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PROBLEM: Infectious diseases can easily spread in daycare centres (DCCs), primarily due to inadequate hygiene practices of both childcare workers and children. Therefore, childcare workers who provide direct care in early childhood play a crucial role in preventing and controlling infectious diseases in DCCs. This systematic review aims to identify current evidence and examine the effect of the infection prevention and control (IPC) programme for childcare workers in daycare centres, and to obtain a pooled estimate of the intervention's effect using meta-analysis, if possible ELIGIBILITY CRITERIA: We searched literature through CINAHL, Medline, Cochrane Library, ScienceDirect, and Scopus databases, we also performed manual searches on Google Scholar and citation lists. Inclusion criteria comprised: 1) Experimental or quasi-experimental design studies that were published in the English language from October 1971 to December 2023, 2) Population focused on childcare workers responsible for early childhood in DCCs, 3) The intervention focused on the ICP programme, and 4) Outcomes related to childcare workers SAMPLE: From 3,964 articles, eight studies were included in this review RESULTS: Half of the total studies concentrated on hand hygiene intervention, while the remaining four addressed the prevention of infectious diseases and infection control. These studies reported an increase in knowledge, self-efficacy, and compliance regarding hand hygiene, and knowledge and practices related to infectious diseases. Two studies included nurses as conductors in the programme CONCLUSION: IPC programme effectively enhances some knowledge and performances in childcare workers IMPLICATION: Nurses can conduct IPC programme within daycare centres by utilizing evidence-based educational tools. Further research is needed to require well-reported studies, especially randomized controlled trials. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023492592.
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According to the information centre hypothesis (ICH), colonial species use social information in roosts to locate ephemeral resources. Validating the ICH necessitates showing that uninformed individuals follow informed ones to the new resource. However, following behaviour may not be essential when individuals have a good memory of the resources' locations. For instance, Egyptian fruit bats forage on spatially predictable trees, but some bear fruit at unpredictable times. These circumstances suggest an alternative ICH pathway in which bats learn when fruits emerge from social cues in the roost but then use spatial memory to locate them without following conspecifics. Here, using an unique field manipulation and high-frequency tracking data, we test for this alternative pathway: we introduced bats smeared with the fruit odour of the unpredictably fruiting Ficus sycomorus trees to the roost, when they bore no fruits, and then tracked the movement of conspecifics exposed to the manipulated social cue. As predicted, bats visited the F. sycomorus trees with significantly higher probabilities than during routine foraging trips (of >200 bats). Our results show how the integration of spatial memory and social cues leads to efficient resource tracking and highlight the value of using large movement datasets and field experiments in behavioural ecology. This article is part of the theme issue 'The spatial-social interface: a theoretical and empirical integration'.
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Quirópteros , Señales (Psicología) , Ficus , Frutas , Memoria Espacial , Animales , Quirópteros/fisiología , Memoria Espacial/fisiología , Ficus/fisiología , Conducta Social , Conducta Alimentaria , Odorantes/análisisRESUMEN
Hip arthroplasties are cost-effective procedures; however, instability and leg length discrepancy are common complications that can lead to higher revision rates and patient dissatisfaction. Preoperative planning aids surgeons in choosing the right offset and neck length before surgery. Nonetheless, intraoperative measures are still necessary due to the differences dictated by the surgical procedure. Several hip trials might be needed to reach the optimum choice of implants. We have introduced a technique that utilizes the trunnion as a reference point to the hip centre of rotation, matching it with the acetabulum centre of rotation after applying the necessary soft tissue tension. This serves as a proximal reference point. Using the trunnion, as opposed to the trial head, allows for a better assessment of tissue tension within the acetabular void, avoiding constraints imposed by the applied trial head. Additionally, determining the acetabulum's centre of rotation is challenging if obscured by the trial head. Matching the two tibial tuberosities indicates the correct leg length, serving as the distal reference point. Both reference points should be considered together to select the right neck length and offset for optimal tissue tension. This technique has been tested on hip arthroplasty patients over five years. All hip surgeons who used this technique agree that it gives a better representation of the tissue tension, easing the challenges when preparing the acetabulum as well as reducing the need for multiple trials.
