Wait times in hip and knee replacement: single-entry model and prioritization

The single-entry model (SEM) in healthcare consolidates waiting lists through a single point-of-entry and patients can see the next available surgeon from a pooled available provider based on the patient’s urgent levels. Prioritization is used to ensure that patients with higher urgent levels may access care quickly. The SEM for hip and knee replacement surgery in the Eastern Health region of Newfoundland and Labrador showed a reduction in wait times for consultation by priority levels. Little is known about the improvement in wait times for surgery and the chance of receiving consultation and surgery within the national benchmarks by priority levels. This study aimed to examine the SEM’s role in timely access to orthopedic services and evaluate an association between factors and receiving consultation and surgery within the national benchmarks through the SEM. Survival analysis was conducted to estimate wait times, examine factors impacting wait times for hip and knee replacement. The data used were adult patients referred to the Orthopedic Central Intake clinic in the Eastern Health region for a total hip or knee arthroplasty assessment between 2011-2019. Logistic regression analysis was used to explore the association between these factors and the receiving consultation and surgery within benchmarks. The study revealed that hip or knee replacement patients with high urgent had more likely to see an orthopedic surgeon for consultation than those with low urgent. Hip or knee replacement patients with priority 1 were more likely to have a consultation within 90 days than their counterparts. Priority levels were not significantly related to the likelihood of having surgery since the decision to surgery was made for both hip and knee. The likelihood of receiving a knee replacement surgery within 182 days was nonsignificant among patients with priority 1, priority 2, and priority 3, while hip replacement patients with priority 3 were more likely to have surgery within 182 days than those with a high priority level. Choosing the next available surgeon shortened wait times for consultation and improved the likelihood of receiving consultation within 90 days. However, this choice was less likely to have surgery within 182 days than choosing a specific surgeon. Incomplete initial referral forms prolonged wait times for consultation but insignificantly impacted the probability of having consultation within 90 days. Patients with knee osteoarthritis were less likely to have consultations within 90 days than patients with other arthritis disorders. This study explored the timely improvement of access to consultation for hip and knee replacement by priority levels and factors impacting wait times through the SEM. An association between wait time for surgery and priority levels was not found in this study, whereas hip replacement patients with low priority were more likely to receive surgery within the benchmark of 182 days than those with high priority. Further studies are needed to investigate this

Evaluation of factors related to entrepreneurial intentions among young pharmacists in the Mekong Delta region: a cross - sectional study in Vietnam

At present, a new wave of entrepreneurship has emerged and made a significant impact in Vietnam despite challenges. The study aims to assess the factors related to the entrepreneurial intentions of young pharmacists in 2023 in the Mekong Delta region. A cross-sectional descriptive method was conducted, involving interviews with 815 young pharmacists living in the Mekong Delta region, via a pre-designed research questionnaire. Results showed that 6 out of 43 variables were eliminated after Cronbach’s alpha was run. The Kaiser-Meyer-Olkin coefficient (0.5–0.923) indicated statistical significance and suitable conditions for Exploratory Factor Analysis. Confirmatory Factor Analysis and Structural Equation Modeling results were consistent with market data. With the impact of difficulties, attitude, perception of behavioral control, subjective norms, achievement needs on knowledge, and knowledge on entrepreneurial intentions (p < 0.05). In conclusion, the study successfully collected samples and gained a deeper understanding of the factors influencing the entrepreneurial intentions of young pharmacists

Sex discrimination based on morphological traits in Mystus mysticetus Roberts, 1992

This study supplemented the way of sex determination of fish based on the regression relationship of some morphological indicators of Mystus mysticetus. A total of 425 fish specimens were collected by trawl nets at Cai Rang - Can Tho and Long Phu - Soc Trang from January to July 2022. After collection, the fish were transferred to the laboratory to determine their total length (TL), standard length (SL), eye diameter (ED), eye distance (DE), body height (BD), head length (HL), and mouth width (MD) before anatomy for sex determination based on gonads. The regression analysis results of TL-SL, TL-ED, TL-DE, TL-BD, TL-HL, and TL-MD showed that SL, DE, and MD could be used to determine the sex of this fish species because SL and DE were dominant in growth in males, and MD was prevalent in females. In addition, SL could be used to determine the sampling time and HL to determine the distribution environment

Giant compound odontoma of the mandible in an adolescent

Abstract Odontomas are one type of benign odontogenic hamartoma that includes the compound and complex odontoma. They are generally reported not to exceed 3 cm in diameter. Odontomas with a diameter exceeding 3 cm are considered giant odontomas. An accurate diagnosis of odontomas cannot be made during the clinical examination. The majority of compound odontoma is diagnosed most commonly during radiographic screening. It should be done in coordination with a histological examination after surgical treatment. We report a case of giant compound odontoma of the mandible in a young boy. The tumor is treated by surgical excision under general anesthesia

