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Intraoral Hirudotherapy for Venous Congestion following Free Flap Head and Neck Reconstruction: Novel Intraoral Technique.

ORL J Otorhinolaryngol Relat Spec 2021 Jul 22:1-4. Epub 2021 Jul 22.

Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.

Intraoral hirudotherapy is traditionally used for venous congestion following head and neck free flap reconstruction. Many institutions and healthcare teams have been reluctant to use intraoral leech therapy due to risks such as migration into the airway, increased infection from intraoral manipulation, and patient discomfort. Several protocols recommend blocking the path to the oropharynx via gauze or leaving a tracheotomy in place to protect the airway. Read More

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Closed form approximations to predict retention times and peak widths in gradient elution under conditions of sample volume overload and sample solvent mismatch.

J Chromatogr A 2021 Jul 1;1653:462376. Epub 2021 Jul 1.

Department of Chemistry, University of Pittsburgh, 219 Parkman Avenue, Pittsburgh, PA, 15260, USA.

Closed form expressions for the prediction of retention times and peak widths for gradient liquid chromatography are particularly useful in understanding, rationalizing and optimizing separations. These expressions are obtained by integrating differential equations, in conjunction with a model of the variation of the retention factor as a function of mobile phase composition. Two of these models, the linear solvent strength (LSS) model and the Neue-Kuss (NK) model are explored in the present work. Read More

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A distributed optimisation framework combining natural gradient with Hessian-free for discriminative sequence training.

Neural Netw 2021 May 29;143:537-549. Epub 2021 May 29.

Cambridge University Engineering Department, Trumpington Street, Cambridge, CB2 1PZ, UK. Electronic address:

This paper presents a novel natural gradient and Hessian-free (NGHF) optimisation framework for neural network training that can operate efficiently in a distributed manner. It relies on the linear conjugate gradient (CG) algorithm to combine the natural gradient (NG) method with local curvature information from Hessian-free (HF). A solution to a numerical issue in CG allows effective parameter updates to be generated with far fewer CG iterations than usually used (e. Read More

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The Association of Service Use and Other Client Factors With the Time to Transition From Home Care to Facility-Based Care.

J Am Med Dir Assoc 2021 Jul 19. Epub 2021 Jul 19.

Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.

Objectives: People are living longer with complex health needs and wish to remain in their homes as their care needs change. We examined which client factors (sociodemographic, health service use, health, and function) influenced older persons' (≥65 years) time to transition from home living to assisted living (AL) or long-term care (LTC) facilities.

Design: Retrospective cohort study. Read More

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ENDOCRINOLOGY IN THE TIME OF COVID-19 - 2021 updates: The Management of Diabetes insipidus and Hyponatraemia.

Eur J Endocrinol 2021 Jul 1. Epub 2021 Jul 1.

M Sherlock, Endocrinology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Tallaght, Dublin 24 , Dublin, Ireland.

COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, with relevance for patients with diabetes insipidus (DI) or hyponatremia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Read More

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Differences in Patient and Physician Perceptions of Urgency for Musculoskeletal Conditions During the COVID-19 Pandemic.

Orthopedics 2021 Jul-Aug;44(4):e534-e538. Epub 2021 Jul 1.

In 2020, the coronavirus disease 2019 (COVID-19) pandemic limited musculoskeletal care to urgent or "nonelective" office visits and procedures. No guidelines exist to inform patients or physicians what meets these criteria. The purpose of this multi-institutional study was to describe the differences in perceptions of urgency for musculoskeletal complaints between patients and providers during the COVID-19 pandemic. Read More

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Outpatient paediatric hand surgery: strategy in healthcare implementation and cost-efficient manner.

Musculoskelet Surg 2021 Jul 22. Epub 2021 Jul 22.

Hand Surgery and Microsurgery Department, AOU Policlinico of Modena, L.Go del Pozzo, 71, 41124, Modena, Italy.

