Flexible 3D Force Sensor Based on Polymer Nanocomposite for Soft Robotics and Medical Applications.

The three-dimensional (3D) force sensor has become essential in industrial and medical applications. The existing conventional 3D force sensors quantify the three-direction force components at a point of interest or extended contact area. However, they are typically made of rigid, complex structures and expensive materials, making them hard to implement in different soft or fixable industrial and medical applications. In this work, a new flexible 3D force sensor based on polymer nanocomposite (PNC) sensing elements was proposed and tested for its sensitivity to forces in the 3D space. Multi-walled carbon nanotube/polyvinylidene fluoride (MWCNT/PVDF) sensing element films were fabricated using the spray coating technique. The MWCNTs play an essential role in strain sensitivity in the sensing elements. They have been utilized for internal strain measurements of the fixable 3D force sensor's structure in response to 3D forces. The MWCNT/PVDF was selected for its high sensitivity and capability to measure high and low-frequency forces. Four sensing elements were distributed into a cross-beam structure configuration, the most typically used solid 3D force sensor. Then, the sensing elements were inserted between two silicone rubber layers to enhance the sensor's flexibility. The developed sensor was tested under different static and dynamic loading scenarios and exhibited excellent sensitivity and ability to distinguish between tension and compression force directions. The proposed sensor can be implemented in vast applications, including soft robotics and prostheses' internal forces of patients with limb amputations.

Ratios of Neutrophils and Platelets to Lymphocytes as Predictors of Postoperative Intensive Care Unit Admission and Length of Stay in Bariatric Surgery Patients: A Retrospective Study.

Background and Objectives: This study aimed to investigate the role of the pre- and postoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting intensive care unit (ICU) admission and postoperative length of stay (LOS) in bariatric surgery. Materials and Methods: We retrospectively analysed 96 patients who underwent bariatric surgery at our institution. The NLR and PLR were calculated in the pre- and postoperative stages. Changes in pre- and postoperative hematological ratios were compared using the Wilcoxon signed-rank test. The optimal cutoff values and area under the curve (AUC) for each ratio were calculated using receiver operating characteristic (ROC) analysis. Multivariate linear regression analysis was used to assess the relationship between each ratio and the postoperative LOS after adjusting for age, sex, and American Society of Anesthesiologists (ASA) score. Results: The median age of our patients was 35.50 years, and 54.2% were male. The preoperative NLR showed a significant increase from 1.44 to 6.38 postoperatively (p < 0.001). The PLR increased from 107.08 preoperatively to 183.58 postoperatively, p < 0.001). ROC analysis showed that the postoperative NLR was a moderate to high predictor of ICU admission (AUC = 0.700, optimal cutoff point = 5.987). The postoperative PLR had less predictive power for ICU admission (AUC = 0.641, optimal cutoff point = 170.950). Ratios that had a statistically significant relationship with the postoperative LOS were the preoperative NLR (standardized ß [95% CI]: 0.296 [0.115-0.598]), postoperative NLR (0.311 [0.034-0.161]), and postoperative PLR (0.236 [0.000-0.005]). Conclusions: The NLR and PLR demonstrated an independent relationship with the postoperative LOS after bariatric surgery and the predictive ability of ICU admission. Both ratios might be useful as simple markers to predict patient outcome after surgery.

External validation of the Manchester Acute Coronary Syndromes ECG risk model within a pre-hospital setting.