Morphometrics allometry changes and sexual dimorphism in Caragobius urolepis (Gobiiformes: Gobiidae)

The present study reported an alternative way of sex-determining for scaleless worm goby Caragobius urolepis based on the regression relationship of some morphological parameters. A total of 328 samples were collected at the trawl nets in two coastal regions in Bac Lieu and Ca Mau from April to August 2022. After collection, the samples were transported to the laboratory in order to measure the total length (TL), body height (BD), head length (HL), the distance of eye (DE), and mouth width (MD) before surgery for accurate sex determination based on gonads. Regression analysis results of TL-BD (growth pattern A+ in females and I in males), TL-HL (growth pattern A+ in females and A- in males), and TL- MD (growth pattern A- in females and A+ in males) could be used to determine the sex of this fish. Moreover, TL-DE and TL-BD could be used to estimate when the samples were collected, e.g , in the dry or wet season, because DE and BD displayed A+ in the wet season but A- in the dry one. The findings could be used as an alternative way to determine fish sex and catching season for this species and others in the Mekong Delta

Reduced Need of Infiltration Anesthesia Accompanied With Other Positive Outcomes in Diode Laser Application for Frenectomy in Children

Introduction: The abnormal maxillary labial frenum is common in children during the primary or mixed dentition stage. A conventional surgery for this abnormality usually requires infiltration anesthesia which leads to fear in children and consequent noncooperation during the surgery. The aim of present study was to evaluate the reduction in the need of infiltration anesthesia, intraoperative bleeding control and postoperative pain and wound healing in children when using the diode laser for abnormal labial frenum in the maxilla.Methods: The present study was carried out among 30 children attending the Hanoi Medical University, Vietnam. A Diode Laser with 810 nm wavelength and power of 0.8 W was used for frenectomy.Results: The proportion of procedures without any need of infiltration anesthesia was 70%, while 93.34% of children demonstrated positive and very positive behavior. Proportion of indolence on the first day after surgery was 83.3%. While 83.3% of children did not take any analgesics, not a single child complained of any pain 3 days after surgery.Conclusion: Our results indicated that the use of diode laser showed several benefits in maxillary labial frenectomy in children. These included reducing the need of infiltration anesthesia, increasing the children’s cooperation as well as decreasing the postoperative pain

Evaluation of Xpert MTB/RIF and MODS assay for the diagnosis of pediatric tuberculosis

BACKGROUND: Tuberculosis (TB) in children is rarely confirmed due to the lack of effective diagnostic tools; only 10 to 15% of pediatric TB is smear positive due to paucibacillary samples and the difficulty of obtaining high-quality specimens from children. We evaluate here the accuracy of Xpert MTB/RIF in comparison with the Micoroscopic observation drug susceptibility (MODS) assay for diagnosis of TB in children using samples stored during a previously reported evaluation of the MODS assay. METHODS: Ninety-six eligible children presenting with suspected TB were recruited consecutively at Pham Ngoc Thach Hospital in Ho Chi Minh City Viet Nam between May to December 2008 and tested by Ziehl-Neelsen smear, MODS and Mycobacterial growth Indicator (MGIT, Becton Dickinson) culture. All samples sent by the treating clinician for testing were included in the analysis. An aliquot of processed sample deposit was stored at −20°C and tested in the present study by Xpert MTB/RIF test. 183 samples from 73 children were available for analysis by Xpert. Accuracy measures of MODS and Xpert were summarized. RESULTS: The sensitivity (%) in detecting children with a clinical diagnosis of TB for smear, MODS and Xpert were 37.9 [95% CI 25.5; 51.6], 51.7 [38.2; 65.0] and 50.0 [36.6; 63.4], respectively (per patient analysis). Xpert was significantly more sensitive than smear (P=0.046). Testing of additional samples did not increase case detection for MODS while testing of a second sputum sample by Xpert detected only two additional cases. The positive and negative predictive values (%) of Xpert were 100.0 [88.0; 100.0] and 34.1 [20.5; 49.9], respectively, while those of MODS were 96.8 [83.3; 99.9] and 33.3 [19.6; 49.5]. CONCLUSION: MODS culture and Xpert MTB/RIF test have similar sensitivities for the detection of pediatric TB. Xpert MTB RIF is able to detect tuberculosis and rifampicin resistance within two hours. MODS allows isolation of cultures for further drug susceptibility testing but requires approximately one week to become positive. Testing of multiple samples by xpert detected only two additional cases and the benefits must be considered against costs in each setting. Further research is required to evaluate the optimal integration of Xpert into pediatric testing algorithms

