Background: The availability of essential medicines and medical supplies is crucial for effectively delivering healthcare services. In Zambia, the Logistics Management Information System (LMIS) is a key tool for manag...Background: The availability of essential medicines and medical supplies is crucial for effectively delivering healthcare services. In Zambia, the Logistics Management Information System (LMIS) is a key tool for managing the supply chain of these commodities. This study aimed to evaluate the effectiveness of LMIS in ensuring the availability of essential medicines and medical supplies in public hospitals in the Copperbelt Province of Zambia. Materials and Methods: From February to April 2022, a cross-sectional study was conducted in 12 public hospitals across the Copperbelt Province. Data were collected using structured questionnaires, checklists, and stock control cards. The study assessed LMIS availability, training, and knowledge among pharmacy personnel, as well as data accuracy, product availability, and order fill rates. Descriptive statistics were used to analyse the data. Results: All surveyed hospitals had LMIS implemented and were using eLMIS as the primary LMIS. Only 47% and 48% of pharmacy personnel received training in eLMIS and Essential Medicines Logistics Improvement Program (EMLIP), respectively. Most personnel demonstrated good knowledge of LMIS, with 77.7% able to log in to eLMIS Facility Edition, 76.6% able to locate stock control cards in the system, and 78.7% able to perform transactions. However, data accuracy from physical and electronic records varied from 0% to 60%, and product availability ranged from 50% to 80%. Order fill rates from Zambia Medicines and Medical Supplies Agency (ZAMMSA) were consistently below 30%. Discrepancies were observed between physical stock counts and eLMIS records. Conclusion: This study found that most hospitals in the Copperbelt Province of Zambia have implemented LMIS use. While LMIS implementation is high in the Copperbelt Province of Zambia, challenges such as low training levels, data inaccuracies, low product availability, and order fill rates persist. Addressing these issues requires a comprehensive approach, including capacity building, data quality improvement, supply chain coordination, and investment in infrastructure and human resources. Strengthening LMIS effectiveness is crucial for improving healthcare delivery and patient outcomes in Zambia.展开更多
The combination and application of information technology and higher education have led to changes in the form and mode of teaching management in higher education,promoting the continuous deepening of digital transfor...The combination and application of information technology and higher education have led to changes in the form and mode of teaching management in higher education,promoting the continuous deepening of digital transformation in higher education.This paper discusses higher education management innovation triggered by digital technology and the new appearance of digital university governance,digital evaluation management,and internal governance of higher education.From the perspective of forging new forms,models,and paths of digital management through digital technology,this paper focuses on analyzing the reshaping of management systems by digitalization in higher education.The promotion and inspiration of digitalization on management system reform are provided,including typical features brought about,new paths opened up,and new advantages shaped.It is emphasized that the establishment of digital management system needs to rely on the systematic integration of multiple aspects.Finally,the challenges and solutions faced by the digital management system are deeply analyzed from the aspects of collaborative management and services,management process interoperability,evaluation and trust protection,and personnel digital literacy.Digital technology drives the transformation of higher education management system,resulting in new forms,models,paths,and methods of networked and digital management based on intelligent analysis and processing of educational and teaching data and promoting higher education management toward digital governance.The comprehensive establishment of a digital management system will unleash strong potential for universities to better fulfill their functions,and the high-quality development of higher education will be more solid and powerful.展开更多
Efficient data management in healthcare is essential for providing timely and accurate patient care, yet traditional partitioning methods in relational databases often struggle with the high volume, heterogeneity, and...Efficient data management in healthcare is essential for providing timely and accurate patient care, yet traditional partitioning methods in relational databases often struggle with the high volume, heterogeneity, and regulatory complexity of healthcare data. This research introduces a tailored partitioning strategy leveraging the MD5 hashing algorithm to enhance data insertion, query performance, and load balancing in healthcare systems. By applying a consistent hash function to patient IDs, our approach achieves uniform distribution of records across partitions, optimizing retrieval paths and reducing access latency while ensuring data integrity and compliance. We evaluated the method through experiments focusing on partitioning efficiency, scalability, and fault tolerance. The partitioning efficiency analysis compared our MD5-based approach with standard round-robin methods, measuring insertion times, query latency, and data distribution balance. Scalability tests assessed system performance across increasing dataset sizes and varying partition counts, while fault tolerance experiments examined data integrity and retrieval performance under simulated partition failures. The experimental results demonstrate that the MD5-based partitioning strategy significantly reduces query retrieval times by optimizing data access patterns, achieving up to X% better performance compared to round-robin methods. It also scales effectively with larger datasets, maintaining low latency and ensuring robust resilience under failure scenarios. This novel approach offers a scalable, efficient, and fault-tolerant solution for healthcare systems, facilitating faster clinical decision-making and improved patient care in complex data environments.展开更多
With the continuous advancement of information technology,traditional teaching management models can no longer meet the demands of modern laboratory management.Information management,characterized by efficiency,conven...With the continuous advancement of information technology,traditional teaching management models can no longer meet the demands of modern laboratory management.Information management,characterized by efficiency,convenience,and intelligence,provides new ideas and directions for reforming laboratory teaching management models in higher education.Based on this,this paper explores reform strategies and practical approaches for laboratory teaching management models from the perspective of information management,aiming to offer references for enhancing the modernization and intelligentization of laboratory teaching management.展开更多
Thedeployment of the Internet of Things(IoT)with smart sensors has facilitated the emergence of fog computing as an important technology for delivering services to smart environments such as campuses,smart cities,and ...Thedeployment of the Internet of Things(IoT)with smart sensors has facilitated the emergence of fog computing as an important technology for delivering services to smart environments such as campuses,smart cities,and smart transportation systems.Fog computing tackles a range of challenges,including processing,storage,bandwidth,latency,and reliability,by locally distributing secure information through end nodes.Consisting of endpoints,fog nodes,and back-end cloud infrastructure,it provides advanced capabilities beyond traditional cloud computing.In smart environments,particularly within smart city transportation systems,the abundance of devices and nodes poses significant challenges related to power consumption and system reliability.To address the challenges of latency,energy consumption,and fault tolerance in these environments,this paper proposes a latency-aware,faulttolerant framework for resource scheduling and data management,referred to as the FORD framework,for smart cities in fog environments.This framework is designed to meet the demands of time-sensitive applications,such as those in smart transportation systems.The FORD framework incorporates latency-aware resource scheduling to optimize task execution in smart city environments,leveraging resources from both fog and cloud environments.Through simulation-based executions,tasks are allocated to the nearest available nodes with minimum latency.In the event of execution failure,a fault-tolerantmechanism is employed to ensure the successful completion of tasks.Upon successful execution,data is efficiently stored in the cloud data center,ensuring data integrity and reliability within the smart city ecosystem.展开更多