The increasingly cost of health care is a relevant problem as well as prolonged waiting time for admission also in emergencies. Effective cost containment measures and expenditure controls are needed to achieve and maintain clinical and organizational appropriateness. Outpatient management has proven to be the most useful method for lower-cost treatment in less severe pathologies, requiring surgery without hospitalization. Read More

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Same Day Surgical Intervention Dramatically Minimizes Complication Occurrence and Optimizes Perioperative Outcomes for Central Cord Syndrome.

Clin Spine Surg 2021 Jul 21. Epub 2021 Jul 21.

Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY Department of Pediatric Neurosurgery, UT Southwestern Medical Center, Dallas, TX Department of Neurologic Surgery, University of Michigan, Ann Arbor, MI Department of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada Department of Neurological Surgery Montefiore Medical Center/Albert Einstein College of Medicine Bronx, NY Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD Deparment of Orthopedic Surgery, SUNY Downstate, New York, NY.

Study Design: This was a retrospective cohort study.

Objective: The aim of this study was to investigate associations between time to surgical intervention and outcomes for central cord syndrome (CCS) patients.

Background: As surgery is increasingly recommended for patients with neurological deterioration CCS, it is important to investigate the relationship between time to surgery and outcomes. Read More

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Magnitude and associated factors of delayed vaccination among children aged 11-23 months in, Tigray, Ethiopia, 2018.

Hum Vaccin Immunother 2021 Jul 22:1-7. Epub 2021 Jul 22.

Department of Midwifery, College of Health Sciences, Aksum University, Aksum, Ethiopia.

Background: Delay in receiving the vaccination is a major public health problem that has been associated with vaccine-preventable disease epidemics. In Ethiopia, many children have not received the benefits of age-appropriate vaccination; thus more than 90% of child deaths are largely due to preventable communicable diseases.

Objective: The present study assessed the magnitude and associated factors of delayed vaccination among 12-23 months old children in Tigray, Ethiopia. Read More

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EXPRESS: Factors influencing the use of different methods of consent in a randomised acute stroke trial, the Third International Stroke Trial (IST-3).

Int J Stroke 2021 Jul 22:17474930211037123. Epub 2021 Jul 22.

University of Edinburgh, DCN, Western General Hospital, Edinburgh, United Kingdom of Great Britain and Northern Ireland.

Background Obtaining informed consent in people with acute stroke is complex since many, as a direct result of their stroke, lose capacity to make important decisions. Furthermore reperfusion interventions are time dependent necessitating rapid consent. We developed 4 different consent approaches to facilitate recruitment of a broad range of patients in the Third International Stroke Trial (IST-3). Read More

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Evaluation of Drug Lags in Development Initiation, New Drug Application and Approval Between Japan and the USA and the Impact of Local Versus Multi-regional Clinical Trials.

Pharmaceut Med 2021 Jul 22. Epub 2021 Jul 22.

Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan.

Background: Drug time lags occur between the date that new drugs are first approved, often in the USA, and approval is granted in other countries. Multi-regional clinical trials (MRCTs) are a key strategy for simultaneous global development and regulatory submission of new drugs. However, no studies have evaluated the impact of MRCT versus local development on key time points in the drug development lifecycle between the USA and Japan. Read More

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The Impact of Small Time Delays on the Onset of Oscillations and Synchrony in Brain Networks.

Front Syst Neurosci 2021 5;15:688517. Epub 2021 Jul 5.

Department of Applied Mathematics, Centre for Theoretical Neuroscience, University of Waterloo, Waterloo, ON, Canada.

The human brain constitutes one of the most advanced networks produced by nature, consisting of billions of neurons communicating with each other. However, this communication is not in real-time, with different communication or time-delays occurring between neurons in different brain areas. Here, we investigate the impacts of these delays by modeling large interacting neural circuits as neural-field systems which model the bulk activity of populations of neurons. Read More

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The Impact of Treatment Delay on Hepatitis C Liver Transplant Outcomes.

J Pharm Pract 2021 Jul 21:8971900211034261. Epub 2021 Jul 21.

