Evaluating research ethics committees in Vietnam and Laos: Results of a validated self-assessment tool.

BACKGROUND: There is an increase in human subject research in developing countries and conducting them in an ethical manner depends on the research ethics oversight in these countries. The purpose of this study is to evaluate the operational, financial, and educational characteristics of research ethics committees (RECs) at institutions in Vietnam and Laos. METHODS: A validated self-assessment tool designed to assess nine major characteristics of RECs was translated into Vietnamese and Laotian. The translated surveys were delivered to and completed by representatives from RECs at institutions in Vietnam and Laos. The surveys were collected, translated back into English, and scored. The data was analyzed to identify potential areas of strength and areas for improvement. RESULTS: The mean survey score for the 19 RECs surveyed was 165.3 out of a maximum of 200 points with a standard deviation of 22.9. Committees scored the highest in the review of specific protocol items (95.6%), submission arrangements and materials (89.5%), and the policies referring to review procedures (85.6%) domains. RECs scored the lowest in the resources domain (65.5%), with only 26.3% of committees having an annual budget. Nearly all RECs have standard operating procedures (94.7%) and policies for disclosing conflicts of interest (89.5%). Most committees use prior ethics training as a criterion to select REC chairs (78.9%) and members (73.7%), with the majority of committees requiring a training course in ethics (76.5%). 68.4% of committees have continuing education in ethics for members and only 42.1% of committees have a budget for member training. CONCLUSION: This study demonstrated that RECs in Vietnam and Laos have strong foundational review processes for research protocols. Important areas of improvement include improved institutional oversight, financial and administrative resources, and the continued ethics education for current committee members.

Sex-based disparities with cost-related medication adherence issues in patients with hypertension, ischemic heart disease, and heart failure.

IMPORTANCE AND OBJECTIVE: Identifying sources of sex-based disparities is the first step in improving clinical outcomes for female patients. Using All of Us data, we examined the association of biological sex with cost-related medication adherence (CRMA) issues in patients with cardiovascular comorbidities. MATERIALS AND METHODS: Retrospective data collection identified the following patients: 18 and older, completing personal medical history surveys, having hypertension (HTN), ischemic heart disease (IHD), or heart failure (HF) with medication use history consistent with these diagnoses. Implementing univariable and adjusted logistic regression, we assessed the influence of biological sex on 7 different patient-reported CRMA outcomes within HTN, IHD, and HF patients. RESULTS: Our study created cohorts of HTN (n = 3891), IHD (n = 5373), and HF (n = 2151) patients having CRMA outcomes data. Within each cohort, females were significantly more likely to report various cost-related medication issues: being unable to afford medications (HTN hazards ratio [HR]: 1.68, confidence interval [CI]: 1.33-2.13; IHD HR: 2.33, CI: 1.72-3.16; HF HR: 1.82, CI: 1.22-2.71), skipping doses (HTN HR: 1.76, CI: 1.30-2.39; IHD HR: 2.37, CI: 1.69-3.64; HF HR: 3.15, CI: 1.87-5.31), taking less medication (HTN HR: 1.86, CI: 1.37-2.45; IHD HR: 2.22, CI: 1.53-3.22; HF HR: 2.99, CI: 1.78-5.02), delaying filling prescriptions (HTN HR: 1.83, CI: 1.43-2.39; IHD HR: 2.02, CI: 1.48-2.77; HF HR: 2.99, CI: 1.79-5.03), and asking for lower cost medications (HTN HR: 1.41, CI: 1.16-1.72; IHD HR: 1.75, CI: 1.37-2.22; HF HR: 1.61, CI: 1.14-2.27). DISCUSSION AND CONCLUSION: Our results clearly demonstrate CRMA issues disproportionately affect female patients with cardiovascular comorbidities, which may contribute to the larger sex-based disparities in cardiovascular care. These findings call for targeted interventions and strategies to address these disparities and ensure equitable access to cardiovascular medications and care for all patients.

Imaging characteristics of posterior interosseous nerve syndrome.

Posterior interosseous nerve syndrome (PINs) is a rare nerve compression syndrome that affects the deep branch of the radial nerve in the supinator muscle region. In this article, we aimed to report a case of a 58-year-old male who had clinical symptoms, electromyographic, ultrasound, and MRI features suggestive of PINs due to compressing the arcade of Frohse. He subsequently underwent surgical correlation at our hospital, and the clinical symptoms were improved significantly.

Exploring Concomitant Acetylcholinesterase Inhibitor and Overactive Bladder Anticholinergic Use and Risk of Hospitalization in Medicare and Dual-Eligible Medicare-Medicaid Populations in a Historic Database.