The dramatic rise in the number of people living in cities has made many environmental and social problems worse.The search for a productive method for disposing of solid waste is the most notable of these problems.Ma...The dramatic rise in the number of people living in cities has made many environmental and social problems worse.The search for a productive method for disposing of solid waste is the most notable of these problems.Many scholars have referred to it as a fuzzy multi-attribute or multi-criteria decision-making problem using various fuzzy set-like approaches because of the inclusion of criteria and anticipated ambiguity.The goal of the current study is to use an innovative methodology to address the expected uncertainties in the problem of solid waste site selection.The characteristics(or sub-attributes)that decision-makers select and the degree of approximation they accept for various options can both be indicators of these uncertainties.To tackle these problems,a novel mathematical structure known as the fuzzy parameterized possibility single valued neutrosophic hypersoft expert set(ρˆ-set),which is initially described,is integrated with a modified version of Sanchez’s method.Following this,an intelligent algorithm is suggested.The steps of the suggested algorithm are explained with an example that explains itself.The compatibility of solid waste management sites and systems is discussed,and rankings are established along with detailed justifications for their viability.This study’s strengths lie in its application of fuzzy parameterization and possibility grading to effectively handle the uncertainties embodied in the parameters’nature and alternative approximations,respectively.It uses specific mathematical formulations to compute the fuzzy parameterized degrees and possibility grades that are missing from the prior literature.It is simpler for the decisionmakers to look at each option separately because the decision is uncertain.Comparing the computed results,it is discovered that they are consistent and dependable because of their preferred properties.展开更多
This article provides a comprehensive analysis of the study by Hou et al,focusing on the complex interplay between psychological and physical factors in the postoperative recovery(POR)of patients with perianal disease...This article provides a comprehensive analysis of the study by Hou et al,focusing on the complex interplay between psychological and physical factors in the postoperative recovery(POR)of patients with perianal diseases.The study sheds light on how illness perception,anxiety,and depression significantly influence recovery outcomes.Hou et al developed a predictive model that demonstrated high accuracy in identifying patients at risk of poor recovery.The article explores the critical role of pre-operative psychological assessment,highlighting the need for mental health support and personalized recovery plans in enhancing POR quality.A multidisciplinary approach,integrating mental health professionals with surgeons,anesthesiologists,and other specialists,is emphasized to ensure comprehensive care for patients.The study’s findings serve as a call to integrate psychological care into surgical practice to optimize outcomes for patients with perianal diseases.展开更多
Diabetic retinopathy(DR)remains a leading cause of vision impairment and blindness among individuals with diabetes,necessitating innovative approaches to screening and management.This editorial explores the transforma...Diabetic retinopathy(DR)remains a leading cause of vision impairment and blindness among individuals with diabetes,necessitating innovative approaches to screening and management.This editorial explores the transformative potential of artificial intelligence(AI)and machine learning(ML)in revolutionizing DR care.AI and ML technologies have demonstrated remarkable advancements in enhancing the accuracy,efficiency,and accessibility of DR screening,helping to overcome barriers to early detection.These technologies leverage vast datasets to identify patterns and predict disease progression with unprecedented precision,enabling clinicians to make more informed decisions.Furthermore,AI-driven solutions hold promise in personalizing management strategies for DR,incorpo-rating predictive analytics to tailor interventions and optimize treatment path-ways.By automating routine tasks,AI can reduce the burden on healthcare providers,allowing for a more focused allocation of resources towards complex patient care.This review aims to evaluate the current advancements and applic-ations of AI and ML in DR screening,and to discuss the potential of these techno-logies in developing personalized management strategies,ultimately aiming to improve patient outcomes and reduce the global burden of DR.The integration of AI and ML in DR care represents a paradigm shift,offering a glimpse into the future of ophthalmic healthcare.展开更多
Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD pat...Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD patients can experience long-term cardiovascular issues,as evidenced by a recent case report of an adult who suffered a ST-segment elevation myocardial infarction due to previous KD in the World Journal of Clinical Cases.This editorial emphasizes the critical need for long-term management and regular surveillance to prevent such complications.By drawing on recent research and case studies,we advocate for a structured approach to follow-up care that includes routine cardiac evaluations and preventive measures.展开更多
BACKGROUND Inadequate glycemic control in patients with type 2 diabetes(T2DM)is a major public health problem and a significant risk factor for the progression of diabetic complications.AIM To evaluate the effects of ...BACKGROUND Inadequate glycemic control in patients with type 2 diabetes(T2DM)is a major public health problem and a significant risk factor for the progression of diabetic complications.AIM To evaluate the effects of intensive and supportive glycemic management strategies over a 12-month period in individuals with T2DM with glycated hemoglobin(HbA1c)≥10%and varying backgrounds of glycemic control.METHODS This prospective observational study investigated glycemic control in patients with poorly controlled T2DM over 12 months.Participants were categorized into four groups based on prior glycemic history:Newly diagnosed,previously well controlled with recent worsening,previously off-target but now worsening,and HbA1c consistently above 10%.HbA1c levels were monitored quarterly,and patients received medical,educational,and dietary support as needed.The analysis focused on the success rates of good glycemic control and the associated factors within each group.RESULTS The study showed significant improvements in HbA1c levels in all participants.The most significant improvement was observed in individuals newly diagnosed with diabetes:65%achieved an HbA1c target of≤7%.The results varied between participants with different glycemic control histories,followed by decreasing success rates:39%in participants with previously good glycemic control,21%in participants whose glycemic control had deteriorated compared to before,and only 10%in participants with persistently poor control,with mean HbA1c levels of 6.3%,7.7%,8.2%,and 9.7%,respectively.After one year,65.2%of the“newly diagnosed patients”,39.3%in the“previously controlled group”,21.9%in the“previously off-target but now worsened'”group and 10%in the“poorly controlled from the start”group had achieved HbA1c levels of 7 and below.CONCLUSION In poorly controlled diabetes,the rate at which treatment goals are achieved is associated with the glycemic background characteristics,emphasizing the need for tailored strategies.Therefore,different and comprehensive treatment approaches are needed for patients with persistent uncontrolled diabetes.展开更多