Department of Pharmacy, 21668University of Maryland Medical Center, Baltimore, MD, USA.

Direct-acting antivirals for the treatment of hepatitis C virus (HCV) have improved outcomes in liver transplant recipients (LTRs). However, the timing of HCV treatment and approach to treating rejection have not been well described. Additionally, pharmacists' roles in these comprehensive areas have not been investigated. Read More

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Group-level human values estimated with web search data and archival data explain the geographic variation in COVID-19 severity in the United States.

Authors:
Mac Zewei Ma

Psychol Health 2021 Jul 21:1-20. Epub 2021 Jul 21.

Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR.

Objectives: values (PF = Openness to change values + Self-enhancement values) motivate self-centred behaviours, and values (SF = Conservation values + Self-transcendence values) promote self-sacrificial counterparts. This research investigated how a state-level PF-SF value-continuum would explain the geographic variation in COVID-19 severity in the United States.

Design: This research estimated state-level values by Google search data (from 2004 to 2019) on value-related words (e. Read More

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Maple syrup urine disease: Characteristics of diagnosis and treatment in 45 patients in Chile.

Am J Med Genet C Semin Med Genet 2021 Jul 21. Epub 2021 Jul 21.

Laboratorio de Genética y Enfermedades Metabólicas, Instituto de Nutrición y Tecnología de Alimentos Doctor Fernando Monckeberg Barros (INTA), Universidad de Chile, Santiago, Chile.

Maple urine syrup disease (MSUD) is an autosomal recessive disorder characterized by deficient activity of the branched-chain alpha ketoacid dehydrogenase (BCKAD) enzymatic complex due to biallelic variants in the alpha (BCKDHA) or beta (BCKDHB) subunits or the acyltransferase component (DBT). Treatment consists in leucine (LEU), isoleucine (ILE), and valine (VAL) (branched-chain amino acids) dietary restriction and strict metabolic control. to determine the characteristics of the Chilean cohort with MSUD currently in follow-up at Instituto de Nutrición y Tecnología de los Alimentos, during the 1990-2017 period Retrospective analytical study in 45 MSUD cases. Read More

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A Cluster of Infections in Belgian Military Personnel after Deployment in Kindu, Democratic Republic of Congo: A Retrospective Study.

Trop Med Infect Dis 2021 Jul 8;6(3). Epub 2021 Jul 8.

Center for Infectious Diseases, Queen Astrid Military Hospital, 1120 Brussels, Belgium.

malaria is often neglected due to its less severe course compared to . In 2011-2012, Belgian Armed Forces identified a cluster of cases among military personnel after deployment in the Democratic Republic of Congo (DRC). In this retrospective, monocentric, observational study, clinical and biological features of soldiers diagnosed with after deployment in DRC were reviewed. Read More

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Type 2 diabetes in pediatrics.

Minerva Pediatr (Torino) 2021 Jul 21. Epub 2021 Jul 21.

Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy -

Type 2 diabetes (T2D) in adolescents has become an increasing health concern throughout the world and its prevention and screening should be implemented in pediatric care. As clinical features at presentation, in some cases can be similar to type 1 diabetes and family history can be in favour of a monogenic form of diabetes, it is pivotal for physicians to be aware of youth-onset T2D specificities to ensure an accurate diagnosis. The global increase of overweight and obesity can complicate the diagnostic process and makes it essential to apply a systematic approach to each new diagnosis. Read More

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Improving the efficiency and reducing variability in patient flow in an outpatient parenteral antibiotic therapy unit of a tertiary care hospital.

Future Healthc J 2021 Jul;8(2):e263-e266

Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.

Outpatient parenteral administration of medications and blood transfusions using an outpatient parenteral antibiotic therapy (OPAT) unit has gradually become a standard of care. We report a continuous quality improvement project that was conducted on an OPAT unit of a tertiary care cancer hospital in Lahore, Pakistan. Prior to the initiation of the project, it was identified that 52% of the patient encounters in the OPAT unit were being delayed by a median of 63. Read More

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Investigating Older Adults' Willingness to Invest Time to Acquire Technology Skills Using a Discounting Approach.

