measure to estimate safety. Sample All infants admitted to the NICU from December 2017 through September 2019 were included. The “preintervention” period was the 6 months prior to the initiation of the intervention bundle (December 2017–May 2018). Results The absolute number of skin-to-skin holds increased from the preintervention phase (range 7–28 holds/month, median 11 holds/month) to the postintervention phase (range 16–100 holds/month, median 55 holds/month). The total unplanned extubations showed no significant change between the preintervention and postintervention periods.

Introduction: We evaluated the impact of public health measures on paediatric emergency department attendances during the COVID-19 and severe acute respiratory syndrome (SARS) outbreaks in Singapore. Methods: Between 1 January 2020 and 31 July 2020, we retrospectively reviewed paediatric emergency department attendances and admissions in a tertiary paediatric hospital in Singapore before and after a national lockdown to combat the spread of COVID-19 in Singapore. Hospital attendances and admissions were compared with data from a corresponding period in 2019 (1 January 2019 to 31 July 2019), as well as during and after the SARS outbreak (1 January 2003 to 31 December 2004). Results: Compared with a corresponding non-outbreak period, emergency department attendances decreased in line with nationwide public health measures during the COVID-19 and SARS outbreaks (2020 and 2003 respectively), before increasing gradually following lifting of restrictions, albeit not to recorded levels before these outbreaks. During the COVID-19 outbreak, mean daily attendances decreased by 40%, from 458 per day in January–July 2019, to 274 per day in January–July 2020. The absolute number of hospital inpatient admissions decreased by 37% from January–July 2019 (19,629) to January–July 2020 (12,304). The proportion of emergency department attendances requiring admission remained similar: 20% in January–July 2019 and 21% in January–July 2020. Conclusion: Nationwide public health measures in Singapore have had an impact on paediatric emergency department attendances and hospital inpatient admissions. Data from this study could inform planning and resource allocation for emergency departments in Singapore and internationally. Keywords: COVID-19, paediatric emergency department, public health measures, SARS

Contains fulltext : 235444.pdf (Publisher’s version ) (Open Access) PURPOSE: Compare patients treated for Retinopathy of Prematurity (ROP) in two consecutive periods. METHODS: Retrospective inventory of anonymized neonatal and ophthalmological data of all patients treated for ROP from 2010 to 2017 in the Netherlands, subdivided in period (P)1: 1-1-2010 to 31-3-2013 and P2: 1-4-2013 to 31-12-2016. Treatment characteristics, adherence to early treatment for ROP (ETROP) criteria, outcome of treatment and changes in neonatal parameters and policy of care were compared. RESULTS: Overall 196 infants were included, 57 infants (113 eyes) in P1 and 139 (275 eyes) in P2, indicating a 2.1-fold increase in ROP treatment. No differences were found in mean gestational age (GA) (25.9 ± 1.7 versus 26.0 ± 1.7 weeks, p = 0.711), mean birth weight (791 ± 311 versus 764 ± 204 grams, p = 0.967) and other neonatal risk factors for ROP. In P2, the number of premature infants born

The objective: analysis of tuberculosis situation among the pediatric population of Russia. Subjects: the data from Federal Statistics Forms no. 8, 30, 33, 47, and 61 were studied. The number of those died is presented as per the data of Rosstat. Research methods: epidemiological and statistical analysis, expert assessment, and content analysis of publications and regulations. Results. In 2005-2019, tuberculosis rates among children and adolescents of 0-17 years old decreased: incidence – from 21.5 to 9.0 per 100,000 children (2.4 times), prevalence – from 28.3 to 10.6 per 100,000 children (2.7 times), mortality – from 0.22 to 0.03 per 100,000 children (7.3 times). The incidence of tuberculosis in children of 0-14 years old decreased from 16.4 to 7.7 per 100,000 children (2.1 times), children of 15-17 years old – from 37.6 to 16.5 per 100,000 children (2.3 times). Boys suffer from tuberculosis less often than girls. The decrease in tuberculosis incidence in children is directly related to the overall improvement of tuberculosis situation in the country including the reduction of exposure to tuberculosis by 2.2 times. In the structure of tuberculosis incidence, the proportion of lung damage increases, while the proportion of other localizations in respiratory organs and extrapulmonary lesions decreases. From 2005 to 2019 among children of 0-14 years old, the proportion of lung damage increased from 18.0 to 32.1%, and among children 15-17 years old – from 80.8 to 89.1%. From 2005 to 2019, among children and adolescents aged 0-17 years notified with tuberculosis at the end of the year, the proportion of those HIV infected increased up to 3.4%, while the absolute number of children decreased down to 108. The proportion of children with MDR TB among those with a positive result of sputum test increases (2005 – 10.0%; 2019 – 45.8%). From 2005 to 2019, the rate of those died of tuberculosis decreased among children of 0-14 years old from 0.17 to 0.02 per 100,000 children (8.5 times), at the age of 15-17 years – from 0.22 to 0.07 per 100,000 children (3.1 times). The number of children aged 0-14 years, registered with post-vaccination complications decreased by 6.2 times (2005 – 947 children, 2019 – 153 children).

Topic This article presents an overview of the burden of peripheral intravenous catheter infections and current evidence-based recommendations for prevention. Clinical Relevance Peripheral intravenous catheters are ubiquitous in most health care settings, fostering an acceptance of the peripheral intravenous catheter as benign and inevitable. This device, however, is far from benign, with reported failure rates as high as 90% from complications such as infection and phlebitis. Although reported rates of bloodstream infection related to peripheral intravenous catheters are much lower than those attributed to central venous catheters, the exponentially higher use of peripheral intravenous catheters indicates that the absolute number of peripheral venous catheter–related bloodstream infections is likely as high as and may surpass the number of central venous catheter–related bloodstream infections, with significant associated morbidity and mortality. Purpose of Paper Sustained improvements in outcomes related to peripheral intravenous catheters will depend on recognition of the root causes of failure and increased commitment to practice patterns consistent with infusion therapy standards of practice, effective education about peripheral intravenous catheters, accurate documentation of all aspects of peripheral intravenous catheter management, and consistent surveillance of patient outcomes related to peripheral intravenous catheters. Content Covered This article reviews the significant burden of peripheral intravenous catheter infections, barriers to effective peripheral intravenous catheter management, and current evidence-based recommendations to prevent this source of patient harm.

Choroid melanoma belongs to malignant tumors. The choice of treatment modality depends on a tumor size and site, ocular tunics conditions, clinic logistics, and the patient’s will. The aim of the study was to evaluate the effectiveness of treatment of patients with choroid melanoma. The data of the Belarusian Cancer Registry and the case histories of patients with choroid melanoma (C69.3, ICD-10) over the period of 1999–2018 were studied. The incidence rates were evaluated on the basis of the analysis of the absolute number of persons taken ill with the disease, crude intensive rates calculated per 1,000,000 of population. To calculate the survival, the disease-specific cumulative 5-year survival rate was used. Significance evaluation was made applying the chisquare test. The incidence rates varied over the 20-year period and were 0.9 ‰ on the average. Enucleation was performed in 724 patients, 13.9 % (101 patients) being registered with synchronous and metachronous cancer. Patients with a sole tumor of choroid melanoma were analyzed. The amount of enucleations performed decreased by a factor of 1.8. To evaluate the survival, the groups of patients with large tumors were formed after enucleation and combination treatment was carried out. Of 623 patients subjected to enucleation, disease progression was established in 159 (25.5 %). Of 159 patients, the onset of disease progression occurred in 25 (15.7 %) in the 1st year, in 50 (31.5 %) in the 2nd year, and in 84 (52.8 %) in the 4th year and later. In the combination treatment group, consisting of 58 patients, decease progression was ascertained in 10 (17.2 %): in the 1st year – in 1 (10.0 %), in the 2nd year – in 6 (60.0 %), and in the 4th and later – in 3 (30.0 %). The survival rate after the organ-sparing treatment is insignificantly higher and increases to the 5th year of the follow-up, although the data are statistically insignificant (p > 0.5). At present, enucleation does not play the leading role in the choice of treatment modality for patients with clinical diagnosis of choroid melanoma. The disease-specific cumulative 5-year survival rate in patients receiving organ-sparing treatment was 85.7 ± 5.1 %, and in those subjected to enucleation – 67.2 ± 2.2 %, the data being statistically insignificant (p > 0.5). The promising trend in treating choroid melanoma patients is the development of organ-sparing treatment techniques.

