In Grenada, West Indies, What Is the Degree of Bat-human Interaction in Households and Is It Associated to Arboviral Disease?

Background: Bats are reservoirs for several zoonotic pathogens, making human-bat interactions particularly concerning. Recent studies documented that Grenadian bats can be infected with Zika, dengue and Chikungunya viruses and Leptospira bacteria among other pathogens. The objective of this study was to estimate the number of homes in Grenada that have a bat infestation, and to determine whether there is a correlation between the number of bat infested homes with the type of roofing or the presence of arbovirus infections of human inhabitants. Methods: An institutional review board (IRB) approved questionnaire delivered through a semi-structured interview was administered at the central bus stop in St. George, Grenada to recruit participants from all six parishes and the island of Carriacou. Results determined the percentage of individuals that had bat roosts in their households, whether this was of concern to them, whether they had taken any steps to keep bats out of their residence, and whether they had confirmed or suspected cases of dengue, Zika or Chikungunya virus infections. Information on the type of roofing and presence of window screens were also documented. Bat type (fruit vs insect eating bats) was attempted by guano description. Results: Results from 210 individual responses provided data showing all six parishes were represented although not equally. Having bats at the household was not associated with parish of residence, roof type or presence or absence of window screens. The results showed 60% of homes in Grenada are bat-infested and 51% of people self-reported recent arbovirus infection; but no correlation between the two. Also, no correlation to a specific type of roof or type of bat was found.Conclusions: A statistically significant number of inhabitants had attempted to remove bats from their homes, indicating that bats are perceived as pest to homes in Grenada, and justifying further research into relocating bats through the use of construction changes, awareness, and the creation of bat houses.

Methods for measuring venous peripherally inserted central catheters in newborns

ABSTRACT Objective: to analyze the results of insertion procedures of Peripherally Inserted Central Catheters in newborns using two measurement methods. Methods: this is a randomized clinical trial, presenting descriptive and exploratory results of variables. It was held at a Neonatal Intensive Care Unit. Data were collected between September 2018 and 2019. The sample analyzed was 88 catheter insertion procedures, distributed in two groups. Study approved by an Institutional Review Board and obtained registration in the country and abroad. Descriptive analysis and logistic regression of data. Results: modified measurement obtained a significant difference for the central catheter tip location. Elective removals and adverse events were not significant between groups; however, poor positioning was related to adverse events. Conclusions: between the two methods analyzed, the modified measurement obtained better results in the proper catheter tip positioning and, consequently, less risk to patients.

Hospital structure elements demarcating (in)visibilities of institutional violence against children

ABSTRACT Objectives: to analyze the hospital structure elements that demarcate (in)visibilities of institutional violence in hospitalized children. Methods: this is a descriptive-exploratory qualitative study that used approaches with Foucault’s thinking. Ten companions and 39 healthcare professionals from a university hospital in Salvador, Bahia participated. Data collection took place from November 2018 to June 2019 through semi-structured interviews. The discourse analysis method was used. The study was approved by the Institutional Review Board. Results: institutional violence was understood in the violations and invisibilities of the structure of health services through the problems: in infrastructure (physical structure, lack of human and material resources, scrapping of equipment); administrative and management; pilgrimage. Final Considerations: it is necessary to realize the invisibilities of the infrastructure to act in confronting institutional violence to hospitalized children.

Protein supplementation versus standard feeds in underweight critically ill children: a pilot dual-centre randomised controlled trial protocol

IntroductionProtein–energy malnutrition, increased catabolism and inadequate nutritional support leads to loss of lean body mass with muscle wasting and delayed recovery in critical illness. However, there remains clinical equipoise regarding the risks and benefits of protein supplementation. This pilot trial will determine the feasibility of performing a larger multicentre trial to determine if a strategy of protein supplementation in critically ill children with body mass index (BMI) z-score ≤−2 is superior to standard enteral nutrition in reducing the length of stay in the paediatric intensive care unit (PICU).Methods and analysisThis is a randomised controlled trial of 70 children in two PICUs in Singapore. Children with BMI z-score ≤−2 on PICU admission, who are expected to require invasive mechanical ventilation for more than 48 hours, will be randomised (1:1 allocation) to protein supplementation of ≥1.5 g/kg/day in addition to standard nutrition, or standard nutrition alone for 7 days after enrolment or until PICU discharge, whichever is earlier. Feasibility outcomes for the trial include effective screening, satisfactory enrolment rate, timely protocol implementation (within first 72 hours) and protocol adherence. Secondary outcomes include mortality, PICU length of stay, muscle mass, anthropometric measurements and functional outcomes.Ethics and disseminationThe trial protocol was approved by the institutional review board of both participating centres (Singhealth Centralised Institutional Review Board and National Healthcare Group Domain Specific Review Board) under the reference number 2020/2742. Findings of the trial will be disseminated through peer-reviewed journals and scientific conferences.Trial registration numberNCT04565613.

