Prompt identification of acute coronary syndrome is a challenge in clinical practice. The 12-lead electrocardiogram (ECG) is readily available during initial patient evaluation, but current rule-based interpretation approaches lack sufficient accuracy. Here we report machine learning-based methods for the prediction of underlying acute myocardial ischemia in patients with chest pain. Using 554 temporal-spatial features of the 12-lead ECG, we train and test multiple classifiers on two independent prospective patient cohorts (n = 1244). While maintaining higher negative predictive value, our final fusion model achieves 52% gain in sensitivity compared to commercial interpretation software and 37% gain in sensitivity compared to experienced clinicians. Such an ultra-early, ECG-based clinical decision support tool, when combined with the judgment of trained emergency personnel, would help to improve clinical outcomes and reduce unnecessary costs in patients with chest pain. Diagnosing a heart attack requires excessive testing and prolonged observation, which frequently requires hospital admission. Here the authors report a machine learning-based system based exclusively on ECG data that can help clinicians identify 37% more heart attacks during initial screening.

Witnessing domestic violence is a common experience among children, but has only recently been recognized as a specific form of abuse. The purpose of this paper is to present a review of the researchers who have examined the experience of children witnessing domestic violence.,Research papers related to witnessing domestic violence and published in leading academic journals in the UK and abroad from January 1980 to September 2018 were identified and reviewed.,Although there were some inconsistent findings, it was found that most of the available research suggests that witnessing domestic violence is prevalent among children and recognized today as a form of abuse. Results from analyzed studies identified high rates of psychological problems among children exposed to witnessing domestic violence. Furthermore, there is evidence that a variety of child and parent characteristics are important to more fully understand what influences have on exposure children’s witnessing domestic violence. In the end, this data emphasize that to be successful, access is essential to the places where the risks for the occurrence of this form of abuse is most evident, in the family, working with the child and the parents/caregivers.,This is an original paper which draws on different research about children witnessing domestic violence.

Background COVID-19 is a global pandemic affecting all aspects of life in all countries. We assessed COVID-19 knowledge and associated factors among dental academics in 26 countries. Methods We invited dental academics to participate in a cross-sectional, multi-country, online survey from March to April 2020. The survey collected data on knowledge of COVID-19 regarding the mode of transmission, symptoms, diagnosis, treatment, protection, and dental treatment precautions as well as participants’ background variables. Multilevel linear models were used to assess the association between dental academics’ knowledge of COVID-19 and individual level (personal and professional) and country-level (number of COVID-19 cases/ million population) factors accounting for random variation among countries. Results Two thousand forty-five academics participated in the survey (response rate 14.3%, with 54.7% female and 67% younger than 46 years of age). The mean (SD) knowledge percent score was 73.2 (11.2) %, and the score of knowledge of symptoms was significantly lower than the score of knowledge of diagnostic methods (53.1 and 85.4%, P  <  0.0001). Knowledge score was significantly higher among those living with a partner/spouse than among those living alone (regression coefficient (B) = 0.48); higher among those with PhD degrees than among those with Bachelor of Dental Science degrees (B = 0.48); higher among those seeing 21 to 30 patients daily than among those seeing no patients (B = 0.65); and higher among those from countries with a higher number of COVID-19 cases/million population (B = 0.0007). Conclusions Dental academics had poorer knowledge of COVID-19 symptoms than of COVID-19 diagnostic methods. Living arrangements, academic degrees, patient load, and magnitude of the epidemic in the country were associated with COVD-19 knowledge among dental academics. Training of dental academics on COVID-19 can be designed using these findings to recruit those with the greatest need.

This work investigates the level of exposure to cadmium (Cd), mercury (Hg), and lead (Pb) via fish and seafood products in adult population in Bosnia and Herzegovina (BiH). Metals content was determined in seven commercial species of fish and seafood products widely available and consumed in BiH. Analysis of Cd and Pb was performed by GFAAS (Graphite furnace atomic absorption spectrometry), and analysis of Hg by FIAS AAS (flow injection cold vapour atomic absorption spectrometry) in accredited laboratory for food analysis. The health risk was determined by the estimated weekly intake, hazard index, target hazard quotients, and percent of tolerable weekly intake or percent of benchmark dose lower confidence limit. Concentration above the maximum residue level (MRL) set in the European Union was found in only one sample (Hg in mackerel). Cd content was generally high in squid, approaching the corresponding MRL in two samples. The hazard index was close to 1 in bluefin tuna and mackerel, mostly due to Hg content. These two fish species should be consumed in moderation, especially by pregnant women. While consumption of various fish and seafood on average is not of significant concern, health risk could not be ruled out for high consumers.

Background: The aim of this study is to compare the antenatal care, body weight, and weight gain in pregnancy between the adolescent and adult pregnancies and, thus, examine the impact of adolescence on the studied parameters. Methods: This prospective study includes 300 pregnant women who were the patients of University Clinical Center Tuzla, Clinic for Gynecology and Obstetrics from January 2011 to December 2014. The women were divided into two groups: an experimental group consisted of 150 adolescent pregnant women aged 13–19 years and a control group consisted of 150 adult pregnant women aged 20–35 years. The following parameters were analyzed: age of pregnant women, number of antenatal controls in pregnancy, prepregnancy body weight, weight gain in pregnancy, parity, and obstetric history data. Results: A significantly higher number of adolescent pregnant women belongs to a subgroup from one to two examinations during pregnancy (P < 0.000013) and to subgroups from three to five examinations (P < 0.000001). A significantly smaller number of adolescent pregnant women performed their first antenatal control in the first 2 lunar months (P < 0.01). A subgroup with optimal body weight (from 51 to 69 kg) are the most prevalent among adolescent pregnant women (P < 0.000001). A significantly larger number of adolescent pregnant women had an optimal weight gain of 7.8 to 12.99 kg (P < 0.001). Conclusions: The adolescent pregnant women have suboptimal antenatal care, which could lead to adverse maternal and birth outcomes, but have optimal body weight and weight gain during pregnancy.

