Relationship Between Quality of Sleep and Psychological Well-being Among Frontline Nurses During the COVID-19 Pandemic in Saudi Arabia.

Background: The coronavirus 2019 (COVID-19) pandemic is a world health emergency crisis that challenges the global health system and healthcare providers, especially frontline nurses' physical and mental well-being. Objective: The aim of the study was to examine the association between depression, anxiety, and sleep quality among nurses working in Saudi Arabian hospitals during the COVID-19 pandemic. Methods: This is an quantitative cross-sectional study. An online self-reported data was collected from 187 nurses who were on duty during COVID-19 pandemic. Results: About 87.2% of the nurses were female nurses; not surprising that 88% had poor sleep quality; 44.4% had moderate anxiety, and 44% of the studied nurses had mild to moderate depression. The study revealed that there was an association between level of anxiety and poor sleep quality. Poor sleep quality and emotional stability of nurses play a major role in quality of care and patients' safety. Conclusion: We conclude that healthcare leaders should adopt an occupational wellbeing program for nurses that focuses on their psychological wellbeing and sleep quality.

Two-Dimensional MXene as a Promising Adsorbent for Trihalomethanes Removal: A Density-Functional Theory Study.

This groundbreaking research delves into the intricate molecular interactions between MXene and trihalomethanes (THs) through a comprehensive theoretical study employing density-functional theory (DFT). Trihalomethanes are common carcinogenic chlorination byproducts found in water sanitation systems. This study focuses on a pristine MXene [Mn+1·Xn] monolayer and its various terminal [Tx] functional groups [Mn+1·XnTx], strategically placed on the surface for enhanced performance. Our investigation involves a detailed analysis of the adsorption energies of THs on different MXene types, with the MXene-Cl layer emerging as the most compatible variant. This specific MXene-Cl layer exhibits remarkable properties, including a total dipole moment (TDM) of 12.443 Debye and a bandgap of 0.570 eV, achieved through meticulous geometry optimization and computational techniques. Notably, THs such as trichloromethane (CHCl3), bromide-chloromethane (CHBrCl2), and dibromochloromethane (CHBr2Cl) demonstrate the highest TDM values, indicating substantial changes in electronic and optical parameters, with TDM values of 16.363, 15.998, and 16.017 Debye, respectively. These findings highlight the potential of the MXene-Cl layer as an effective adsorbent and detector for CHF3, CHClF2, CHCl3, CHBrCl2, and CHBr2Cl. Additionally, we observe a proportional increase in the TDM and bandgap energy, indicative of conductivity, for various termination atom combinations, such as Mxene-O-OH, Mxene-O-F, Mxene-O-Cl, Mxene-OH-F, Mxene-F-Cl, and Mxene-OH-Cl, with bandgap energies measured at 0.734, 0.940, 1.120, 0.835, and 0.927 eV, respectively. Utilizing DFT, we elucidate the adsorption energies of THs on different MXene surfaces. Our results conclusively demonstrate the significant influence of the termination atom nature and quantity on MXene's primitive TDM value. This research contributes to our understanding of MXene-THs interactions, offering promising avenues for the development of efficient adsorbents and detectors for THs. Ultimately, these advancements hold the potential to revolutionize water sanitation practices and enhance environmental safety.

Public awareness of side effects of systemic steroids in Asir region, Saudi Arabia.

Background: Corticosteroids have been used since the 50s and it represent the most important and frequently used class of anti-inflammatory and immunosuppressive drugs for the treatment of several diseases such as numerous neoplastic, asthma, allergy, rheumatoid arthritis, and dermatological disorders. This study aims to determine the public awareness of side effects of systemic steroids in Asir region, Saudi Arabia. Methods: A descriptive cross-sectional web-based study was used. An online questionnaire was developed by the study researchers based on the literature review and consultations of the field experts. The questionnaire included the following components: Participants demographic data, medical history, and steroids use. Also, it covered participants awareness regarding systemic steroids and side effects. Results: A total of 439 participants fulfilling the inclusion criteria completed the study questionnaire. Ages ranged from 18 to 65 years with mean age of 26.1 ± 13.9 years old, of those, 227 (51.7%) respondents were males. Around 346 (78.8%) had poor overall awareness level while only 93 (21.2%) had good awareness regarding systematic steroids. The study also showed that awareness was significantly higher among young aged participants in the health care field and among those who previously used steroids. Two hundred and eighty two (64.2%) of the respondents reported previous use of steroids. Conclusion: In conclusion, the current study showed that nearly one out of each five people know about systemic steroids and related side effects which is below the satisfactory level. Higher awareness was observed with regards drug associated side effects and long-term use consequences.

