Background: Health challenges that are difficult to manage at primary health centres should be referred to secondary health facilities, and if untreated, to the tertiary hospitals. A good referral should include the p...Background: Health challenges that are difficult to manage at primary health centres should be referred to secondary health facilities, and if untreated, to the tertiary hospitals. A good referral should include the patient’s biography, such as age, gender, tribe, religion, occupation, medical history, the reason for the referral, treatments received, and clinical diagnosis. Objectives: To evaluate the referral patterns, indications for referrals, and feto-maternal outcomes for obstetric patients who were referred to the University of Port Harcourt Teaching Hospital. Materials and Methods: A prospective study of patients admitted to the Obstetric unit from January 1, 2021, to December 31, 2022. Data was collected from patients while on admission or clinic visits and recorded in an excel spread sheet. Data was analyzed with the Statistical Package for Social Sciences (SPSS) version 25. Results: Of the 3469 patients were admitted to the obstetric unit, 1476 and 1993 were admitted in 2021 and 2022, respectively. Most (70.35%) of the patients were in the 20-34 years age group, parity 1-4 was the most frequent (66.49%), while 85.39% of patients were booked. 10.46% of the booked patients were referred from other facilities, whereas 89.54% of patients were booked at our facility from the onset. Most common indications of referrals were previous caesarean section (CS) at term (40.09%) and hypertensive disorders of pregnancy (17.59%). The outcome for 2021 indicated 17 maternal deaths, 132 fetal deaths and 1010 live births, giving maternal mortality ratio (MMR) as 1810.44 per 100,000 live births and perinatal mortality ratio (PMR) of 130.7 per 1000 births respectively. In 2022, there were 17 maternal deaths, 130 fetal deaths and 1297 deliveries, giving a MMR of 1399 per 100,000 live births and a PMR of 100.2 per 1000 births. Conclusion: The pattern of referral among obstetric patients in this study shows that a lot of the patients do not get adequate care at the lower cadre of the referral system, hence adequate facilities should be made available in primary and secondary health centres to tackle obstetric emergencies.展开更多
This article proposes and demonstrates a retrodirective array(RDA)for two-way wireless communication with automatic beam tracking.The proposed RDA is enabled by specifically designed chips made using a domestic comple...This article proposes and demonstrates a retrodirective array(RDA)for two-way wireless communication with automatic beam tracking.The proposed RDA is enabled by specifically designed chips made using a domestic complementary metal-oxide semiconductor(CMOS)process.The highly integrated CMOS chip includes a receiving(Rx)chain,a transmitting(Tx)chain,and a unique tracking phaselocked loop(PLL)for the crucial conjugated phase recovery in the RDA.This article also proposes a method to reduce the beam pointing error(BPE)in a conventional RDA.To validate the above ideas simply yet without loss of generality,a 2.4 GHz RDA is demonstrated through two-way communication links between the Rx and Tx chains,and an on-chip quadrature coupler is designed to achieve a nonretrodirective signal suppression of 23 dBc.The experimental results demonstrate that the proposed RDA,which incorporates domestically manufactured low-cost 0.18 lm CMOS chips,is capable of automatically tracking beams covering±40with a reduced BPE.Each CMOS chip in the RDA has a compact size of 4.62 mm^(2) and a low power consumption of 0.15 W.To the best of the authors’knowledge,this is the first research to demonstrate an RDA with a fully customized CMOS chip for wireless communication with automatic beam tracking。展开更多
The data post-processing scheme based on two-way classical communication(TWCC)can improve the tolerable bit error rate and extend the maximal transmission distance when used in a quantum key distribution(QKD)system.In...The data post-processing scheme based on two-way classical communication(TWCC)can improve the tolerable bit error rate and extend the maximal transmission distance when used in a quantum key distribution(QKD)system.In this study,we apply the TWCC method to improve the performance of reference-frame-independent quantum key distribution(RFI-QKD),and analyze the influence of the TWCC method on the performance of decoy-state RFI-QKD in both asymptotic and non-asymptotic cases.Our numerical simulation results show that the TWCC method is able to extend the maximal transmission distance from 175 km to 198 km and improve the tolerable bit error rate from 10.48%to 16.75%.At the same time,the performance of RFI-QKD in terms of the secret key rate and maximum transmission distance are still greatly improved when statistical fluctuations are considered.We conclude that RFI-QKD with the TWCC method is of practical interest.展开更多