Introduction: The reduction of infant mortality is still a challenge for health services. Despite the decline observed in Brazil, infant mortality remains a major concern in Public Health. In Piauí with the implementation of the Cegonha Network and the Neonatal Component in recent years, a decline in the maternal, infant and neonatal mortality rate can be noticed, but mothers and babies are still being lost due to preventive causes. Despite the advances that the state had after the implementation of the stork network, this development did not happen equally in all health regions, with most of the centralized assistance still in the capital. Objective: This study aimed to assess the epidemiological profile of neonatal mortality in the state of Piauí. Methodology: A retrospective, descriptive study with a quantitative approach was carried out, and the data were collected in the DATASUS system and tabulated using TABWIN AND TABNET. Results: There was a reduction in the total absolute number of deaths between the years 2007 to 2015, with an increase of approximately 4.5% between the years 2015 and 2016. Early neonatal mortality comprised more than 3/4 of neonatal deaths . Over 53% of deaths are of low birth weight newborns. About 48.7% of deaths refer to premature infants. Conclusions: The findings revealed the main characteristics of neonatal deaths in Piauí in the time series (2007-2016). Introducción: la reducción de la mortalidad infantil sigue siendo un desafío para los servicios de salud. A pesar de la disminución observada en Brasil, la mortalidad infantil sigue siendo una preocupación importante en la salud pública. En Piauí con la implementación de la Red Cegonha y el Componente Neonatal en los últimos años, se puede notar una disminución en la tasa de mortalidad materna, infantil y neonatal, pero las madres y los bebés todavía se están perdiendo debido a causas preventivas. A pesar de los avances que tuvo el estado después de la implementación de la red de cigüeñas, este desarrollo no ocurrió por igual en todas las regiones de salud, con la mayor parte de la asistencia centralizada todavía en la capital. Objetivo: Este estudio tuvo como objetivo evaluar el perfil epidemiológico de la mortalidad neonatal en el estado de Piauí. Metodología: se realizó un estudio descriptivo retrospectivo con un enfoque cuantitativo, y los datos se recopilaron en el sistema DATASUS y se tabularon con TABWIN Y TABNET. Resultados: Hubo una reducción en el número absoluto total de muertes entre los años 2007 a 2015, con un aumento de aproximadamente 4.5% entre los años 2015 y 2016. La mortalidad neonatal temprana comprendió más de 3/4 de las muertes neonatales. . Más del 53% de las muertes son de recién nacidos con bajo peso al nacer. Alrededor del 48.7% de las muertes se refieren a bebés prematuros. Conclusiones: los hallazgos revelaron las principales características de las muertes neonatales en Piauí en la serie temporal (2007-2016). Introdução: A redução da mortalidade infantil é ainda um desafio para os serviços de saúde. Apesar do declínio observado no Brasil, a mortalidade infantil permanece como uma grande preocupação em Saúde Pública. No Piauí com a implantação da Rede Cegonha e do Componente Neonatal nos últimos anos pode-se perceber um declínio no índice de mortalidade materna, infantil e neonatal, mas ainda continua-se perdendo mães e bebês por causas evitais. Apesar dos avanços que o estado teve após a implantação da rede cegonha esse desenvolvimento não se deu por igual em todas as regiões de saúde, ficando a maior parte da assistência centralizada ainda na capital. Objetivo: Este trabalho teve o objetivo de avaliar o perfil epidemiológico da mortalidade neonatal o estado do Piauí. Metodologia: Foi realizado um estudo retrospectivo, descritivo, abordagem quantitativa, e os dados foram coletados no sistema do DATASUS e tabulados utilizando o TABWIN E TABNET. Resultados: Observou-se uma redução do número absoluto total de óbitos entre os anos 2007 a 2015, havendo um aumento de aproximadamente 4,5% entre os anos de 2015 e 2016. A mortalidade neonatal precoce compreendeu mais de 3/4 dos óbitos neonatais. Mais de 53% dos óbitos são de RN de baixo peso. Cerca de 48,7% dos óbitos referem-se aos prematuros. Conclusões: Os achados revelaram as principais características dos óbitos neonatais no Piauí na série temporal (2007-2016).

Objective. The aim of this study was to characterize the subsets of circulating CD56+ NK cells in pSS patients and their potential value in the diagnosis and/or prediction of prognosis in patients with pSS. Methods. We included 52 pSS patients fulfilling the 2002 AECG criteria or 2012 ACR criteria and 20 age- and gender-matched healthy volunteers. The frequency and absolute number of NK cells and CD56 NK cell subsets in peripheral blood samples were detected by flow cytometry. Other laboratory parameters such as the IgG level and complement protein levels were extracted from the clinical system. Results. Both the frequency and the absolute number of peripheral blood NK cells were reduced in pSS patients compared to healthy controls. The proportion of CD56bright NK cell subset was increased, and the proportion of CD56dim NK cell subset was decreased among NK cells, resulting in the ratio of CD56bright NK to CD56dim NK which was significantly elevated in pSS patients. ROC analysis indicated that the AUC of CD56bright NK/CD56dim NK ratio was 0.838, and the best diagnostic cut-off point was 0.0487 for pSS patients. Furthermore, this CD56bright NK/CD56dim NK ratio was positively correlated with the IgG level and negatively correlated with the complement protein C3 and C4 levels. More importantly, the CD56bright/CD56dim NK ratio was either slightly increased or not changed in other autoimmune diseases such as SLE and IgG4-related disease. Conclusion. Our findings suggest that the ratio of blood CD56bright NK to CD56dim NK might have a diagnostic value relatively specific for pSS.

An increase in life expectancy is one of the main strategic objectives declared by the Russian Federation. Thus, an understanding of how this objective can be achieved with available recourses in the most efficient way is warranted. We propose an automated method for estimating the contribution of cause-specific mortaLity to Life expectancy. To iLLustrate the proposed method, we used the data from primary mortality databases in the Krasnoyarsk region - one of the largest federal subjects of the Russian Federation - and the data on the average population of the of the region from 1999 to 2018 from the Federal state statistics office in Krasnoyarsk, Khakassia Republic and Tyva Republic. A computer program "DeathAnaLytics" has been developed by the authors for automated calculation of the contribution of cause-specific mortality to Life expectancy. The main idea behind is to calculate an integral indicator that takes into account both the contribution of deaths from various causes and the absolute number of these deaths. The paper presents the stages of calculation, interpretation and a practical example. The use of the methodology presented in the article aLLows to identify the causes of death that have the greatest impact contribution to reduction of Life expectancy, which in turn aLLows to identify targets for pubLic heaLth measures that wiLL most effectiveLy increase Life expectancy of the popuLation.

Contains fulltext : 220534.pdf (Publisher’s version ) (Open Access) We performed a retrospective cohort study in the Dutch patient population to identify active substances with a relatively high number of adverse drug reactions (ADRs) potentially related to drug switching. For this, we analyzed drug switches and reported ADRs related to switching between June 1, 2009, and December 31, 2016, for a selection of 20 active substances. We also compared pharmacovigilance analyses based on the absolute, switch-corrected, and user-corrected numbers of ADRs. In total, 1,348 reported ADRs and over 23.8 million drug switches were obtained from the National Health Care Institute in The Netherlands and from Lareb, which is The Netherlands Pharmacovigilance Centre. There was no correlation between the number of ADRs and the number of switches, but, on average, we found 5.7 reported ADRs per 100,000 switches. The number was relatively high for rivastigmine, levothyroxine, methylphenidate, and salbutamol, with 74.9, 50.9, 47.6, and 26.1 ADRs per 100,000 switches, respectively. When comparing analyses using the absolute number and the switch-corrected number of ADRs, we demonstrate that different active substances would be identified as having a relatively high number of ADRs, and different time periods of increased numbers of ADRs would be observed. We also demonstrate similar results when using the user-corrected number of ADRs instead of the switch-corrected number of ADRs, allowing for a more feasible approach in pharmacovigilance practice. This study demonstrates that pharmacovigilance analyses of switch-related ADRs leads to different results when the number of reported ADRs is corrected for the actual number of drug switches.