This editorial highlights a recently published study examining the effectiveness of music therapy combined with motivational interviewing(MI)in addressing an-xiety and depression among young and middle-aged patients f...This editorial highlights a recently published study examining the effectiveness of music therapy combined with motivational interviewing(MI)in addressing an-xiety and depression among young and middle-aged patients following percuta-neous coronary intervention.It further explores existing evidence and potential future research directions for MI in postoperative rehabilitation and chronic disease management.MI aims to facilitate behavioral change and promote healthier lifestyles by fostering a trusting relationship with patients and enhan-cing intrinsic motivation.Research has demonstrated its effectiveness in posto-perative recovery for oncological surgery,stroke,organ transplants,and gastroin-testinal procedures,as well as in managing chronic conditions such as diabetes,obesity,and periodontal disease.The approach is patient-centered,adaptable,cost-effective,and easily replicable,though its limitations include reliance on the therapist’s expertise,variability in individual responses,and insufficient long-term follow-up studies.Future research could focus on developing individualized and precise intervention models,exploring applications in digital health management,and confirming long-term outcomes to provide more compre-hensive support for patient rehabilitation.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)is strongly associated with an increased risk of thrombotic events,including severe outcomes such as pulmonary embolism.Elevated D-dimer levels are a critical biomarker for...BACKGROUND Coronavirus disease 2019(COVID-19)is strongly associated with an increased risk of thrombotic events,including severe outcomes such as pulmonary embolism.Elevated D-dimer levels are a critical biomarker for assessing this risk.In Gabon,early implementation of anticoagulation therapy and D-dimer testing has been crucial in managing COVID-19.This study hypothesizes that elevated Ddimer levels are linked to increased COVID-19 severity.AIM To determine the impact of D-dimer levels on COVID-19 severity and their role in guiding clinical decisions.METHODS This retrospective study analyzed COVID-19 patients admitted to two hospitals in Gabon between March 2020 and December 2023.The study included patients with confirmed COVID-19 diagnoses and available D-dimer measurements at admission.Data on demographics,clinical outcomes,D-dimer levels,and healthcare costs were collected.COVID-19 severity was classified as non-severe(outpatients)or severe(inpatients).A multivariable logistic regression model was used to assess the relationship between D-dimer levels and disease severity,with adjusted odds ratios(OR)and 95%CI.RESULTS A total of 3004 patients were included,with a mean age of 50.17 years,and the majority were female(53.43%).Elevated D-dimer levels were found in 65.81%of patients,and 57.21%of these experienced severe COVID-19.Univariate analysis showed that patients with elevated D-dimer levels had 3.33 times higher odds of severe COVID-19(OR=3.33,95%CI:2.84-3.92,P<0.001),and this association remained significant in the multivariable analysis,adjusted for age,sex,and year of collection.The financial analysis revealed a substantial burden,particularly for uninsured patients.CONCLUSION D-dimer predicts COVID-19 severity and guides treatment,but the high cost of anticoagulant therapy highlights the need for policies ensuring affordable access in resource-limited settings like Gabon.展开更多
The development of sustainable sludge management systems requires looking at them with a new vision in which the concepts of SD(Sustainable Development)must integrate those of CE(Circular Economy),both concepts subjec...The development of sustainable sludge management systems requires looking at them with a new vision in which the concepts of SD(Sustainable Development)must integrate those of CE(Circular Economy),both concepts subject to the principles of TD(Thermodynamics),thus allowing the adoption of actions that are all the more effective the more complete the evaluation of the social dimension has been.This involves a new“Way of thinking”which sees the sludge system as the“Locomotive”of the entire wastewater/sludge treatment train and is developed through“Ways of acting”which includes both“Technical”actions to maximize recoveries of useful materials and/or or energy,and“Socio/Institutional”actions to overcome barriers linked to local cultures and traditions,also considering that the specific local context heavily influences the choices capable of satisfying the concepts of CE.It follows the need of issuing realistic and applicable regulations and overcoming social barriers,such as lack of infrastructure and/or qualified personnel,to achieve an effective integration of the concepts of CE with the more general ones of sustainability.展开更多
Humans have always engaged with their surroundings and the ecology in which they live.However,during the industrial age,this contact has been more intense and has had a substantial impact on environment and ecosystems...Humans have always engaged with their surroundings and the ecology in which they live.However,during the industrial age,this contact has been more intense and has had a substantial impact on environment and ecosystems.For example,overexploitation of natural resources,mining,pollution,and deforestation are all elements that negatively affect biodiversity and natural resources.Few studies have been conducted to evaluate the damage caused,despite the significant uncontrolled pressure from human activity.However,maintaining its environment is essential to the survival of coastal fishing.Goal:This study’s goal was to evaluate how human activity affected Tabounsou’s coastal ecology in order to suggest remedial actions for sustainable management.The following was the methodological approach used:executive consultation and archival analysis;stakeholder survey(locals,farmers,salt producers,fishers,and loggers);inventory of species;anthropogenic activity inventory;evaluation of how human activity affects aquatic life in the research region;suggestion and action for sustainable management;Outcome:Executive consultation indicated that the main issues are:construction projects that reduce the estuary’s surface area;agricultural practices such as woodcutting and salt farming;the rise in resource exploitation;noncompliance with fisheries laws;and the catching of young fish.Eighty-three percent of fisherman ditch their nets on the coast after using them,but only seventeen percent burn them.With a 75%frequency rate,the same survey indicates that most fisherman fish around the coast.In the Tabounsou area,according to loggers’survey,68%of the wood cut is Rhizophora,24%is Avicennia,and 8%is Laguncularia.Three fish stocks,representing nine families and nine species,were identified by the species inventory.At 18%and 15%,respectively,the actors most frequently capture the species Pseudotolithus elongatus and Arius parkii.According to a poll of 30 farmers,90%of them apply fertilizer to their soil,while only 10%do not.During the dry season,salt is grown.According to two actors,Bougna Toro Toro produces 100 kg of salt per day,followed by Khoumawadé,which produces 80 kg,and Toumbibougni,which produces 70 kg.展开更多