Macroporous silica ceramic was obtained using clay and diatomite. Boric acid as a low-cost additive in the amount of 1 wt% was used. These porous materials were obtained at low forming pressure (40-80 MPa) and lower sintering temperature (850-1300 ?C) for 4h in air. The influence of boric acid, forming pressure, and sintering temperature on the microstructure, porosity parameters, and mechanical properties of obtained porous monoliths were investigated. As-received and the modified samples were characterized by X-ray diffraction, FTIR, SEM, and mercury porosimetry measurements. As for modified clay and diatomite, they were pressed at 60 MPa and then sintered at 1150 ?C, obtaining porosities of about 10 % and 60 %, respectively. Both of the analyzed samples had the pore diameter in the range of macroporous materials. The pore diameters of clay samples are ranging from 0.1-10 ?m, whereas the pore diameter of diatomite samples was slightly lower with values ranging from 0.05-5 ?m. Modified diatomite samples have a lower Young modulus in comparison to modified clay samples.

This study analyzes the feasibility of valorizing industrial by-product, fly ash from a thermal power plant as a partial replacement of mineral filler-limestone for the production of self-compacting concrete (SCC). Three types of SCC mixtures with different portions of fly ash and the reference mixture with limestone were designed. The synthesized SCCs in the fresh state were examined for density, entrained air content, flowability (Slump flow, Slump flow time (t500), V-funnel time (tv)), passing ability (L-box), and segregation resistance, while hardened state testing included: density, compressive and flexural strength, static modulus of elasticity, water permeability, resistance against freezing in the presence of de-icing salt, and SEM analysis. Taking into account the obtained results it can be concluded that the addition of fly ash has a positive impact on the concrete properties and that the optimal content of fly ash is 20 % with respect to the total filler mass.

Objectives To evaluate the clinical outcome and complications in the pediatric population who had splenectomy at our institution, emphasizing the incidence of postplenectomy reactive thrombocytosis (RT) and its clinical significance in children without underlying hematological malignancies. Materials and methods The medical records of pediatric patients undergoing splenectomy were retrospectively reviewed for the period 1999–2018. The following variables were analyzed: Demographic parameters (age, sex), indications for surgery, operative procedures, preoperative and postoperative platelet count (postplenectomy RT), the use of anticoagulant therapy, and postoperative complications. The patients were divided into two groups according to indications for splenectomy: The non-neoplastic hematology group and the non-hematology group (splenectomy for trauma or other spleen non-hematological pathology). Results Fifty-two pediatric (37 male and 15 female) patients who underwent splenectomy at our institution were reviewed. Thirty-four patients (65%) were in the non-hematological group (splenic rupture, cysts, and abscess) and 18 patients (35%) in the non-neoplastic hematological group (hereditary spherocytosis and immune thrombocytopenia). The two groups did not differ significantly in regards to the patients’ age, sex, and preoperative platelet count (P>0.05 for all variables). Forty-nine patients (94.2%) developed postplenectomy RT. The percentages of mild, moderate and extreme thrombocytosis were 48.9%, 30.7%, and 20.4%, respectively. The comparisons of RT patients between the non-neoplastic hematology and the non-hematology group revealed no significant differences in regards to the patients’ age, sex, preoperative and postoperative platelet counts, preoperative and postoperative leukocyte counts, and the average length of hospital stay (P>0.05 for all variables). None of the patients from the cohort was affected by any thrombotic or hemorrhagic complications. Conclusions We confirm that RT is a very common event following splenectomy, but in this study it was not associated with clinically evident thrombotic or hemorrhagic complications in children undergoing splenectomy for trauma, structural lesions or non-neoplastic hematological disorders.

We investigate the local and global character of the unique equilibrium point and boundedness of the solutions of certain homogeneous fractional difference equation with quadratic terms. Also, we consider Neimark–Sacker bifurcations and give the asymptotic approximation of the invariant curve.

Healthcare systems and general surgeons are being challenged by the current pandemic. The European Association for Endoscopic Surgery (EAES) aimed to evaluate surgeons’ experiences and perspectives, to identify gaps in knowledge, to record shortcomings in resources and to register research priorities. An ad hoc web-based survey of EAES members and affiliates was developed by the EAES Research Committee. The questionnaire consisted of 69 items divided into the following sections: (Ι) demographics, (II) institutional burdens and management strategies, and (III) analysis of resource, knowledge, and evidence gaps. Descriptive statistics were summarized as frequencies, medians, ranges,, and interquartile ranges, as appropriate. The survey took place between March 25th and April 16th with a total of 550 surgeons from 79 countries. Eighty-one percent had to postpone elective cases or suspend their practice and 35% assumed roles not related to their primary expertise. One-fourth of respondents reported having encountered abdominal pathologies in COVID-19-positive patients, most frequently acute appendicitis (47% of respondents). The effect of protective measures in surgical or endoscopic procedures on infected patients, the effect of endoscopic surgery on infected patients, and the infectivity of positive patients undergoing laparoscopic surgery were prioritized as knowledge gaps and research priorities. Perspectives and priorities of EAES members in the era of the pandemic are hereto summarized. Research evidence is urgently needed to effectively respond to challenges arisen from the pandemic.