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BACKGROUND: Hypertension (HT) silently threatens one in three adults, especially older adults, who struggle with blood pressure (BP) control because of limited health access, poor adherence to medication and failure to make lifestyle changes. This increases their risk for heart disease, kidney failure and dementia. Fortunately, adult day care centres (ADCCs) offer hope. These community facilities provide daytime care, including health support services, social activities and exercise. This study investigated the perceived effect of adult daycare centre attendance on BP control and treatment adherence. METHODS: A mainly descriptive study at MUCPP Community Health Centre (CHC) in Bloemfontein, South Africa, between July 2020 and September 2020, used questionnaires researchers completed during interviews. The researchers approached 372 hypertensive patients of a minimum of 60 years old and at least 2 years since being diagnosed. RESULTS: Of the 90 who attended ADCCs, 71.1% had controlled hypertension compared to 51.4% of those who did not. While treatment adherence showed no difference, a positive association between ADCC attendance and BP control is evident. CONCLUSION: The findings suggest a promising link between ADCC attendance and improved BP control in older adults with hypertension. Adult Day Care Centres warrant further exploration as it seems to be an encouraging support intervention for this vulnerable population.Contribution: This study highlights the positive impact ADCCs have on hypertension management in older adults, urging increased physician awareness and patient referrals.
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Centros de Día para Mayores , Hipertensión , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/terapia , Masculino , Femenino , Persona de Mediana Edad , Sudáfrica/epidemiología , Anciano , Encuestas y Cuestionarios , Antihipertensivos/uso terapéutico , Cumplimiento de la MedicaciónRESUMEN
BACKGROUND: Although some evidence is available from low- and middle-income countries, no South African data are available on how women experience healthcare during treatment for an incomplete miscarriage. AIM: This study sets out to explore and describe the experiences of healthcare among women who suffered an incomplete spontaneous miscarriage in the Witzenberg subdistrict, a rural area in the Western Cape province of South Africa. SETTING: Witzenberg subdistrict, Western Cape province, South Africa. METHODS: This study used a descriptive exploratory qualitative study design. In-person interviews were held with women who experienced a miscarriage. Interviews followed a semi-structured format by a single interviewer to explore the various aspects involving experiences of healthcare. RESULTS: Eight interviews were conducted and analysed. The five themes that arose from transcribed data were: (1) a need for safety, (2) pain management, (3) moderating behaviours and attitudes, (4) disorienting healthcare systems and (5) abandonment. Several factors contributed to the loss of physical and emotional safety in the emergency centre environment. Timeous emotional and pharmacological pain management were found to be a gap while patients awaited care. Clear communication and staff attitude were found to be integral to the patient's experience and could avoid the perception of abandonment. CONCLUSION: There is a universal need for basic respectful, supportive and safe care in patients who attend an emergency centre for early pregnancy complications in rural South African. Specific focus should be given to clear communication and appropriate emotional support during and after the miscarriage.Contribution: This study can be used as a guide to improve services by ensuring respectful, transparent, informed, and appropriate continuity of care.