The aim of this study was to describe waste management practices at Kisangani’s central market and the associated factors. A cross-sectional analytical study was carried out among 403 users of the Kisangani central m...The aim of this study was to describe waste management practices at Kisangani’s central market and the associated factors. A cross-sectional analytical study was carried out among 403 users of the Kisangani central market during the period from 01 July 2023 to 02 September 2023. It was found that 80.40% of respondents had poor waste management practices. There was an association between waste management practices and marital status, the category of respondent, the category of goods sold, knowledge of the definition of waste, the management mechanism in place and the availability of management materials and equipment. In conclusion, the proper management of waste from Kisangani’s central market by its users is proving to be a serious public health problem, and several factors are involved. Insufficient financial resources to make waste bins available at all vendors’ stalls, combined with the ineffectiveness of the hygiene committee, are undermining waste management at Kisangani’s central market, which calls for an effective management policy from the market’s managers and sufficient financial resources to alleviate the problem.展开更多
Water is essential for agricultural production;however,climate change has exacerbated drought and water stress in arid and semi-arid areas such as Iran.Despite these challenges,irrigation water efficiency remains low,...Water is essential for agricultural production;however,climate change has exacerbated drought and water stress in arid and semi-arid areas such as Iran.Despite these challenges,irrigation water efficiency remains low,and current water management schemes are inadequate.Consequently,Iranian crops suffer from low water productivity,highlighting the urgent need for enhanced productivity and improved water management strategies.In this study,we investigated irrigation management conditions in the Hamidiyeh farm,Khuzestan Province,Iran and used the calibrated AquaCrop and WinSRFR(a surface irrigation simulation model)models to reflect these conditions.Subsequently,we examined different management scenarios using each model and evaluated the results from the second year.The findings demonstrated that combining simulation of the AquaCrop and WinSRFR models was highly effective and could be employed for irrigation management in the field.The AquaCrop model accurately simulated wheat yield in the first year,being 2.6 t/hm^(2),which closely aligned with the measured yield of 3.0 t/hm^(2).Additionally,using the WinSRFR model to adjust the length of existing borders from 200 to 180 m resulted in a 45.0%increase in efficiency during the second year.To enhance water use efficiency in the field,we recommended adopting borders with a length of 180 m,a width of 10 m,and a flow rate of 15 to 18 L/s.The AquaCrop and WinSRFR models accurately predicted border irrigation conditions,achieving the highest water use efficiency at a flow rate of 18 L/s.Combining these models increased farmers'average water consumption efficiency from 0.30 to 0.99 kg/m^(3)in the second year.Therefore,the results obtained from the AquaCrop and WinSRFR models are within a reasonable range and consistent with international recommendations.This adjustment is projected to improve the water use efficiency in the field by approximately 45.0%when utilizing the border irrigation method.Therefore,integrating these two models can provide comprehensive management solutions for regional farmers.展开更多
With the growth of the construction industry,risk management in construction projects has garnered significant attention from the academic community.Effective risk management during the decision-making stage can great...With the growth of the construction industry,risk management in construction projects has garnered significant attention from the academic community.Effective risk management during the decision-making stage can greatly enhance project management efficiency.This paper integrates the AHP-entropy value method and constructs a risk management model based on the DPSIR framework for construction projects.The model is applied to evaluate and analyze the risk level of the decision-making stage in a navigation and electricity hub project in Chongqing Municipality.The results demonstrate the scientific validity and effectiveness of the proposed model.展开更多
Climate change is becoming a major issue for agriculture and the well-being of farmers. The objective of this article is to identify and analyze the production factors that may influence the competitiveness level of a...Climate change is becoming a major issue for agriculture and the well-being of farmers. The objective of this article is to identify and analyze the production factors that may influence the competitiveness level of agricultural operations, as well as to establish a structural and functional typology of these farms. Using Principal component analysis (PCA) combined with hierarchical ascending classification (HAC) on 250 farmers, the study was able to set farms typology. Furthermore, variance analysis and econometric models (linear et quadratic) were also used for in-depth analysis. The results show the existence of three groups of farm (GA, GB, GC): GA (19.7%), GB (65.3%), and GC (15%). Drought spells and flood are the main climatic risks affecting rain-fed farm operations. For irrigated crops such as rice, the major constraints remain bird attacks, the invasion of pests and nematodes. Climate variability significantly increases the prevalence of morbidities in the region by raising the number of inactive individuals. This significantly and differentially affects the outcomes of these assets. Health expenditures represent a significant share (GB: 12% and GC: 11%) and a non-negligible share (GA: 8.4%). However, larger participations (GC) show better economic performance due to economies of scale, but all categories would benefit from adopting appropriate strategies to reduce losses and increase their resilience.展开更多
BACKGROUND: Targeted temperature management(TTM) is a common therapeutic intervention, yet its cost-effectiveness remains uncertain. This study aimed to evaluate the real-world cost-effectiveness of TTM compared with ...BACKGROUND: Targeted temperature management(TTM) is a common therapeutic intervention, yet its cost-effectiveness remains uncertain. This study aimed to evaluate the real-world cost-effectiveness of TTM compared with that of conventional care in adult out-of-hospital cardiac arrest(OHCA) survivors using clinical patient-level data.METHODS: We conducted a retrospective cohort study at an academic medical center in the USA to assess the cost-effectiveness of TTM in adult non-traumatic OHCA survivors between 1 January, 2019 and 30 June, 2023. The primary outcome was survival to hospital discharge. Incremental cost-effectiveness ratios(ICERs) were calculated and compared with various decision makers' willingness to pay. Cost-effectiveness acceptability curves were utilized to evaluate the economic attractiveness of TTM. Uncertainty about the incremental cost and effect was explored with a 95% confidence ellipse.RESULTS: Among 925 non-traumatic OHCA survivors, only 30(3%) received TTM. After adjusting for potential confounders, the TTM group did not demonstrate a significantly lower cost(delta cost-$5,141, 95% confidence interval [95% CI]: $-35,347 to $25,065, P=0.79) and higher survival to hospital discharge(delta effect 6%, 95% CI:-11% to 23%, P=0.41). Additionally, a 95% confidence ellipse indicated uncertainty reflected by evidence that the true value of the ICER could be in any of the quadrants of the cost-effectiveness plane.CONCLUSION: Although TTM did not demonstrate a clear survival benefit in this study, its potential cost-effectiveness warrants further investigation with larger sample sizes. These findings highlight the need for additional research to optimize TTM use in OHCA care and inform resource allocation decisions.展开更多
Background Antibiotic therapy in infertility management is one of the most frequent and useful practices in sub-Saharan setting. Infertility of tubal origin and secondary to infections are the most prevalent. The curr...Background Antibiotic therapy in infertility management is one of the most frequent and useful practices in sub-Saharan setting. Infertility of tubal origin and secondary to infections are the most prevalent. The current study aimed to take stock of antibiotic therapy in infertility management without in Vitro Fertilization (IVF). Material and Methods A cross-sectional analytical study undertaken in University Clinics of Kinshasa and the Edith Medical Center, from January 2001 to December 2021. It involved 3754 patients who sought care for infertility and received antibiotics during the treatment. Results The mean age of the patients was 33.3 ± 5.7 years and ranged from 16 to 49 years. Most of them were nulliparous with secondary infertility. The average duration of infertility was 4.5 ± 3.6 years and ranged from 1 to 20 years. Most had a history of unsafe abortion and tubal obstruction. The pelvic infections were the main diagnosis. After antibiotic therapy, especially made of Doxycycline alone or in association 442 (8.8%) patients conceived. Conclusion In the low-income sub-Saharan setting, infection remained the common cause of infertility and doxycycline was found to be the most used and efficient antibiotics.展开更多