Terbium Removal from Aqueous Solutions Using a In2O3 Nanoadsorbent and Arthrospira platensis Biomass.

Terbium is a rare-earth element with critical importance for industry. Two adsorbents of different origin, In2O3 nanoparticles and the biological sorbent Arthrospira platensis, were applied for terbium removal from aqueous solutions. Several analytical techniques, including X-ray diffraction, Fourier-transform infrared spectroscopy, and scanning electron microscopy, were employed to characterize the adsorbents. The effect of time, pH, and terbium concentration on the adsorption efficiency was evaluated. For both adsorbents, adsorption efficiency was shown to be dependent on the time of interaction and the pH of the solution. Maximum removal of terbium by Arthrospira platensis was attained at pH 3.0 and by In2O3 at pH 4.0-7.0, both after 3 min of interaction. Several equilibrium (Langmuir, Freundlich, and Temkin) and kinetics (pseudo-first order, pseudo-second order, and Elovich) models were applied to describe the adsorption. The maximum adsorption capacity was calculated from the Langmuir model as 212 mg/g for Arthrospira platensis and 94.7 mg/g for the In2O3 nanoadsorbent. The studied adsorbents can be regarded as potential candidates for terbium recovery from wastewater.

ZnO doped C: Facile synthesis, characterization and photocatalytic degradation of dyes.

Carbon doped ZnO nanoparticles have been synthesized from the thermal decomposition of Zinc citrate precursor. The precursor was synthesized from semi-solid paste and then subjected to calcination at 700 °C to produce ZnO nanoparticles. The precursor and ZnO were characterized by Fourier Transform Infrared Spectroscopy, UV-visible (UV-Vis) spectra, Transmission Electron Microscope, Field Emission Scanning Electron Microscope, Energy Dispersive Analysis by X-ray (EDAX), X-ray powder diffraction (XRD), and X-ray photoelectron spectroscopy (XPS). The results ensured the formation of hexagonal 2D-ZnO nanoparticles with a layer thickness of 25 nm. The optical band gap of ZnO was determined and found to be 2.9 eV, which is lower than the bulk. Photocatalytic degradation of Fluorescein dye as an anionic dye and Rhodamine B as a cationic dye was evaluated via C-ZnO NPs under UV irradiation. ZnO displayed 99% degradation of Fluorescein dye after 240 min and a complete photocatalytic degradation of Rhodamine B dye after 120 min under UV irradiation.

Effectiveness of Porcelain Polishing Methods on the Roughness and Color Stability of CAD-CAM Ceramics after Orthodontic Bracket Debonding.