In this paper,an intelligent reflecting surface(IRS)-and-unmanned aerial vehicle(UAV)-assisted two-way amplify-and-forward(AF)relay network in maritime Internet of Things(IoT)is proposed,where ship1(S1)and ship2(S2)ca...In this paper,an intelligent reflecting surface(IRS)-and-unmanned aerial vehicle(UAV)-assisted two-way amplify-and-forward(AF)relay network in maritime Internet of Things(IoT)is proposed,where ship1(S1)and ship2(S2)can be viewed as data collecting centers.To enhance the message exchange rate between S1 and S2,a problem of maximizing minimum rate is cast,where the variables,namely AF relay beamforming matrix and IRS phase shifts of two time slots,need to be optimized.To achieve a maximum rate,a low-complexity alternately iterative(AI)scheme based on zero forcing and successive convex approximation(LC-ZF-SCA)algorithm is presented.To obtain a significant rate enhancement,a high-performance AI method based on one step,semidefinite programming and penalty SCA(ONSSDP-PSCA)is proposed.Simulation results show that by the proposed LC-ZF-SCA and ONS-SDP-PSCA methods,the rate of the IRS-and-UAV-assisted AF relay network surpass those of with random phase and only AF relay networks.Moreover,ONS-SDP-PSCA perform better than LC-ZF-SCA in aspect of rate.展开更多
BACKGROUND Few studies have evaluated the frequency of and the reasons behind the refusal of listing liver transplantation candidates.AIM To assess the ineligibility rate for liver transplantation and its motivations....BACKGROUND Few studies have evaluated the frequency of and the reasons behind the refusal of listing liver transplantation candidates.AIM To assess the ineligibility rate for liver transplantation and its motivations.METHODS A single-center retrospective study was conducted on adult patients which entailed a formal multidisciplinary assessment for liver transplantation eligibility.The predictors for listing were evaluated using multivariable logistic regression.RESULTS In our center,314 patients underwent multidisciplinary work-up before liver transplantation enlisting over a three-year period.The most frequent reasons for transplant evaluation were decompensated cirrhosis(51.6%)and hepatocellular carcinoma(35.7%).The non-listing rate was 53.8%and the transplant rate was 34.4%for the whole cohort.Two hundred and five motivations for ineligibility were collected.The most common contraindications were psychological(9.3%),cardiovascular(6.8%),and surgical(5.9%).Inappropriate or premature referral accounted for 76(37.1%)cases.On multivariable analysis,a referral from another hospital(OR:2.113;95%CI:1.259–3.548)served as an independent predictor of non-listing.CONCLUSION A non-listing decision occurred in half of our cohort and was based on an inappropriate or premature referral in one case out of three.The referral from another hospital was taken as a strong predictor of non-listing.展开更多
This paper investigates the security and reliability of information transmission within an underlay wiretap energy harvesting cognitive two-way relay network.In the network,energy-constrained secondary network(SN)node...This paper investigates the security and reliability of information transmission within an underlay wiretap energy harvesting cognitive two-way relay network.In the network,energy-constrained secondary network(SN)nodes harvest energy from radio frequency signals of a multi-antenna power beacon.Two SN sources exchange their messages via a SN decode-and-forward relay in the presence of a multiantenna eavesdropper by using a four-phase time division broadcast protocol,and the hardware impairments of SN nodes and eavesdropper are modeled.To alleviate eavesdropping attacks,the artificial noise is applied by SN nodes.The physical layer security performance of SN is analyzed and evaluated by the exact closed-form expressions of outage probability(OP),intercept probability(IP),and OP+IP over quasistatic Rayleigh fading channel.Additionally,due to the complexity of OP+IP expression,a self-adaptive chaotic quantum particle swarm optimization-based resource allocation algorithm is proposed to jointly optimize energy harvesting ratio and power allocation factor,which can achieve security-reliability tradeoff for SN.Extensive simulations demonstrate the correctness of theoretical analysis and the effectiveness of the proposed optimization algorithm.展开更多
Aim: This article investigates the increasing awareness of Obstructive Sleep Apnoea (OSA) as a potentially serious health risk and highlights the role of the dentist in managing mild to moderate OSA cases which can be...Aim: This article investigates the increasing awareness of Obstructive Sleep Apnoea (OSA) as a potentially serious health risk and highlights the role of the dentist in managing mild to moderate OSA cases which can be improved with an intra-oral mandibular advancement appliance. Methods: Data from referrals to a Prosthodontic Unit from 01-01-2019 to 18-8-2022 were analysed. Results: A total of 240 consecutive referrals to an NHS hospital where a patient was fitted with a mandibular advancement appliance (MAA) were analysed and 160 (67%) were male and 80 (33%) were female. The mean age in years was 52 (2019), 50 (2020), 52 (2021) and 51 (2022). Mean age of male referrals was 51 and female referrals was 53. Conclusion: There are a large number of patients with OSA seeking a dental device and practitioners should be aware of this treatment modality to help the medical team manage OSA. Clinical relevance: Dentists may need to have a greater understanding of OSA and be able to provide MAAs.展开更多