The Asia-Pacific region is home to a 4.3-billion population and one of the most rapidly aging regions. Addressing the eye care needs in the region would greatly boost the progress toward achieving universal eye health. Over 20 countries/regions have actively engaged in the "VISION 2020" initiative launched since 1999, and remarkable achievements have been witnessed as demonstrated by an increase in both the number and density of ophthalmologists in almost all countries. Nevertheless, formidable and emerging challenges are to be overcome in the coming century. From 1990 to 2015, the absolute number of blind people increased by 17.9%, largely due to population growth and aging. The Asia-Pacific region, the most populous continent with a rapidly aging population, would inevitably be left to tackle this challenge. Furthermore, a high prevalence of blinding eye diseases imposes great pressure on current eye care services, with South Asia having the highest age-standardized prevalence of moderate to severe visual impairment (17.5%) and mild vision impairment (12.2%) globally, and high-income countries having the highest overall prevalence of myopia, reaching 53.4% with East Asia having the second-highest overall prevalence (51.6%). Moreover, the availability of ophthalmic resources varies greatly in the region, with the density of ophthalmologists ranging from over 114 ophthalmologists per million population in Japan to 0 in Micronesia, and a highly disproportionate urban-rural distribution. This article aims to shed light on challenges faced by the Asia-Pacific ophthalmic community and propose corresponding strategies to tackle those challenges.

Introducción: Las malformaciones congénitas (MC) representan la segunda causa de muertes infantiles en Argentina. Objetivo: Analizar la tendencia secular (1980-2018) de las muertes infantiles por MC a nivel regional y provincial. Materiales y Métodos: Los datos proceden de la DEIS (Ministerio de Salud) y comprenden el número absoluto de fallecidos y de nacidos vivos y las defunciones por MC codificadas según CIE-10 (Códigos Q00-Q99). Se calculó por regiones (Centro, NOA, NEA, Cuyo y Patagonia) y provincias la tasa de MI por MC (TMI-MC) (número de muertos por malformaciones congénitas / número de recién nacidos) y la proporción de muertes infantiles por malformaciones congénitas (PM-MC) (porcentaje de muertes por malformaciones congénitas / muertes por todas las causas). El período se dividió en 7 subgrupos de cinco años y uno de 4. La tendencia secular se analizó mediante un modelo de Poisson. Para representar de manera gráfica las diferencias en la TMI-MC y PM-MC a nivel regional se utilizó un gráfico de líneas y barras. Resultados: A nivel país se registró un patrón caracterizado por el descenso y ascenso significativos de la TMI-MC y PM-MC respectivamente. Este patrón se repite en las regiones Centro, Cuyo y Patagonia y en las provincias de Buenos Aires, Santa Fé, Entre Ríos, Neuquén, La Pampa, Mendoza y Santa Cruz. En las restantes regiones y provincias la TMI-MC exhibe un comportamiento heterogéneo. Conclusión: La heterogeneidad regional y provincial de la tendencia de TMI-MC y PM-MC refleja las inequidades espaciales socioeconómicas del país en las últimas décadas.

ObjectiveThis study systematically reviews the data extracted from the Global Burden of Disease Study and sets out to assess the age-specific and sex-specific mortality and disability attributable to different forms of tobacco from 1990 to 2017, for Nepal.DesignThis cross-sectional study extracted data from the Institute for Health Metrics and Evaluation’s Global Burden of Disease database, then was quantitatively analysed to show the trends and patterns of prevalence of tobacco use, deaths and disability-adjusted life-years (DALYs) attributable to tobacco use from different diseases from the year 1990 to 2017 in Nepal.SettingNepal.ResultsIn between 1990 and 2015, the age-standardised prevalence of daily tobacco smoking decreased by 33% in males, 48% in females and 28% in both. By 2017, the age-standardised mortality rate and DALYs attributable to tobacco use, including any form, decreased by 34% and 41%, respectively, with tobacco smoking having the most contribution. However, the absolute number of deaths and DALYs increased by 39% and 3%, respectively. An increasing rate of deaths and DALYs attributable to tobacco was noted with an increase in age. Non-communicable diseases were responsible for most deaths and disabilities attributable to tobacco use.ConclusionThe prevalence of smoking along with the age-standardised mortality rate and DALYs shows a decreasing trend. However, attention should be made to implement a strong plan to control all forms of tobacco including secondhand exposure.

In terms of the absolute number of COVID-19 positive cases, India is among the top four countries in the world. There is a lot of unwarranted criticism about the alleged inadequacy of COVID-19 testing in India. The facts available from international and publicly available online non-government source covering the entire world show otherwise. While India is fourth in terms of an absolute number of cases, its rank is 132nd in terms of cases per million population and 107th for deaths per million population. These are indications that India is doing much better in the battle against COVID-19 than it is getting credit for. The correct benchmark for the adequacy of testing is the percentage of COVID-19 positive results as compared to the total number of tests performed. India ranks 5th (out of 215) in this respect – being better than some western countries such as the USA, Spain, and France. Thus, the Indian strategy for COVID-19 testing is better and more appropriate than the majority of other countries with the large absolute number of positive cases.

Objective: The aim of this study was to examine the effect of intrauterine fetal gender on mothers’ level of happiness.Method: This cross-sectional study consisted of 6000 pregnant women who enrolled at the obstetric polyclinic of a state hospital. 638 pregnant women were selected using a random sampling method. The data were collected between April and June 2016 using a data collection form and the Oxford Happiness Scale. In evaluating the data absolute number, percentage, mean, standard deviation, T-test and ANOVA test were employed.Findings: The mean age for the pregnant women was 27.55 ± 5.33 and the mean score on the Oxford Happiness Scale was 122.54 ± 17.18. In this study, there were significant differences observed in age during pregnancy, education level and the gender of child desired by the womens’ partners and consequent happiness scores.Result: The pregnant women were found to be moderately happy on average. Young age of the pregnant woman, being highly educated, and the partner having expressed no choice in the sex of the child was associated with an increase in the level of women’s happiness. Healthcare staff have a duty to educate society about gender equality

OBJECTIVE The aim: Was to compare the changes in hematological parameters of blood in the conditions of prolonged exposure of lead sulfide nanoparticles (NP) of different sizes and of lead nitrate. PATIENTS AND METHODS Materials and methods: The study was conducted on mature male Wistar rats 160-180 g, intraperitoneally injected with Pb(NO3)2 and NP PbS of 26-34 nm and 50-80 nm in 0,94 mg/kg/day dose adjusted to lead. Toxic effects were evaluated after 1,5 months, 3 months and 1 month after exposure. The studies were performed on hematologic analyzer. RESULTS Results: Changes in peripheral blood were characterized by decrease in the hemoglobin level in the blood. An increase in the total number of leucocytes was observed, which is statistically significant by the increase of number of lymphocytes and the absolute number of monocytes. Changes in the platelet number were characterized by an increase in the average volume of platelets and a decrease in the platelet heterogeneity index. CONCLUSION Conclusions: The most pronounced changes hemoglobin level in the blood and concentration of hemoglobin in the erythrocyte were observed in the effects of PbS NP (50-80 nm), but leucocytes indicators - of PbS NP (26-34 nm) and Pb(NO3)2.

In Bengkulu Province in 2017, the absolute number of maternal deaths was 28, consisting of 6 maternal deaths, 10 maternal deaths, 12 postpartum maternal deaths . This research aim ed to study the association between mother’s knowledge and personal hygiene with duration of perin eal wound healing in postpartum mothers in the Basuki Rahmad Community Health Center in Bengkulu City. Th e type of this research was Analytical Survey with cross sectional design. The population in this study were all post partum mothers who gave birth as many as 32 mothers. The sampling technique used was T otal S ampling. The data collection in this study used primary data through questionnaires. Data analysis of this research uses univariate and bibvariat analysis with Chi-Square test (χ2) and Contingency Coefficient test (C). The results found : o f the 32 mothers, there were 21 mothers who had long duration of wound healing , 17 mothers had insufficient knowledge, 20 mothers had poor personal hygiene . Ther e was a relationship between mother’s knowledge with the duration of perin eal wound healing in puerperal mothers, with the category of close relationship , and t here was a relationship of personal hygiene with the duration of perin eal wound healing in puerperal mothers, with a close relationship category. It is expected that the community health center can increase mother’s knowledge about r ecovery of perine al wounds and personal hygiene by giving counseling to pregnant women during A ntenatal Care and Pregnant Mothers Class visit . Keywords : knowledge, personal hygiene, wound healing

Introduction we examined the consequences of applying the new EWGSOP2 algorithm for sarcopenia screening instead of the former EWGSOP algorithm (EWGSOP1) in geriatric inpatients. Methods the dataset of our formerly published Sarcopenia in Geriatric Elderly (SAGE) study includes 144 geriatric inpatients (86 women, 58 men, mean age 80.7±5.6 years) with measurements of gait speed, handgrip strength and appendicular muscle mass by dual x-ray absorptiometry (DXA). We analysed the agreement between EWGSOP and EWGSOP2 algorithms in identifying patients as sarcopenic/non-sarcopenic. Differences in the distribution sarcopenic vs. non-sarcopenic were assessed by Chi²-test. Results sarcopenia prevalence according to EWGSOP1 (41 (27.7%)) was significantly higher than with EWGSOP2 (26(18.1%), p Discussion there is a substantial mismatch in sarcopenia case finding according to EWGSOP1 and EWGSOP2. The overall prevalence and the number of men diagnosed with sarcopenia are significantly lower in EWGSOP2. While the absolute number of women identified as sarcopenic remains relatively constant, the overlap of individual cases between the two definitions is low.