Increased utilization of all ceramic restorations for aesthetic consideration in combination with routine adult orthodontic practice has led to numerous clinical challenges. Obtaining adequate bond strength between the orthodontic bracket and all-ceramic restoration and damage to the ceramic surface during the bracket debonding procedure needs to be better understood. This study analyzed the surface texture and color change of glazed and bracket-debonded ceramic CAD-CAM materials and the efficiency of porcelain polishing systems in restoring surface morphology and color. A total of 30 rectangular test specimens from each lithium disilicate CAD (LD-CAD), polymer-infiltrated ceramic (PICN), zirconia-reinforced lithium silicate glass ceramic (ZLS), and 5YTZP zirconia (5YZP) were prepared. The ceramic samples were embedded within acrylic resin, and baseline surface roughness and color were recorded using an optical profilometer and a reflected color spectrophotometer. The porcelain samples were bonded with lower incisor ceramic brackets. The samples were thermocycled 2000 times between 5 and 55 °C. Afterward, the brackets were peeled with bracket-removing pliers. The resin adhesive from the debonded surface was eliminated with tungsten carbide bur, and samples were randomly divided into three subgroups of (n = 10) to be polished with Diapol-twist (DT), a Keramik-Politur 4313B Komet polishing kit (KK), and a Horico diamond polisher (HDP). The polished surface roughness and color were recorded. The data were statistically analyzed using a two-way analysis of variance at p < 0.05. The debonded porcelain surfaces across the groups displayed significantly higher mean surface roughness (Ra) compared to glazed surfaces. The debonded 5YZP showed the least Ra at 0.661 (0.09), while the highest Ra was recorded by PICN at 4.057 (0.82). All of the polishing systems evaluated in the study significantly reduced the surface roughness. However, they were unsuccessful in regaining the surface topography of the glazed surface. The flexible discs (DT) produced the smoothest surface, followed by the diamond-impregnated rubber points (KK). Unpolished porcelain surfaces had a discernable mean color difference from glazed surfaces. Polished surfaces from the different polishing systems among the all-ceramic groups achieved a clinically acceptable mean color difference. Polishing debonded rough porcelain surfaces is imperative, and flexible discs performed better in all of the tested CAD-CAM ceramic materials.

Facial Demodicosis-Induced Skin Hyperpigmentation in an Immunocompromised Man Treated Successfully with Ivermectin 1% Cream: A Case Report.

Demodex folliculorum is a common ectoparasite of humans that inhabits follicular infundibulum and sebaceous ducts. Its role in various dermatological diseases is well studied. However, data on demodex-induced skin pigmentation are very limited. A diagnosis of this entity can be easily missed for other causes of facial hyperpigmentation such as melasma, lichen planus pigmentosus, erythema dyschromicum perstans, post-inflammatory hyperpigmentation, and drug-induced hyperpigmentation. Here, we report a case of facial demodicosis-induced skin hyperpigmentation in a 35-year-old Saudi male who is on multiple immunosuppressive agents. He was successfully treated with ivermectin 1% cream and had a dramatic improvement at his 3-month follow-up. Our aim is to shed light on this underdiagnosed cause of facial hyperpigmentation which can be easily diagnosed and followed up by bed side dermoscopic examination and managed effectively by anti-demodectic therapies.

Assessment of Public's Awareness Regarding Irritable Bowel Syndrome in Aseer Region, Saudi Arabia.

Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by altered bowel habits, abdominal pain, or discomfort. It is a highly prevalent disorder that affects patients' quality of life. A workup is usually required to diagnose IBS, as its differential diagnosis includes some serious conditions such as carcinoma of the colon. The present study aimed to assess the awareness and beliefs of the general population regarding IBS. This study was conducted in the Aseer Region, in the southwestern part of Saudi Arabia. It followed a cross-sectional research design that was conducted during the period from January to March 2021 using a structured self-administered questionnaire to assess the demographic variables in addition to questions to assess participants' awareness and beliefs related to IBS. Following a convenience sample, the study included 779 participants, with 43.3% being male, mostly in the age group 21-30 years (36.7%), and 68.7% being university graduates. Most participants (70.5%) were aware of IBS, and had the correct knowledge about its etiology, symptoms, risk factors, prognosis, and management. It is recommended to conduct various awareness-raising programs regarding IBS to improve the public's knowledge and to decrease functional disabilities and their impact on life.

Primary Cutaneous Follicle Center Lymphoma Presenting as a Solitary Nodule on the Forearm of an Adolescent Girl: A Case Report and Literature Review.

