Primary care of patients with sexually transmitted diseases or genitourinary symptoms in Hong Kong

Objectives. To determine the adequacy of care received from general practitioners by patients with sexually transmitted diseases or genitourinary symptoms. Design. Prospective study. Setting. Hong Kong. Participants. Diagnoses and drug data obtained from logbooks submitted by doctors studying for the Diploma in Family Medicine and candidates for Fellowship examinations between 1999 and 2002. Main outcome measures. Diagnosis or symptom of a sexually transmitted disease and prescribed treatment. Results. Sexually transmitted diseases and genitourinary symptoms accounted for 1.1% of the workload of these community doctors in Hong Kong. The majority of patients were young adult males. The overall standard of treatment was inadequate: both multi-pharmacy and inappropriate treatment was common; in up to 30% of cases, doctors ignored local or international guidelines. Conclusion. Primary care doctors play an important role in the diagnosis and management of sexually transmitted diseases or genitourinary symptoms in Hong Kong. A high index of suspicion should be maintained and continuing education made available if doctors are to provide an equally high standard of care.published_or_final_versio

The impact of landscape sparsification on modelling and analysis of the invasion process

Climate change is a major threat to species, unless their populations are able to invade and colonise new landscapes of more suitable environment. In this paper, we propose a new model of the invasion process using a tool of landscape network sparsification to efficiently estimate a duration of the process. More specifically, we aim to simplify the structure of large landscapes using the concept of sparsification in order to substantially decrease the time required to compute a good estimate of the invasion time in these landscapes. For this purpose, two different simulation methods have been compared: full and R-local simulations, which are based on the concept of dense and sparse networks, respectively. These two methods are applied to real heterogeneous landscapes in the United Kingdom to compute the total estimated time to invade landscapes. We examine how the duration of the invasion process is affected by different factors, such as dispersal coefficient, landscape quality and landscape size. Extensive evaluations have been carried out, showing that the R-local method approximates the duration of the invasion process to high accuracy using a substantially reduced computation time

Frontline Maintenance Treatment for Ovarian Cancer

PURPOSE OF REVIEW: Advanced epithelial ovarian cancer remains the most lethal gynaecological cancer. Most patients with advanced disease will relapse within 3 years after primary treatment with surgery and chemotherapy. Recurrences become increasing difficult to treat due to the emergence of drug resistance and 5-year survival has changed little over the last decade. Maintenance treatment, here defined as treatment given beyond primary chemotherapy, can both consolidate the response and prolong the control of disease which is an approach to improve survival. RECENT FINDINGS: Here we review maintenance strategies such as targeting angiogenesis, interference of DNA repair through inhibition of PARP, combinations of targeting agents, and immunotherapy and hormonal therapy. Much has been learnt from the success and challenges of these treatments that have in the last few years which led to significant reduction in disease recurrence, changed the guidelines for treatment, and established a new paradigm for the treatment of ovarian cancer

Energy Efficiency Optimization for Mutual-Coupling-Aware Wireless Communication System based on RIS-enhanced SWIPT

The widespread deployment of the Internet of Things (IoT) is promoting interest in simultaneous wireless information and power transfer (SWIPT), the performance of which can be further improved by employing a reconfigurable intelligent surface (RIS). In this paper, we propose a novel RIS-enhanced SWIPT system built on an electromagnetic-compliant framework. The mutual-coupling effects in the whole system are presented explicitly. Moreover, the reconfigurability of RIS is no longer expressed by the reflection-coefficient matrix but by the impedances of the tunable circuit. For comparison, both the no-coupling and the coupling-awareness cases are discussed. In particular, the energy efficiency (EE) is maximized by cooperatively optimizing the impedance parameters of the RIS elements as well as the active beamforming vectors at the base station (BS). For the coupling-awareness case, the considered problem is split into several sub-problems and solved alternatively due to its nonconvexity. Firstly, it is transformed into a more solvable form by applying the Neuman series approximation, which can be resolved iteratively. Then an alternative optimization (AO) framework and semi-definite relaxation (SDR), successive convex approximation (SCA), and Dinkelbach’s algorithm are applied to solve each sub-problem decomposed from it. Owning to the similarity between the two cases, the no-coupling one can be viewed as a reduced form of the coupling case and thus solved through a similar approach. Numerical results reveal the influence of mutual-coupling effects on the EE, especially in the RIS with closely spaced elements. In addition, physical beam designs are presented to demonstrate how the RIS assists SWIPT through various reflecting states in different conditions

Consumption of oral antibiotic formulations for young children according to the WHO Access, Watch, Reserve (AWaRe) antibiotic groups: an analysis of sales data from 70 middle-income and high-income countries