OBJECTIVES: The Manchester Acute Coronary Syndromes ECG (MACS-ECG) prediction model calculates a score based on objective ECG measurements to give the probability of a non-ST elevation myocardial infarction (NSTEMI). The model showed good performance in the emergency department (ED), but its accuracy in the pre-hospital setting is unknown. We aimed to externally validate MACS-ECG in the pre-hospital environment. METHODS: We undertook a secondary analysis from the Pre-hospital Evaluation of Sensitive Troponin (PRESTO) study, a multi-centre prospective study to validate decision aids in the pre-hospital setting (26 February 2019 to 23 March 2020). Patients with chest pain where the treating paramedic suspected acute coronary syndrome were included. Paramedics collected demographic and historical data and interpreted ECGs contemporaneously (as 'normal' or 'abnormal'). After completing recruitment, we analysed ECGs to calculate the MACS-ECG score, using both a pre-defined threshold and a novel threshold that optimises sensitivity to differentiate AMI from non-AMI. This was compared with subjective ECG interpretation by paramedics. The diagnosis of AMI was adjudicated by two investigators based on serial troponin testing in hospital. RESULTS: Of 691 participants, 87 had type 1 AMI and 687 had complete data for paramedic ECG interpretation. The MACS-ECG model had a C-index of 0.68 (95% CI: 0.61 to 0.75). At the pre-determined cut-off, MACS-ECG had 2.3% (95% CI: 0.3% to 8.1%) sensitivity, 99.5% (95% CI: 98.6% to 99.9%) specificity, 40.0% (95% CI: 10.2% to 79.3%) positive predictive value (PPV) and 87.6% (87.3% to 88.0%) negative predictive value (NPV). At the optimal threshold for sensitivity, MACS-ECG had 50.6% sensitivity (39.6% to 61.5%), 83.1% specificity (79.9% to 86.0%), 30.1% PPV (24.7% to 36.2%) and 92.1% NPV (90.4% to 93.5%). In comparison, paramedics had a sensitivity of 71.3% (95% CI: 60.8% to 80.5%) with 53.8% (95% CI: 53.8% to 61.8%) specificity, 19.7% (17.2% to 22.45%) PPV and 93.3% (90.8% to 95.1%) NPV. CONCLUSION: Neither MACS-ECG nor paramedic ECG interpretation had a sufficiently high PPV or NPV to 'rule in' or 'rule out' NSTEMI alone.

Towards enhanced telephone triage for chest pain: a Delphi study to define life-threatening conditions that must be identified.

BACKGROUND: Improving telephone triage for patients with chest pain has been identified as a national research priority. However, there is a lack of strong evidence to define the life-threatening conditions (LTCs) that telephone triage ought to identify. Therefore, we aimed to build consensus for the LTCs associated with chest pain that ought to be identified during telephone triage for emergency calls. METHODS: We conducted a Delphi study in three rounds. Twenty experts in pre-hospital care and emergency medicine experience from the UK were invited to participate. In round I, experts were asked to list all LTCs that would require priority 1, 2, and 4 ambulance responses. Round II was a ranking evaluation, and round III was a consensus round. Consensus level was predefined at > = 70%. RESULTS: A total of 15 participants responded to round one and 10 to rounds two and three. Of 185 conditions initially identified by the experts, 26 reached consensus in the final round. Ten conditions met consensus for requiring priority 1 response: oesophageal perforation/rupture; ST elevation myocardial infarction; non-ST elevation myocardial infarction with clinical compromise (defined, also by consensus, as oxygen saturation < 90%, heart rate < 40/min or systolic blood pressure < 90 mmHg); acute heart failure; cardiac tamponade; life-threatening asthma; cardiac arrest; tension pneumothorax and massive pulmonary embolism. An additional six conditions met consensus for priority 2 response, and three for priority 4 response. CONCLUSION: Using expert consensus, we have defined the LTCs that may present with chest pain, which ought to receive a high-priority ambulance response. This list of conditions can now form a composite primary outcome for future studies to derive and validate clinical prediction models that will optimise telephone triage for patients with a primary complaint of chest pain.

Improving the understanding of originator and biosimilar biologics among healthcare providers in Saudi Arabia.

The loss of patentability of many originator biologics has led to the rapid introduction of biosimilar agents. The anticipated economic benefit of introducing such agent has been accompanied by vagueness surrounding their biotechnology, approval requirements, positioning in treatment paradigms and potential for adverse events. The Second Symposium on Biologics and Biosimilars "Beyond Clinical Practice" was held on 24th-26th January 2020 aiming at improving the understanding of these new agents in a diverse interactive conference and to guide stakeholders how to introduce biosimilars into clinical practice. The symposium consisted of 4 tracks and 3 workshops. A total of 217 participants attended the meeting. The majority were pharmacists (78.8%) followed by physicians (18.9%) and other healthcare providers (2.3%). The workshops covered the following topics: basics of pharmacoeconomics, pharmacovigilance and patients' perspective toward biosimilar biologics. While, the 4 main tracks included: Introduction to biosimilars, challenges in clinical practice, regulatory and pharmacoeconomic aspects and Challenges in biosimilar pharmacovigilance.