Primary cutaneous B-cell lymphomas (PCBCLs) are very rare to be seen in pediatric and adolescent age group, especially primary cutaneous follicle center lymphoma (PCFCL) which is considered the least occurring main subtype. Here, we describe a 16-year-old girl who developed a slowly growing solitary firm smooth surfaced erythematous nodule over her forearm. Histopathological examination showed a dense dermal nodular, periadnexal and perivascular lymphoid infiltrate extending deep to the subcutis. Immunohistochemical staining showed a B-cell population with positivity for CD20, variable staining for BCL6 and CD10 and uniquely staining for BCL2. Although a primary cutaneous marginal zone lymphoma (PCMZL) was considered but the presences of interfollicular BCL6 and CD10 positivity established the diagnosis of PCFCL. To our knowledge, only 12 cases of pediatric and adolescent PCFCL have been described in the literature.

Promise of Real-World Evidence for Patient Centricity in Gulf Cooperation Council Countries: Call to Action.

Presently, Gulf Cooperation Council countries are lagging in the generation of real-world data and use of real-world evidence for patient-centered care compared with the global average. In a collaborative effort, experts from multiple domains of the healthcare environment from the Gulf Cooperation Council countries came together to present their views and recommended key action points for the generation of robust real-world data and leveraging real-world evidence in the countries. The opinions of the experts are presented, along with existing barriers to the effective generation of real-world evidence in the countries. The Gulf Cooperation Council countries are undergoing transformative changes paving the way for improved healthcare measures; however, the challenges in generating reliable, robust, accessible, and secure real-world evidence are persistent. Hence, ongoing public-private engagements, as well as collaborations between regulators, policymakers, healthcare professionals, insurance and pharmaceutical companies, and patients, are warranted. A few notable examples of real-world evidence studies highlighting the benefits of real-world evidence for gaining valuable insights into patient-centric decision making are also discussed. The actionable steps identified for successful real-world evidence generation would provide long-term, real-world evidence-based patient-centric benefits for the countries.

An unusual presentation of acute diaphragmatic hernia complicated by tension gastrothorax an under-recognized cause of cardiac arrest due to a fall from a height: A case report and literature review.

A diaphragmatic hernia is a protrusion of the abdominal contents into the negative pressure thoracic cavity through a congenital or acquired diaphragmatic defect. Generally, acquired diaphragmatic hernia is a rare, life-threatening condition that usually follows blunt/penetrating trauma or an iatrogenic cause, resulting in the diaphragmatic rupture, accompanied by the herniation of abdominal visceral organs. We report a 47-year-old male construction worker who sustained a fall from a height of about 30 feet height. He presented with hypoxia initially and, after a primary survey, was found to have a traumatic rupture of the diaphragm with herniation of the stomach and abdominal contents, causing signs of obstructive shock. After adequate resuscitation in the Emergency Department, he was rushed to operating room. There, he suffered two very short pulseless electrical activity cardiac arrests. Therefore, an emergency anterolateral thoracotomy was done, and it was extended into laparotomy to reduce the abdominal contents through the diaphragmatic tear of 12 cm, which restored the spontaneous circulation. He recovered eventually, despite chest infections and pulmonary atelectasis, and was discharged on the 28th day and remained in good condition during the outpatient visit. Tension gastrothorax or viscerothorax is rare, but an under-recognized cause of cardiac arrest in the trauma setting necessitates a vigilant evaluation and early suspicion to prevent a catastrophic outcome. This case report emphasizes the inclusion of tension viscero or abdominal thorax as one of the recognizable causes of a pulseless electrical activity cardiac arrest.

Treatment of idiopathic internal jugular vein thrombosis in a healthy woman with enoxaparin and rivaroxiban: Case report and literature narrative review.