Overactive bladder prevalence increases in older adults often complicating the management of other comorbidities. The theoretical antagonism between the parasympathetic-blocking anticholinergic agent and the parasympathetic stimulatory agents concomitantly used by patients is only recently being explored. The primary aim was to determine the frequency of the annual use of acetylcholinesterase inhibitors, overactive bladder anticholinergics, and the use of both agents in the same year. The secondary aim was measurement of the association between annual hospitalization and same-year use of both acetylcholinesterase inhibitors and anticholinergics. The US nationally representative MarketScan® Medicare databases were analyzed. In the Medicare enrollees, there were 122 020, 141 920, and 15 639 users of acetylcholinesterase inhibitors, anticholinergics, and both agents, respectively. The percentage of acetylcholinesterase inhibitor users who also used anticholinergics was 12.8%. Comparing users of both acetylcholinesterase inhibitors and anticholinergics to those using AChEI alone, 5 608 of the former experienced a hospitalization (35.9%) compared to 33 182 of the latter (31.2%). There was an increased risk of hospitalization for those using both acetylcholinesterase inhibitors and anticholinergics in the same year, with an odds ratio (OR) of 1.23 (95% CI, 1.19, 1.28). Clinicians should consider improved monitoring of the usage of both medications and clarify alternative regimens that avoid anticholinergics in at-risk older adults.

xImpact: Intelligent Wireless System for Cost-Effective Rapid Condition Assessment of Bridges under Impacts.

Bridge strikes by over-height vehicles or ships are critical sudden events. Due to their unpredictable nature, many events go unnoticed or unreported, but they can induce structural failures or hidden damage that accelerates the bridge's long-term degradation. Therefore, always-on monitoring is essential for deployed systems to enhance bridge safety through the reliable detection of such events and the rapid assessment of bridge conditions. Traditional bridge monitoring systems using wired sensors are too expensive for widespread implementation, mainly due to their significant installation cost. In this paper, an intelligent wireless monitoring system is developed as a cost-effective solution. It employs ultralow-power, event-triggered wireless sensor prototypes, which enables on-demand, high-fidelity sensing without missing unpredictable impact events. Furthermore, the proposed system adopts a smart artificial intelligence (AI)-based framework for rapid bridge assessment by utilizing artificial neural networks. Specifically, it can identify the impact location and estimate the peak force and impulse of impacts. The obtained impact information is used to provide early estimation of bridge conditions, allowing the bridge engineers to prioritize resource allocation for the timely inspection of the more severe impacts. The performance of the proposed monitoring system is demonstrated through a full-scale field test. The test results show that the developed system can capture the onset of bridge impacts, provide high-quality synchronized data, and offer a rapid damage assessment of bridges under impact events, achieving the error of around 2 m in impact localization, 1 kN for peak force estimation, and 0.01 kN·s for impulse estimation. Long-term deployment is planned in the future to demonstrate its reliability for real-life impact events.

Development and Validation of a Framework for Smart Wireless Strain and Acceleration Sensing.

Civil infrastructure worldwide is subject to factors such as aging and deterioration. Structural health monitoring (SHM) can be used to assess the impact of these processes on structural performance. SHM demands have evolved from routine monitoring to real-time and autonomous assessment. One of the frontiers in achieving effective SHM systems has been the use of wireless smart sensors (WSSs), which are attractive compared to wired sensors, due to their flexibility of use, lower costs, and ease of long-term deployment. Most WSSs use accelerometers to collect global dynamic vibration data. However, obtaining local behaviors in a structure using measurands such as strain may also be desirable. While wireless strain sensors have previously been developed by some researchers, there is still a need for a high sensitivity wireless strain sensor that fully meets the general demands for monitoring large-scale civil infrastructure. In this paper, a framework for synchronized wireless high-fidelity acceleration and strain sensing, which is commonly termed multimetric sensing in the literature, is proposed. The framework is implemented on the Xnode, a next-generation wireless smart sensor platform, and integrates with the strain sensor for strain acquisition. An application of the multimetric sensing framework is illustrated for total displacement estimation. Finally, the potential of the proposed framework integrated with vision-based measurement systems for multi-point displacement estimation with camera-motion compensation is demonstrated. The proposed approach is verified experimentally, showing the potential of the developed framework for various SHM applications.

Local Electric Field Changes during the Photoconversion of the Bathy Phytochrome Agp2.