The association between the preoperative absolute neutrophil count (NC), lymphocyte count (LC), and monocyte count (MC) in the peripheral blood and the prognosis of gastric cancer (GC) patients has not been investigated widely. We enrolled 445 patients who underwent surgery for GC between January, 2005 and April, 2013 to analyze the correlations among NC, LC, and MC and their prognoses. Based on cut-off values calculated by ROC analysis, patients were sub grouped as having: NC ≥ 4477 (NCHigh), NC

How accurately can all recorded locations of 97 knife homicides in one year be forecast across all 4835 Lower Layer Super Output Areas (LSOAs) of London, based only upon all 3506 known locations of nonfatal knife injury assaults in the preceding year? All recorded “knife crimes” in the Metropolitan Police Service (MPS) area of London in the financial year 2016–2017 (year 1) were manually reviewed to identify all 3506 reported locations of knife-enabled (KE) but nonfatal injuries, as distinct from other events digitally coded as “knife crimes”, such as displaying, threatening with, or carrying knives. All KE homicides in 2017–2018 (year 2) were then added to the database. Each KE injury assault in year 1 was classified for occurrence in one of London’s 4835 LSOAs. The total N of such crimes within each LSOA was summed across all records to divide all LSOAs into seven categories of frequency of KE injury assaults in 2016/2017: 0, 1, 2, 3, 4, 5, and 6 or more. We then divided the N of LSOAs in each category in 2016/2017 (year 1) into the total N of knife homicides in 2017/2018 (year 2). False positives, false negatives, and percentage of homicides targeted were calculated for six different targeting plans. Over two thirds (69%) of KE homicides in 2017/2018 (year 2) occurred in just 67 (1.4%) of all 4835 LSOAs, comprising 3.3% of the 2048 LSOAs that had had one or more of the 3506 KE injury assaults mapped in 2016/2017 (year 1). The proportion of LSOAS with a KE homicide in year 2 was higher where there were higher numbers of KE injury assaults per LSOA in year 1. Among LSOAs with zero assaults in year 1, only 1% had a KE homicide in year 2. Among LSOAs with six or more KE injury assaults in year 1, 15% had a KE homicide in year 2. While the risk of homicide was 1400% higher in the hottest spots of knife assaults than in the coolest spots, the absolute number of year two KE homicides in those hottest areas was only 6% of the total. All LSOAs with one or more year 1 KE assaults had three times as much KE homicide risk than LSOAs with no year 1 KE assaults. Targeting all 2048 areas that had one or more year 1 KE assaults would have yielded a true positive rate of over 3% and covered 69% of actual homicide locations. The true negative rate for 2781 areas that would not have been targeted based on having no year 1 KE injuries would have been 99%. Predicting which local areas are most likely to suffer knife-enabled homicides, based only on recent nonfatal knife injuries, can pinpoint risks of homicide in local areas that are up to 1400% higher than in most local areas, offering a range of strategies for resource allocation.

The neuronal microtubule cytoskeleton underlies the polarization and proper functioning of neurons, amongst others by providing tracks for motor proteins that drive intracellular transport. Different subsets of neuronal microtubules, varying in composition, stability, and motor preference, are known to exist, but the high density of microtubules has so far precluded mapping their relative abundance and three-dimensional organization. Here, we use different super-resolution techniques (STED, Expansion Microscopy) to explore the nanoscale organization of the neuronal microtubule network in rat hippocampal neurons. This revealed that in dendrites acetylated microtubules are enriched in the core of the dendritic shaft, while tyrosinated microtubules are enriched near the plasma membrane, thus forming a shell around the acetylated microtubules. Moreover, using a novel analysis pipeline we quantified the absolute number of acetylated and tyrosinated microtubules within dendrites and found that they account for 65–75% and ~20–30% of all microtubules, respectively, leaving only few microtubules that do not fall in either category. Because these different microtubule subtypes facilitate different motor proteins, these novel insights help to understand the spatial regulation of intracellular transport., eLife digest Cells in the body need to control the position of the molecules and other components inside them. To do this, they use a system of proteins that work a bit like a road network. The ‘roads’ are tubular structures known as microtubules, while ‘vehicles’ are transporters, called motor proteins, that ‘walk’ along the microtubules. Microtubule networks are important in all cells, but especially in neurons, which can grow very large. These cells have tree-like branches called dendrites that receive messages from other neurons. Dendrites contain different types of microtubules with many chemical modifications. These modifications consist of specific molecules or ‘groups’ becoming attached to or removed from the microtubules to change their properties – for example, microtubules can be ‘acetylated’ or ‘detyrosinated’. Motor proteins prefer different kinds of microtubules, and so understanding transport inside cells involves creating a precise roadmap showing how many of each type of microtubule exist and where they go. Using different super-resolution microscopy techniques, Katrukha et al. created maps of the microtubules in rat neurons. These show that acetylated microtubules form a core in the centre of the dendrites, while tyrosinated microtubules (which did not undergo detyrosination) line the cell membrane of the dendrites. Katrukha et al. then used the maps to determine that acetylated microtubules account for 65 to 70% of all microtubules, while tyrosinated microtubules make up 20 to 30%. This means that most microtubules fall into these two categories. The work by Katrukha et al. provides one of the first quantitative estimates of the relative amount of acetylated and tyrosinated microtubules, starting to shed light on how cells control their transport network. This could ultimately allow researchers to explore how transport changes in health and disease.

OBJECTIVE In this study, the authors sought to determine which US medical schools have produced the most neurosurgery residents and to evaluate potential associations between recruitment and medical school characteristics. METHODS Demographic and bibliometric characteristics were collected for 1572 residents in US-based and Accreditation Council for Graduate Medical Education (ACGME)–accredited neurosurgery programs over the 2014 to 2020 match period using publicly available websites. US medical school characteristics were collected, including class size, presence of a home neurosurgery program, number of clinical neurosurgery faculty, research funding, presence of a neurosurgery interest group, and a top 10 ranking via U.S. News & World Report or Doximity. Correlations and associations were then evaluated using Pearson’s correlation coefficient (PCC), independent-samples t-test, and univariable or stepwise multivariable linear regression, as appropriate. RESULTS Vanderbilt University produced the most neurosurgery residents as a percentage of medical graduates at 3.799%. Case Western Reserve University produced the greatest absolute number of neurosurgery residents (n = 40). The following factors were shown to be associated with a higher mean percentage of graduates entering neurosurgery: number of clinical neurosurgery faculty (PCC 0.509, p < 0.001), presence of a neurosurgery interest group (1.022% ± 0.737% vs 0.351% ± 0.327%, p < 0.001) or home neurosurgery program (1.169% ± 0.766% vs 0.428% ± 0.327%, p < 0.001), allopathic compared with osteopathic school (0.976% ± 0.719% vs 0.232% ± 0.272%, p < 0.001), U.S. News top 10 ranking for neurology and neurosurgery (1.923% ± 0.924% vs 0.757% ± 0.607%, p < 0.001), Doximity top 10 residency program ranking (1.715% ± 0.803% vs 0.814% ± 0.688%, p < 0.001), and amount of NIH funding (PCC 0.528, p < 0.001). CONCLUSIONS The results of this study have delineated which medical schools produced the most neurosurgery residents currently in training, and the most important independent factors predicting the percentage of graduates entering neurosurgery and the preresidency h-index.