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Investigación Cualitativa , Humanos , Femenino , Sudáfrica , Adulto , Embarazo , Aborto Espontáneo/psicología , Satisfacción del Paciente , Entrevistas como Asunto , Adulto Joven , Aborto Incompleto/terapia , Población RuralRESUMEN
This study investigates the determination of the centre of pressure (COP) on spherical sports objects such as cricket balls and footballs using gyroscope data from Inertial Measurement Units (IMUs). Conventional pressure sensors are not suitable for capturing the tangential forces responsible for torque generation. This research presents a novel method to calculate the COP solely from gyroscope data and avoids the complexity of isolating user-induced accelerations from IMU data. The COP is determined from the cross-product of consecutive torque vectors intersecting the surface of the sphere. Effective noise management techniques, including filtering and data interpolation, were employed to improve COP visualisation. Experiments were conducted using a smart cricket ball and a smart football. Validation tests using spin rates between 7.5 and 12 rps and torques ranging from 0.08 to 0.12 Nm confirmed consistent COP clustering around the expected positions. Further analysis extended to various spin bowling deliveries recorded using a smart cricket ball, and a curved football kick recorded using a smart football demonstrated the wide applicability of the method. The COPs of various spin bowling deliveries showed adjacent positions on the surface of the ball, traversing through backspin, sidespin and topspin, excluding the flipper and doosra deliveries. The calculation of the COP on the surface of the soccer ball could only be achieved by increasing the data sampling frequency sevenfold using curve fitting. Knowledge and use of the COP position offers significant advances in understanding and analysing ball dynamics in sports.
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The primary goal of this study was to develop a simulation model of a long counter available at Canadian Nuclear Laboratories (CNL). Using the Monte Carlo N-Particle version 6 (MCNP6) code, the model was used to calculate, as a function of incident energy, the number of counts recorded per source neutron, effective centre, and sensitivity. This study also carried out measurements of the neutron emission rate of and direct neutron flux at 2 m from an in-house 252Cf neutron source.
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BACKGROUND: With advancements in perioperative care, joint replacement (JR) surgery is undergoing a transition from opacified in-patient institutions to nimble out-patient Ambulatory Surgical Centers (ASC). The goal of JR in ASC setting is safe patient discharge with subsequent rehabilitation without readmission. Multi-modal preoperative rehabilitation (MMPR) is a novel field of perioperative care, encompassing comprehensive parameters to ensure smooth transition from fitness for surgery to JR in outpatient setting. At present, there are no open-access schemes for selecting patients qualified for JR in the ASC setting. In this article, we propose an evidence-based, 10-point systematic evaluation of patients with target endpoints for MMPR to qualify patients for JR as an outpatient procedure. This checklist is a non-proprietary scheme serving as an initial framework for surgeons exploring surgery in the ASC setting. BODY: We introduce factors for a prehabilitation scheme, called Checklist Outpatient-Joint Replacement (CO-JR) to qualify patients for outpatient JR surgery. These factors have been developed based on an extensive literature review and the significant experience of authors to incorporate variables that drive a successful outpatient JR procedure. The factors include patient education, psychiatric & cognitive ability, medical fitness, musculoskeletal capability, financial ability, transportation access, patient motivation, information technology (IT) capabilities, along with ability to recover independently at home postoperatively. The CO-JR scheme is under the process of validation at multiple institutions. We introduce this as a starting point for collaborative development of an open-access scheme for all surgeons to learn and adapt as needed for their respective global region. CONCLUSION: We established a non-proprietary 10-point CO-JR scheme, serving as a framework for surgeons to successfully select patients for JR surgery in the ASC setting. We encourage concomitant validation of this scheme globally. Our goal is to reach an international consensus on an open-access scheme, available for all surgeons to enrol patients for JR in the ASC setting, but modifiable to accommodate regional needs.