Synthesis and Characterization of Silver Nanoplates by a Seed-mediated Method

Silver nanoplates (SNPs) having different size were synthesized by a seed-mediated method. The seeds -silver nanoparticles with 4 – 6 nm diameters were synthesized first by reducing silver nitrate with sodium borohydride in the present of Trisodium Citrate and Hydrogen peroxide. Then these seeds were developed by continue reducing Ag$^+$ ions with various amount of L-Ascorbic acid to form SNPs. Our analysis showed that the concentratrion of L-Ascorbic acid, a secondary reducing agent, played an important role to form SNPs. In addition, the size and in-plane dipole plasmon resonance wavelenght of silver nanoplates were increased when the concentration of added silver nitrate increased. The characterization of SNPs were studied by UV-Vis, FE-SEM, EDS and TEM methods

Efficacy of a high potency O1 Manisa monovalent vaccine against heterologous challenge with a FMDV O Mya98 lineage virus in pigs 4 and 7 days post vaccination

Early protection with a high potency (>6PD50) foot-and-mouth disease (FMD) O1 Manisa (Middle-EastSouth Asia lineage) vaccine against challenge with O/VIT/2010 (O Mya98 lineage) was tested in pigs. Only two pigs that were vaccinated seven days prior to challenge had any demonstrable antibodies as a result of vaccination at the time of challenge. However, 80% and 60% of pigs that were vaccinated seven and four days prior to coronary band challenge were protected. Vaccination significantly reduced the amount of virus excreted in nasal swabs, saliva and faeces compared to unvaccinated and infected controls. Virus and viral RNA could be detected in some pigs until termination of the experiment 14 days after challenge.Antibodies to the non-structural proteins (NSP) were detected in only one pig that was challenged four days post vaccination (dpv) and transiently in two pigs that were challenged seven dpv at only one timepoint. For each vaccine and control group, a group of unvaccinated pigs were kept in the same room but with no direct contact with the infected pigs to determine whether vaccination prevented transmission. Despite the presence of live virus and viral RNA in these indirect contact pigs, the groups in contact with the vaccinated and infected pigs did not develop clinical signs nor did they sero-convert. Contact pigs in the same room as unvaccinated challenged controls did show signs of disease and virus infection that resulted in sero-conversion to the NSP. A breach of the wall that separated the two groups at nine days post challenge might have contributed to this finding. This study showed that high potency vaccine can provide protection to pigs soon after vaccination and that aerosol transmission within rooms is a rare event.Funding was provided in part by the livestock industries in Australia through Animal Health Australia. The AHA funds are matched through the Meat and Livestock Australia Donor Company by the Australian Government under MLA Project P.PSH 0652.http://www.elsevier.com/locate/vaccinehb201

Prognostic Values of Serum Lactate-to-Bicarbonate Ratio and Lactate for Predicting 28-Day IN-Hospital Mortality in Children With Dengue Shock Syndrome

This study aimed to assess the clinical utility of blood lactate-to-bicarbonate (L/B) ratio, as a prognostic factor for 28-day in-hospital mortality in children with dengue shock syndrome (DSS), admitted to the pediatric intensive care unit (PICU). This single-center retrospective study was conducted at a tertiary children hospital in southern Vietnam from 2013 to mid-2022. Prognostic models for DSS mortality were developed, using a predefined set of covariates in the first 24 hours of PICU admission. Area under the curves (AUCs), multivariable logistic and Least Absolute Shrinkage and Selection Operator (LASSO) regressions, bootstrapping and calibration slope were performed. A total of 492 children with DSS and complete clinical and biomarker data were included in the analysis, and 26 (5.3%) patients died. The predictive values for DSS mortality, regarding lactate showing AUC 0.876 (95% CI, 0.807-0.944), and that of L/B ratio 0.867 (95% CI, 0.80-0.934) (P values of both biomarkers \u3c .001). The optimal cutoff point of the L/B ratio was 0.25, while that of lactate was 4.2 mmol/L. The multivariable model showed significant clinical predictors of DSS fatality including severe bleeding, cumulative amount of fluid infused and vasoactive-inotropic score (\u3e30) in the first 24 hours of PICU admission. Combined with the identified clinical predictors, the L/B ratio yielded higher prognostic values (odds ratio [OR] = 8.66, 95% confidence interval [CI], 1.96-38.3; P \u3c .01) than the lactate-based model (OR = 1.35, 95% CI, 1.15-1.58; P \u3c .001). Both the L/B and lactate models showed similarly good performances. Considering that the L/B ratio has a better prognostic value than the lactate model, it may be considered a potential prognostic biomarker in clinical use for predicting 28-day mortality in PICU-admitted children with DSS