Introduction: Venous thrombosis is a medical condition that occurs when a blood clot forms in a vein. These clots usually develop in the lower leg, thigh, or pelvis but can also occur in the arm. It is essential to know about Venous thrombosis because it can happen to anybody and cause severe illness and disability. Fortunately, if the diagnosis is early, the outcomes will be excellent. However, idiopathic or spontaneous internal jugular vein thrombosis is a rare but potentially fatal condition. Method: here, we presented a rare case of Internal jugular vein thrombosis (IJVT) and reviewed the literature on cases of IJVT to describe clinical features, associated risk factors, possible complications, ways of investigations, and outcomes. Results: Among 57 cases (56 in the literature plus our case), 25 patients out of 57 had a chief complaint of neck swelling, and only five complained of neck pain; on the other hand, four patients were asymptomatic. Thirty-five patients had a risk factor of developing thrombosis, 19 patients had a malignancy, and 22 did not have an obvious risk factor. To diagnose IJVT, ultrasound alone was used in 11 patients, Ct alone was used in 13 patients, and a combination of CT and ultrasound was used in 21 patients. Conclusion: IJVT thrombosis is a rare condition, but its diagnosis requires reasonable radiological and laboratory investigations; early treatment is warranted to avoid fetal complications.

Image Exchange in the Middle East: a Survey.

Developing an enterprise approach to imaging technology rather than a radiology focus has recently increased. The communicator needs to be aware of this shift.The Middle East countries participated in the survey have confirmed the following major benefits of Medical Image Exchange: ✔ Fast access to both image and report ✔ Enable tele-services for second opinion, consulting and reporting ✔ Improve patient journey, workflow and diagnosis ✔ Allowed more patient engagement to be in place The Middle East countries that participated in this survey have agreed on the following shared challenges regarding Medical Imaging Exchange: ✔ Lack of enterprise imaging governance at the early stage of implementation. It will organize the who, when, and how. In addition, any fees and or payment involved for physicians ✔ Infrastructure availability to handle such large volume of data. Growing from mega-byte to petabyte per year is challenge for infrastructure. Cloud against On Premises-Installation implementation model ✔ Interoperability and integration to connect multi specialties from different systems. In addition, how far existing systems are ready for that. A standard-based framework is mature for image exchange, but what follows for other domains? There is a need to move beyond radiology images so as to include images from pathology, ophthalmology, and dermatology There are other countries in the region requiring guidance, support, and funding to move forward from the compact disc into internet-based interoperable image exchange. This should be considered part of the World Health Organization and the United Nation development to the region in the healthcare sector.

Highly Accurate Identification of Bacteria's Antibiotic Resistance Based on Raman Spectroscopy and U-Net Deep Learning Algorithms.

Bacterial pathogens especially antibiotic-resistant ones are a public health concern worldwide. To oppose the morbidity and mortality associated with them, it is critical to select an appropriate antibiotic by performing a rapid bacterial diagnosis. Using a combination of Raman spectroscopy and deep learning algorithms to identify bacteria is a rapid and reliable method. Nevertheless, due to the loss of information during training a model, some deep learning algorithms suffer from low accuracy. Herein, we modify the U-Net architecture to fit our purpose of classifying the one-dimensional Raman spectra. The proposed U-Net model provides highly accurate identification of the 30 isolates of bacteria and yeast, empiric treatment groups, and antimicrobial resistance, thanks to its capability to concatenate and copy important features from the encoder layers to the decoder layers, thereby decreasing the data loss. The accuracies of the model for the 30-isolate level, empiric treatment level, and antimicrobial resistance level tasks are 86.3, 97.84, and 95%, respectively. The proposed deep learning model has a high potential for not only bacterial identification but also for other diagnostic purposes in the biomedical field.

Understanding the Mechanism Underlie the Antidiabetic Activity of Oleuropein Using Ex-Vivo Approach.