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BACKGROUND: The Duke criteria for diagnosing infective endocarditis (IE) were recently updated by the International Society for Cardiovascular Infectious Diseases (ISCVID) with the purpose of enhancing diagnostic specificity and sensitivity. This study investigated the performance of the Duke-ISCVID criteria in relation to previous criteria. METHOD: This retrospective single centre cohort study included patients referred to the Lund IE Team (LIET) between 2017 and 2022, and compared episodes classified according to the 2000 modified Duke, European Society of Cardiology (ESC) 2015, and 2023 Duke-ISCVID criteria. The LIET's decision to treat episodes as IE served as the reference standard. RESULTS: The study cohort comprised 661 episodes of potential IE. The LIET classified 498 (75%) episodes as IE. The Duke-ISCVID criteria classified a slightly higher proportion of episodes as definite IE (56.4%) compared to the ESC 2015 criteria (54.9%), and the modified Duke (51.1%). The Duke-ISCVID criteria had higher sensitivity (72.5%) for definite IE compared to ESC 2015 (70.7%, p = .57) and modified Duke (66.1%, p = .033). The specificities were similar for the Duke-ISCVID criteria (92.6%), compared to ESC 2015 (93.9%, p = .83) and the modified Duke criteria (95.0%, p = .49). When considering both definite and possible IE positive, specificity for all criteria was low: 32.5% for the Duke-ISCVID criteria, 41.7% for ESC 2015 (p = .086), and 42.3% for modified Duke criteria (p = .11), while the sensitivity was not significantly lower. DISCUSSION: The Duke-ISCVID criteria demonstrated slightly improved sensitivity for diagnosing IE whereas specificity remained unchanged. Further refinement of the Duke-ISCVID criteria is needed to balance sensitivity and specificity.
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Background: Early childcare attendance may be related to children's internalizing and externalizing symptoms throughout childhood and young adolescence, however evidence from Europe is limited. We aimed to assess this association across multiple population-based birth cohorts of children recruited in different European countries. Methods: Data come from six parent-offspring prospective birth cohort studies across five European countries within the EU Child Cohort Network. A total of 87,208 parent-child dyads were included in the study. To test associations between childcare attendance (centre-based or informal) anytime between ages 0 and 4 years and children's internalizing and externalizing symptoms in middle childhood and young adolescence (measured at: 5-6 years, 7-9 years, and 10-13 years) a two-stage individual participant data meta-analysis was implemented. Linear regression models were performed in each cohort separately; combined random-effects meta-analysis was then used to obtain overall association estimates. In secondary analyses, we tested interactions between childcare attendance and mother's post-partum depression, low education status, and the child's sex. Findings: Compared to children who were exclusively cared for by their parents prior to school entry, those who attended centre-based childcare had lower levels of internalizing symptoms in all age groups [5-6 years: ß: -1.78 (95% CI: -3.39, -0.16); 7-9 years: ß: -0.55 (95% CI: -0.88, -0.73); 10-13 years: ß: -0.76 (95% CI: -1.15, -0.37)]. Children who attended informal childcare appeared to have elevated levels of internalizing symptoms between 7-9 and 10-13 years, respectively [ß: 1.65 (95% CI: 1.25, 2.06); ß: 1.25 (95% CI: 0.96, 1.54)]. Informal childcare attendance was also associated with increased levels of children's externalizing symptoms between 7-9 and 10-13 years, respectively [ß: 2.84 (95% CI: 1.41, 4.26); ß: 2.19 (95% CI: 0.54, 3.84)]. Interpretation: Early centre-based childcare is associated with decreased levels of children's internalizing symptoms compared to exclusive parental care. For informal childcare, opposite associations were observed. Overall, our results suggest that centre-based childcare attendance may be associated with slight positive impacts on children's emotional development and should be encouraged by public policies. In addition, children from socioeconomically disadvantaged families require special attention, as they may not sufficiently benefit from universal early childhood education and care (ECEC). Funding: This research was funded by the ERC Consolidator grant RESEDA (Horizon Europe, 101001420).