Internal Bleaching of Endodontically Treated Teeth: A Dental Practitioner's Perspective from Kingdom of Saudi Arabia.

AIM: To determine the knowledge and attitude of dental practitioners (DPs) for internal bleaching technique (IBT) in Kingdom of Saudi Arabia. MATERIALS AND METHODS: A cross-sectional study was developed based on a convenient sampling of dental practitioners and specialists working in Kingdom of Saudi Arabia. DPs responded to a structured, self-administered questionnaire for evaluation of their knowledge and attitude toward IBT. The questionnaire had two components: (i) the characteristics of the study participants; and (ii) the items related to the internal bleaching technique (IBT). Data analysis was conducted using SPSS (version 25.0), with descriptive statistics and a bivariate analysis. RESULTS: A total of 532 dental practitioners (61.3% males and 38.7% females) participated in this study. The response rate of participation was estimated at 92.5%. Almost 37% participants considered the sodium perborate as the most commonly used dental material for internal bleaching. Almost 70% participants reported that superficial enamel discoloration was a contraindication for internal bleaching in endodontically treated teeth. CONCLUSION: DPs have good knowledge and attitude on use of IBT for discolored teeth. In general, there is a need to improve knowledge and attitude of dental professionals about the IBT by attending continuing dental educational programs. CLINICAL SIGNIFICANCE: Saving of the remaining tooth structure is a main principle of the different types of dental treatments. So the IBT should be known for all dental practitioners to use it before going to more aggressive dental treatment options such as full crowns. How to cite this article: Doumani M, Alotaibi AN, Al Hussain F, et al. Internal Bleaching of Endodontically Treated Teeth: A Dental Practitioner's Perspective from Kingdom of Saudi Arabia. J Contemp Dent Pract 2019;20(10):1141-1145.

Olmsted syndrome with oral involvement, including premature teeth loss.

INTRODUCTION: Olmsted syndrome is a rare palmoplantar keratodermal disease that has not previously been reported to have an association with periodontal disease. The aim of this study is to report and document a case of Olmsted syndrome with evidence of severe periodontal disease. CASE REPORT: A 38-year old Saudi male patient presented to the dental clinic diagnosed previously with Olmsted syndrome. Clinical and radiographic examinations were done and provided evidence of the typical clinical findings in Olmsted syndrome and evidence of severe periodontal disease. The patient had severe generalized hyperkeratotic lesions on the palms, soles, and perioral skin as well as hyperkeratosis of oral mucosa at multiple sites. CONCLUSION: This case report documents the first reported case of Olmsted syndrome to be associated with severe periodontal disease. The altered differentiation of oral mucosa linked to Olmsted syndrome may contribute to the periodontal disease. Patients diagnosed with this syndrome should receive a comprehensive oral examination to determine whether periodontal destruction is a significant component of their disease or not.

A proposed scalable design and simulation of wireless sensor network-based long-distance water pipeline leakage monitoring system.

Anomalies such as leakage and bursts in water pipelines have severe consequences for the environment and the economy. To ensure the reliability of water pipelines, they must be monitored effectively. Wireless Sensor Networks (WSNs) have emerged as an effective technology for monitoring critical infrastructure such as water, oil and gas pipelines. In this paper, we present a scalable design and simulation of a water pipeline leakage monitoring system using Radio Frequency IDentification (RFID) and WSN technology. The proposed design targets long-distance aboveground water pipelines that have special considerations for maintenance, energy consumption and cost. The design is based on deploying a group of mobile wireless sensor nodes inside the pipeline and allowing them to work cooperatively according to a prescheduled order. Under this mechanism, only one node is active at a time, while the other nodes are sleeping. The node whose turn is next wakes up according to one of three wakeup techniques: location-based, time-based and interrupt-driven. In this paper, mathematical models are derived for each technique to estimate the corresponding energy consumption and memory size requirements. The proposed equations are analyzed and the results are validated using simulation.

