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side informing service users of both their right to access such care and how to do so. Further work is necessary with members from minority communities who are mostly absent from this study to explore if, and how, COVID-19 may have exacerbated already existing disparities.

Limited research has examined mobile phone-based platforms for survey recruitment, especially during the COVID-19 pandemic in Brazil. Our objective was to investigate the feasibility and representativeness of mobile phone-based advertisement during a preliminary study about COVID-19 vaccine hesitation in Brazil. Moreover, we evaluate whether the older population can be reached through mobile phone-based platforms of the survey.

We conducted a study in December 2021 based on a preliminary survey about the COVID-19 vaccine hesitation in Assis, Brazil, Sao Paulo state. From a list of the adult population hesitant about the second dose of the COVID-19 vaccine, we sent a mobile phone-based advertisement inviting the participants to answer the survey for one week. The respondent's data were collected in a Google form platform. The comparison between the target population and the respondents was made using the Chi-squared test and the Welch's test, using a P-value of 0.05 as significative.

The response rate waeans of recruiting for survey research.Diabetic retinopathy (DR) is one of the most important complications of diabetes. Accurate segmentation of DR lesions is of great importance for the early diagnosis of DR. However, simultaneous segmentation of multi-type DR lesions is technically challenging because of 1) the lack of pixel-level annotations and 2) the large diversity between different types of DR lesions. In this study, first, we propose a novel Poisson-blending data augmentation (PBDA) algorithm to generate synthetic images, which can be easily utilized to expand the existing training data for lesion segmentation. We perform extensive experiments to recognize the important attributes in the PBDA algorithm. We show that position constraints are of great importance and that the synthesis density of one type of lesion has a joint influence on the segmentation of other types of lesions. Second, we propose a convolutional neural network architecture, named DSR-U-Net++ (i.e., DC-SC residual U-Net++), for the simultaneous segmentation of multi-type DR lesions. Ablation studies showed that the mean area under precision recall curve (AUPR) for all four types of lesions increased by >5% with PBDA. The proposed DSR-U-Net++ with PBDA outperformed the state-of-the-art methods by 1.7%-9.9% on the Indian Diabetic Retinopathy Image Dataset (IDRiD) and 67.3% on the e-ophtha dataset with respect to mean AUPR. The developed method would be an efficient tool to generate large-scale task-specific training data for other medical anomaly segmentation tasks.

We aimed to investigate whether SARS-CoV-2 infection was associated with an increased risk of incident epilepsy.

National register-based matched study. Verified cases of SARS-CoV-2 infection were acquired from the system for communicable disease surveillance in Sweden (SmiNet) and linked to data from the National Patient Register (NPR) and Cause of Death register in Sweden. Cases and non-infected controls were compared using a Cox proportional hazards model.

A total of 1,221,801 SARS-CoV-2 infected patients and 1,223,312 controls were included. Infection was not associated with an increased risk of epilepsy on a whole population level (HR 1.01, 95% CI 0.92-1.12). Statistically significant effects were observed in patients between 61 and 80 years (HR 1.66, 95% CI 1.37-2.02), also when adjusting for stroke, traumatic brain injury, tumours (same age group HR 1.50, 95% CI 1.24-1.82) and mechanical ventilation (HR 1.28, 95% CI 1.05-1.57). In patients 81-100 years, a similar significant difference was observelikely very small.

Unplanned transfer of trauma patients to the intensive care unit (ICU) carries an associated increase in mortality, hospital length of stay, and cost. Trauma teams need to determine which patients necessitate ICU admission on presentation rather than waiting to intervene on deteriorating patients. This study sought to develop a novel Clinical Risk of Acute ICU Status during Hospitalization (CRASH) score to predict the risk of unplanned ICU admission.

The 2017 Trauma Quality Improvement Program database was queried for patients admitted to nonICU locations. The group was randomly divided into two equal sets (derivation and validation). Multiple logistic regression models were created to determine the risk of unplanned ICU admission using patient demographics, comorbidities, and injuries. The weighted average and relative impact of each independent predictor were used to derive a CRASH score. The score was validated using area under the curve.

A total of 624,786 trauma patients were admitted to nonICU locations. From 312,393 patients in the derivation-set, 3769 (1.2%) had an unplanned ICU admission. A total of 24 independent predictors of unplanned ICU admission were identified and the CRASH score was derived with scores ranging from 0 to 32. The unplanned ICU admission rate increased steadily from 0.1% to 3.9% then 12.9% at scores of 0, 6, and 14, respectively. The area under the curve for was 0.78.

The CRASH score is a novel and validated tool to predict unplanned ICU admission for trauma patients. This tool may help providers admit patients to the appropriate level of care or identify patients at-risk for decompensation.

The CRASH score is a novel and validated tool to predict unplanned ICU admission for trauma patients. AZD5438 concentration This tool may help providers admit patients to the appropriate level of care or identify patients at-risk for decompensation.

There is a growing need for small-diameter (<6mm) off-the-shelf synthetic vascular conduits for different surgical bypass procedures, with actual synthetic conduits showing unacceptable thrombosis rates. The goal of this study was tobuild vascular grafts with better compliance than standard synthetic conduits andwith an inner layer stimulating endothelialization while remaining antithrombogenic.