The rate of mother-to-child transmission (MTCT) of HIV from breastfeeding is increasing relative to other causes of MTCT. Early effective preconception and antenatal antiretroviral therapy (ART) reduces intrauterine and intrapartum MTCT, whereas maternal post-partum HIV acquisition, untreated maternal HIV, and suboptimal postnatal maternal ART adherence increase the risk of MTCT through breastfeeding. Although the absolute number of cases of MTCT acquired through breastfeeding is decreasing, the rate of decrease is less than the decrease in intrauterine and intrapartum MTCT. Unless current strategies are universally applied, they might not be sufficient to eliminate MTCT due to breastfeeding. Urgent action is needed to evaluate and implement additional preventive biomedical strategies in high HIV prevalence and incidence settings to eliminate MTCT from breastfeeding. Preventive strategies include: pre-exposure prophylaxis in breastfeeding women who have an increased risk of acquiring HIV; postnatal reinforcement strategies, such as maternal retesting for HIV, maternal care reinforcement, and prophylaxis in infants exposed to HIV via breastmilk; and active (vaccine) or passive immunoprophylaxis with long-acting broadly neutralising antibodies. acceptedVersion

Background Malaria is a life-threatening disease worldwide, but lacks studies on its incidence at the global level. We aimed to describe global trends and regional diversities in incidence of malaria infection, to make global tailored implications for malaria prevention. Methods We used the data from the Global Burden of Disease Study 2019. The age-standardized incidence rate (ASR) and absolute number of malaria episodes showed the epidemic status of malaria infection. The estimated annual percentage change of ASR and changes in malaria episodes quantified the malaria incidence trends. The connection between ASRs and traveller number indicated infection risk for travellers. Results Globally, the malaria ASR decreased by an average 0.80% (95% confidence interval 0.58–1.02%) per year from 1990 to 2019; however, it slightly increased from 3195.32 per 100 000 in 2015 to 3247.02 per 100 000 in 2019. The incidence rate of children under 5 was higher than other age groups. A total of 40 countries had higher ASRs in 2019 than in 2015, with the largest expansion in Cabo Verde (from 2.02 per 100 000 to 597.00 per 100 000). After 2015, the ASRs in high-middle, middle and low-middle Socio-demographic Index regions began to rise and the uptrends remained in 2019. Central, Western and Eastern Sub-Saharan Africa had the highest ASRs since 1990, and traveller number in Eastern and Western Sub-Saharan Africa increased by 31.24 and 7.58%, respectively, from 2017 to 2018. Especially, most countries with ASR over 10 000 per 100 000 had increase in traveller number from 2017 to 2018, with the highest change by 89.56% in Mozambique. Conclusions Malaria is still a public health threat for locals and travellers in Sub-Saharan Africa and other malaria-endemic areas, especially for children under 5. There were unexpected global uptrends of malaria ASRs from 2015 to 2019. More studies are needed to achieve the goal of malaria elimination.

To preserve the country's population is among one of the most vital tasks over the period of existence of the new Russia and constitutes the subject of national security. The article presents the results of analysis of population mortality rate of the Russian Federation, the Central Federal Okrug and City of Moscow during the first eight months of 2020 towards to concurrent period of 2019. In January-March 2020, the population total mortality rate, retaining prevalent trends of number of preceding years, decreased in the Russian Federation by 3.8%, in the Central Federal Okrug by 3.0% and in City of Moscow by 3.9%. However, since April-May the situation has changed dramatically and, according to the results of January-August, mortality by this time has increased, and its growth made up to 6.5% in the Russian Federation, 7.8% in the Central Federal Okrug and 15.6% in the City of Moscow. In May 2020, the gain of absolute number of the deceased in the Russian Federation by months (towards to concurrent month of 2019) made up to 11.9%, in June to 18.6%, in July to 19.7% and in August to 9.6%. In Moscow, the peak values of this increase were noted in May - 57.2% and in June - 41.6% In the conditions of new coronavirus infection pandemic, the share of COVID-19, as main cause of death (ICD-10 codes U07.1 and U07.2), in the structure of total mortality in April-August consisted 3.2% and in the structure of excess deaths in May-August - 28.6%. The increase of mortality and continued decrease of birth rate resulted in increasing of natural population loss by 1.5 times and more and reached such values as -3.6 in the Russian Federation, -4.9 in the Central Federal Okrug and -1.6 in the City of Moscow (per 1000 of population). The process of depopulation of the Russian nation not only retained, but significantly has become significantly aggravated.

PURPOSE To assess the changing diversity of faculty in specific clinical and basic science departments, stratified by sex and underrepresented in medicine (URM) status, at all Liaison Committee on Medical Education (LCME)-accredited medical schools. METHOD In this retrospective, cross-sectional, observational study, the authors used data from the Association of American Medical Colleges Faculty Roster (data pulled in October 2019) to identify trends in clinical department faculty and in basic science department faculty by sex and URM status. They included full-time faculty at all LCME-accredited medical schools from 1979 to 2018. They compared the proportions of faculty across separate departments according to sex and URM status, and they used 2-independent-sample t test and simple linear regressions for statistical comparisons. RESULTS The number of full-time faculty increased from 49,909 in 1979 to 175,326 in 2018. The largest increase occurred in clinical departments, where the number of faculty increased from 38,726 to 155,677 (a fourfold increase). The number of faculty in basic science departments increased from 11,183 to 19,649 (a 1.8-fold increase). The proportions of faculty who were non-URM females (compared with non-URM males, URM females, and URM males) increased the most-from 14.4% (5,595 of 38,726) to 37.6% (58,478 of 155,677) for clinical departments, and from 14.9% (1,669 of 11,183) to 33.0% (6,485 of 19,649) for basic science departments. Growth was steady but slow among URM faculty, especially for Black males; the absolute number of male URM faculty remained low in both basic science and clinical departments. The proportions of females and URM faculty were highest in the departments of obstetrics and gynecology, pediatrics, and family medicine. CONCLUSIONS The substantial increase in faculty, especially in clinical departments, has led to greater diversity, but mostly among non-URM females. The rise of URM male and URM female faculty has been minimal.

Purpose: To examine the absolute number and the proportions of articles published in general high-ranked ophthalmology journals for each ophthalmic subspecialty during the last decade, and to examine the publishing trends over the study period. Methods: All original articles published between January 2010 and December 2019 in the selected general clinical ophthalmic journals were included in the study. All abstracts of original articles were reviewed and deemed to be related to 1 of the 11 ophthalmic subspecialties. Results: Six journals and 10,232 abstracts were reviewed. Articles focused on medical retina were the most common in the last decade (35.22%) while articles focused on strabismus were the least common (2.11%). The total number of articles published per year decreased during the last decade ( p Conclusions: During the last decade, there have been differences in the proportion of publications of different ophthalmology subspecialties in high impact factor journals. This probably derives from demographic changes and advances in diagnosis and treatment. The proportion of articles focused on medical retina was the highest during all years while the proportion of articles focused on strabismus was consistently the lowest.

SUMMARY OBJECTIVES: To describe the incidence by gender and region, lethality, and costs associated with the treatment of femoral fractures in the elderly (≥ 60 years) hospitalized in the Unified Health System (SUS) of Brasil between 2008 and 2018. METHODS: This is a cross-sectional, descriptive, retrospective study of hospitalizations of elderly people due to femoral fractures by analyzing secondary data obtained from the SUS Hospital Information System (SIH/SUS) between 2008 and 2018; for calculation of epidemiological coefficients, we used information from demographic censuses (2000 and 2010) of the Brazilian Geography and Statistics Institute (IBGE). RESULTS: A total of 478,274 hospitalizations were recorded in the period; the incidence was 1.7 times higher in females (overall average of 274.91/100,000 for women and 161/100,000 for men). The Southeast region had the highest absolute number of hospitalizations and the South region presented the highest annual overall average incidence (224.02/100,000). The average annual cost for SUS for the treatment of femoral fractures in the elderly was R$ 99,718,574.30. CONCLUSIONS: In the evaluated period (2008-2018), femoral fractures in the elderly had a high incidence (478,274 hospitalizations; 224.02 cases/100,000 elderly), a predominance of females (1.7F/1.0M), a higher absolute number of hospitalizations in the Southeast region and a higher incidence in the South region; the lethality was high (an increase of 17.46%; overall mean coefficient of 4.99%/year); and the costs for the SUS were huge (an increase of 126.24%; average annual expenditure of R$ 99,718,574.30). RESUMO OBJETIVOS: Descrever a incidência por gênero e região, a letalidade e os custos associados ao tratamento de fraturas do fêmur em idosos (≥ 60 anos) internados no Sistema Único de Saúde (SUS) do Brasil entre 2008 e 2018. MÉTODOS: Estudo transversal, descritivo e retrospectivo das internações de idosos por fraturas do fêmur mediante análise dos dados secundários obtidos do Sistema de Informações Hospitalares do SUS (SIH/SUS) entre 2008 e 2018; para cálculo dos coeficientes epidemiológicos, utilizamos informações dos censos demográficos (2000 e 2010) do Instituto Brasileiro de Geografia e Estatística (IBGE). RESULTADOS: Foram registradas 478.274 mil internações no período. A incidência foi 1,7 vezes maior no gênero feminino (média geral de 274,91/100.000 para mulheres e 161/100.000 para homens). A região sudeste obteve maior número absoluto de internações e na região sul apresentou a maior incidência média geral anual (224,02/100.000). O custo médio anual do SUS para o tratamento das fraturas de fêmur em idosos foi de R$ 99.718.574,30. CONCLUSÕES: No período avaliado (2008-2018), as fraturas do fêmur em idosos apresentaram alta incidência (478.274 mil internações; 224,02 casos/100.000 idosos), predomínio do gênero feminino (1,7F/1,0M), maior número absoluto de internações na região sudeste e maior incidência na região sul; a letalidade foi elevada (aumento de 17,46%; média geral do coeficiente de 4,99%/ano); e, os custos para o SUS foram vultuosos (aumento de 126,24%, média anual de gastos de R$ 99.718.574,30).