Effects of MC-100093 on Ethanol Drinking and the Expression of Astrocytic Glutamate Transporters in the Mesocorticolimbic Brain Regions of Male and Female Alcohol-Preferring Rats.

Chronic ethanol consumption increased extracellular glutamate concentrations in several reward brain regions. Glutamate homeostasis is regulated in majority by astrocytic glutamate transporter 1 (GLT-1) as well as the interactive role of cystine/glutamate antiporter (xCT). In this study, we aimed to determine the attenuating effects of a novel beta-lactam MC-100093, lacking the antibacterial properties, on ethanol consumption and GLT-1 and xCT expression in the subregions of nucleus accumbens (NAc core and NAc shell) and medial prefrontal cortex (Infralimbic, mPFC-IL and Prelimbic, mPFC-PL) in male and female alcohol-preferring (P) rats. Female and male rats were exposed to free access to ethanol (15% v/v) and (30% v/v) and water for five weeks, and on Week 6, rats were administered 100 mg/kg (i.p) of MC-100093 or saline for five days. MC-100093 reduced ethanol consumption in both male and female P rats from Day 1-5. Additionally, MC-100093 upregulated GLT-1 and xCT expression in the mPFC and NAc subregions as compared to ethanol-saline groups in female and male rats. Chronic ethanol intake reduced GLT-1 and xCT expression in the IL and PL in female and male rats, except there was no reduction in GLT-1 expression in the mPFC-PL in female rats. Although, MC-100093 upregulated GLT-1 and xCT expression in the subregions of NAc, we did not observe any reduction in GLT-1 and xCT expression with chronic ethanol intake in female rats. These findings strongly suggest that MC-100093 treatment effectively reduced ethanol intake and upregulated GLT-1 and xCT expression in the mPFC and NAc subregions in male and female P rats.

Effects of novel GLT-1 modulator, MC-100093, on neuroinflammatory and neurotrophic biomarkers in mesocorticolimbic brain regions of male alcohol preferring rats exposed chronically to ethanol.

Chronic ethanol consumption can lead to increased extracellular glutamate concentrations in key reward brain regions, such as medial prefrontal cortex (mPFC) and nucleus accumbens (NAc), and consequently leading to oxidative stress and neuroinflammation. Previous studies from our lab tested ß-lactam antibiotics and novel beta-lactam non-antibiotic, MC-100093, and showed these ß-lactam upregulated the major astrocytic glutamate transporter, GLT-1, and consequently reduced ethanol intake and normalized glutamate homeostasis. This present study tested the effects of novel synthetic ß-lactam non-antibiotic drug, MC-100093, in chronic ethanol intake and neuroinflammatory and trophic factors in subregions of the NAc (NAc core and shell) and mPFC (Prelimbic, PL; and Infralimbic, IL) of male P rats. MC-100093 treatment reduced ethanol intake after 5-week drinking regimen. Importantly, MC-100093 attenuated ethanol-induced downregulation of brain derived neurotrophic factor (BDNF) expression in these brain regions. In addition, MC-100093 attenuated ethanol-induced upregulation of pro-inflammatory cytokines such as TNF-a and HMGB1 in all these brain regions. Furthermore, MC-100093 treatment attenuated ethanol-induced increase in RAGE in these brain regions. MC-100093 prevented neuroinflammation caused by ethanol intake as well as increased neurotrophic factor in mesocorticolimbic brain regions. MC-100093 treatment reduced ethanol intake and this behavioral effect was associated with attenuation of reduced trophic factors and increased pro-inflammatory factors. MC-100093 is considered a small molecule that may have potential therapeutic effects for the treatment of the effects of chronic exposure to ethanol.

Awareness of Diabetic Patients in the Qassim Region About Diabetic Foot and Its Complications.