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INTRODUCTION: Poisons information centres provide phone-based risk assessment and management advice on poisonings. Unintentional poisonings are a common reason for consulting a poisons information centre, and older adults are at increased risk of unintentional poisoning and adverse outcomes. We describe patterns of unintentional poisoning in older adults reported to a regional poisons information centre. METHODS: We conducted a retrospective audit of poisons information centre call records and identified unintentional poisonings involving older adults (≥75 years) over a 12-month period to determine patient demographics and poisoning circumstances (substances, contributing factors, and disposition recommendation). Univariate analyses identified variables associated with hospital referral and multivariate models to identify independent risk factors in home-dwelling older adults. RESULTS: We identified 2,757 calls. More exposures occurred in women (62%) and involved therapeutic errors (70.8%). Paracetamol was the most common drug involved (11%), and cardiovascular drugs were the most common drug class (36%). Only 14.3% of the study population was referred to hospital. Independent risk factors for hospital referral in home-dwelling older adults were exposure to cardiovascular, centrally acting and antihyperglycaemics, non-oral route of administration and symptoms at the time of the call. DISCUSSION: Unintentional poisoning is not uncommon, and our findings are similar to those in other countries over recent decades. These findings suggest that unintentional poisoning in older adults is inadequately addressed by current medication safety strategies. Our findings indicate the value of timely advice by poisons information centres for preventing potentially unnecessary hospitalizations. CONCLUSION: Further research is needed to identify more effective approaches to medication safety strategies for older adults. Poisons information centre data contribute to pharmacovigilance activities and could inform patient care.
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BACKGROUND: Commercial genome-wide genotyping arrays have historically neglected coverage of genetic variation across populations. OBJECTIVE: We aimed to create a multi-ancestry genome-wide array that would include a wide range of neuro-specific genetic content to facilitate genetic research in neurological disorders across multiple ancestral groups, fostering diversity and inclusivity in research studies. METHODS: We developed the Illumina NeuroBooster Array (NBA), a custom high-throughput and cost-effective platform on a backbone of 1,914,934 variants from the Infinium Global Diversity Array and added custom content comprising 95,273 variants associated with more than 70 neurological conditions or traits, and we further tested its performance on more than 2000 patient samples. This novel platform includes approximately 10,000 tagging variants to facilitate imputation and analyses of neurodegenerative disease-related genome-wide association study loci across diverse populations. RESULTS: In this article, we describe NBA's potential as an efficient means for researchers to assess known and novel disease genetic associations in a multi-ancestry framework. The NBA can identify rare genetic variants and accurately impute more than 15 million common variants across populations. Apart from enabling sample prioritization for further whole-genome sequencing studies, we envisage that NBA will play a pivotal role in recruitment for interventional studies in the precision medicine space. CONCLUSIONS: From a broader perspective, the NBA serves as a promising means to foster collaborative research endeavors in the field of neurological disorders worldwide. Ultimately, this carefully designed tool is poised to make a substantial contribution to uncovering the genetic etiology underlying these debilitating conditions. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.
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Purpose: Incubation centres are gaining significant prominence as they play a crucial role in providing supportive environment and encouraging entrepreneurship among students. Considering its importance, the study is intended to offer a thorough knowledge of incubators' role in promoting entrepreneurship growth using data acquired from Dakshina Kannada Management Institutes. It also intends to investigate the efficacy and success of incubators using a variety of metrics. Methods: This study is based on the mixed-method approach, where specifically the concurrent qual-quant approach is adopted. An in-depth interview was undertaken, and a structured questionnaire was formulated to collect the data from final year Masters' students from the Management Institutes. Qualitative analysis was narrated and quantitative analysis was carried out using SPSS 26 and AMOS 23, with descriptive statistics, t-test, regression analysis, and SEM which were utilized to evaluate the association between variables. Results: The study has highlighted the importance of reputation and credibility of the incubation centre, along with the significance of building a strong network as integral factors for learning from it. Overall, the study has found that students' perception of education collaboration, and policy regulatory framework pertaining to incubation centres highly impacted the effectiveness of the incubation centre, which further enhances its success. Implications: This study helps to handle challenges for young entrepreneurs through proper direction and support, by refining their business ideas and collaborations with local and regional businesses to create a healthy entrepreneurship environment by fostering the integration between government bodies, financial institutions, and venture capitalists with the entrepreneurs and key stakeholders. Originality/rationale: As an exceptional highlight than other studies, this study focused on assessing the impact of awareness, perception, education and collaboration, policy and regulatory frameworks, and challenges on the effectiveness of incubators, and success of incubation centre. This has provided the answers to more comprehensive questions pertaining to incubation centre using mixed method approach. The combination of qualitative and quantitative results has identified novel findings which urges the incubation centres to identify the startups with high growth potential where the major challenges lie in convincing the students to implement their own business ideas.