Background The 2017 WHO Model List of Essential Medicines for Children (EMLc) groups antibiotics as Access, Watch, or Reserve, based on recommendations of their use as first-choice and second-choice empirical treatment for the most common infections. This grouping provides an opportunity to review country-level antibiotic consumption and a potential for stewardship. Therefore, we aimed to review 2015 levels of oral antibiotic consumption by young children globally. Methods We analysed wholesale antibiotic sales in 70 middle-income and high-income countries in 2015. We identified oral antibiotic formulations appropriate for use in young children (defined as child-appropriate formulations [CAFs]) using wholesale data from the IQVIA-Multinational Integrated Data Analysis System database, and we estimated 2015 antibiotic consumption in reference to the 2017 WHO EMLc Access, Watch, Reserve (AWaRe) antibiotic groups. We used three metrics for assessment of intra-country patterns: access percentage, defined as the number of CAF standard units of Access antibiotics divided by the total number of CAF standard units; amoxicillin index, defined as the number of amoxicillin CAF standard units divided by the total number of CAF standard units; and access-to-watch index, defined as the ratio of Access-to-Watch CAF standard units. Findings The overall median volume of CAF antibiotic standard units sold in 2015 per country was 74·5 million (IQR 12·4–210·7 million). The median access percentage among the 70 countries was 76·3% (IQR 62·6–84·2). The amoxicillin index was low (median 30·7%, IQR 14·3–47·3). The median access-to-watch index was 6·0 (IQR 3·1–9·8). CAF antibiotic consumption patterns were highly variable between the 70 countries, without a clear difference between high-income and middle-income countries. Interpretation Antibiotics in the Access group have a key role in treating young children globally. A simple combination of metrics based on the AWaRe groups can be informative on individual countries' patterns of antibiotic consumption and stewardship opportunities. These metrics could support countries in the development of programmes to improve access to core Access antibiotics, particularly amoxicillin. Funding Global Antibiotic R&D Partnership (German Federal Ministry of Health, Médecins Sans Frontières, Netherlands Ministry of Health, Welfare and Sport, and UK Department for International Development)

Medical teachers’ experience of emergency remote teaching during the COVID-19 pandemic: a cross-institutional study

Background: The COVID-19 pandemic and the consequent social distancing measures caused unprecedented disruption for medical and healthcare education. This study examined medical teachers’ experience with emergency remote teaching during the pandemic and their acceptance of online teaching after the pandemic. Methods: In this sequential mixed methods study, online surveys were disseminated to teachers (n = 139) at two Asia–Pacific medical schools to evaluate their experience with emergency remote teaching during the pandemic. Subsequently, in-depth interviews were conducted with teachers from both institutions (n = 13). Each interviewee was classified into an adopter category based on Rogers’ Diffusion of Innovations Theory. Interview transcripts were analyzed thematically, and the descriptive themes were mapped to broader themes partly based on the Technology Acceptance Model and these included: (i) perceived usefulness of online teaching, (ii) perceived ease of delivering online teaching, (iii) experience with institutional support and (iv) acceptance of online teaching after the pandemic. Results: Our participants described accounts of successes with their emergency remote teaching and difficulties they experienced. In general, most participants found it difficult to deliver clinical skills teaching remotely and manage large groups of students in synchronous online classes. With regards to institutional support, teachers with lower technological literacy required just-in-time technical support, while teachers who were innovative in their online teaching practices found that IT support alone could not fully address their needs. It was also found that teachers’ acceptance of online teaching after the pandemic was influenced by their belief about the usefulness of online teaching. Conclusions: This study demonstrated that our participants managed to adapt to emergency remote teaching during this pandemic, and it also identified a myriad of drivers and blockers to online teaching adoption for medical teachers. It highlights the need for institutes to better support their teaching staff with diverse needs in their online teaching

Development of a single-visit protocol for the management of pregnancy of unknown location following in vitro fertilization: a retrospective study