Innov Aging 2021 20;5(2):igab017. Epub 2021 May 20.

Center on Aging and Behavioral Research, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA.

Background And Objectives: Delay discounting is a common behavioral phenomenon that can influence decision making. A person with a higher discounting rate (DR) will have a stronger preference for smaller, more immediate rewards over larger, delayed rewards than will a person with a lower DR. This study used a novel approach to investigate, among a diverse sample of older adults, discounting of the time people were willing to invest to acquire technology skills across various technologies. Read More

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Characterizing the modern light environment and its influence on circadian rhythms.

Proc Biol Sci 2021 Jul 21;288(1955):20210721. Epub 2021 Jul 21.

Department of Biology, Emory University, Atlanta, GA, USA.

Humans have largely supplanted natural light cycles with a variety of electric light sources and schedules misaligned with day-night cycles. Circadian disruption has been linked to a number of disease processes, but the extent of circadian disruption among the population is unknown. In this study, we measured light exposure and wrist temperature among residents of an urban area during each of the four seasons, as well as light illuminance in nearby outdoor locations. Read More

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Timing of Nonculprit Percutaneous Coronary Intervention after ST-Elevation Myocardial Infarction.

Cardiology 2021 Jul 20:1-10. Epub 2021 Jul 20.

Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.

Introduction: Complete revascularization of ST-elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) has recently shown to reduce risk of adverse cardiovascular events, including cardiovascular death. Optimal timing of revascularization of nonculprit lesions remains controversial. We aimed to measure cardiac outcomes related to duration between primary percutaneous coronary intervention (pPCI) of the culprit lesion and staged PCI (sPCI) of nonculprit lesions. Read More

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COVID-19 Lockdown Effects on Acute Stroke Care in Latin America.

J Stroke Cerebrovasc Dis 2021 Jul 3;30(9):105985. Epub 2021 Jul 3.

Departamento de Neurología Vascular, Centro Integral de Neurología Vascular, Fleni, Ciudad Autónoma de Buenos Aires, Argentina.

Objectives: COVID-19 pandemic has forced important changes in health care worldwide. Stroke care networks have been affected, especially during peak periods. We assessed the impact of the pandemic and lockdowns in stroke admissions and care in Latin America. Read More

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Dynamical and static multisynchronization analysis for coupled multistable memristive neural networks with hybrid control.

Neural Netw 2021 Jul 9;143:515-524. Epub 2021 Jul 9.

Institute of Computational Intelligence, Czestochowa University of Technology, 42-200 Czestochowa, Poland; Information Technology Institute, Academy of Social Sciences, 90-113, Łódź, Poland.

This paper investigates the dynamical multisynchronization (DMS) and static multisynchronization (SMS) problems for a class of delayed coupled multistable memristive neural networks (DCMMNNs) via a novel hybrid controller which includes delayed impulsive control and state feedback control. Based on the state-space partition method and the geometrical properties of the activation function, each subnetwork has multiple locally exponential stable equilibrium states. By employing a new Halanay-type inequality and the impulsive control theory, some new linear matrix inequalities (LMIs)-based sufficient conditions are proposed. Read More

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Finite-Time Observer-Based Sliding-Mode Control for Markovian Jump Systems With Switching Chain: Average Dwell-Time Method.

IEEE Trans Cybern 2021 Jul 20;PP. Epub 2021 Jul 20.

In this article, the finite-time observer-based sliding-mode control (SMC) problem is considered for stochastic Markovian jump systems (MJSs) with a deterministic switching chain (DSC) subject to time-varying delay and packet losses (PLs). First, the stochastic MJSs with DSC are appropriately modeled and the PLs case is characterized by using some Bernoulli random variables. Then, a nonfragile finite-time bounded sliding-mode observer is designed. Read More

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General Purpose Low-Level Reinforcement Learning Control for Multi-Axis Rotor Aerial Vehicles.