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Patients with thymoma (THYM)-associated myasthenia gravis (MG) typically have a poor prognosis and recurring illness. This study aimed to discover important biomarkers associated with immune cell infiltration and THYM-associated MG (THYM-MG) development. Gene expression microarray data were downloaded from The Cancer Genome Atlas website (TCGA) and Gene Expression Omnibus (GEO). A total of 102 differentially expressed genes were investigated. According to the immune infiltration data, the distribution of Tfh cells, B cells, and CD4 T cells differed significantly between the THYM-MG and THYM-NMG groups. WGCNA derived 25 coexpression modules; one hub module (the blue module) strongly correlated with Tfh cells. Combining differential genes revealed 21 intersecting genes. LASSO analysis subsequently revealed 16 hub genes as potential THYM-MG biomarkers. ROC curve analysis of the predictive model revealed moderate diagnostic value. The association between the 16 hub genes and infiltrating immune cells was further evaluated in TIMER2.0 and the validation dataset. Draggability analysis identified the therapeutic target genes PTGS2 and ALB, along with significant drugs including Firocoxib, Alclofenac, Pyridostigmine, and Stavudine. This was validated through MD simulation, PCA, and MM-GBSA analyses. The interaction between numerous activated B cells and follicular helper T cells is closely associated with THYM-MG pathogenesis from a bioinformatics perspective. Hub genes (including SP6, SCUBE3, B3GNT7, and MAGEL2) may be downregulated in immune cells in THYM-MG and associated with progression.
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AIM: To explore the disruptive influence of workplace gaslighting behaviours and mobbing on nurses' career entrenchment across multiple healthcare centres. DESIGN: A multi-centre cross-sectional. METHODS: Data were collected from 483 nurses from various healthcare settings in Egypt, spanning from January 2024 to February 2024. The Gaslighting at Work Questionnaire, Luxembourg Workplace Mobbing Scale and Career Entrenchment Scale were employed for data collection. RESULTS: The study revealed moderate levels of gaslighting, mobbing and nurses' career entrenchment. Also, there is a negative correlation between nurses' career entrenchment and both gaslighting and mobbing, while gaslighting and mobbing exhibit a positive correlation. The study also highlighted regional disparities in the prevalence of these phenomena, with the highest incidences noted in urban healthcare settings. CONCLUSION: The findings underscore the critical impact of workplace gaslighting and mobbing on nurses' career entrenchment. REPORTING METHOD: The relevant reporting method has been adhered to, that is, STROBE. IMPLICATION FOR THE PROFESSION: The future of the nursing profession requires building productive nurses who can cope with negative workplace experiences. This could be achieved by cultivating a workplace culture that has zero tolerance for these experiences. Offering counselling services or employee assistance programmes to help nurses cope with the emotional toll of these negative experiences is a promising strategy. IMPACT: This study is the first to examine serious workplace practices like gaslighting and mobbing in a nursing context, emphasizing their effect on nursing-sensitive indicators like career entrenchment. It is one of the important initiatives geared towards upgrading the competitiveness and magnetism of healthcare organizations in the era of green human resources management. Results provide valuable insights for nurse leaders to control nursing turnover and shortage crises in different endeavours. PATIENT OR PUBLIC CONTRIBUTION: In our study, nurses from diverse geographical regions and varied specialties actively participate, offering a rich tapestry of experiences and perspectives.