AIM:To determine whether a communication instru-ment provided to patients prior to their primary carephysician(PCP)visit initiates a conversation with theirPCP about colorectal cancer screening(CRC-S),impact-ing scree...AIM:To determine whether a communication instru-ment provided to patients prior to their primary carephysician(PCP)visit initiates a conversation with theirPCP about colorectal cancer screening(CRC-S),impact-ing screening referral rates in fully insured and underin-sured patients.METHODS:A prospective randomized control studywas performed at a single academic center outpatient internal medicine(IRMC,underinsured)and fam-ily medicine(FMRC,insured)resident clinics prior to scheduled visits.In the intervention group,a pamphlet about the benefit of CRC-S and a reminder card were given to patients before the scheduled visit for prompt-ing of CRC-S referral by their PCP.The main outcome measured was frequency of CRC-S referral in each clinic after intervention.RESULTS:In the IRMC,148 patients participated,a control group of 72 patients(40F and 32M)and 76 patients(48F and 28M)in the intervention group.Re-ferrals for CRC-S occurred in 45/72(63%)of control vs 70/76(92%)in the intervention group(P≤0.001).In the FMRC,126 patients participated,66(39F:27M)con-trol and 60(33F:27M)in the intervention group.CRC-S referrals occurred in 47/66(71%)of controls vs 56/60(98%)in the intervention group(P≤0.001).CONCLUSION:Patient initiated physician prompting produced a significant referral increase for CRC-S in un-derinsured and insured patient populations.Additional investigation aimed at increasing CRC-S acceptance is warranted.展开更多
Background:To characterize emergency optometrist referrals triaged at a tertiary ophthalmology care center by pathology,physical exam findings,and provisional diagnosis accuracy.Methods:Variables extracted from the pa...Background:To characterize emergency optometrist referrals triaged at a tertiary ophthalmology care center by pathology,physical exam findings,and provisional diagnosis accuracy.Methods:Variables extracted from the patients’charts included date of referral,age,sex,eye(s)under examination,visual acuity(VA)at the time of referral,intraocular pressure(IOP)at the time of the referral,the referring optometrist’s provisional diagnosis,VA at the time of the ophthalmologist consultation,IOP at the time of the ophthalmologist consultation,number of days between referral and ophthalmic consultation,and the ophthalmologist’s diagnosis.Results:After categorizing disease by anatomical location,absolute agreement between optometrist provisional diagnosis and ophthalmologist diagnosis was 60%.A strong correlation was found between optometrist and ophthalmologist VA measurements.IOP measurements were checked less frequently by optometrists.In cases where referral IOP was documented,no significant difference was observed between optometrist and ophthalmologist IOP measures.Conclusions:VA and IOP measurements by optometrists are reliable,but IOP is less frequently checked in the optometry setting.While optometrist referrals correctly localized eye pathology in 60%of cases,posterior pathology was missed in two cases of retinal tear and retinal detachment.展开更多
Introduction: A functional maternal referral system should encompass a feasible communication system between health facilities. In Uganda, the current paper-based patient referral form is associated with inadequate pa...Introduction: A functional maternal referral system should encompass a feasible communication system between health facilities. In Uganda, the current paper-based patient referral form is associated with inadequate patient-information and low feedback rates. A recent quasi-experimental study demonstrated that a phone-based communication intervention is feasible for iterative communication between health facilities, and there were improved maternal-fetal outcomes and high rates of feedback. However, the acceptability of the intervention was not assessed. Objective: The study assessed the acceptability of a phone-based communication intervention by the health care workers (HCWs) for iterative communication between the referring and receiving health facilities. Methods: This was a qualitative study conducted in South Western Uganda, in April 2021. The study employed a theoretical framework of acceptability of medical interventions. We conducted in-depth interviews with HCWs and used deductive-inductive analysis. Results: We enrolled a total of 23 HCWs, of whom 69.6% (n = 16) were females while 30.4% (n = 7) were males. Majority (65.2%, n = 15), were midwives and the rest were: doctors (30.4%, n = 7) and a nurse (4.3%). The HCWs were positive towards the intervention: they believed that the intervention reduced delays, promoted professional escort, encouraged sharing of supplies, enabled exchange of relatively more patient details, feedback and improved case management. They believed it was culturally acceptable and had enough skills and experience of operating phones. All participants recommended scale out of the intervention, but advised on the need for dedicated human-resource to coordinate phone calls, ensure availability of airtime and charged battery. Conclusion: This study demonstrates that the phone-based communication intervention was highly accepted by the healthcare workers, and that hospitals can successfully give feedback to lower health centres through iterative phone calls. This provides a possible solution to the long-standing challenge of poor feedback rates and a vicious cycle of poor maternal-fetal outcomes in resource limited settings.展开更多