Tubular vascular conduits made of a scaffold of polyurethane/polycaprolactone combined with a bioactive coating based on chondroitin sulfate (CS) were created using electrospinning and plasma polymerization. Invitro testing followed by a comparative invivo trial in a sheep model as bilateral carotid bypasses was performed to assess the conduits' performance compared to the actual standard.

Invitro, the novel small-diameter (5mm) electrospun vascular grafts coated with chondroitin sulfate (CS) showed 10 times more compliance compared to commercial expanded polytetrafluoroethylene (ePTFE) conduits while maintaiane/polycaprolactone scaffold in order to make it prone to transmural endothelialization while being resistant to strenuous conditions.

Outcomes in patients with isolated traumatic brain injury (iTBI) have not been evaluated comprehensively in low-income and middle-income countries. We aimed to study the in-hospital iTBI mortality and its associated risk factors in a prospective multicenter Indian trauma registry.

Patients with iTBI (head and neck Abbreviated Injury Score ≥2 and other region Abbreviated Injury Score ≤2) were included. Study variables comprised age, gender, mechanism of injury, systolic blood pressure (SBP) at arrival, Glasgow Coma Scale (GCS) score - classified as mild (13-15), moderate (9-12), and severe (3-8), transfer status, and time to presentation at any participating hospital. A multivariable logistic regression was performed to assess the impact of these factors on 24-h and 30-d mortality following iTBI.

Among 5042 included patients, 24-h and 30-d in-hospital mortalities were 5.9% and 22.4%. On a regression analysis, 30-d mortality was associated with age ≥45y (odds ratio [OR]=2.1 [1.6-2.7]), railway injury mechanisms (OR=2.1 [1.3-3.5]), SBP <90mmHg (OR=2.6 [1.6-4.1]), and moderate (OR=3.8 [3.0-5.0]) to severe (OR=21.1 [16.8-26.7]) iTBI based on GCS scores. 24-h mortality showed similar trends. Patients transferred to the participating hospitals from other centers had higher odds of 30-d mortality (OR=1.4 [1.2-1.8]) compared to those arriving directly. Those who received neurosurgical intervention had lower odds of 24-h mortality (0.3 [0.2-0.4]).

Age ≥45y, GCS score ≤12, and SBP <90mmHg at arrival increased the risk of in-hospital mortality from iTBI.

Age ≥45 y, GCS score ≤12, and SBP less then 90 mmHg at arrival increased the risk of in-hospital mortality from iTBI.

Trauma-specific performance improvement (PI) activities are highly variable among Emergency Medical Services (EMS) providers. This study assesses the perception of the trauma PI activities of EMS providers in the state of Ohio and identifies potential barriers to conducting a successful program.

An institutional review board-approved, voluntary, and anonymous Qualtrics survey was disseminated to all EMS agencies registered under the Ohio Department of Public Safety throughout the 88 counties of Ohio. It included questions regarding what agencies considered trauma-specific PI activities, how frequently they completed those activities, and barriers related to conducting such PI activities. There were both open-ended and closed-ended questions in the survey, along with a follow-up interview. The data were descriptively and thematically analyzed.

From the recorded responses (341), most the respondents (98.5%) either agreed or strongly agreed that trauma-specific PI activities improve performance of EMS provuma-specific PI activities among EMS agencies in the state. Common barriers could potentially be mitigated by collaboration between agencies, trauma centers, and state-led initiatives. With the increased frequency of mass shootings and other large-scale trauma disasters, it is imperative from a state and regional level to address these inconsistencies and further elucidate effective measures of trauma PI for the EMS community.

Our results showed variability in the perception, execution, and availability of trauma-specific PI activities among EMS agencies in the state. Common barriers could potentially be mitigated by collaboration between agencies, trauma centers, and state-led initiatives. With the increased frequency of mass shootings and other large-scale trauma disasters, it is imperative from a state and regional level to address these inconsistencies and further elucidate effective measures of trauma PI for the EMS community.

Collagen degradation can lead to early postoperative weakness in colorectal anastomosis. Matrix metalloproteinase inhibitors (MMPIs) are shown to decrease collagen breakdown and enhance healing in anastomosis in animal models. Here, we evaluated the effectiveness of a novel anastomotic augmentation ring (AAR) that releases doxycycline, an MMPI, from a poly(lactic-co-glycolic) acid ring in porcine anastomoses.

Two end-to-end stapled colorectal anastomoses were performed in 20 Yorkshire-Hampshire pigs. AAR was randomly incorporated into either the proximal or distal anastomosis as treatment, while nonaugmented anastomosis served as a control. Animals were then euthanized on days 3, 4, and 5 before anastomosis explantation and burst pressure measurement. Each anastomosis site was also collected for histology, hydroxyproline content, and gene expression microarray analyses.

No abscess or anastomotic leak was detected. Average burst pressures were not significantly different at any time point. There is no statistical difference in collagen content between the treatment group and controls.