Developing Deep-Learning Methods for Diagnosis and Prognosis of Pediatric Progressive Diseases Using Modern Imaging Techniques

Purpose and Rationale. Central nervous system manifestations form a significant burden of disease in young children. There have been efforts to correlate the neurological disease state in tuberous sclerosis complex (TSC) neurological disease state with imaging findings is a standard part of patient care. However, such analysis of neuroimaging is time- and labor-intensive. Automated approaches to these tasks are needed to improve speed, accuracy, and availability. Automated medical image analysis tools based on 3D/2D deep learning algorithms can help improve the quality and consistency of image diagnosis and interpretation for cognitive disorders in infants. We propose to automate neuroimaging analysis with artificial intelligence algorithms. This novel approach can be used to improve the accuracy of TSC diagnosis and treatment. Deep learning (DL) is among the most successful types of machine learning and utilizes deep artificial neural networks (ANNs), which can determine efficient feature representations of input data. DL algorithms have created new opportunities in medical image analysis. Applications of DL, specifically convolutional neural networks (CNNs), in medical image analysis, cover a broad spectrum of tasks, including risk prediction/estimation with a machine learning system trained on these classification tasks. Study population. We reviewed an NIMH Data Archive (NDA) dataset that was collected in 2010. We also reviewed imaging data from patients and normal cases from birth to 8 years of age acquired at Le Bonheur Children’s Hospital from 2014 to 2020. The University of Tennessee Health Science Center Institutional Review Board (IRB) approved this study. Research Design and Study Procedures. Following Institutional Review Board (IRB) approval, this thesis: 1) Presents the first 2D/3D fusion CNN models to estimate the age of infants from birth to 3 years of age. 2) Presents the first work to look at whole-brain network to automatically distinguish TSC brain structural pathology from normal cases using a 3DCNN model. Conclusions. The study findings indicate that deep neural networks tackle the problem of early prediction of cognitive and neurodevelopmental disorders and structural brain pathology based on MRI automatically in TSC children. It is the hope of the author that analysis of MRI images via methods of deep learning will have a positive impact on healthcare for infants and children at risk of rare diseases.

Effect of Electrical Impedance Tomography-Guided Early Mobilization in Patients After Major Upper Abdominal Surgery: Protocol for a Prospective Cohort Study

Background: Pulmonary complications are common in patients after upper abdominal surgery, resulting in poor clinical outcomes and increased costs of hospitalization. Enhanced Recovery After Surgery Guidelines strongly recommend early mobilization post-operatively; however, the quality of the evidence is poor, and indicators for quantifying the effectiveness of early mobilization are lacking. This study will evaluate the effectiveness of early mobilization in patients undergoing an upper abdominal surgery using electrical impedance tomography (EIT). Specifically, we will use EIT to assess and compare the lung ventilation distribution among various regions of interest (ROI) before and after mobilization in this patient population. Additionally, we will assess the temporal differences in the distribution of ventilation in various ROI during mobilization in an effort to develop personalized activity programs for this patient population.Methods: In this prospective, single-center cohort study, we aim to recruit 50 patients after upper abdominal surgery between July 1, 2021 and June 30, 2022. This study will use EIT to quantify the ventilation distribution among different ROI. On post-operative day 1, the nurses will assist the patient to sit on the chair beside the bed. Patient's heart rate, blood pressure, oxygen saturation, respiratory rate, and ROI 1-4 will be recorded before the mobilization as baseline. These data will be recorded again at 15, 30, 60, 90, and 120 min after mobilization, and the changes in vital signs and ROI 1-4 values at each time point before and after mobilization will be compared.Ethics and Dissemination: The study protocol has been approved by the Institutional Review Board of Liaocheng Cardiac Hospital (2020036). The trial is registered at chictr.org.cn with identifier ChiCTR2100042877, registered on January 31, 2021. The results of the study will be presented at relevant national and international conferences and submitted to international peer-reviewed journals. There are no plans to communicate results specifically to participants. Important protocol modifications, such as changes to eligibility criteria, outcomes, or analyses, will be communicated to all relevant parties (including investigators, Institutional Review Board, trial participants, trial registries, journals, and regulators) as needed via email or in-person communication.