Background: Hypertensive disease in pregnancy is an important cause of morbidity, long-term disability, and maternal and neonatal mortality. The aim is to determine the socio-demographic characteristics and maternal p...Background: Hypertensive disease in pregnancy is an important cause of morbidity, long-term disability, and maternal and neonatal mortality. The aim is to determine the socio-demographic characteristics and maternal prognosis of these women with Hypertension during pregnancy. Material and Method: We conducted a cross-sectional study, we interview patients and after discussion we transcripts in a database in Excel software before analysis with SPSS version 20.0 and Stata 14.0 The qualitative variables have been summarised by the Percentage and the quantitative variables will be summarised by Means and Standard Deviation. The associations of the variables were calculated by Pearson’s chi-square test with a significance level set at a p-value Result: The average age of the patients was 30.33 ± 7.020 years, 92.1% were married, 79.8% lived in urban areas, most of the patients were overweight (43%), 92.1% of them had monofetal pregnancies, 36% were multiparous, 34.2% had a previous history of preeclampsia in pregnancy and 14% were known to have hypertension. Pre-eclampsia was the most frequent form of hypertension in pregnancy with 73.68% of cases and represents 84.8% of severe forms of hypertension in pregnancy, 53.4% of the patients delivered vaginally. Eclampsia was the most frequent complication in our patients with 31.7% frequency and among the socio-demographic parameters, age and body mass index were significantly associated with maternal complications. Conclusion: Maternal age and body mass index are important socio-demographic factors associated with the occurrence of maternal complications in women with hypertensive disorders in pregnancy.展开更多
This research investigates the behavior of a 2×2 pile group under two-directional lateral loads in addition to the vertical load.Through three-dimensional numerical modeling based on Flac 3D software,the study ex...This research investigates the behavior of a 2×2 pile group under two-directional lateral loads in addition to the vertical load.Through three-dimensional numerical modeling based on Flac 3D software,the study examines the total bearing capacity and efficiency coefficient of the pile group,considering factors such as the angle of lateral load,relative pile spacing,and relative stiffness of the pile-soil system.The findings highlight the significance of these factors in understanding and predicting the response of pile groups to changing lateral load directions.The results reveal that increasing the angle of the lateral load from 0°to 45°enhances both the maximum total lateral load and the efficiency coefficient of the pile group.When the relative stiffness of the pile-soil system significantly increases,soil stiffening occurs and reducing the relative spacing of the piles from 7 to 3 times the diameter of the piles diminishes the influence of the pile group.Consequently,the response of the pile group to lateral loads becomes more linear,with only a slight alteration in the maximum total lateral load and the efficiency coefficient when the lateral load is angled from 0°to 45°.Conversely,increasing the relative distance between the piles,specifically from 3 to 7 times the diameter of the piles,amplifies the influence of the pile group.Both the maximum total lateral load and the efficiency coefficient of the pile group exhibit an observed increase.These provide insights for designing pile groups and optimizing their performance under lateral loading conditions.展开更多
BACKGROUND Indications to refer patients with cirrhosis for liver transplant evaluation(LTE)include hepatic decompensation or a model for end stage liver disease(MELDNa)score≥15.Few studies have evaluated how delayin...BACKGROUND Indications to refer patients with cirrhosis for liver transplant evaluation(LTE)include hepatic decompensation or a model for end stage liver disease(MELDNa)score≥15.Few studies have evaluated how delaying referral beyond these criteria affects patient outcomes.AIM To evaluate clinical characteristics of patients undergoing inpatient LTE and to assess the effects of delayed LTE on patient outcomes(death,transplantation).METHODS This is a single center retrospective cohort study assessing all patients undergoing inpatient LTE(n=159)at a large quaternary care and liver transplant center between 10/23/2017-7/31/2021.Delayed referral was defined as having prior indication(decompensation,MELD-Na≥15)for LTE without referral.Early referral was defined as referrals made within 3 mo of having an indication based on practice guidelines.Logistic regression and Cox Hazard Regression were used to evaluate the relationship between delayed referral and patient outcomes.RESULTS Many patients who require expedited inpatient LTE had delayed referrals.Misconceptions regarding transplant candidacy were a leading cause of delayed referral.Ultimately,delayed referrals negatively affected overall patient outcome and an independent predictor of both death and not receiving a transplant.Delayed referral was associated with a 2.5 hazard risk of death.CONCLUSION Beyond initial access to an liver transplant(LT)center,delaying LTE increases risk of death and reduces risk of LT in patients with chronic liver disease.There is substantial opportunity to increase the percentage of patients undergoing LTE when first clinically indicated.It is crucial for providers to remain informed about the latest guidelines on liver transplant candidacy and the transplant referral process.展开更多