Background: Oleuropein, the main constituent of olive fruit and leaves, has been reported to protect against insulin resistance and diabetes. While many experimental investigations have examined the mechanisms by which oleuropein improves insulin resistance and diabetes, much of these investigations have been carried out in either muscle cell lines or in vivo models two scenarios with many drawbacks. Accordingly, to simplify identification of mechanisms by which oleuropein regulates specific cellular processes, we resort, in the present study, to isolated muscle preparation which enables better metabolic milieu control and permit more detailed analyses. Methods: For this purpose, soleus muscles were incubated for 12 h without or with palmitate (1.5 mM) in the presence or absence of oleuropein (1.5 mM), and compound C. Insulin-stimulated glucose transport, glucose transporter type 4 (GLUT4) translocation, Akt substrate of 160 kDa (AS160) phosphorylation and adenosine monophosphate-activated protein kinase (AMPK) phosphorylation were examined. Results: Palmitate treatment reduced insulin-stimulated glucose transport, GLUT4 translocation and AS160 phosphorylation, but AMPK phosphorylation was not changed. Oleuropein administration (12 h) fully rescued insulin-stimulated glucose transport, but partially restored GLUT4 translocation. However, it fully restored AS160 phosphorylation, raising the possibility that oleuropein may also have contributed to the restoration of glucose transport by increased GLUT4 intrinsic activity. Inhibition of AMPK phosphorylation with compound C (50 µM) prevented oleuropein -induced improvements in insulin-stimulated glucose transport, GLUT4 translocation, and AS160 phosphorylation. Conclusion: Our results clearly indicate that oleuropein alleviates palmitate-induced insulin resistance appears to occur via an AMPK-dependent mechanism involving improvements in the functionality of the AS160-GLUT4 signaling system.

Pelvic osteotomies in hip dysplasia: why, when and how?

Acetabular dysplasia is a significant problem in the spectrum of developmental dysplasia of hip. In a younger child, positioning the femoral head into the acetabulum helps in reciprocal remodeling of the acetabulum and correction of dysplasia. In an older child, the remodeling potential is limited and often the acetabular dysplasia needs surgical intervention in the form of a pelvic osteotomy. Thus, pelvic osteotomy forms an integral part of surgical management of hip dysplasia. The ultimate goal of these osteotomies is to preclude or postpone the development of osteoarthritis and add more years of life to the native hip. Pelvic osteotomies play a pivotal role in normalizing hip morphology. The choice of pelvic osteotomy depends on the age of a child, the type of dysplasia and the status of the tri-radiate cartilage. Several types of re-directional and reshaping pelvic osteotomies have been described in the literature to improve the stability and restore the anatomy and biomechanics of the dysplastic hip. This article attempts to review the current indications for various pelvic osteotomies with a brief description of their techniques along with the outcomes and complications published thus far. Besides, the guidelines to choose the right pelvic osteotomy are also provided.

Is there a role for controlled repositioning and mini-open primary osteoplasty in the management of unstable slipped capital femoral epiphysis?

The management of unstable slipped capital femoral epiphysis is controversial with variable rates of avascular necrosis (AVN). Treatment options include in-situ stabilization, gentle/positional reduction and screw fixation and modified Dunn's procedure (MDP). We present a technique of controlled repositioning (CRP) of the epiphysis to pre-acute slip stage, screw fixation and primary osteoplasty. Between 2015 and 2020, 38 unstable slips were treated in our institution. Of these, 14 underwent successful CRP and the rest were treated with MDP. All the 14 patients who had CRP and completed 1-year follow-up were included for this study. The head-neck angle (HNA) was measured at presentation and alpha angle, head-neck offset and AVN were assessed during follow-up. The average age was 14 years (9-18) and mean follow-up was 17.7 months (12-43). The average intraoperative flexion internal rotation before osteoplasty was -18.5° (-40° to -5°) which improved to +22.1° (+15° to +30°). The average preoperative HNA was 48.7° (34.1° to 70.7°) which improved to 18.4° (1.8° to 35.7°) post-operatively. At final follow-up, the average alpha angle and head-neck offset were 46.4° (30.9° to 64.6°) and 0.22 (0.09 to 0.96), respectively. The AVN rate in the CRP group was 7.1% compared with 20.8% in the MDP group, which was not significant (P = 0.383). Two patients had screw breakage. CRP, screw fixation and mini-open primary osteoplasty is a feasible treatment option in a subgroup of patients with unstable SCFEs. The limitation with this technique is that the final decision is made intraoperatively, and hence the patient and parents need to be counselled and consented appropriately. Level of evidence: Level IV-Case series.