Sensors (Basel) 2021 Jul 2;21(13). Epub 2021 Jul 2.

Department of Mechanical Engineering, National Yang Ming Chiao Tung University, Hsinchu City 30010, Taiwan.

This paper proposes a multipurpose reinforcement learning based low-level multirotor unmanned aerial vehicles control structure constructed using neural networks with model-free training. Other low-level reinforcement learning controllers developed in studies have only been applicable to a model-specific and physical-parameter-specific multirotor, and time-consuming training is required when switching to a different vehicle. We use a 6-degree-of-freedom dynamic model combining acceleration-based control from the policy neural network to overcome these problems. Read More

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A Novel Approach to the Job Shop Scheduling Problem Based on the Deep Q-Network in a Cooperative Multi-Access Edge Computing Ecosystem.

Sensors (Basel) 2021 Jul 2;21(13). Epub 2021 Jul 2.

Department of Smart Factory Convergence, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon 16419, Korea.

In this study, based on multi-access edge computing (MEC), we provided the possibility of cooperating manufacturing processes. We tried to solve the job shop scheduling problem by applying DQN (deep Q-network), a reinforcement learning model, to this method. Here, to alleviate the overload of computing resources, an efficient DQN was used for the experiments using transfer learning data. Read More

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Alpha-Fetoprotein- and CD40Ligand-Expressing Dendritic Cells for Immunotherapy of Hepatocellular Carcinoma.

Cancers (Basel) 2021 Jul 5;13(13). Epub 2021 Jul 5.

Department of Internal Medicine I, University Hospital of Bonn, 53127 Bonn, Germany.

Dendritic cells (DC) as professional antigen presenting cells are able to prime T-cells against the tumor-associated antigen α-fetoprotein (AFP) for immunotherapy of hepatocellular carcinoma (HCC). However, a strong immunosuppressive tumor environment limits their efficacy in patients. The co-stimulation with CD40Ligand (CD40L) is critical in the maturation of DC and T-cell priming. Read More

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Changes in Motor Behavior Predict Falls and Identify Acute Events.

West J Nurs Res 2021 Jul 20:1939459211031981. Epub 2021 Jul 20.

The University of Pennsylvania School of Nursing, Philadelphia, PA, USA.

This study aimed to examine how changes in motor behavior are associated with falls, delirium, and urinary tract infections (UTIs). Twenty-three (128 observations) skilled nursing residents were examined for up to 18 months. In multilevel models, motor behaviors (e. Read More

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Interleukin-6 as A Prognostic Biomarker in Perinatal Asphyxia.

Iran J Child Neurol 2021 ;15(3):119-130

Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Objective: Early diagnosis is has a crucial role in both prevention and treatment of asphyxia-related complications. The current study aimed to evaluate the prognostic value of interleukin-6 (IL-6) and hypoxic-ischemic encephalopathy grade in the prediction of mortality and the developmental status of neonates affected by prenatal asphyxia.

Materials & Methods: This cohort study was conducted on 38 term asphyxiated infants at Ghaem hospital, Mashhad, Iran, from 2013 to 2017. Read More

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January 2021

Pediatric Foreign Body Aspiration: Time of Occurrence and Factors Affecting Outcomes.

Pediatr Emerg Care 2021 Jul 20. Epub 2021 Jul 20.

From the University of California, San Diego School of Medicine, La Jolla, CA Department of Otolaryngology Head and Neck Surgery, University of California, San Diego, CA and Division of Pediatric Otolaryngology, Rady Children's Hospital, San Diego, CA.

Objectives: The goal of this study was to assess which factors could affect outcomes in pediatric patients undergoing bronchoscopy for foreign body aspiration (FBA).

Methods: This is a retrospective case series study evaluating patients who underwent bronchoscopies because of FBA at a tertiary pediatric hospital between January 1, 2010, and December 6. 2018. Read More

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