In this paper,we investigate the secrecy outage performance for the two-way integrated satellite unmanned aerial vehicle relay networks with hardware impairments.Particularly,the closed-form expression for the secrecy...In this paper,we investigate the secrecy outage performance for the two-way integrated satellite unmanned aerial vehicle relay networks with hardware impairments.Particularly,the closed-form expression for the secrecy outage probability is obtained.Moreover,to get more information on the secrecy outage probability in a high signalto-noise regime,the asymptotic analysis along with the secrecy diversity order and secrecy coding gain for the secrecy outage probability are also further obtained,which presents a fast method to evaluate the impact of system parameters and hardware impairments on the considered network.Finally,Monte Carlo simulation results are provided to show the efficiency of the theoretical analysis.展开更多
文摘Background: Health challenges that are difficult to manage at primary health centres should be referred to secondary health facilities, and if untreated, to the tertiary hospitals. A good referral should include the patient’s biography, such as age, gender, tribe, religion, occupation, medical history, the reason for the referral, treatments received, and clinical diagnosis. Objectives: To evaluate the referral patterns, indications for referrals, and feto-maternal outcomes for obstetric patients who were referred to the University of Port Harcourt Teaching Hospital. Materials and Methods: A prospective study of patients admitted to the Obstetric unit from January 1, 2021, to December 31, 2022. Data was collected from patients while on admission or clinic visits and recorded in an excel spread sheet. Data was analyzed with the Statistical Package for Social Sciences (SPSS) version 25. Results: Of the 3469 patients were admitted to the obstetric unit, 1476 and 1993 were admitted in 2021 and 2022, respectively. Most (70.35%) of the patients were in the 20-34 years age group, parity 1-4 was the most frequent (66.49%), while 85.39% of patients were booked. 10.46% of the booked patients were referred from other facilities, whereas 89.54% of patients were booked at our facility from the onset. Most common indications of referrals were previous caesarean section (CS) at term (40.09%) and hypertensive disorders of pregnancy (17.59%). The outcome for 2021 indicated 17 maternal deaths, 132 fetal deaths and 1010 live births, giving maternal mortality ratio (MMR) as 1810.44 per 100,000 live births and perinatal mortality ratio (PMR) of 130.7 per 1000 births respectively. In 2022, there were 17 maternal deaths, 130 fetal deaths and 1297 deliveries, giving a MMR of 1399 per 100,000 live births and a PMR of 100.2 per 1000 births. Conclusion: The pattern of referral among obstetric patients in this study shows that a lot of the patients do not get adequate care at the lower cadre of the referral system, hence adequate facilities should be made available in primary and secondary health centres to tackle obstetric emergencies.
基金supported in part by the National Key Research and Development Program of China(2019YFB2204701)in part by the National Natural Science Foundation of China(61831006,62022023,and 62250610223)in part by the Big Data Computing Center at Southeast University for numerical calculation.
文摘This article proposes and demonstrates a retrodirective array(RDA)for two-way wireless communication with automatic beam tracking.The proposed RDA is enabled by specifically designed chips made using a domestic complementary metal-oxide semiconductor(CMOS)process.The highly integrated CMOS chip includes a receiving(Rx)chain,a transmitting(Tx)chain,and a unique tracking phaselocked loop(PLL)for the crucial conjugated phase recovery in the RDA.This article also proposes a method to reduce the beam pointing error(BPE)in a conventional RDA.To validate the above ideas simply yet without loss of generality,a 2.4 GHz RDA is demonstrated through two-way communication links between the Rx and Tx chains,and an on-chip quadrature coupler is designed to achieve a nonretrodirective signal suppression of 23 dBc.The experimental results demonstrate that the proposed RDA,which incorporates domestically manufactured low-cost 0.18 lm CMOS chips,is capable of automatically tracking beams covering±40with a reduced BPE.Each CMOS chip in the RDA has a compact size of 4.62 mm^(2) and a low power consumption of 0.15 W.To the best of the authors’knowledge,this is the first research to demonstrate an RDA with a fully customized CMOS chip for wireless communication with automatic beam tracking。
基金supported by the National Natural Science Foundation of China(Grant Nos.61505261,62101597,61605248,and 61675235)the National Key Research and Development Program of China(Grant No.2020YFA0309702)+2 种基金the China Postdoctoral Science Foundation(Grant No.2021M691536)the Natural Science Foundation of Henan Province(Grant Nos.202300410534 and 202300410532)the Anhui Initiative in Quantum Information Technologies.
文摘The data post-processing scheme based on two-way classical communication(TWCC)can improve the tolerable bit error rate and extend the maximal transmission distance when used in a quantum key distribution(QKD)system.In this study,we apply the TWCC method to improve the performance of reference-frame-independent quantum key distribution(RFI-QKD),and analyze the influence of the TWCC method on the performance of decoy-state RFI-QKD in both asymptotic and non-asymptotic cases.Our numerical simulation results show that the TWCC method is able to extend the maximal transmission distance from 175 km to 198 km and improve the tolerable bit error rate from 10.48%to 16.75%.At the same time,the performance of RFI-QKD in terms of the secret key rate and maximum transmission distance are still greatly improved when statistical fluctuations are considered.We conclude that RFI-QKD with the TWCC method is of practical interest.