Phytochromes switch between a physiologically inactive and active state via a light-induced reaction cascade, which is initiated by isomerization of the tetrapyrrole chromophore and leads to the functionally relevant secondary structure transition of a protein segment (tongue). Although details of the underlying cause-effect relationships are not known, electrostatic fields are likely to play a crucial role in coupling chromophores and protein structural changes. Here, we studied local electric field changes during the photoconversion of the dark state Pfr to the photoactivated state Pr of the bathy phytochrome Agp2. Substituting Tyr165 and Phe192 in the chromophore pocket by para-cyanophenylalanine (pCNF), we monitored the respective nitrile stretching modes in the various states of photoconversion (vibrational Stark effect). Resonance Raman and IR spectroscopic analyses revealed that both pCNF-substituted variants undergo the same photoinduced structural changes as wild-type Agp2. Based on a structural model for the Pfr state of F192pCNF, a molecular mechanical-quantum mechanical approach was employed to calculate the electric field at the nitrile group and the respective stretching frequency, in excellent agreement with the experiment. These calculations serve as a reference for determining the electric field changes in the photoinduced states of F192pCNF. Unlike F192pCNF, the nitrile group in Y165pCNF is strongly hydrogen bonded such that the theoretical approach is not applicable. However, in both variants, the largest changes of the nitrile stretching modes occur in the last step of the photoconversion, supporting the view that the proton-coupled restructuring of the tongue is accompanied by a change of the electric field.

Access route selection for percutaneous coronary intervention among Vietnamese patients: Implications for in-hospital costs and outcomes.

BACKGROUND: Little is known about rates of access site (transradial (TRI) or transfemoral (TFI)) preference for percutaneous coronary intervention (PCI) and in-hospital costs of patients undergoing these procedures in lower-and middle-countries. Here, we report on access site use, in-hospital costs and outcomes of patients undergoing PCI in Vietnam. METHODS: Information from 868 patients were included in the cohort of 1022 patients recruited into the first PCI registry in Vietnam. The total hospital costs and in-hospital outcomes of patients undergoing TRI and TFI were compared. Hospital costs were obtained from the hospital admission system, and major adverse cardiac events, major bleeding events and length of stay were identified through review of medical records. FINDINGS: TRI was the dominant access site for interventionists (694/868 patients). The TFI group reported more lesions of the left main artery, more previous coronary artery bypass grafts and previous PCI in comparison with the TRI group (all p < 0.05). The TRI group was associated with a lower overall cost of admission (the adjusted difference was -1526.3 USD, 95% confident interval CI (-1996.2; -1056.3), shorter length of hospital stay (-2 days, CI (-2.8; -1.2)) and lower rates of major bleeding post-procedure. Procedural factors such as radial access site, left main disease, PCI ≥2 stents, and PCI ≥ 2 lesions having the most impact on the in-hospital cost of patients undergoing PCI. INTERPRETATIONS: Among patients undergoing PCI, TRI was associated with lower costs and favourable clinical outcomes relative to TFI. FUNDING: This research received partial financial support from Curtin University, Australia.

Immunogenicity of Oxford-AstraZeneca COVID-19 vaccine in Vietnamese healthcare workers

We studied the immunogenicity of Oxford-AstraZeneca vaccine in Vietnamese healthcare workers. We collected blood samples before each dose, at 14 days after each dose, and month 1 and 3 after dose 1 from each participant alongside demographics data. We measured neutralizing antibodies using a surrogate virus neutralization assay. The 554 study participants (136 males and 418 females) were aged between 22-71 years (median: 36 years). 104 and 94 out of 144 selected participants were successfully followed up at 14 days after dose 2 and 3 months after dose 1, respectively. Neutralizing antibodies increased after each dose, with the sero-conversion rate reaching 98.1% (102/104) at 14 days after dose 2. At month 3 after dose 1, neutralizing antibody levels decreased, while 94.7% (89/94) of the study participants remained seropositive. Oxford-AstraZeneca COVID-19 vaccine is immunogenic in Vietnamese healthcare workers. The requirement for a third dose warrants further research.

Outcomes following the percutaneous coronary intervention in contemporary Vietnamese practice: Insight from a single centre prospective cohort.