Introduction Diabetes mellitus (DM) is a chronic condition brought on by either insufficient insulin production by the pancreas or inefficient insulin utilization by the body. A hormone called insulin controls blood sugar. Patients with type 1 or type 2 diabetes frequently experience diabetes complications, which are also a major cause of morbidity and mortality. Microvascular and macrovascular problems of diabetes are the two main categories, with the former having a significantly higher prevalence than the latter. In contrast to macrovascular problems, which include cardiovascular disease, stroke, and peripheral artery disease (PAD), microvascular sequelae include neuropathy, nephropathy, and retinopathy. The occurrence of a foot ulcer coupled with neuropathy, PAD, and infection is known as diabetic foot (DF) syndrome, and it is a primary factor in lower limb amputation. Finally, there are additional diabetes problems that fall outside of the two categories listed before, including birth defects, dental disease, and decreased infection resistance. Aim This study aimed to evaluate the awareness of diabetic patients in the Qassim region about diabetic foot and its complications. Patient and methods This retrospective cohort study was conducted between January 2021 and January 2022 among diabetic patients. The patients were contacted through the contact numbers listed in their medical charts at the Diabetic Center in King Saud Hospital in Unaizah and the Diabetes Center in King Fahad Specialist Hospital. The data were collected by sending the link to the targeted patients using the Google Form questionnaire. Results Of the 384 diabetic patients, 51.6% were females, and 28.6% were aged between 18 and 30 years old. A previous history of foot ulcers has been reported by 10.4%. The overall mean score was 11.3 (SD 2.99) out of 20 points, with poor, moderate, and good awareness levels constituting 25.8%, 66.4%, and 7.8%, respectively. Factors associated with increased awareness include younger age, female gender, having no associated chronic disease, and not experiencing soreness on the foot or leg. Conclusion There was modest awareness among the diabetic population regarding diabetes foot care and its complications. Independent significant predictors of increased knowledge include younger age, female gender, having no associated chronic disease, and not experiencing soreness on the foot or leg. Increased diabetic education is vital to improving awareness levels of diabetic foot complications.

Impact of COVID-19 pandemic on transplant laboratories: How to mitigate?

A positive flow cytometry crossmatch (FCXM) due to donor specific antibodies (DSA) constitutes a risk for kidney transplantation; such a finding may indicates an unacceptable donor for this patient. However, positive FCXM in the absence of DSA is considered discordant and need further investigations. During COVID-19 pandemic, we observed 22% discordant results out of 445 FCXM performed during eight months period in our laboratory and another 7% were invalid due to high background negative control (NC). No study has addressed the impact of COVID-19 pandemic on FCXM and the overall pre-kidney transplant workups or described a solution to deal with these non-specific reactivities. Herein, we analyzed all FCXM results in SARS-CoV-2 seropositive patients and addressed how this pandemic affected significantly the pre-kidney transplant workups, highlighting both technical and financial implications. We also shared our modified FCXM procedures using dithiotheritol (DTT) sera treatment or blocking donor cells with negative control human serum (NCS) which we found to be successful to abrogate 98% of all discordant FCXM results and to validate all invalid results due to high background NC. In conclusion, COVID-19 pandemic has affected our HLA laboratory significantly by creating many false positive or invalid crossmatch results. Transplant laboratories must consider this before test interpretations and immune risk assessments. We recommend the use of DTT serum treatment to remove nonspecific bindings in the sera of kidney transplant candidates and the use of NCS-blocked donor cells to correct high background when performing FCXM in transplant candidates or donors with recent history of SARS-CoV-2 immunization respectively.

Towards exploring current challenges and future opportunities relating to the prehospital triage of patients with traumatic brain injury: a mixed-methods study protocol.