STUDY QUESTION: Can women with pregnancy of unknown location (PUL) following in vitro fertilization (IVF) be risk-stratified regarding the subsequent need for medical intervention, based on their demographic characteristics and the results of serum biochemistry at the initial visit? SUMMARY ANSWER: The ratio of serum hCG to number of days from conception (hCG/C) or the initial serum hCG level at ≥5 weeks' gestation could be used to estimate the risk of women presenting with PUL following IVF and needing medical intervention during their follow-up. WHAT IS KNOWN ALREADY: In women with uncertain conception dates presenting with PUL, a single serum hCG measurement cannot be used to predict the final pregnancy outcomes, thus, serial levels are mandatory to establish a correct diagnosis. Serum progesterone levels can help to risk-stratify women at their initial visit but are not accurate in those taking progesterone supplementation, such as women pregnant following IVF. STUDY DESIGN, SIZE, DURATION: This was a retrospective study carried out at two specialist early pregnancy assessment units between May 2008 and January 2021. A total of 224 women met the criteria for inclusion, but 14 women did not complete the follow-up and were excluded from the study. PARTICIPANTS/MATERIALS, SETTING, METHODS: We selected women who had an IVF pregnancy and presented with PUL at ≥5 weeks' gestation. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 30/210 (14.0%, 95% CI 9.9-19.8) women initially diagnosed with PUL required surgical intervention. The hCG/C was significantly higher in the group of women requiring an intervention compared to those who did not (P = 0.003), with an odds ratio of 3.65 (95% CI 1.49-8.89, P = 0.004). A hCG/C  0.05). LIMITATIONS, REASONS FOR CAUTION: A limitation of our study is that it is retrospective in nature, and as such, we were reliant on existing data. WIDER IMPLICATIONS OF THE FINDINGS: A previous study in women with PUL after spontaneous conception found that a 2% intervention rate was considered low enough to eliminate the need for close follow-up and serial blood tests. Using the same 2% cut-off, a quarter of women with PUL after IVF could also avoid attending for further visits and investigations. STUDY FUNDING/COMPETING INTEREST(S): No external funding was required for this study. No conflicts of interest are required to be declared. TRIAL REGISTRATION NUMBER: N/A

Estimating global trends in total and childhood antibiotic consumption, 2011-2015

Introduction Understanding patterns of antibiotic consumption is essential to ensure access to appropriate antibiotics when needed and to minimise overuse, which can lead to antibiotic resistance. We aimed to describe changes in global antibiotic consumption between 2011 and 2015. Methods We analysed wholesale data on total antibiotic sales and antibiotics sold as child-appropriate formulations (CAFs), stratified by country income level (low/middle-income and high-income countries (LMICs and HICs)). The volume of antibiotics sold per year was recorded for 36 LMICs and 39 HICs, measured in standard units (SU: 1 SU is equivalent to a single tablet, capsule or 5 mL ampoule/vial/oral suspension) and SU per person, overall and as CAFs. Changes over time were quantified as percentage changes and compound annual growth rates in consumption per person. Analyses were conducted separately for total sales, sales of antibiotics in the Access and Watch groups of the WHO’s Essential Medicines List for children 2017, for amoxicillin and amoxicillin with clavulanic acid. Results Antibiotic consumption increased slightly between 2011 and 2015, from 6.85×1010 SU to 7.44×1010 SU overall and from 1.66×1010 SU to 1.78×1010 SU for CAFs. However, trends differed between countries and for specific antibiotics; for example, consumption of amoxicillin as CAFs changed little in LMICs and HICs, but that of amoxicillin with clavulanic acid increased by 6.8% per year in LMICs and decreased by 1.0% per year in HICs. Conclusions As measured in standard units in sales data, the rate of increase in global antibiotic consumption may be slowing. However, the trends appear to differ between countries and drugs. In the absence of routine surveillance of antibiotic use in many countries, these data provide important indicators of trends in consumption which should be confirmed in national and local studies of prescribing

Energy Minimization in D2D-Assisted Cache-Enabled Internet of Things: A Deep Reinforcement Learning Approach

Mobile edge caching (MEC) and device-to-device (D2D) communications are two potential technologies to resolve traffic overload problems in the Internet of Things. Previous works usually investigate them separately with MEC for traffic offloading and D2D for information transmission. In this article, a joint framework consisting of MEC and cache-enabled D2D communications is proposed to minimize the energy cost of systematic traffic transmission, where file popularity and user preference are the critical criteria for small base stations (SBSs) and user devices, respectively. Under this framework, we propose a novel caching strategy, where the Markov decision process is applied to model the requesting behaviors. A novel scheme based on reinforcement learning (RL) is proposed to reveal the popularity of files as well as users' preference. In particular, a Q-learning algorithm and a deep Q-network algorithm are, respectively, applied to user devices and the SBS due to different complexities of status. To save the energy cost of systematic traffic transmission, users acquire partial traffic through D2D communications based on the cached contents and user distribution. Taking the memory limits, D2D available files, and status changing into consideration, the proposed RL algorithm enables user devices and the SBS to prefetch the optimal files while learning, which can reduce the energy cost significantly. Simulation results demonstrate the superior energy saving performance of the proposed RL-based algorithm over other existing methods under various conditions