Correction: Lin et al. Potent Anticancer Effects of Epidithiodiketopiperazine NT1721 in Cutaneous T Cell Lymphoma. Cancers 2021, 13, 3367

There is an omission in the Institutional Review Board Statement and Conflict of Interest statements of the paper [...]

Institutional Review Board (IRB) Shopping- Accessible for Public Comment

Context: IRB Forum Shopping is an under-researched yet highly-relevant ethical issue in the context of clinical research. IRB members review the proposed research methods to ensure the ethical principles. The IRB has the authority to approve or disapprove the research proposals that fall within the institutional policy and adheres to SOP (Standard Operating Procedures). When the research project has obtained an unfavorable or conditional IRB review, the researcher bypass the process of addressing the IRB’s decision by deserting the IRB and selecting another forum that will provide favorable review. Currently, proposed regulations to prohibit IRB shopping are available for public comment. The FDA report made clear that no empirical evidence exists to support the widespread of IRB shopping.

Retention of knowledge and clinical competence among Ugandan mid-level health providers 1 year after intensive clinical mentorship in TB and HIV management

Introduction Clinical mentorship is effective in improving knowledge and competence of health providers and may be a useful task sharing approach for improving antiretroviral therapy. However, the endurance of the effect of clinical mentorship is uncertain. Methods The midlevel health providers who participated in a cluster-randomized trial of one-on-one, on-site, clinical mentorship in tuberculosis and HIV for 8 h a week, every 6 weeks over 9 months were followed to determine if the gains in knowledge and competence that occurred after the intervention were sustained 6- and 12-months post-intervention. In December 2014 and June 2015, their knowledge and clinical competence were respectively assessed using vignettes and a clinical observation tool of patient care. Multilevel mixed effects regression analysis was used to compare the differences in mean scores for knowledge and clinical competence between times 0, 1, 2, and 3 by arm. Results At the end of the intervention phase of the trial, the mean gain in knowledge scores and clinical competence scores in the intervention arm was 13.4% (95% confidence interval ([CI]: 7.2, 19.6), and 27.8% (95% CI: 21.1, 34.5) respectively, with no changes seen in the control arm. Following the end of the intervention; knowledge mean scores in the intervention arm did not significantly decrease at 6 months (0.6% [95% CI − 1.4, 2.6]) or 12 months (− 2.8% [95% CI: − 5.9, 0.3]) while scores in the control arm significantly increased at 6 months (6.6% [95% CI: 4.4, 8.9]) and 12 months (7.9% [95% CI: 5.4, 10.5]). Also, no significant decrease in clinical competence mean scores for intervention arm was seen at 6 month (2.8% [95% CI: − 1.8, 7.5] and 12 months (3.7% [95% CI: − 2.4, 9.8]) while in the control arm, a significant increase was seen at 6 months (5.8% [95% CI: 1.2, 10.3] and 12 months (11.5% [95% CI: 7.6, 15.5]). Conclusions Mentees sustained the competence and knowledge gained after the intervention for a period of one year. Although, there was an increase in knowledge in the control group over the follow-up period, MLP in the intervention arm experienced earlier and sustained gains. One-on-one clinical mentorship should be scaled-up as a task-sharing approach to improve clinical care. Trial Registration The study received ethics approvals from 3 institutions—the US Centers for Disease Control and Prevention Institutional Review Board (USA), the Institutional Review Board “JCRC’s HIV/AIDS Research Committee” IRB#1-IRB00001515 with Federal Wide Assurance number (FWA00009772) based in Kampala and the Uganda National Council of Science and Technology (Uganda) which approves all scientific protocols to be implemented in Uganda.