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Introduction: An effective referral system is necessary to ensure quality and an optimum continuum of care. In the Kingdom of Saudi Arabia, an e-referral system known as the Saudi Medical Appointments and Referrals Centre (SMARC), has been fully functioning since 2019. This study aims to explore the rate of medical e-referral request acceptance in the KSA, and to study the factors associated with acceptance. Methods: This period cross-sectional study utilised secondary collected data from the SMARC e-referral system. The data spans both 2020 and 2021 and covers the entirety of the KSA. Bivariate analyses and binary logistic regression analyses were performed to compute adjusted Odds Ratios (aORs) and 95% confidence intervals. Results: Of the total 632,763 referral requests across the 2 years, 469,073 requests (74.13%) were accepted. Absence of available machinery was a significant predictor for referral acceptance compared to other reasons. Acceptance was highest for children under 14 with 28,956 (75.48%) and 63,979 (75.48%) accepted referrals, respectively. Patients requiring critical care from all age groups also had the highest acceptance including 6,237 referrals for paediatric intensive care unit (83.54%) and 34,126 referrals for intensive care unit (79.65%). All lifesaving referrals, 42,087 referrals, were accepted (100.00%). Psychiatric patients were observed to have the highest proportion for accepted referrals with 8,170 requests (82.50%) followed by organ transplantations with 1,005 requests (80.92%). Sex was seen to be a significant predictor for referrals, where the odds of acceptances for females increased by 2% compared to their male counterparts (95% CI = 1.01-1.04). Also, proportion of acceptance was highest for the Eastern business unit compared to all other units. External referrals were 32% less likely to be accepted than internal referrals (95% CI = 0.67-0.69). Conclusion: The current findings indicate that the e-referral system is mostly able to cater to the health services of the most vulnerable of patients. However, there remains areas for health policy improvement, especially in terms of resource allocation.
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Derivación y Consulta , Humanos , Arabia Saudita , Derivación y Consulta/estadística & datos numéricos , Estudios Transversales , Masculino , Femenino , Adulto , Persona de Mediana Edad , Adolescente , Niño , Preescolar , Bases de Datos Factuales , Adulto Joven , Lactante , Aceptación de la Atención de Salud/estadística & datos numéricos , AncianoRESUMEN
Introduction: Extracting beat-by-beat information from electrocardiograms (ECGs) is crucial for various downstream diagnostic tasks that rely on ECG-based measurements. However, these measurements can be expensive and time-consuming to produce, especially for long-term recordings. Traditional ECG detection and delineation methods, relying on classical signal processing algorithms such as those based on wavelet transforms, produce high-quality delineations but struggle to generalise to diverse ECG patterns. Machine learning (ML) techniques based on deep learning algorithms have emerged as promising alternatives, capable of achieving similar performance without handcrafted features or thresholds. However, supervised ML techniques require large annotated datasets for training, and existing datasets for ECG detection/delineation are limited in size and the range of pathological conditions they represent. Methods: This article addresses this challenge by introducing two key innovations. First, we develop a synthetic data generation scheme that probabilistically constructs unseen ECG traces from "pools" of fundamental segments extracted from existing databases. A set of rules guides the arrangement of these segments into coherent synthetic traces, while expert domain knowledge ensures the realism of the generated traces, increasing the input variability for training the model. Second, we propose two novel segmentation-based loss functions that encourage the accurate prediction of the number of independent ECG structures and promote tighter segmentation boundaries by focusing on a reduced number of samples. Results: The proposed approach achieves remarkable performance, with a F 1 -score of 99.38% and delineation errors of 2.19 ± 17.73 ms and 4.45 ± 18.32 ms for ECG segment onsets and offsets across the P, QRS, and T waves. These results, aggregated from three diverse freely available databases (QT, LU, and Zhejiang), surpass current state-of-the-art detection and delineation approaches. Discussion: Notably, the model demonstrated exceptional performance despite variations in lead configurations, sampling frequencies, and represented pathophysiology mechanisms, underscoring its robust generalisation capabilities. Real-world examples, featuring clinical data with various pathologies, illustrate the potential of our approach to streamline ECG analysis across different medical settings, fostered by releasing the codes as open source.