基金supported in part by the National Natural Science Foundation of China (Nos.U22A2002, and 62071234)the Hainan Province Science and Technology Special Fund (ZDKJ2021022)+1 种基金the Scientific Research Fund Project of Hainan University under Grant KYQD(ZR)-21008the Collaborative Innovation Center of Information Technology, Hainan University (XTCX2022XXC07)
文摘In this paper,an intelligent reflecting surface(IRS)-and-unmanned aerial vehicle(UAV)-assisted two-way amplify-and-forward(AF)relay network in maritime Internet of Things(IoT)is proposed,where ship1(S1)and ship2(S2)can be viewed as data collecting centers.To enhance the message exchange rate between S1 and S2,a problem of maximizing minimum rate is cast,where the variables,namely AF relay beamforming matrix and IRS phase shifts of two time slots,need to be optimized.To achieve a maximum rate,a low-complexity alternately iterative(AI)scheme based on zero forcing and successive convex approximation(LC-ZF-SCA)algorithm is presented.To obtain a significant rate enhancement,a high-performance AI method based on one step,semidefinite programming and penalty SCA(ONSSDP-PSCA)is proposed.Simulation results show that by the proposed LC-ZF-SCA and ONS-SDP-PSCA methods,the rate of the IRS-and-UAV-assisted AF relay network surpass those of with random phase and only AF relay networks.Moreover,ONS-SDP-PSCA perform better than LC-ZF-SCA in aspect of rate.
文摘BACKGROUND Few studies have evaluated the frequency of and the reasons behind the refusal of listing liver transplantation candidates.AIM To assess the ineligibility rate for liver transplantation and its motivations.METHODS A single-center retrospective study was conducted on adult patients which entailed a formal multidisciplinary assessment for liver transplantation eligibility.The predictors for listing were evaluated using multivariable logistic regression.RESULTS In our center,314 patients underwent multidisciplinary work-up before liver transplantation enlisting over a three-year period.The most frequent reasons for transplant evaluation were decompensated cirrhosis(51.6%)and hepatocellular carcinoma(35.7%).The non-listing rate was 53.8%and the transplant rate was 34.4%for the whole cohort.Two hundred and five motivations for ineligibility were collected.The most common contraindications were psychological(9.3%),cardiovascular(6.8%),and surgical(5.9%).Inappropriate or premature referral accounted for 76(37.1%)cases.On multivariable analysis,a referral from another hospital(OR:2.113;95%CI:1.259–3.548)served as an independent predictor of non-listing.CONCLUSION A non-listing decision occurred in half of our cohort and was based on an inappropriate or premature referral in one case out of three.The referral from another hospital was taken as a strong predictor of non-listing.
基金supported in part by the National Natural Science Foundation of China under Grant 61971450in part by the Hunan Provincial Science and Technology Project Foundation under Grant 2018TP1018+1 种基金in part by the Natural Science Foundation of Hunan Province under Grant 2018JJ2533in part by Hunan Province College Students Research Learning and Innovative Experiment Project under Grant S202110542056。
文摘This paper investigates the security and reliability of information transmission within an underlay wiretap energy harvesting cognitive two-way relay network.In the network,energy-constrained secondary network(SN)nodes harvest energy from radio frequency signals of a multi-antenna power beacon.Two SN sources exchange their messages via a SN decode-and-forward relay in the presence of a multiantenna eavesdropper by using a four-phase time division broadcast protocol,and the hardware impairments of SN nodes and eavesdropper are modeled.To alleviate eavesdropping attacks,the artificial noise is applied by SN nodes.The physical layer security performance of SN is analyzed and evaluated by the exact closed-form expressions of outage probability(OP),intercept probability(IP),and OP+IP over quasistatic Rayleigh fading channel.Additionally,due to the complexity of OP+IP expression,a self-adaptive chaotic quantum particle swarm optimization-based resource allocation algorithm is proposed to jointly optimize energy harvesting ratio and power allocation factor,which can achieve security-reliability tradeoff for SN.Extensive simulations demonstrate the correctness of theoretical analysis and the effectiveness of the proposed optimization algorithm.