INTRODUCTION: Traumatic brain injury (TBI) is a major global health burden that results in disability and loss of health. Identifying those patients who require specialist neuroscience care can be challenging due to the low accuracy of existing prehospital trauma triage tools. Despite the widespread use of decision aids to 'rule out' TBI in hospitals, they are not widely used in the prehospital environment. We aim to provide a snapshot of current prehospital practices in the UK, and to explore facilitators and challenges that may be encountered when adopting new tools for decision support. METHODS AND ANALYSIS: A mixed-methods study will be conducted using a convergent design approach. In the first phase, we will conduct a national survey of current practice in which every participating ambulance service in the UK will receive an online questionnaire, and only one response is required. In the second phase, semistructured interviews will be conducted to explore the perceptions of ambulance service personnel regarding the implementation of new triage methods that may enhance triage decisions. The survey questions and the interview topic guide were piloted and externally reviewed. Quantitative data will be summarised using descriptive statistics; qualitative data will be analysed thematically. ETHICS AND DISSEMINATION: This study has been approved by the Health Research Authority (REC reference 22/HRA/2035). Our findings may inform the design of future care pathways and research as well as identify challenges and opportunities for future development of prehospital triage tools for patients with suspected TBI. Our findings will be published in peer-reviewed journals, relevant national and international conferences, and will be included in a PhD thesis.

The diagnostic accuracy of prehospital triage tools in identifying patients with traumatic brain injury: A systematic review.

INTRODUCTION: Prehospital care providers are usually the first responders for patients with traumatic brain injury (TBI). Early identification of patients with TBI enables them to receive trauma centre care, which improves outcomes. Two recent systematic reviews concluded that prehospital triage tools for undifferentiated major trauma have low accuracy. However, neither review focused specifically on patients with suspected TBI. Therefore, we aimed to systematically review the existing evidence on the diagnostic performance of prehospital triage tools for patients with suspected TBI. METHODS: A comprehensive search of the current literature was conducted using Medline, EMBASE, CINAHL Plus and the Cochrane library (inception to 1st June 2021). We also searched Google Scholar, OpenGrey, pre-prints (MedRxiv) and dissertation databases. We included all studies published in English language evaluating the accuracy of prehospital triage tools for TBI. We assessed methodological quality and risk of bias using a modified Quality Assessment of Diagnostic Studies (QUADAS-2) tool. Two reviewers independently performed searches, screened titles and abstracts and undertook methodological quality assessments. Due to the heterogeneity in the population of interest and prehospital triage tools used, a narrative synthesis was undertaken. RESULTS: The initial search identified 1787 articles, of which 8 unique eligible studies met the inclusion criteria (5 retrospective, 2 prospective, 1 mixed). Overall, sensitivity of triage tools studied ranged from 19.8% to 87.9% for TBI identification. Specificity ranged from 41.4% to 94.4%. Two decision tools have been validated more than once: HITS-NS (2 studies, sensitivity 28.3-32.6%, specificity 89.1-94.4%) and the Field Triage Decision Scheme (4 studies, sensitivity 19.8-64.5%, specificity 77.4%-93.1%). Existing tools appear to systematically under-triage older patients. CONCLUSION: Further efforts are needed to improve and optimise prehospital triage tools. Consideration of additional predictors (e.g., biomarkers, clinical decision aids and paramedic judgement) may be required to improve diagnostic accuracy.

Formulation of Multicomponent Chrysin-Hydroxy Propyl ß Cyclodextrin-Poloxamer Inclusion Complex Using Spray Dry Method: Physicochemical Characterization to Cell Viability Assessment.

The work aimed to enhance chrysin (CHR) water solubility, dissolution, and in vitro antibacterial as well as cell viability. Chrysin binary, as well as ternary inclusion complex, were prepared using the spray drying method. The influence of an auxiliary component (poloxamer; PLX) was also assessed after being incorporated into the chrysin HP ßCD complex (CHR-BC) and formed as a chrysin ternary complex (CHR-TC). The phase solubility investigation was carried out in order to assess the complexation efficiency and stability constant. The samples were assessed for the dissolution test, physicochemical evaluation, antibacterial activity, and cell viability tests were also assessed. The results of the phase solubility investigation showed that the stability constant for the binary system (268 M-1) was lower than the ternary system (720 M-1). The complex stability was validated by the greater stability constant value. The dissolution results showed that pure CHR had a limited release of 32.55 ± 1.7% in 60 min, while prepared CHR-TC and CHR-BC both demonstrated maximum CHR releases of 99.03 ± 2.34% and 71.95 ±2.1%, respectively. The dissolution study's findings revealed that the release of CHR was much improved over that of pure CHR. A study using a scanning electron microscope showed that CHR-TC contains more agglomerated and amorphous components. The higher conversion of crystalline CHR into an amorphous form is responsible for the structural alterations that are observed. After complexation, the distinctive peaks of pure CHR changed due to the complexation with HP ßCD and PLX. The antimicrobial and cell viability results revealed improved antimicrobial activity as well as a lower IC50 value than pure CHR against the tested anticancer cell line (MCF7).