Read alignment is the central step of many analytic pipelines that perform SNP calling. To reduce error, it is common practice to pre-process raw sequencing reads to remove low-quality bases and residual adapter contamination, a procedure collectively known as ‘trimming’. Trimming is widely assumed to increase the accuracy of SNP calling although there are relatively few systematic evaluations of its effects and no clear consensus on its efficacy. As sequencing datasets increase both in number and size, it is worthwhile reappraising computational operations of ambiguous benefit, particularly when the scope of many analyses now routinely incorporate thousands of samples, increasing the time and cost required.Using a curated set of 17 Gram-negative bacterial genomes, this study evaluated the impact of four read trimming utilities (Atropos, fastp, Trim Galore, and Trimmomatic), each used with a range of stringencies, on the accuracy and completeness of three bacterial SNP calling pipelines. We found that read trimming made only small, and statistically insignificant, increases in SNP calling accuracy even when using the highest-performing pre-processor, fastp.To extend these findings, we re-analysed > 6500 publicly-archived sequencing datasets from E. coli, M. tuberculosis and S. aureus. Of the approximately 125 million SNPs called across all samples, the same bases were called in 98.8% of cases, irrespective of whether raw reads or trimmed reads were used. However, when using trimmed reads, the proportion of non-homozygous calls (a proxy of false positives) was significantly reduced by approximately 1%. This suggests that trimming rarely alters the set of variant bases called but can affect their level of support. We conclude that read quality- and adapter-trimming add relatively little value to a SNP calling pipeline and may only be necessary if small differences in the absolute number of SNP calls are critical. Read trimming remains routinely performed prior to SNP calling likely out of concern that to do otherwise would substantially increase the number of false positive calls. While historically this may have been the case, our data suggests this concern is now unfounded.Impact StatementShort-read sequencing data is routinely pre-processed before use, to trim off low-quality regions and remove contaminating sequences introduced during its preparation. This cleaning procedure – ‘read trimming’ – is widely assumed to increase the accuracy of any later analyses, although there are relatively few systematic evaluations of trimming strategies and no clear consensus on their efficacy. We used real sequencing data from 17 bacterial genomes to show that several commonly-used read trimming tools, used across a range of stringencies, had only a minimal, statistically insignificant, effect on later SNP calling. To extend these results, we re-analysed > 6500 publicly-archived sequencing datasets, calling SNPs both with and without any read trimming. We found that of the approximately 125 million SNPs within this dataset, 98.8% were identically called irrespective of whether raw reads or trimmed reads were used. Taken together, these results question the necessity of read trimming as a routine pre-processing operation.Data SummaryAll analyses conducted in this study use publicly-available third-party software. All data and parameters necessary to replicate these analyses are provided within the article or through supplementary data files. > 6500 SRA sample accessions, representing Illumina paired-end sequencing data from E. coli, M. tuberculosis and S.aureus, and used to evaluate the impact of fastq pre-processing, are listed in Supplementary Tables 3, 5 and 7.

PURPOSE Both bone-scan and cross-sectional imaging are indicated in the staging of high-risk prostate cancer (PCa). However, 68Ga-prostate-specific membrane antigen (PSMA)-PET/computed tomography (CT) has proven to be an excellent tracer for detection of skeletal metastases. The aim of this study was to assess if adding skeletal imaging (with 18F-Fluoride-PET/CT) to 68-Ga-PSMA-PET/CT had any impact on high-risk PCa staging. METHOD Fifty treatment-naive, histopathologically proven, high-risk (European Association of Urology) PCa patients underwent both 68-Ga-PSMA-PET/CT and 18F-Fluoride-PET/CT for staging. RESULTS Fluoride-PET/CT detected significantly a higher number of skeletal metastases/patient than PSMA-PET/CT (median 4.5/patient vs 3.0; Wilcoxan-signed-rank-test, P = 0.060) and there was a significantly higher proportion of only Fluoride-avid than only PSMA-avid lesions (McNemar-test P < 0.001). No significant advantage was seen in patient-wise metrics. Most lesions missed by PSMA-PET/CT were in flat bones (25/33). serum prostate specific antigen (S.PSA) showed positive correlation with both, the number of lesions [r(PSMA)-0.555 (P = 0.006) and r(Fluoride)-0.622 (P = 0.001)] as well as tumor to background ratio (TBR) [[r-0.706 (P < 0.001) and 0.516 (P = 0.010)]. Median TBR was significantly higher in PSMA-PET/CT (22.77 vs 16.30; P < 0.001). All three patients with only Fluoride-avid lesions (also not identified in bone-scan) showed biochemical response with additional therapy. CONCLUSION Though, Fluoride-PET/CT detected a higher absolute number of lesions than PSMA-PET/CT, no significant advantage was seen in patient-wise metrics. Fluoride-PET/CT added second-line management in only 3/50 patients, which could have been reduced to 1/50, with more sensitive evaluation of flat bones in PSMA-PET-CT. Therefore, additional skeletal imaging is not needed with 68-Ga-PSMA-PET/CT in initial staging of high-risk PCa.

IntroductionThere is significant interest in the mental health impact of the COVID-19 pandemic. Helicopter Emergency Medical Services (HEMS) attend the most seriously unwell and injured patients in the community; their data therefore present an early opportunity to examine self-harm trends. The primary aim was to compare the incidence of deliberate self-harm incident (DSH-I) encounters by HEMS before and during the first wave of COVID-19.MethodsData were obtained from all three East of England HEMS: total number of activations and stand-downs, number of DSH-I activations and stand-downs, self-harm mechanism and number of ‘severe’ DSH-I patient encounters, in two 61-day periods: 1 March to 30 April in 2019 (control) and 2020 (COVID-19). Severe DSH-I was defined as cardiac arrest and/or died prehospital. Proportions were compared with a Fisher’s exact test.ResultsThere were a total of 1725 HEMS activations: n=981 (control) and n=744 (COVID-19), a decrease of 24.2% during COVID-19. DSH-I patient encounters increased by 65.4%: n=26 (control) and n=43 (COVID-19). The proportion of encounters that were DSH-I and severe DSH-I both significantly increased during COVID-19: p=0.002 and p=0.001, respectively. The absolute number of hangings and falls from height both approximately tripled during COVID-19, whereas the number of other mechanisms remained almost constant.ConclusionDespite a reduction in overall HEMS patient encounters, there were significant increases in both the proportion of DSH-Is and their severity attended by HEMS during the first wave of the COVID-19 pandemic in the East of England.

Purpose: The world population is aging. As direct consequence, geriatric trauma is increasing both in absolute number and in the proportion of annual admissions causing a challenge for the health-care system worldwide. The aim of this review is to delineate the specific and practice rules for the management of mild brain trauma in the elderly. Methods: Systematic review of the last 15 years literature on mild traumatic brain injury (nTBI) in elderly patients. Results: A total of 68 articles met all eligibility criteria and were selected for the systematic review. We collected 29% high-quality studies and 71% low-quality studies. Conclusion: Clinical advices for a comprehensive management are provided. Current outcome data from mTBIs in the elderly show a condition that cannot be sustained in the future by families, society, and health-care systems. There is a strong need for more research on geriatric mild brain trauma addressed to prevent falls, to reduce the impact of polypharmacy, and to define specific management strategies.