BACKGROUND: Evidence regarding the outcomes of percutaneous coronary intervention (PCI) in low-and-middle incomes countries remains limited. OBJECTIVES: To report the outcomes post PCI at discharge, 30 days and 12 months in Vietnam and identify the key factors associated with adverse outcomes at 12 months. METHODS: We used data from a single centre prospective cohort in Vietnam. Data regarding demographics, clinical presentation, procedural information, and outcomes of patients were collected and analysed. Primary outcomes were mortality and major adverse cardiac and cerebrovascular events. RESULTS: In total, 926 patients were included. Poor outcomes were relatively low in those undergoing PCI. Predictors of mortality and major adverse cardiac and cerebrovascular events at 12 months post-PCI included being older than 75, being male, having acute myocardial infarction, left ventricular ejection fraction ≤ 40%, prior cerebral vascular disease and having an unsuccessful PCI. CONCLUSIONS: Adverse outcomes of patients undergoing PCI in Vietnam are relatively low in comparison with those reported in other countries across the Asia Pacific region. Identification of factors associated with poor outcomes is beneficial for improving the quality of cardiac care and developing the prediction model of outcomes post-PCI in Vietnam.

Development of Synchronized High-Sensitivity Wireless Accelerometer for Structural Health Monitoring.

The use of digital accelerometers featuring high sensitivity and low noise levels in wireless smart sensors (WSSs) is becoming increasingly common for structural health monitoring (SHM) applications. Improvements in the design of Micro Electro-Mechanical System (MEMS) based digital accelerometers allow for high resolution sensing required for SHM with low power consumption suitable for WSSs. However, new approaches are needed to synchronize data from these sensors. Data synchronization is essential in wireless smart sensor networks (WSSNs) for accurate condition assessment of structures and reduced false-positive indications of damage. Efforts to achieve synchronized data sampling from multiple WSS nodes with digital accelerometers have been lacking, primarily because these sensors feature an internal Analog to Digital Converter (ADC) to which the host platform has no direct access. The result is increased uncertainty in the ADC startup time and thus worse synchronization among sensors. In this study, a high-sensitivity digital accelerometer is integrated with a next-generation WSS platform, the Xnode. An adaptive iterative algorithm is used to characterize these delays without the need for a dedicated evaluation setup and hardware-level access to the ADC. Extensive tests are conducted to evaluate the performance of the accelerometer experimentally. Overall time-synchronization achieved is under 15 µs, demonstrating the efficacy of this approach for synchronization of critical SHM applications.

SARS-CoV-2 detection in nasopharyngeal throat swabs by metagenomics

Metagenomics could detect SARS-CoV-2 in all eight nasopharyngeal/throat swabs with high/low viral loads, and rhinovirus in a co-infected patient. The sequenced viruses belonged to lineage B1. Because metagenomics could detect novel pathogen and co-infection, and generate sequence data for epidemiological investigation, it is an attractive approach for infectious-disease diagnosis.

Total and Stroke Related Imaging Utilization Patterns During the COVID-19 Pandemic

During the COVID-19 pandemic, radiology practices are reporting a decrease in imaging volumes. We review total imaging volume, CTA head and neck volume, critical results rate, and stroke intervention rates before and during the COVID-19 pandemic. Total imaging volume as well as CTA head and neck imaging fell approximately 60% since the beginning of the pandemic. Critical results fell 60-70% for total imaging as well as for CTA head and neck. Compared to the same time frame a year prior, the number of stroke codes at the early impact of the pandemic had decreased approximately 50%. Proportional reductions in total imaging volume, stroke-related imaging, and associated critical result reports during the COVID-19 pandemic raise concern for missed stroke diagnoses in our population.

The natural history and transmission potential of asymptomatic SARS-CoV-2 infection

BackgroundLittle is known about the natural history of asymptomatic SARS-CoV-2 infection or its contribution to infection transmission. MethodsWe conducted a prospective study at a quarantine centre for COVID-19 in Ho Chi Minh City, Vietnam. We enrolled quarantined people with RT-PCR-confirmed SARS-CoV-2 infection, collecting clinical data, travel and contact history, and saliva at enrolment and daily nasopharyngeal throat swabs (NTS) for RT-PCR testing. We compared the natural history and transmission potential of asymptomatic and symptomatic individuals. ResultsBetween March 10th and April 4th, 2020, 14,000 quarantined people were tested for SARS-CoV-2; 49 were positive. Of these, 30 participated in the study: 13(43%) never had symptoms and 17(57%) were symptomatic. 17(57%) participants acquired their infection outside Vietnam. Compared with symptomatic individuals, asymptomatic people were less likely to have detectable SARS-CoV-2 in NTS samples collected at enrolment (8/13 (62%) vs. 17/17 (100%) P=0.02). SARS-CoV-2 RNA was detected in 20/27 (74%) available saliva; 7/11 (64%) in the asymptomatic and 13/16 (81%) in the symptomatic group (P=0.56). Analysis of the probability of RT-PCR positivity showed asymptomatic participants had faster viral clearance than symptomatic participants (P<0.001 for difference over first 19 days). This difference was most pronounced during the first week of follow-up. Two of the asymptomatic individuals appeared to transmit the infection to up to four contacts. ConclusionsAsymptomatic SARS-CoV-2 infection is common and can be detected by analysis of saliva or NTS. NTS viral loads fall faster in asymptomatic individuals, but they appear able to transmit the virus to others.

