Background Evaluation of indeterminate biliary strictures typically involves collection and analysis of tissue or cells. Brush cytology and intraductal biopsies that are routinely performed during ...ERCP to assess malignant-appearing biliary strictures are limited by relatively low sensitivity. Objective To study the comparative effectiveness of brushings for cytology and intraductal biopsies in the etiology of biliary strictures. Design Meta-analysis. Setting Referral center. Patients PUBMED and Embase databases were reviewed for studies published to April 2014 where diagnostic correlation of histology was available. Intervention Database and review of study findings. Main Outcome Measurements Sensitivity and specificity. Results The pooled sensitivity and specificity of brushings for the diagnosis of malignant biliary strictures was 45% (95% confidence interval CI, 40%-50%) and 99% (95% CI, 98%-100%), respectively. The pooled diagnostic odds ratio to detect malignant biliary strictures was 33.43 (95% CI, 14.29-78.24). For intraductal biopsies, the pooled sensitivity and specificity were 48.1% (95% CI, 42.8%-53.4%) and 99.2% (95% CI, 97.6%-99.8%), respectively. The pooled diagnostic odds ratio to detect malignant biliary strictures was 43.18 (95% CI, 19.39-95.83). A combination of both modalities only modestly increased the sensitivity (59.4%; 95% CI, 53.7%-64.8%) with a specificity of 100% (95% CI, 98.8%-100.0%). The Begg-Mazumdar and Egger tests indicated a low potential for publication bias. Limitations Inclusion of low-quality studies. Conclusion Our study suggests that both brushings and biopsy are comparable and have limited sensitivity for the diagnosis of malignant biliary strictures. A combination of both only modestly increases the sensitivity.
Background: Adjustment for comorbidities is common in performance benchmarking and risk prediction. Despite the exponential upsurge in the number of articles citing or comparing Charlson, Elixhauser, ...and their variants, no systematic review has been conducted on studies comparing comorbidity measures in use with administrative data. We present a systematic review of these multiple comparison studies and introduce a new meta-analytical approach to identify the best performing comorbidity measures/indices for short-term (inpatient+≤30 d) and long-term (outpatient+≥30d) mortality. Methods: Articles up to March 18, 2011 were searched based on our predefined terms. The bibliography of the chosen articles and the relevant reviews were also searched and reviewed. Multiple comparisons between comorbidity measures/indices were split into all possible pairs. We used the hypergeometric test and confidence intervals for proportions to identify the comparators with significantly superior/inferior performance for short-term and longterm mortality. In addition, useful information such as the influence of lookback periods was extracted and reported. Results: Out of 1312 retrieved articles, 54 articles were eligible. The Deyo variant of Charlson was the most commonly referred comparator followed by the Elixhauser measure. Compared with baseline variables such as age and sex, comorbidity adjustment methods seem to better predict long-term than short-term mortality and Elixhauser seems to be the best predictor for this outcome. For short-term mortality, however, recalibration giving empirical weights seems more important than the choice of comorbidity measure. Conclusions: The performance of a given comorbidity measure depends on the patient group and outcome. In general, the Elixhauser index seems the best so far, particularly for mortality beyond 30 days, although several newer, more inclusive measures are promising.
5
′
,
5
′′
-dibromo-o-cresolsulfophthalein (BCP) films were deposited on glass, quartz, and n-Si substrates by using conventional thermal evaporation method. XRD studies showed that the BCP has a ...polycrystalline structure in powder form and a nanocrystalline structure in thin film form. The nanostructure character of BCP films is confirmed by using a high-resolution transmission electron microscope (HRTEM). Thermal stability and phase change were examined by means of thermogravimetric analysis (TGA) and the differential scanning calorimetry (DSC), respectively. Optical absorption studies of BCP films were done in the wavelength range 200-2500 nm. The films showed a direct optical energy gap of 1.89
eV
. Current versus voltage (
I
-
V
) characteristics of Au/BCP/n-Si/Al were studied in darkness and in illumination modes. The device shows photoinduced charge transfer and can be used as a photodiode.