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In France, teenage pregnancy has remained a relatively moderate and stable phenomenon for several decades. Public discourse on young people's sexuality and the issue of teenage pregnancies focuses overwhelmingly on two themes: contraception and voluntary termination of pregnancy, leaving in the shadows the reality of the experiences of these young under-age mothers. Thus, one of the major challenges of support in maternity centers is to ensure the coexistence of psychic movements linked to adolescent reorganization and those linked to the birth of motherhood. With this in mind, we have been able to highlight the importance of care structures for these mothers, acting as a substitute family figure for these young people. This support seems to have fostered the creation of more appropriate conditions for the establishment of the first mother-baby bonds in these initially very precarious psychological contexts.
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Embarazo en Adolescencia , Humanos , Embarazo en Adolescencia/psicología , Adolescente , Femenino , Embarazo , Francia , Madres/psicologíaRESUMEN
Adults requiring total hip arthroplasty (THA) for childhood disorder sequelae present with shortening, limp, pain, and altered gait. THA, which can be particularly challenging due to altered anatomy, requires careful planning, assessment, and computed tomography evaluation. Preoperative templating is essential to establish the appropriate acetabular and femoral size. Information regarding neck length and offset is needed to ensure the proper options are available at THA. Hip centre restoration must be planned preoperatively and achieved intraoperatively with appropriate exposure, identification, and stable fixation with optimum-size components. Identifying the actual acetabular floor is essential as changes include altered anatomy, distortion of the margins and version changes. Proximal femur changes include anatomical variation, decreased canal diameter, cortical thickness, changes in anteversion, and metaphyseal and diaphyseal mismatch. Preoperative assessment should consist of limb assessment for variations due to prior surgical procedures. Evaluation of the shortening pattern with the relationship of the lesser trochanter to the teardrop would help identify and plan for subtrochanteric shortening osteotomy, especially in high-riding hips. The surgical approach must ensure adequate exposure and soft tissue release to achieve restoration of the anatomical hip centre. The femoral components may require modularity to enable restoration of anteversion and optimum fixation.
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Rabies is a lethal zoonotic disease that threatens human health. As the only viral surface protein, the rabies virus (RABV) glycoprotein (G) induces main neutralizing antibody (Nab) responses; however, Nab titre is closely correlated with the conformation of G. Virus-like particles (VLP) formed by the co-expression of RABV G and matrix protein (M) improve retention and antigen presentation, inducing broad, durable immune responses. RABV nucleoprotein (N) can elicit humoral and cellular immune responses. Hence, we developed a series of nucleoside-modified RABV mRNA vaccines encoding wild-type G, soluble trimeric RABV G formed by an artificial trimer motif (tG-MTQ), membrane-anchored prefusion-stabilized G (preG). Furthermore, we also developed RABV VLP mRNA vaccine co-expressing preG and M to generate VLPs, and VLP/N mRNA vaccine co-expressing preG, M, and N. The RABV mRNA vaccines induced higher humoral and cellular responses than inactivated rabies vaccine, and completely protected mice against intracerebral challenge. Additionally, the IgG and Nab titres in RABV preG, VLP and VLP/N mRNA groups were significantly higher than those in G and tG-MTQ groups. A single administration of VLP or VLP/N mRNA vaccines elicited protective Nab responses, the Nab titres were significantly higher than that in inactivated rabies vaccine group at day 7. Moreover, RABV VLP and VLP/N mRNA vaccines showed superior capacities to elicit potent germinal centre, long-lived plasma cell and memory B cell responses, which linked to high titre and durable Nab responses. In summary, our data demonstrated that RABV VLP and VLP/N mRNA vaccines could be promising candidates against rabies.