Sudden Event Monitoring of Civil Infrastructure Using Demand-Based Wireless Smart Sensors.

Wireless smart sensors (WSS) have been proposed as an effective means to reduce the high cost of wired structural health monitoring systems. However, many damage scenarios for civil infrastructure involve sudden events, such as strong earthquakes, which can result in damage or even failure in a matter of seconds. Wireless monitoring systems typically employ duty cycling to reduce power consumption; hence, they will miss such events if they are in power-saving sleep mode when the events occur. This paper develops a demand-based WSS to meet the requirements of sudden event monitoring with minimal power budget and low response latency, without sacrificing high-fidelity measurements or risking a loss of critical information. In the proposed WSS, a programmable event-based switch is implemented utilizing a low-power trigger accelerometer; the switch is integrated in a high-fidelity sensor platform. Particularly, the approach can rapidly turn on the WSS upon the occurrence of a sudden event and seamlessly transition from low-power acceleration measurement to high-fidelity data acquisition. The capabilities of the proposed WSS are validated through laboratory and field experiments. The results show that the proposed approach is able to capture the occurrence of sudden events and provide high-fidelity data for structural condition assessment in an efficient manner.

Exploring risk factors associated with intimate partner violence in Vietnam: results from a cross-sectional national survey.

OBJECTIVES: Empirical evidence documents that some risk factors for intimate partner violence (IPV) are similar across contexts, while others differ considerably. In Vietnam, there was a need to investigate risk factors for IPV to support evidence-based policy and programming. METHODS: Using the dataset gathered in the 2010 National Study on Domestic Violence against Women, forty variables were explored in logistic regression analysis, including socio-demographic characteristics of women and their husbands, other experiences with violence, husband's behaviours, family support, and context-specific variables such as the sex of their children. RESULTS: Fifteen independent factors remained strongly associated with IPV. Significant risk was associated with husbands' behaviour that supports male power (extra-marital relationships; fighting with other men) and alcohol use. Violence experienced in childhood increased the likelihood of women experiencing and of men perpetrating IPV. Notable was further the association with women's higher financial contribution to the household and lack of association with not having sons. CONCLUSIONS: The findings support theories describing how underlying gender and power imbalance are fundamental causes of IPV and indicate the need for context-specific interventions.

Measuring attitudes about intimate partner violence against women: the ATT-IPV scale.

In lower-income settings, women more often than men justify intimate partner violence (IPV). Yet, the role of measurement invariance across gender is unstudied. We developed the ATT-IPV scale to measure attitudes about physical violence against wives in 1,055 married men and women ages 18-50 in My Hao district, Vietnam. Across 10 items about transgressions of the wife, women more often than men agreed that a man had good reason to hit his wife (3 % to 92 %; 0 % to 67 %). In random split-half samples, one-factor exploratory factor analysis (EFA) (N 1 = 527) and confirmatory factor analysis (CFA) (N 2 = 528) models for nine items with sufficient variability had significant loadings (0.575-0.883; 0.502-0.897) and good fit (RMSEA = 0.068, 0.048; CFI = 0.951, 0.978, TLI = 0.935, 0.970). Three items had significant uniform differential item functioning (DIF) by gender, and adjustment for DIF revealed that measurement noninvariance was partially masking men's lower propensity than women to justify IPV. A CFA model for the six items without DIF had excellent fit (RMSEA = 0.019, CFI = 0.994, TLI = 0.991) and an attitudinal gender gap similar to the DIF-adjusted nine-item model, suggesting that the six-item scale reliably measures attitudes about IPV across gender. Researchers should validate the scale in urban Vietnam and elsewhere and decompose DIF-adjusted gender attitudinal gaps.

Divorce in the context of domestic violence against women in Vietnam.

This paper examines obstacles for women who face domestic violence in making decisions about divorce and in seeking and securing support for a divorce. The research was undertaken in the context of a project in one district of a coastal province in Vietnam that sought to reduce gender based-violence and mitigate its effects. Data from in-depth interviews and focus-group discussions are used to examine abused women's attitudes, strategies and behaviours and the responses of people in their communities and in the support system established by the project. The findings show that social norms supporting marriage discourage abused women from seeking divorce and, in some cases, any kind of support, and discourage community-based support networks, police and local court systems from providing effective assistance to these women.