National research guideline for prehospital emergency medical care: A prospective Delphi-study.

OBJECTIVES: To identify the most important research topics to establish a national research agenda and protocol for prehospital research in Saudi Arabia (KSA). METHODS: A 3-round modified Delphi consensus methods were used to determine high-priority research topics. Round I included an open-ended question to list all high-priority research topics in a prehospital setting in Riyadh, KSA. Rounds II and III included ranking evaluation and consensus agreement. The included topics were listed based on the agreement of ≥70% of the experts participating in the study. The study was carried out between November 2021 and February 2022. RESULTS: In total, 100 prehospital experts in KSA were invited to participate in all 3 rounds. Of these, 47 responded in round I, 34 in round II, and 39 in round III. In round I, participants submitted 278 research topics. After deduplication and sorting, 78 topics were assessed in the other 2 rounds. CONCLUSION: In this modified Delphi study, an expert panel identified the top prehospital emergency medical services (EMS) care research priorities. The leading research priorities included clinical and operational ideas. The proposed 32 high-priority topics can be used to guide researchers, research networks, policymakers, and funding organizations involved in EMS.

Demographic and Cultural Differences in the Acceptance and Pursuit of Cosmetic Surgery: A Systematic Literature Review.

Worldwide, the numbers of cosmetic procedures continue to climb. However, cosmetic surgery (CS) continues to be plagued by negative stigmatization. This study reviews the literature to identify how attitudes toward CS vary by sex, age, race, culture, and nationality, and aims to determine how other factors like media exposure interact with demographics to influence how well CS is accepted. METHODS: A PRISMA-guided systematic review of the literature was conducted to identify all English-language papers reporting on CS or plastic surgery acceptance, attitudes, or stigmatization, specifically examining for data on age, sex, race/ethnicity, culture, and media influence. RESULTS: In total, 1515 abstracts were reviewed, of which 94 were deemed pertinent enough to warrant a full-text review. Among the potential demographic predictors of CS acceptance, the one with the most supportive data is sex, with women comprising roughly 90% of all CS patients in virtually all populations studied and consistently exhibiting greater CS knowledge and acceptance. Culturally, the pursuit of beauty through CS is a universal phenomenon, although different countries, races, and cultures differ in how willingly CS is embraced, and in the aesthetic goals of those choosing to have it. In countries with culturally diverse societies like the United States, non-Hispanic Whites continue to predominate among CS patients, but the number of CS patients of other races is rising disproportionately. In this trend, social media is playing a major role. CONCLUSION: Healthcare practitioners performing cosmetic procedures need to consider demographic and cultural differences of the patients in order to enhance their understanding of their patients' aesthetic goals and expectations.

Accuracy of emergency medical services (EMS) telephone triage in identifying acute coronary syndrome (ACS) for patients with chest pain: a systematic literature review.

OBJECTIVE: To systematically appraise the available evidence to determine the accuracy of decision aids for emergency medical services (EMS) telephone triage of patients with chest pain suspected to be caused by acute coronary syndrome (ACS) or life-threatening conditions. DESIGN: Systematic review. DATA SOURCES: Electronic searches were performed in Embase 1974, Medline 1946 and CINAHL 1937 databases from 3 March 2020 to 4 March 2020. ELIGIBILITY CRITERIA: The review included all types of original studies that included adult patients (>18 years) who called EMS with a primary complaint of chest pain and evaluated dispatch triage priority by telephone. Outcomes of interest were a final diagnosis of ACS, acute myocardial infarction or other life-threatening conditions. DATA EXTRACTION AND SYNTHESIS: Two authors independently extracted data on study design, population, study period, outcome and all data for assessment of accuracy, including cross-tabulation of triage priority against the outcomes of interest. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 assessment tool. RESULTS: Searches identified 553 papers, of which 3 were eligible for inclusion. Those reports described the evaluation of three different prediction models with variation in the variables used to detect ACS. The overall results showed that dispatch triage tools have good sensitivity to detect ACS and life-threatening conditions, even though they are used to triage signs and symptoms rather than diagnosing the patients. On the other hand, prediction models were built to detect ACS and life-threatening conditions, and therefore, prediction models showed better sensitivity and negative predictive value than dispatch triage tools. CONCLUSION: We have identified three prediction models for telephone triage of patients with chest pain. While they have been found to have greater accuracy than standard EMS dispatch systems, prospective external validation is essential before clinical use is considered. PROSPERO REGISTRATION NUMBER: This systematic review was pre-registered on the International prospective register of systematic reviews (PROSPERO) database (reference CRD42020171184).