Contemporary approach to understand and manage COVID-19-related arrhythmia.

Arrhythmia, one of the most common complications of COVID-19, was reported in nearly one-third of diagnosed COVID-19 patients, with higher prevalence rate among ICU admitted patients. The underlying etiology for arrhythmia in these cases are mostly multifactorial as those patients may suffer from one or more of the following predisposing mechanisms; catecholamine surge, hypoxia, myocarditis, cytokine storm, QTc prolongation, electrolyte disturbance, and pro-arrhythmic drugs usage. Obviously, the risk for arrhythmia and the associated lethal outcome would rise dramatically among patients with preexisting cardiac disease such as myocardial ischemia, heart failure, cardiomyopathy, and hereditary arrhythmias. Considering all of these variables, the management strategy of COVID-19 patients should expand from managing a viral infection and related host immune response to include the prevention of predictable causes for arrhythmia. This may necessitate the need to investigate the role of some drugs that modulate the pathway of arrhythmia generation. Of these drugs, we discuss the potential role of adrenergic antagonists, trimetazidine, ranolazine, and the debatable angiotensin converting enzyme inhibitors drugs. We also recommend monitoring the level of: unbound free fatty acids, serum electrolytes, troponin, and QTc (even in the absence of apparent pro-arrhythmic drug use) as these may be the only indicators for patients at risk for arrhythmic complications.

Making Waves: Collaboration in the time of SARS-CoV-2 - rapid development of an international co-operation and wastewater surveillance database to support public health decision-making.

The presence of SARS-CoV-2 RNA in wastewater was first reported in March 2020. Over the subsequent months, the potential for wastewater surveillance to contribute to COVID-19 mitigation programmes has been the focus of intense national and international research activities, gaining the attention of policy makers and the public. As a new application of an established methodology, focused collaboration between public health practitioners and wastewater researchers is essential to developing a common understanding on how, when and where the outputs of this non-invasive community-level approach can deliver actionable outcomes for public health authorities. Within this context, the NORMAN SCORE "SARS-CoV-2 in sewage" database provides a platform for rapid, open access data sharing, validated by the uploading of 276 data sets from nine countries to-date. Through offering direct access to underpinning meta-data sets (and describing its use in data interpretation), the NORMAN SCORE database is a resource for the development of recommendations on minimum data requirements for wastewater pathogen surveillance. It is also a tool to engage public health practitioners in discussions on use of the approach, providing an opportunity to build mutual understanding of the demand and supply for data and facilitate the translation of this promising research application into public health practice.

Impedance planimetry values for predicting clinical response following peroral endoscopic myotomy.

BACKGROUND: There is growing interest in developing impedance planimetry as a tool to enhance the clinical outcomes for endoscopic and surgical management of achalasia. The primary aim of this study was to determine whether impedance planimetry measurements can predict clinical response and reflux following peroral endoscopic myotomy (POEM). METHODS: A multicenter cohort study of patients with achalasia undergoing POEM was established from prospective databases and retrospective chart reviews. Patients who underwent impedance planimetry before and after POEM were included. Clinical response was defined as an Eckardt score of ≤ 3. Tenfold cross-validated area under curve (AUC) values were established for the different impedance planimetry measurements associated with clinical response and reflux development. RESULTS: Of the 290 patients included, 91.7 % (266/290) had a clinical response and 39.4 % (108/274) developed reflux following POEM. The most predictive impedance planimetry measurements for a clinical response were: percent change in cross-sectional area (%ΔCSA) and percent change in distensibility index (%ΔDI), with AUCs of 0.75 and 0.73, respectively. Optimal cutoff values for %ΔCSA and %ΔDI to determine a clinical response were a change of 360 % and 272 %, respectively. Impedance planimetry values were much poorer at predicting post-POEM reflux, with AUCs ranging from 0.40 to 0.62. CONCLUSION: Percent change in CSA and distensibility index were the most predictive measures of a clinical response, with a moderate predictive ability. Impedance planimetry values for predicting reflux following POEM showed weak predictive capacity.