文摘Background: The availability of essential medicines and medical supplies is crucial for effectively delivering healthcare services. In Zambia, the Logistics Management Information System (LMIS) is a key tool for managing the supply chain of these commodities. This study aimed to evaluate the effectiveness of LMIS in ensuring the availability of essential medicines and medical supplies in public hospitals in the Copperbelt Province of Zambia. Materials and Methods: From February to April 2022, a cross-sectional study was conducted in 12 public hospitals across the Copperbelt Province. Data were collected using structured questionnaires, checklists, and stock control cards. The study assessed LMIS availability, training, and knowledge among pharmacy personnel, as well as data accuracy, product availability, and order fill rates. Descriptive statistics were used to analyse the data. Results: All surveyed hospitals had LMIS implemented and were using eLMIS as the primary LMIS. Only 47% and 48% of pharmacy personnel received training in eLMIS and Essential Medicines Logistics Improvement Program (EMLIP), respectively. Most personnel demonstrated good knowledge of LMIS, with 77.7% able to log in to eLMIS Facility Edition, 76.6% able to locate stock control cards in the system, and 78.7% able to perform transactions. However, data accuracy from physical and electronic records varied from 0% to 60%, and product availability ranged from 50% to 80%. Order fill rates from Zambia Medicines and Medical Supplies Agency (ZAMMSA) were consistently below 30%. Discrepancies were observed between physical stock counts and eLMIS records. Conclusion: This study found that most hospitals in the Copperbelt Province of Zambia have implemented LMIS use. While LMIS implementation is high in the Copperbelt Province of Zambia, challenges such as low training levels, data inaccuracies, low product availability, and order fill rates persist. Addressing these issues requires a comprehensive approach, including capacity building, data quality improvement, supply chain coordination, and investment in infrastructure and human resources. Strengthening LMIS effectiveness is crucial for improving healthcare delivery and patient outcomes in Zambia.
基金supported by the Project of the 2023 Shandong Province Higher Education Curriculum Ideological and Political Education Reform Research Project“Value Connotation,Intrinsic Logic,and Method Path:Student-centered College Curriculum Ideological and Political Integration‘Salt’in Course Teaching”(SZ2023003)Shandong Provincial Department of Education Key Teaching and Research Project“Ideological and Political Guidance,Goal Orientation,and Multidimensional Integration—Research and Practice of Embedded System Series Curriculum Teaching for New Engineering Majors”(Z2022232)+2 种基金2023 Harbin Institute of Technology(Weihai)Education and Teaching Reform Research Project“Connotation Elements,Related Logic,and Core Measures:Basic Paradigm of Curriculum Construction and Classroom Teaching Reform”(2023MSZZ01)the Key Teaching and Research Project of Shandong Provincial Department of Education,“I+IV”Mentor System—Exploration and Practice of Innovative Talents Training Model for Intelligent Vehicle Engineering New Engineering(Z2023002)the 2024 Harbin Institute of Technology(Weihai)Experimental Teaching and Teaching Laboratory Construction Research Project“Online and Offline Mixing,Virtual-practical Operation Integration,Industrial Technology Guidance—Research and Exploration of New Form Experimental Teaching of Computer Composition Principles”(2024SYZZ03)。
文摘The combination and application of information technology and higher education have led to changes in the form and mode of teaching management in higher education,promoting the continuous deepening of digital transformation in higher education.This paper discusses higher education management innovation triggered by digital technology and the new appearance of digital university governance,digital evaluation management,and internal governance of higher education.From the perspective of forging new forms,models,and paths of digital management through digital technology,this paper focuses on analyzing the reshaping of management systems by digitalization in higher education.The promotion and inspiration of digitalization on management system reform are provided,including typical features brought about,new paths opened up,and new advantages shaped.It is emphasized that the establishment of digital management system needs to rely on the systematic integration of multiple aspects.Finally,the challenges and solutions faced by the digital management system are deeply analyzed from the aspects of collaborative management and services,management process interoperability,evaluation and trust protection,and personnel digital literacy.Digital technology drives the transformation of higher education management system,resulting in new forms,models,paths,and methods of networked and digital management based on intelligent analysis and processing of educational and teaching data and promoting higher education management toward digital governance.The comprehensive establishment of a digital management system will unleash strong potential for universities to better fulfill their functions,and the high-quality development of higher education will be more solid and powerful.
文摘Efficient data management in healthcare is essential for providing timely and accurate patient care, yet traditional partitioning methods in relational databases often struggle with the high volume, heterogeneity, and regulatory complexity of healthcare data. This research introduces a tailored partitioning strategy leveraging the MD5 hashing algorithm to enhance data insertion, query performance, and load balancing in healthcare systems. By applying a consistent hash function to patient IDs, our approach achieves uniform distribution of records across partitions, optimizing retrieval paths and reducing access latency while ensuring data integrity and compliance. We evaluated the method through experiments focusing on partitioning efficiency, scalability, and fault tolerance. The partitioning efficiency analysis compared our MD5-based approach with standard round-robin methods, measuring insertion times, query latency, and data distribution balance. Scalability tests assessed system performance across increasing dataset sizes and varying partition counts, while fault tolerance experiments examined data integrity and retrieval performance under simulated partition failures. The experimental results demonstrate that the MD5-based partitioning strategy significantly reduces query retrieval times by optimizing data access patterns, achieving up to X% better performance compared to round-robin methods. It also scales effectively with larger datasets, maintaining low latency and ensuring robust resilience under failure scenarios. This novel approach offers a scalable, efficient, and fault-tolerant solution for healthcare systems, facilitating faster clinical decision-making and improved patient care in complex data environments.
文摘With the continuous advancement of information technology,traditional teaching management models can no longer meet the demands of modern laboratory management.Information management,characterized by efficiency,convenience,and intelligence,provides new ideas and directions for reforming laboratory teaching management models in higher education.Based on this,this paper explores reform strategies and practical approaches for laboratory teaching management models from the perspective of information management,aiming to offer references for enhancing the modernization and intelligentization of laboratory teaching management.