Background and Aims Digital cholangioscopes provide higher-resolution imaging of the pancreatobiliary tract compared with fiberoptic instruments. The role of a new, digital, single-operator ...cholangiopancreatoscopy (SOC) system for diagnosis and treatment of pancreatobiliary disorders in clinical practice is not known. Methods We performed a multicenter, observational study of 105 consecutive patients with suspected pancreatobiliary disorders. The main outcome measures were (1) sensitivity and specificity of SOC visual appearance and biopsies in the diagnosis of indeterminate biliary strictures and (2) achieving complete duct clearance in patients with biliary or pancreatic duct stones. Results A total of 98 cholangioscopy and 7 pancreatoscopy procedures were performed in 105 patients. Superior views of the ductal lumen and mucosa were obtained in all 44 patients with indeterminate biliary strictures. Among the 44 patients who underwent SOC-guided biopsies, the specimen was adequate for histologic evaluation in 43 patients (97.7%). The sensitivity and specificity of SOC visual impression for diagnosis of malignancy was 90% (95% confidence interval CI, 69.9%-97.2%) and 95.8% (95% CI, 79.8%-99.3%), respectively. The sensitivity and specificity of SOC-guided biopsies for diagnosis of malignancy was 85% (95% CI, 64.0%-94.8%) and 100% (95% CI, 86.2%-100%). In patients with biliary or pancreatic duct stones (N = 36), complete duct clearance with stone removal in 1 session was accomplished in 86.1% of patients (31/36). Three patients (2.9%) experienced SOC-related adverse events that included cholangitis in 2 patients and postprocedure pancreatitis in 1 patient. Conclusions SOC has become an integral part of the ERCP armamentarium and has high accuracy in the evaluation of indeterminate biliary strictures. Complete stone clearance was achieved in all but 1 patient with challenging biliary or pancreatic duct stones. (Clinical trial registration number: NCT01815619 .)
Worldwide, maize (Zea mays L.) is considered an important food and fodder crop. Compost as a soil amendment and potassium (K) could enhance the maize yield. Therefore, two field experiments were ...carried out in the two seasons 2017 and 2018 to study the effects of compost at three levels and four forms of potassium fertilization on the yellow maize hybrid 'Pioneer SC 30N11' yield components. To conduct the field trials, a split plot system in three replications was established. Three compost levels (0, 5 and 10 ton/ha) were in the main plots, and four potassium forms (untreated, nano-potassium fertilizer, humic acid and potassium sulfate) were in the subplots. Plot size was 10.50 m
, with 5 ridges with 3 m length and 0.7 m width. The results indicated that the application of compost (as organic manure) and the potassium forms significantly affected the plant height, ear length, grains number/rows, grains number/ear, 100- grain weight, straw and biological yields, grain protein and K contents in both seasons. Increasing the compost from 5 to 10 ton/ha increased the yield, its components, protein and K contents. The foliar application of nano-potassium followed by humic acid increased all the studied characteristics. The interaction between compost manure (10 ton/ha) and nano-potassium (500 cm
/ha) or humic acid (10 ton/ha) recorded the highest mean values for all parameters during both harvest seasons.
Introduction
Healthcare services are primarily focusing on medical and physical treatment of COVID-19 while psychosocial and mental health needs are not considered a priority.
Objectives
The purpose ...of this study was to explore how recovered individuals with COVID-19 adapted to their psychological and social stressors during infection period.
Methods
A descriptive phenomenological approach conducted using a purposeful sample of 13 individuals recovered from COVID-19 in Jordan. Data collected using unstructured interviews.
Results
Perception of being diagnosed with COVID-19 revealed to three major themes; positive learning (acceptance, avoiding social pressure, and normalizing), tolerating ambiguity (denial and seeking information and guidance), and resilience (caring family, professionals’ support, self-grieving, optimism, positive thinking, and spirituality).
Conclusions
The study indicates that there is a need to integrate psychosocial and mental health care services into healthcare plans provided to individuals with COVID-19.
Disclosure
No significant relationships.
Introduction
Individuals confirmed with COVID-19 were isolated or treated in medical and well-designated units; however, such a situation probably causing psychological and mental health problems ...that require prompt intervention.
Objectives
The purpose of this study was to identify the knowledge and management of healthcare workers regarding psychosocial and mental health priorities and needs of individuals with COVID-19.
Methods
This is a cross-sectional descriptive study. The data collected conveniently at one single point in time from 101 healthcare workers in Jordan directly managing the health of individuals with COVID-19.
Results
healthcare workers have moderate to a high level of knowledge of psychological distress related to COVID-19; mean ranged from 50-70% agreement and confidence. Healthcare workers had moderate to a high level of management of psychosocial and mental health needs. In general, healthcare workers were able to identify mental and psychosocial health needs and priorities at a moderate level. Healthcare workers’ knowledge had a positive and significant correlation with age (r = .24, p = .012) and years of experience (r = .28, p =.004), and a significant difference was found in their management towards using mental and psychosocial care between those who are trained on psychological first aids and those who are not (t = - 3.11, p = .003).
Conclusions
there is a need to train healthcare workers to integrate psychosocial and mental health care while managing psychological distress related to COVID-19.
Disclosure
No significant relationships.