Aim This study examined the prevalence and clinical significance of the sapovirus infection in children with acute gastroenteritis before and after the introduction of the rotavirus vaccination in Finland in 2009. Methods We collected 1437 stool samples from children under 16 years during three prospective hospital-based surveillance studies of acute gastroenteritis at Tampere University Hospital, Finland. The children were seen in the emergency department (47%) or admitted to the ward (53%). Sapovirus findings from 2006 to 2008 (n = 759), before national immunisation, were compared to 2009-2011 (n = 330) and 2012-2014 (n = 348), after the national programme was launched. Results The overall incidence of the sapovirus was 3.3%. It was present in 1.4% of acute gastroenteritis cases in 2006-2008 and 5.5% in the post-vaccination years, but the absolute number did not increase. Sapoviruses mainly occurred in the winter and spring, but did not follow the prevalence of the norovirus or rotavirus. Sapovirus GI.1 and GII.1 were the most common genotypes, but the predominant strain was different each season. Many sapovirus lineages appeared during multiple seasons and reappeared later. Conclusion The sapovirus was uncommonly and sporadically detected in children seen in the hospital for acute gastroenteritis, and its relative role increased after national immunisation was introduced.

Introducción. Las inmunodeficiencias primarias son enfermedades genéticas del sistema inmune que incrementan la susceptibilidad a infecciones. Una de las formas más graves en niños es la inmunodeficiencia combinada severa.Presentación del caso. Se presenta el caso de un niño que fue diagnosticado con inmunodeficiencia combinada severa; este era un paciente masculino de ocho meses que presentó cuadro clínico consistente en múltiples hospitalizaciones debido a infección por citomegalovirus, endocarditis por Candida albicans e infección recurrente de las vías urinarias por Pseudomonas aeruginosa.El perfil inmunológico mostró disminución del número absoluto de células CD3+ y CD19+, lo que permitió realizar el diagnóstico de inmunodeficiencia combinada severa instaurándose manejo; sin embargo, el niño no se recuperó y falleció.Conclusiones. Las inmunodeficiencias primarias son patologías que requieren una intervención oportuna que permita brindar un mejor pronóstico a los pacientes.

Introduction and objectives PCSK9 inhibitors (PCSK9i) are safe and effective lipid-lowering drugs . Their main limitation is their high cost. The aim of this study was to estimate the number of patients eligible for treatment with PCSK9i according to distinct published criteria. Methods Data were obtained from the Information System for the Development of Research in Primary Care. Included patients were equal to or older than 18 years and had at least 1 low-density lipoprotein cholesterol measurement recorded between 2006 and 2014 (n = 2 500 907). An indication for treatment with PCSK9i was assigned according to the following guidelines: National Health System, Spanish Society of Arteriosclerosis , Spanish Society of Cardiology, National Institute for Health and Care Excellence, and the European Society of Cardiology/European Atherosclerosis Society Task Force. Lipid-lowering treatment was defined as optimized if it reduced low-density lipoprotein levels by ≥ 50% and adherence was > 80%. Results Among the Spanish population aged 18 years or older, the number of possible candidates to receive PCSK9i in an optimal lipid-lowering treatment scenario ranged from 0.1% to 1.7%, depending on the guideline considered. The subgroup of patients with the highest proportion of potential candidates consisted of patients with familial hypercholesterolemia , and the subgroup with the highest absolute number consisted of patients in secondary cardiovascular prevention. Conclusions The number of candidates to receive PCSK9i in conditions of real-world clinical practice is high and varies widely depending on the recommendations of distinct scientific societies.

The difficulty in conducting meaningful clinical research is a multifactorial issue, involving political, financial and cultural problems, which can lead to unexpected negative long-term consequences, in terms of knowledge advancement and impact on patient care. The aims of the present review were to evaluate the publications of Italian radiotherapy (RT) groups during a 20-year period and to verify whether research is still appealing to young radiation oncologists (ROs) in Italy. PubMed database was searched for English-language articles published by Italian groups from January 1985 to December 2005. Analyzed variables were: publication/year, kind of study, geographical area and age of the first author. The systematic review identified 3291 articles: 1207 papers fulfilled the inclusion criteria. The number of Italian published papers increased during the examined period. Retrospective analyses, prospective phase I–II trials and literature reviews were 44, 20 and 14.5% of all published manuscripts, respectively. Randomized trials showed a mild increase from 2000 to 2005, but their absolute number remained low respect to other types of studies (4%). Northern Italy produced the very most of Italian research papers (58.7%). The age of the first/second author was evaluated on 716 papers: In more than 50% of cases, the first author was younger than 40. Despite a general gradual improvement, RT clinical research suffers in Italy (as elsewhere) from insufficient funding, with a negative impact on evidence production. It is worth noting that clinical research is still appealing and accessible to junior Italian RO.

Background Firearm-related injuries cause significant morbidity and mortality in the United States (US), consuming resources and fueling political and public health discourse. Most analyses of firearm injuries are based on fatality statistics. Here, we describe the epidemiology of firearm injuries presenting to US emergency departments (EDs). Methods We performed a retrospective study of the Healthcare Cost and Utilization Program Nationwide Emergency Department Survey (NEDS) from 2009 to 2012. NEDS is the largest all-payer ED survey in the US containing approximately 30 million annual records. Results include survey-adjusted counts, proportions, means, and rates, and confidence intervals of age-stratified ED discharges for firearm injuries. Results There were 71,111 (se = 613) ED discharges for firearm injuries in 2009; the absolute number increased 3.9% (se = 1.2) to 75,559 (se = 610) in 2012. 18-to-44-year-olds accounted for the largest proportion of total injuries with 52,187 (se = 527) in 2009 and 56,644 (se = 528) in 2012—a 7.2% (se = 1.6) relative rate increase and an absolute increase of 3.3/100,000 (se = 0.7). Firearm injuries among children

Background: The World Health Organization (WHO) and the Global Burden of Disease (GBD) study at the Institute for Health Metrics and Evaluation (IHME) periodically provide global estimates of tuberculosis (TB) mortality. We compared the 2015 WHO and GBD TB mortality estimates and explored which factors might drive the differences. Methods: We extracted the number of estimated TB-attributable deaths, disaggregated by age, HIV status, sex and country from publicly available WHO and GBD datasets for the year 2015. We ‘standardized’ differences between sources by adjusting each country’s difference in absolute number of deaths by the average number of deaths estimated by both sources. Results: For 195 countries with estimates from both institutions, WHO estimated 1 768 482 deaths attributable to TB, whereas GBD estimated 1 322 916 deaths, a difference of 445 566 deaths or 29% of the average of the two estimates. The countries with the largest absolute differences in deaths were Nigeria (216 621), Bangladesh (49 863) and Tanzania (38 272). The standardized difference was not associated with HIV prevalence, prevalence of multidrug resistance or global region, but did show correlation with the case detection rate as estimated by WHO [r ¼ 0.37, 95% confidence interval (CI): 049; 0.24] or, inversely, with case detection rate based on GBD data (r ¼ 0.44, 95% CI: 0.31; 0.54). Countries with a recent national prevalence survey had higher standardized differences (higher estimates by WHO) than those without (P ¼ 0.006). After exclusion of countries with recent prevalence surveys, the overall correlation between both estimates was r ¼ 0.991. Conclusions: A few countries account for the large global discrepancy in TB mortality estimates. The differences are due to the methodological approaches used by WHO and GBD. The use and interpretation of prevalence survey data and case detection rates seem to play a role in the observed differences.

The vast majority of differentiated thyroid cancers (DTC) are characterized by an innocuous nature, excellent patient survival, and limited treatment requirement. However, a significant proportion of affected patients is prone to receiving overtreatment, due to undertreatment concerns associated with the difficulty to differentiate them from a small minority affected by aggressive DTC. Identification of prognostic factors and development of staging systems has helped to reduce the proportion of overtreatment in DTC. However, the absolute number of overtreated patients continues to increase, as a result of an on-going incidence surge in early DTC associated with the increased application and sensitivity of modern diagnostic tools. In the present paper, we describe how DTC treatment can be optimized by thoughtful evidence-based balancing of oncologic safety against treatment associated morbidity.