基金supported by the Deanship of Scientific Research and Graduate Studies at King Khalid University under research grant number(R.G.P.2/93/45).
文摘Thedeployment of the Internet of Things(IoT)with smart sensors has facilitated the emergence of fog computing as an important technology for delivering services to smart environments such as campuses,smart cities,and smart transportation systems.Fog computing tackles a range of challenges,including processing,storage,bandwidth,latency,and reliability,by locally distributing secure information through end nodes.Consisting of endpoints,fog nodes,and back-end cloud infrastructure,it provides advanced capabilities beyond traditional cloud computing.In smart environments,particularly within smart city transportation systems,the abundance of devices and nodes poses significant challenges related to power consumption and system reliability.To address the challenges of latency,energy consumption,and fault tolerance in these environments,this paper proposes a latency-aware,faulttolerant framework for resource scheduling and data management,referred to as the FORD framework,for smart cities in fog environments.This framework is designed to meet the demands of time-sensitive applications,such as those in smart transportation systems.The FORD framework incorporates latency-aware resource scheduling to optimize task execution in smart city environments,leveraging resources from both fog and cloud environments.Through simulation-based executions,tasks are allocated to the nearest available nodes with minimum latency.In the event of execution failure,a fault-tolerantmechanism is employed to ensure the successful completion of tasks.Upon successful execution,data is efficiently stored in the cloud data center,ensuring data integrity and reliability within the smart city ecosystem.
文摘The dramatic rise in the number of people living in cities has made many environmental and social problems worse.The search for a productive method for disposing of solid waste is the most notable of these problems.Many scholars have referred to it as a fuzzy multi-attribute or multi-criteria decision-making problem using various fuzzy set-like approaches because of the inclusion of criteria and anticipated ambiguity.The goal of the current study is to use an innovative methodology to address the expected uncertainties in the problem of solid waste site selection.The characteristics(or sub-attributes)that decision-makers select and the degree of approximation they accept for various options can both be indicators of these uncertainties.To tackle these problems,a novel mathematical structure known as the fuzzy parameterized possibility single valued neutrosophic hypersoft expert set(ρˆ-set),which is initially described,is integrated with a modified version of Sanchez’s method.Following this,an intelligent algorithm is suggested.The steps of the suggested algorithm are explained with an example that explains itself.The compatibility of solid waste management sites and systems is discussed,and rankings are established along with detailed justifications for their viability.This study’s strengths lie in its application of fuzzy parameterization and possibility grading to effectively handle the uncertainties embodied in the parameters’nature and alternative approximations,respectively.It uses specific mathematical formulations to compute the fuzzy parameterized degrees and possibility grades that are missing from the prior literature.It is simpler for the decisionmakers to look at each option separately because the decision is uncertain.Comparing the computed results,it is discovered that they are consistent and dependable because of their preferred properties.
基金Supported by National Research Foundation of Korea,No.NRF-2021S1A5A8062526.
文摘This article provides a comprehensive analysis of the study by Hou et al,focusing on the complex interplay between psychological and physical factors in the postoperative recovery(POR)of patients with perianal diseases.The study sheds light on how illness perception,anxiety,and depression significantly influence recovery outcomes.Hou et al developed a predictive model that demonstrated high accuracy in identifying patients at risk of poor recovery.The article explores the critical role of pre-operative psychological assessment,highlighting the need for mental health support and personalized recovery plans in enhancing POR quality.A multidisciplinary approach,integrating mental health professionals with surgeons,anesthesiologists,and other specialists,is emphasized to ensure comprehensive care for patients.The study’s findings serve as a call to integrate psychological care into surgical practice to optimize outcomes for patients with perianal diseases.
文摘Diabetic retinopathy(DR)remains a leading cause of vision impairment and blindness among individuals with diabetes,necessitating innovative approaches to screening and management.This editorial explores the transformative potential of artificial intelligence(AI)and machine learning(ML)in revolutionizing DR care.AI and ML technologies have demonstrated remarkable advancements in enhancing the accuracy,efficiency,and accessibility of DR screening,helping to overcome barriers to early detection.These technologies leverage vast datasets to identify patterns and predict disease progression with unprecedented precision,enabling clinicians to make more informed decisions.Furthermore,AI-driven solutions hold promise in personalizing management strategies for DR,incorpo-rating predictive analytics to tailor interventions and optimize treatment path-ways.By automating routine tasks,AI can reduce the burden on healthcare providers,allowing for a more focused allocation of resources towards complex patient care.This review aims to evaluate the current advancements and applic-ations of AI and ML in DR screening,and to discuss the potential of these techno-logies in developing personalized management strategies,ultimately aiming to improve patient outcomes and reduce the global burden of DR.The integration of AI and ML in DR care represents a paradigm shift,offering a glimpse into the future of ophthalmic healthcare.
文摘Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD patients can experience long-term cardiovascular issues,as evidenced by a recent case report of an adult who suffered a ST-segment elevation myocardial infarction due to previous KD in the World Journal of Clinical Cases.This editorial emphasizes the critical need for long-term management and regular surveillance to prevent such complications.By drawing on recent research and case studies,we advocate for a structured approach to follow-up care that includes routine cardiac evaluations and preventive measures.
文摘BACKGROUND Inadequate glycemic control in patients with type 2 diabetes(T2DM)is a major public health problem and a significant risk factor for the progression of diabetic complications.AIM To evaluate the effects of intensive and supportive glycemic management strategies over a 12-month period in individuals with T2DM with glycated hemoglobin(HbA1c)≥10%and varying backgrounds of glycemic control.METHODS This prospective observational study investigated glycemic control in patients with poorly controlled T2DM over 12 months.Participants were categorized into four groups based on prior glycemic history:Newly diagnosed,previously well controlled with recent worsening,previously off-target but now worsening,and HbA1c consistently above 10%.HbA1c levels were monitored quarterly,and patients received medical,educational,and dietary support as needed.The analysis focused on the success rates of good glycemic control and the associated factors within each group.RESULTS The study showed significant improvements in HbA1c levels in all participants.The most significant improvement was observed in individuals newly diagnosed with diabetes:65%achieved an HbA1c target of≤7%.The results varied between participants with different glycemic control histories,followed by decreasing success rates:39%in participants with previously good glycemic control,21%in participants whose glycemic control had deteriorated compared to before,and only 10%in participants with persistently poor control,with mean HbA1c levels of 6.3%,7.7%,8.2%,and 9.7%,respectively.After one year,65.2%of the“newly diagnosed patients”,39.3%in the“previously controlled group”,21.9%in the“previously off-target but now worsened'”group and 10%in the“poorly controlled from the start”group had achieved HbA1c levels of 7 and below.CONCLUSION In poorly controlled diabetes,the rate at which treatment goals are achieved is associated with the glycemic background characteristics,emphasizing the need for tailored strategies.Therefore,different and comprehensive treatment approaches are needed for patients with persistent uncontrolled diabetes.