A systematic review of population-based gingival health studies among children and adolescents with autism spectrum disorder.

The prevalence of autism spectrum disorder (ASD) is close to 1% in the United States of America and other countries. Special attention should be given to oral health in individuals with ASD as they are often affected by oral diseases. However, gingival health in children with ASD and adolescents is controversial in terms of the severity of disease and number of people affected. AIM: To conduct a systematic review and meta-analysis to assess the gingival health status of children and adolescents with ASD. METHODS: The search was conducted using eight databases for articles that met the inclusion and exclusion criteria. This search produced 742 relevant papers, but only five with sufficient data on gingival and plaque indices were eligible for inclusion in this systematic review and meta-analysis. RESULTS: The homogeneity of the sample was tested using the Cohen Q test, which identified significant heterogeneity (P < 0.0001), indicating the use of the random effect's standard mean difference. Significantly higher gingival index and plaque index values were found in children and adolescents with ASD than in children without ASD. CONCLUSION: Individuals with ASD need help and better access to oral healthcare. Further investigation is needed with regard to gingival health in individuals with ASD and caries risk assessment to understand how this disorder affects oral health. A standardized index for gingival health will help in the inclusion of more studies to assess gingival health in children and adolescents with ASD.

Ketogenic Diets: Side Effects, Attitude, and Quality of Life.

INTRODUCTION: The ketogenic diet has been in use since the 1920s as a therapy for epilepsy. Since the 1960s, it has also become widely known as one of the methods for obesity treatment. Recently, this diet has been promoted as a lifestyle, making it highly controversial in terms of its practicality as a lifestyle diet and its duration without affecting one's health or quality of life. Hence, this study assessed ketogenic diets from the people's perspective of side effects, attitude, and quality of life. METHOD: This retrospective observational study evaluated people who experienced or still practice a ketogenic diet. Health-related quality of life, the standard four-item set of healthy days core questions, was employed. We distributed the survey as an electronic self-assessment using Google Forms. The data were reviewed and automatically copied into a personal computer, arranged in a data-sheet in Microsoft Excel, and analyzed using Statistical Package for the Social Sciences version 27 (Armonk, NY: IBM Corp.). The data were mainly expressed as numbers and percentages. RESULTS: A total of 226 subjects who adopted a ketogenic diet were interviewed to explore their diet experience. Females were slightly more than males (52.7% vs. 47.3%), and more than one-half (55.3%) of this study population aged 18-35 years. Obesity accounted for 55.3%, and the majority of the respondents (69.9%) adopted a ketogenic diet for more than one month. Among the most frequently reported symptoms were nausea (mild, 29.2%; moderate, 16.4%; severe nausea, 5.8%), dizziness (mild, 39.8%; moderate, 27.4%; severe, 11.5%), polyuria (72.1% in total), and lethargy (69.7%). Furthermore, 90.3% of them felt happy about adopting a ketogenic diet, and 81.9% would recommend it for anyone who wants to lose weight. CONCLUSION: A ketogenic diet was practiced mostly for one to six months, making it a short-term solution to weight loss. The outcomes of the participants approved the efficacy of the ketogenic diet in weight reduction. Different symptoms and side effects occurred with varying intensities, especially in the first few days of adopting this diet. Overall, the ketogenic diet did not affect the quality of life and yielded a very positive overall experience.