文摘Aim: This article investigates the increasing awareness of Obstructive Sleep Apnoea (OSA) as a potentially serious health risk and highlights the role of the dentist in managing mild to moderate OSA cases which can be improved with an intra-oral mandibular advancement appliance. Methods: Data from referrals to a Prosthodontic Unit from 01-01-2019 to 18-8-2022 were analysed. Results: A total of 240 consecutive referrals to an NHS hospital where a patient was fitted with a mandibular advancement appliance (MAA) were analysed and 160 (67%) were male and 80 (33%) were female. The mean age in years was 52 (2019), 50 (2020), 52 (2021) and 51 (2022). Mean age of male referrals was 51 and female referrals was 53. Conclusion: There are a large number of patients with OSA seeking a dental device and practitioners should be aware of this treatment modality to help the medical team manage OSA. Clinical relevance: Dentists may need to have a greater understanding of OSA and be able to provide MAAs.
文摘AIM:To determine whether a communication instru-ment provided to patients prior to their primary carephysician(PCP)visit initiates a conversation with theirPCP about colorectal cancer screening(CRC-S),impact-ing screening referral rates in fully insured and underin-sured patients.METHODS:A prospective randomized control studywas performed at a single academic center outpatient internal medicine(IRMC,underinsured)and fam-ily medicine(FMRC,insured)resident clinics prior to scheduled visits.In the intervention group,a pamphlet about the benefit of CRC-S and a reminder card were given to patients before the scheduled visit for prompt-ing of CRC-S referral by their PCP.The main outcome measured was frequency of CRC-S referral in each clinic after intervention.RESULTS:In the IRMC,148 patients participated,a control group of 72 patients(40F and 32M)and 76 patients(48F and 28M)in the intervention group.Re-ferrals for CRC-S occurred in 45/72(63%)of control vs 70/76(92%)in the intervention group(P≤0.001).In the FMRC,126 patients participated,66(39F:27M)con-trol and 60(33F:27M)in the intervention group.CRC-S referrals occurred in 47/66(71%)of controls vs 56/60(98%)in the intervention group(P≤0.001).CONCLUSION:Patient initiated physician prompting produced a significant referral increase for CRC-S in un-derinsured and insured patient populations.Additional investigation aimed at increasing CRC-S acceptance is warranted.
文摘Background:To characterize emergency optometrist referrals triaged at a tertiary ophthalmology care center by pathology,physical exam findings,and provisional diagnosis accuracy.Methods:Variables extracted from the patients’charts included date of referral,age,sex,eye(s)under examination,visual acuity(VA)at the time of referral,intraocular pressure(IOP)at the time of the referral,the referring optometrist’s provisional diagnosis,VA at the time of the ophthalmologist consultation,IOP at the time of the ophthalmologist consultation,number of days between referral and ophthalmic consultation,and the ophthalmologist’s diagnosis.Results:After categorizing disease by anatomical location,absolute agreement between optometrist provisional diagnosis and ophthalmologist diagnosis was 60%.A strong correlation was found between optometrist and ophthalmologist VA measurements.IOP measurements were checked less frequently by optometrists.In cases where referral IOP was documented,no significant difference was observed between optometrist and ophthalmologist IOP measures.Conclusions:VA and IOP measurements by optometrists are reliable,but IOP is less frequently checked in the optometry setting.While optometrist referrals correctly localized eye pathology in 60%of cases,posterior pathology was missed in two cases of retinal tear and retinal detachment.
文摘Introduction: A functional maternal referral system should encompass a feasible communication system between health facilities. In Uganda, the current paper-based patient referral form is associated with inadequate patient-information and low feedback rates. A recent quasi-experimental study demonstrated that a phone-based communication intervention is feasible for iterative communication between health facilities, and there were improved maternal-fetal outcomes and high rates of feedback. However, the acceptability of the intervention was not assessed. Objective: The study assessed the acceptability of a phone-based communication intervention by the health care workers (HCWs) for iterative communication between the referring and receiving health facilities. Methods: This was a qualitative study conducted in South Western Uganda, in April 2021. The study employed a theoretical framework of acceptability of medical interventions. We conducted in-depth interviews with HCWs and used deductive-inductive analysis. Results: We enrolled a total of 23 HCWs, of whom 69.6% (n = 16) were females while 30.4% (n = 7) were males. Majority (65.2%, n = 15), were midwives and the rest were: doctors (30.4%, n = 7) and a nurse (4.3%). The HCWs were positive towards the intervention: they believed that the intervention reduced delays, promoted professional escort, encouraged sharing of supplies, enabled exchange of relatively more patient details, feedback and improved case management. They believed it was culturally acceptable and had enough skills and experience of operating phones. All participants recommended scale out of the intervention, but advised on the need for dedicated human-resource to coordinate phone calls, ensure availability of airtime and charged battery. Conclusion: This study demonstrates that the phone-based communication intervention was highly accepted by the healthcare workers, and that hospitals can successfully give feedback to lower health centres through iterative phone calls. This provides a possible solution to the long-standing challenge of poor feedback rates and a vicious cycle of poor maternal-fetal outcomes in resource limited settings.