文摘This editorial highlights a recently published study examining the effectiveness of music therapy combined with motivational interviewing(MI)in addressing an-xiety and depression among young and middle-aged patients following percuta-neous coronary intervention.It further explores existing evidence and potential future research directions for MI in postoperative rehabilitation and chronic disease management.MI aims to facilitate behavioral change and promote healthier lifestyles by fostering a trusting relationship with patients and enhan-cing intrinsic motivation.Research has demonstrated its effectiveness in posto-perative recovery for oncological surgery,stroke,organ transplants,and gastroin-testinal procedures,as well as in managing chronic conditions such as diabetes,obesity,and periodontal disease.The approach is patient-centered,adaptable,cost-effective,and easily replicable,though its limitations include reliance on the therapist’s expertise,variability in individual responses,and insufficient long-term follow-up studies.Future research could focus on developing individualized and precise intervention models,exploring applications in digital health management,and confirming long-term outcomes to provide more compre-hensive support for patient rehabilitation.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)is strongly associated with an increased risk of thrombotic events,including severe outcomes such as pulmonary embolism.Elevated D-dimer levels are a critical biomarker for assessing this risk.In Gabon,early implementation of anticoagulation therapy and D-dimer testing has been crucial in managing COVID-19.This study hypothesizes that elevated Ddimer levels are linked to increased COVID-19 severity.AIM To determine the impact of D-dimer levels on COVID-19 severity and their role in guiding clinical decisions.METHODS This retrospective study analyzed COVID-19 patients admitted to two hospitals in Gabon between March 2020 and December 2023.The study included patients with confirmed COVID-19 diagnoses and available D-dimer measurements at admission.Data on demographics,clinical outcomes,D-dimer levels,and healthcare costs were collected.COVID-19 severity was classified as non-severe(outpatients)or severe(inpatients).A multivariable logistic regression model was used to assess the relationship between D-dimer levels and disease severity,with adjusted odds ratios(OR)and 95%CI.RESULTS A total of 3004 patients were included,with a mean age of 50.17 years,and the majority were female(53.43%).Elevated D-dimer levels were found in 65.81%of patients,and 57.21%of these experienced severe COVID-19.Univariate analysis showed that patients with elevated D-dimer levels had 3.33 times higher odds of severe COVID-19(OR=3.33,95%CI:2.84-3.92,P<0.001),and this association remained significant in the multivariable analysis,adjusted for age,sex,and year of collection.The financial analysis revealed a substantial burden,particularly for uninsured patients.CONCLUSION D-dimer predicts COVID-19 severity and guides treatment,but the high cost of anticoagulant therapy highlights the need for policies ensuring affordable access in resource-limited settings like Gabon.
文摘The development of sustainable sludge management systems requires looking at them with a new vision in which the concepts of SD(Sustainable Development)must integrate those of CE(Circular Economy),both concepts subject to the principles of TD(Thermodynamics),thus allowing the adoption of actions that are all the more effective the more complete the evaluation of the social dimension has been.This involves a new“Way of thinking”which sees the sludge system as the“Locomotive”of the entire wastewater/sludge treatment train and is developed through“Ways of acting”which includes both“Technical”actions to maximize recoveries of useful materials and/or or energy,and“Socio/Institutional”actions to overcome barriers linked to local cultures and traditions,also considering that the specific local context heavily influences the choices capable of satisfying the concepts of CE.It follows the need of issuing realistic and applicable regulations and overcoming social barriers,such as lack of infrastructure and/or qualified personnel,to achieve an effective integration of the concepts of CE with the more general ones of sustainability.
文摘Humans have always engaged with their surroundings and the ecology in which they live.However,during the industrial age,this contact has been more intense and has had a substantial impact on environment and ecosystems.For example,overexploitation of natural resources,mining,pollution,and deforestation are all elements that negatively affect biodiversity and natural resources.Few studies have been conducted to evaluate the damage caused,despite the significant uncontrolled pressure from human activity.However,maintaining its environment is essential to the survival of coastal fishing.Goal:This study’s goal was to evaluate how human activity affected Tabounsou’s coastal ecology in order to suggest remedial actions for sustainable management.The following was the methodological approach used:executive consultation and archival analysis;stakeholder survey(locals,farmers,salt producers,fishers,and loggers);inventory of species;anthropogenic activity inventory;evaluation of how human activity affects aquatic life in the research region;suggestion and action for sustainable management;Outcome:Executive consultation indicated that the main issues are:construction projects that reduce the estuary’s surface area;agricultural practices such as woodcutting and salt farming;the rise in resource exploitation;noncompliance with fisheries laws;and the catching of young fish.Eighty-three percent of fisherman ditch their nets on the coast after using them,but only seventeen percent burn them.With a 75%frequency rate,the same survey indicates that most fisherman fish around the coast.In the Tabounsou area,according to loggers’survey,68%of the wood cut is Rhizophora,24%is Avicennia,and 8%is Laguncularia.Three fish stocks,representing nine families and nine species,were identified by the species inventory.At 18%and 15%,respectively,the actors most frequently capture the species Pseudotolithus elongatus and Arius parkii.According to a poll of 30 farmers,90%of them apply fertilizer to their soil,while only 10%do not.During the dry season,salt is grown.According to two actors,Bougna Toro Toro produces 100 kg of salt per day,followed by Khoumawadé,which produces 80 kg,and Toumbibougni,which produces 70 kg.
文摘The aim of this study was to describe waste management practices at Kisangani’s central market and the associated factors. A cross-sectional analytical study was carried out among 403 users of the Kisangani central market during the period from 01 July 2023 to 02 September 2023. It was found that 80.40% of respondents had poor waste management practices. There was an association between waste management practices and marital status, the category of respondent, the category of goods sold, knowledge of the definition of waste, the management mechanism in place and the availability of management materials and equipment. In conclusion, the proper management of waste from Kisangani’s central market by its users is proving to be a serious public health problem, and several factors are involved. Insufficient financial resources to make waste bins available at all vendors’ stalls, combined with the ineffectiveness of the hygiene committee, are undermining waste management at Kisangani’s central market, which calls for an effective management policy from the market’s managers and sufficient financial resources to alleviate the problem.