Neodymium-doped polyaniline supported Zn-Al layered double hydroxide (PANI@Nd-LDH) nanocomposite has been prepared via an ex-situ oxidative polymerization process. The as-prepared nanocomposite shows ...selective fluorescence detection and adsorption of hexavalent chromium Cr(VI) within a short period. The fluorescence intensity of PANI@Nd-LDH decreases linearly with Cr(VI) concentrations ranging from 200 ppb to 1000 ppb with a limit of detection (LOD) of 1.5 nM and a limit of quantification (LOQ) of 96 nM. The sensing mechanism can be ascribed by the inner filter effect of Cr(VI), the intercalation of Cr(VI) within the intergallery region of LDH, and the synergistic affinity of metal ions along with the polymer chain for Cr(VI). The adsorption performance of PANI@Nd-LDH nanocomposite is evaluated for Cr(VI) from wastewaters, which displayed high removal capacity towards Cr(VI) (219 mg/g) as compared on bare Nd-LDH (123 mg/g) and LDH (88 mg/g) respectively. The adsorption of Cr(VI) on PANI@Nd-LDH depends on the pH of the aqueous solution. The adsorption isotherm and kinetics are supported by the Langmuir model and pseudo-second-order model, respectively. Owing to the highly sensitive detection and adsorption of Cr(VI) from aqueous water samples demonstrated the potential application of PANI@Nd-LDH as an excellent environmental probe can be exploited.
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•PANI@Nd-LDH was synthesized and employed for selective detection and removal of Cr(VI) in water.•PANI@Nd-LDH shows excellent sensitivity for the detection of Cr(VI) at ppb level.•The high adsorption capacity for Cr(VI) (219 mg/g) is attributed to complexation and ionic interactions.•The detection of Cr(VI) is based on inner filter effect and ionic interactions.•PANI@Nd-LDH could possibly emerge as an excellent adsorbent as well as sensor for the removal of Cr(VI) from wastewater.
Background The most ominous adverse event of primary sclerosing cholangitis (PSC) is development of cholangiocarcinoma (CCA). There is a wide variation in the reported diagnostic yield of bile duct ...brush cytology in PSC strictures. Objective To determine the diagnostic utility of biliary brush cytology for CCA detection in patients with PSC. Design Meta-analysis. Systematic search of PubMed, EMBASE, Web of Science, and the Cochrane Library for relevant studies published up to December 2012. Setting Meta-analysis of diagnostic parameters. Patients A total of 747 patients in studies (both retrospective and prospective) in which histopathologic correlation of CCA was available. Intervention Meta-analysis. Construction of 2 × 2 contingency data. Main Outcome Measurements Sensitivity, specificity, likelihood ratio, and pooled diagnostic odds ratio. Results The search yielded 54 studies of which 11, involving 747 patients, were included in our meta-analysis. The pooled sensitivity and specificity of bile duct brushings for a diagnosis of CCA in patients with PSC were 43% (95% confidence interval CI, 35%-52%) and 97% (95% CI, 95%-98%), respectively. The pooled diagnostic odds ratio to detect CCA was 20.23 (95% CI, 8.75-46.79). The heterogeneity indices of χ2 statistics, I2 measure of inconsistency, and the Cochran Q test were 0.156, 14.4, and 30.5%, respectively. Visual inspection of the funnel plot showed low potential for publication bias. Limitations Inclusion of low-quality studies, study heterogeneity. Conclusion Our study suggests that bile duct brushing is a simple and highly specific technique for detection of CCA in patients with PSC. However, the modest sensitivity from bile duct brushing precludes its utility as a diagnostic tool for early detection of CCA in patients with PSC.
Abstract
Perovskite oxide materials, specifically MgTiO
3
(MT) and Li-doped MgTiO
3
(MTxLi), were synthesized via a sol–gel method and calcination at 800 °C. This study explores the impact of varying ...Li doping levels (x = 0, 0.01, 0.05, and 0.1) on the crystalline structure and properties of MgTiO
3
. X-ray diffraction analysis revealed a well-defined rhombohedral MgTiO
3
phase. Optical diffuse reflectance measurements provided insights into energy gap values, refractive index, and dielectric constant. Li
+
doping enhanced the electrical properties of MgTiO
3
, with a notable phase transition observed at 50 °C. The study investigated impedance and AC conductivity under varying temperature and frequency conditions (25–120 °C, 4 Hz to 8 MHz). Electrochemical analysis through cyclic voltammetry and electrochemical impedance spectroscopy confirmed highly electrocatalytic properties for MTxLi, particularly when modified onto screen-printed electrodes. This work not only advances the understanding of Li-doped MgTiO
3
nanostructures but also highlights their significant potential for direct electrochemical applications, particularly in the realm of energy storage.
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