Background In 2020, a second wave of COVID-19 cases unevenly affected places in England, and different levels of tiered restrictions were introduced in different parts of the country. Previous research has examined the impact of national lockdowns on transmission. We aimed to examine the differences in the effect of localised restrictions on COVID-19 cases and how these differences varied by deprivation. Methods We examined the transmission impact of tier 3 restrictions using data on weekly reported COVID-19 cases, adjusted for case-detection rates for 7201 neighbourhoods in England. We identified areas that entered tier 3 restrictions in October and December, 2020, constructed a synthetic control group of places under tier 2 restrictions, and compared changes in weekly infections over a 4-week period. Sufficiently granular data on deaths were not available to investigate excess mortality. We analysed whether this effect varied by level of deprivation and the prevalence of a new variant (B.1.1.7), by stratifying the synthetic control weighting by subgroups and then including an interaction term between subgroup and intervention in the regression model. We used the English Indices of Multiple Deprivation and its tertiles in the stratification to measure deprivation. We tested the spatial spillover effects excluding tier 2 areas within 20 km of tier 3 areas. Ethics approval was not needed. Findings The introduction of tier 3 restrictions was associated with a reduction in infections of 14% (95% CI 10–19) in October and of 20% (13–29) in December, or with a reduction in absolute number of total infections of 3536 (95% CI 2880–4192) in October and of 92 732 (49 776–135 688) in December, compared with what would have been expected under tier 2 restrictions. The effects were similar across levels of deprivation and by the prevalence of the new variant. We found smaller effects with high non-significant p values when excluding boundary areas. Interpretation Compared to tier 2 restrictions, restrictions on hospitality and meeting outdoors in tier 3 areas had a moderate effect on transmission and these restrictions did not appear to increase inequalities in COVID-19 cases. Limitations include a lack of specificity as to which of the main restrictions contributed to this effect, potentially biases from the crude measure of case-detection rates applied, and the lack of controls for individual or household characteristics in this ecological analysis. Funding National Institute for Health Research (NIHR).

BackgroundThe London Ambulance Service (LAS) runs an Emergency Responder (ER) scheme, where trained volunteers respond to 999 calls in blue-light rapid response vehicles (RRVs), alongside the statutory ambulance service response.The COVID-19 pandemic caused an unprecedented surge in call volume which, combined with reduced staffing of double-crewed ambulances (DCAs) due to illness, severely impaired the service’s ability to respond to calls.In response to this, as well as increasing volunteer RRV shifts, ERs were given additional up-skill training to work with regular ambulance service clinicians on DCAs, thus increasing the number of DCAs available to attend calls.This study aims to review the response to the COVID-19 pandemic provided by ERs.MethodA retrospective review was conducted of all ER shifts on volunteer RRVs and the service’s front-line DCAs. Data from the same time period (March 1 – April 30) was compared between 2019 (pre-pandemic period) and 2020 (pandemic period). The statistical significance of proportions was calculated using the χ2 test.ResultsThe absolute number of RRV hours volunteered by ERs increased by 34.2% (2,017 to 2,707), resulting in a 21.2% increase in RRV shifts (227 to 275) during the pandemic period. Furthermore, the proportion of C1 (life-threatening) incidents attended by ER RRVs doubled (32.4% vs 61.1%, p < 0.0001). In addition to RRV shifts, ERs volunteered 1,222 hours on DCAs during the pandemic, resulting in 125 additional DCA resources available. The combined total hours provided by ERs (RRV/DCA) increased by 94.8% (2,017 to 3,929).DiscussionVolunteer responders are a valuable resource during times of surge. In addition to volunteer RRV shifts, they have to the potential to assist ambulance service clinicians on DCAs. Future pandemic or winter-pressure plans should incorporate volunteer responders. This study predominantly looked at volunteer capacity, and further work is required to investigate patient-centred outcomes.

Aspirin could reduce the risk of cancer metastasis. Circulating tumor cells (CTCs) are a key factor of cancer metastasis, but no evidence has revealed how aspirin affects CTCs and its epithelial–mesenchymal transition (EMT). Here, we conducted a clinical trial to investigate how aspirin affects CTCs in metastatic colorectal cancer (MCC) and breast cancer patients (MBC). The trial is retrospective registered at clinicaltrials.gov (NCT02602938). The eligible patients are given 100 mg aspirin q.d. for 8 weeks, and CTCs are evaluated at baseline, 4 and 8 weeks for absolute number, phenotype (epithelial type, E+, mesenchymal type, M+, and biophenotypic type, B+), and vimentin expression. Data on 21 MCC and 19 MBC patients are analyzed, and it revealed that the CTC numbers decreased with aspirin treatment in MCC (p

The objective of the study: to investigate the prevalence of extrapulmonary tuberculosis in HIV patients in Moscow and to study the potential of computed tomography to detect extrapulmonary tuberculosis in the HIV infected. Subjects and Methods . Data of 6,588 new TB patients, detected in Moscow in 2014-2015 were analyzed, as well as CTs of 118 of TB/HIV patients, which were performed in 2014-2016. Results. In Moscow, the absolute number of extrapulmonary tuberculosis patients went down by 67.5% from 2012 to 2016 (140 persons). In Russia and in Moscow, the number of new extrapulmonary tuberculosis patients tends to decrease and currently makes approxamtely 3% versus 4-5% in 2011-2012. Among HIV negative TB patients the part of those with lesions within pulmonary parenchyma made 94%, and among the HIV positive it made 74.8% (p

BACKGROUND AND OBJECTIVES The integration of a restrictive packed red blood cells (PRBC) transfusion strategy into daily clinical practice presents a challenge. This study describes the effect of an intervention including educational presentations and computerized alerts on PRBC utilization at a tertiary hospital. MATERIALS AND METHODS During December 2014, lectures describing recommended PRBC transfusion indications were presented to all non-intensive care departments. Starting from January 2015, an alert was added to the electronic drug ordering system recommending transfusions at a haemoglobin (Hb) level

Background: Eggs have acquired a greater importance as an inexpensive and high-quality protein. The Brazilian egg industry has been characterized by a constant production expansion in the last decade, increasing the number of housed animals and facilitating the spread of many diseases. In order to reduce the sanitary and financial risks, decisions regard­ing the production and the health status of the flock must be made based on objective criteria. The use of Artificial Neural Networks (ANN) is a valuable tool to reduce the subjectivity of the analysis. In this context, the aim of this study was at validating the ANNs as viable tool to be employed in the prediction and management of commercial egg production flocks.Materials, Methods & Results: Data from 42 flocks of commercial layer hens from a poultry company were selected. The data refer to the period between 2010 and 2018 and it represents a total of 600,000 layers. Six parameters were selected as “output” data (number of dead birds per week, feed consumption, number of eggs, weekly weight, weekly egg produc­tion and flock uniformity) and a total of 13 parameters were selected as “input” data (flock age, flock identification, total hens in the flock, weekly weight, flock uniformity, lineage, weekly mortality, absolute number of dead birds, eggs/hen, weekly egg production, feed consumption, flock location, creation phase). ANNs were elaborated by software programs NeuroShell Predictor and NeuroShell Classifier. The programs identified input variables for the assembly of the networks seeking the prediction of the variables called outgoing that are subsequently validated. This validation goes through the comparison between the predictions and the real data present in the database that was the basis for the work. Validation of each ANN is expressed by the specific statistical parameters multiple determination (R2) and Mean Squared Error (MSE). For instance, R2 above 0.70 expresses a good validation. ANN developed for the output variable “number of dead birds per week” presented R2= 0.9533 and MSE= 256.88. For “feed consumption”, the results were R2= 0.7382 and MSE= 274.56. For “number of eggs (eggs/hen)”, the results were R2= 0.9901 and MSE= 172.26. For “weekly weight”, R2= 0.9712 and MSE= 11154.41. For “weekly egg production”, R2= 0.8015 and MSE= 72.60. For “flock uniformity”, R2= -2.9955 and MSE= 431.82.Discussion: From the six ANN designed in this study, in five it was possible to validate the predictions by comparing predictions with the real data. In one output parameter (“flock uniformity”), it was not possible to have adequate validation due to insufficient data in our database. For “number of dead birds per week”, “feed consumption”, “weekly weight” and “uniformity”, the most important variable was “flock age” (27.5%, 52.5%, 55.2% and 37.9%, respectively). For “number of eggs (eggs/hen)”, “uniformity” (52.1%) was the most relevant variable for prediction. For “weekly egg production”, “flock age” and “number of eggs (eggs/hen)” were the most important zootechnical parameters, both with a relative contribution of 38.2%. The results showed that even with the use of a robust tool such as ANNs, it is necessary to have well-noted and clear information that expresses the reality of the flocks. In any case, the results presented allow us to state that ANNs are capable for the management of data generated in a commercial egg production facility. The process of evaluation of these data would be improved if ANNs were routinely used by the professionals linked to this activity.