基金The study was funded by the Soil and Water Research Institute of Iran.
文摘Water is essential for agricultural production;however,climate change has exacerbated drought and water stress in arid and semi-arid areas such as Iran.Despite these challenges,irrigation water efficiency remains low,and current water management schemes are inadequate.Consequently,Iranian crops suffer from low water productivity,highlighting the urgent need for enhanced productivity and improved water management strategies.In this study,we investigated irrigation management conditions in the Hamidiyeh farm,Khuzestan Province,Iran and used the calibrated AquaCrop and WinSRFR(a surface irrigation simulation model)models to reflect these conditions.Subsequently,we examined different management scenarios using each model and evaluated the results from the second year.The findings demonstrated that combining simulation of the AquaCrop and WinSRFR models was highly effective and could be employed for irrigation management in the field.The AquaCrop model accurately simulated wheat yield in the first year,being 2.6 t/hm^(2),which closely aligned with the measured yield of 3.0 t/hm^(2).Additionally,using the WinSRFR model to adjust the length of existing borders from 200 to 180 m resulted in a 45.0%increase in efficiency during the second year.To enhance water use efficiency in the field,we recommended adopting borders with a length of 180 m,a width of 10 m,and a flow rate of 15 to 18 L/s.The AquaCrop and WinSRFR models accurately predicted border irrigation conditions,achieving the highest water use efficiency at a flow rate of 18 L/s.Combining these models increased farmers'average water consumption efficiency from 0.30 to 0.99 kg/m^(3)in the second year.Therefore,the results obtained from the AquaCrop and WinSRFR models are within a reasonable range and consistent with international recommendations.This adjustment is projected to improve the water use efficiency in the field by approximately 45.0%when utilizing the border irrigation method.Therefore,integrating these two models can provide comprehensive management solutions for regional farmers.
文摘With the growth of the construction industry,risk management in construction projects has garnered significant attention from the academic community.Effective risk management during the decision-making stage can greatly enhance project management efficiency.This paper integrates the AHP-entropy value method and constructs a risk management model based on the DPSIR framework for construction projects.The model is applied to evaluate and analyze the risk level of the decision-making stage in a navigation and electricity hub project in Chongqing Municipality.The results demonstrate the scientific validity and effectiveness of the proposed model.
文摘Climate change is becoming a major issue for agriculture and the well-being of farmers. The objective of this article is to identify and analyze the production factors that may influence the competitiveness level of agricultural operations, as well as to establish a structural and functional typology of these farms. Using Principal component analysis (PCA) combined with hierarchical ascending classification (HAC) on 250 farmers, the study was able to set farms typology. Furthermore, variance analysis and econometric models (linear et quadratic) were also used for in-depth analysis. The results show the existence of three groups of farm (GA, GB, GC): GA (19.7%), GB (65.3%), and GC (15%). Drought spells and flood are the main climatic risks affecting rain-fed farm operations. For irrigated crops such as rice, the major constraints remain bird attacks, the invasion of pests and nematodes. Climate variability significantly increases the prevalence of morbidities in the region by raising the number of inactive individuals. This significantly and differentially affects the outcomes of these assets. Health expenditures represent a significant share (GB: 12% and GC: 11%) and a non-negligible share (GA: 8.4%). However, larger participations (GC) show better economic performance due to economies of scale, but all categories would benefit from adopting appropriate strategies to reduce losses and increase their resilience.
基金supported by Faculty of MedicineChiang Mai University+2 种基金supported by the National Center for Advancing Translational SciencesNational Institutes of Healththrough grant number UL1 TR001860. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH。
文摘BACKGROUND: Targeted temperature management(TTM) is a common therapeutic intervention, yet its cost-effectiveness remains uncertain. This study aimed to evaluate the real-world cost-effectiveness of TTM compared with that of conventional care in adult out-of-hospital cardiac arrest(OHCA) survivors using clinical patient-level data.METHODS: We conducted a retrospective cohort study at an academic medical center in the USA to assess the cost-effectiveness of TTM in adult non-traumatic OHCA survivors between 1 January, 2019 and 30 June, 2023. The primary outcome was survival to hospital discharge. Incremental cost-effectiveness ratios(ICERs) were calculated and compared with various decision makers' willingness to pay. Cost-effectiveness acceptability curves were utilized to evaluate the economic attractiveness of TTM. Uncertainty about the incremental cost and effect was explored with a 95% confidence ellipse.RESULTS: Among 925 non-traumatic OHCA survivors, only 30(3%) received TTM. After adjusting for potential confounders, the TTM group did not demonstrate a significantly lower cost(delta cost-$5,141, 95% confidence interval [95% CI]: $-35,347 to $25,065, P=0.79) and higher survival to hospital discharge(delta effect 6%, 95% CI:-11% to 23%, P=0.41). Additionally, a 95% confidence ellipse indicated uncertainty reflected by evidence that the true value of the ICER could be in any of the quadrants of the cost-effectiveness plane.CONCLUSION: Although TTM did not demonstrate a clear survival benefit in this study, its potential cost-effectiveness warrants further investigation with larger sample sizes. These findings highlight the need for additional research to optimize TTM use in OHCA care and inform resource allocation decisions.
文摘Background Antibiotic therapy in infertility management is one of the most frequent and useful practices in sub-Saharan setting. Infertility of tubal origin and secondary to infections are the most prevalent. The current study aimed to take stock of antibiotic therapy in infertility management without in Vitro Fertilization (IVF). Material and Methods A cross-sectional analytical study undertaken in University Clinics of Kinshasa and the Edith Medical Center, from January 2001 to December 2021. It involved 3754 patients who sought care for infertility and received antibiotics during the treatment. Results The mean age of the patients was 33.3 ± 5.7 years and ranged from 16 to 49 years. Most of them were nulliparous with secondary infertility. The average duration of infertility was 4.5 ± 3.6 years and ranged from 1 to 20 years. Most had a history of unsafe abortion and tubal obstruction. The pelvic infections were the main diagnosis. After antibiotic therapy, especially made of Doxycycline alone or in association 442 (8.8%) patients conceived. Conclusion In the low-income sub-Saharan setting, infection remained the common cause of infertility and doxycycline was found to be the most used and efficient antibiotics.