文摘Background: Hypertensive disease in pregnancy is an important cause of morbidity, long-term disability, and maternal and neonatal mortality. The aim is to determine the socio-demographic characteristics and maternal prognosis of these women with Hypertension during pregnancy. Material and Method: We conducted a cross-sectional study, we interview patients and after discussion we transcripts in a database in Excel software before analysis with SPSS version 20.0 and Stata 14.0 The qualitative variables have been summarised by the Percentage and the quantitative variables will be summarised by Means and Standard Deviation. The associations of the variables were calculated by Pearson’s chi-square test with a significance level set at a p-value Result: The average age of the patients was 30.33 ± 7.020 years, 92.1% were married, 79.8% lived in urban areas, most of the patients were overweight (43%), 92.1% of them had monofetal pregnancies, 36% were multiparous, 34.2% had a previous history of preeclampsia in pregnancy and 14% were known to have hypertension. Pre-eclampsia was the most frequent form of hypertension in pregnancy with 73.68% of cases and represents 84.8% of severe forms of hypertension in pregnancy, 53.4% of the patients delivered vaginally. Eclampsia was the most frequent complication in our patients with 31.7% frequency and among the socio-demographic parameters, age and body mass index were significantly associated with maternal complications. Conclusion: Maternal age and body mass index are important socio-demographic factors associated with the occurrence of maternal complications in women with hypertensive disorders in pregnancy.
文摘This research investigates the behavior of a 2×2 pile group under two-directional lateral loads in addition to the vertical load.Through three-dimensional numerical modeling based on Flac 3D software,the study examines the total bearing capacity and efficiency coefficient of the pile group,considering factors such as the angle of lateral load,relative pile spacing,and relative stiffness of the pile-soil system.The findings highlight the significance of these factors in understanding and predicting the response of pile groups to changing lateral load directions.The results reveal that increasing the angle of the lateral load from 0°to 45°enhances both the maximum total lateral load and the efficiency coefficient of the pile group.When the relative stiffness of the pile-soil system significantly increases,soil stiffening occurs and reducing the relative spacing of the piles from 7 to 3 times the diameter of the piles diminishes the influence of the pile group.Consequently,the response of the pile group to lateral loads becomes more linear,with only a slight alteration in the maximum total lateral load and the efficiency coefficient when the lateral load is angled from 0°to 45°.Conversely,increasing the relative distance between the piles,specifically from 3 to 7 times the diameter of the piles,amplifies the influence of the pile group.Both the maximum total lateral load and the efficiency coefficient of the pile group exhibit an observed increase.These provide insights for designing pile groups and optimizing their performance under lateral loading conditions.
文摘BACKGROUND Indications to refer patients with cirrhosis for liver transplant evaluation(LTE)include hepatic decompensation or a model for end stage liver disease(MELDNa)score≥15.Few studies have evaluated how delaying referral beyond these criteria affects patient outcomes.AIM To evaluate clinical characteristics of patients undergoing inpatient LTE and to assess the effects of delayed LTE on patient outcomes(death,transplantation).METHODS This is a single center retrospective cohort study assessing all patients undergoing inpatient LTE(n=159)at a large quaternary care and liver transplant center between 10/23/2017-7/31/2021.Delayed referral was defined as having prior indication(decompensation,MELD-Na≥15)for LTE without referral.Early referral was defined as referrals made within 3 mo of having an indication based on practice guidelines.Logistic regression and Cox Hazard Regression were used to evaluate the relationship between delayed referral and patient outcomes.RESULTS Many patients who require expedited inpatient LTE had delayed referrals.Misconceptions regarding transplant candidacy were a leading cause of delayed referral.Ultimately,delayed referrals negatively affected overall patient outcome and an independent predictor of both death and not receiving a transplant.Delayed referral was associated with a 2.5 hazard risk of death.CONCLUSION Beyond initial access to an liver transplant(LT)center,delaying LTE increases risk of death and reduces risk of LT in patients with chronic liver disease.There is substantial opportunity to increase the percentage of patients undergoing LTE when first clinically indicated.It is crucial for providers to remain informed about the latest guidelines on liver transplant candidacy and the transplant referral process.
基金supported by the Natural Science Foundation of China under Grant No.62001517.
文摘In this paper,we investigate the secrecy outage performance for the two-way integrated satellite unmanned aerial vehicle relay networks with hardware impairments.Particularly,the closed-form expression for the secrecy outage probability is obtained.Moreover,to get more information on the secrecy outage probability in a high signalto-noise regime,the asymptotic analysis along with the secrecy diversity order and secrecy coding gain for the secrecy outage probability are also further obtained,which presents a fast method to evaluate the impact of system parameters and hardware impairments on the considered network.Finally,Monte Carlo simulation results are provided to show the efficiency of the theoretical analysis.