Palliative Care Need in India: A Systematic Review and Meta-analysis

Background

To achieve sustainable development goal 3.8, countries must prioritise the provision of palliative care. We aimed to estimate the prevalence of palliative care needs in India.

Methods

A systematic literature search was conducted in databases of PubMed, Cochrane, Embase, Web of Science, and EBSCO Host. We included community-based studies published in English between inception and April 30, 2023. We excluded hospital-based studies that were conducted solely including diseased patients. Data were extracted independently, and a quality assessment was performed. To estimate the pooled prevalence and 95% confidence intervals (CI), we used the random-effects model. Heterogeneity was assessed using the Q statistic and I2 test. Subgroup analyses were conducted based on the study site, urban-rural distribution, gender, and age groups. Publication bias was evaluated using a funnel plot and Egger test. STATA software was used for data analysis.

Results

Out of the 2632 articles identified, 8 cross-sectional studies were included. Using the random-effects model, the pooled estimate of palliative care needs was found to be 6.21/1000 population (95% CI: 2.42-11.64). The southern region showed a prevalence of 10.83/1000 compared to 2.24/1000 in the northern region. Urban areas had a prevalence of 3.34/1000, while rural areas had a prevalence of 7.69/1000. Among females, the prevalence was 9.64/1000, compared to 6.77/1000 among males. Notably, individuals aged over 60 years had a higher prevalence of palliative care needs, with a rate of 37.86/1000 population.

Conclusion

This systematic review and meta-analysis highlight a substantial need for palliative care in India, with a prevalence of 6.21 individuals/1000 population.

An assessment of methane emission from the CNG cylinder testing stations in Delhi and its implication for global warming

Methane is an important greenhouse gas, which constitutes minimum 90% of automotive grade compressed natural gas (CNG) used in India. The use of CNG as automotive fuel has been implemented in almost all major tier I to tier III cities of the country. Delhi, the capital city of India, has world largest CNG-fuelled public transport system. The cylinders fitted to the CNG-fuelled vehicles are required to be subjected to hydrostatic stretch test every 3 years at Government of India approved CNG cylinder testing stations, as mandated under Rule 35 of Gas Cylinders Rules, 2016. During the testing of cylinders, CNG present in the cylinders are discharged in the atmosphere at the degassing point of CNG testing stations. This study estimates annual methane emissions from the CNG cylinder testing stations of Delhi. The annual average methane emission from the CNG cylinder testing stations of Delhi was found to be 30.8 tons during the year 2019. The uncertainties in the emission estimate are also identified and discussed.

Estimation of premorbid intelligence: Demographical and current neurocognitive functioning based algorithms

BACKGROUND & AIM

Establishing a premorbid level of intellectual functioning is crucial for determining the severity level of impairment and prognosis for patients in clinical setting. Therefore, the study aimed to develop a method to estimate premorbid IQ of Hindi speaking Indian population.

METHODS AND MATERIALS

A Hindi vocabulary test was developed (N = 60) and standardized (N = 100). The regression algorithm has been developed using VAIS, WAPIS, RPMT, and a newly developed Vocabulary test, and validated on 100 normal individuals and on 39 brain injury patients.

RESULTS

The estimated premorbid Verbal IQ and performance IQ equation was developed by using demographic variables combine with Hindi vocabulary scores and Matrix Reasoning raw scores respectively. Both the estimated premorbid verbal and performance IQ were found to be significant and valid in estimating verbal and performance IQ in normal and brain injury population.

CONCLUSION

These equations for estimating verbal and performance IQ were found significantly accurate in predicting verbal and performance IQ.

Estimating perceived parental substance use disorder: Using register data to adjust for non-participation in survey research

AIMS

To estimate the prevalence of parental substance use disorder (PSUD) in the general population based on young adults' reports adjusted for non-participation using register-based indicators of PSUD.

DESIGN

A national sample survey study combined with a retrospective register-based study. Setting Denmark. Participants 10,414 young people (aged 15-25 years) invited to two national sample surveys in 2014 and 2015 (5,755 participants and 4,659 non-participants).

MEASUREMENTS

A crude prevalence of PSUD was calculated based on participants' reports. Parental data from medical, mortality, prescription, and treatment registers (from the young adults' birth until the time of the surveys) were used to estimate a register-based prevalence of PSUD for both participants and non-participants. Differences between participants and non-participants were analysed using bivariate comparisons. Inverse probability weighting was used to adjust for bias due to non-participation. The crude prevalence of PSUD based on survey data was adjusted using the ratio of incidence proportion of the register-based PSUD compared with the survey-based PSUD.

FINDINGS

A total of 731 (12.7%) of the 5,755 survey participants reported PSUD. Register-based PSUD was more common among non-participants (856/4,659; 18.4%) compared with participants (738/5,755; 12.8%, OR = 1.53, 95% CI 1.38-1.70). The adjusted estimate of the survey-based PSUD increased by 2.5 percentage points, from 12.7% to 15.2%.

CONCLUSIONS

In the absence of register data, youth-reported PSUD is likely to underestimate the number of young people experiencing PSUD.

Mining TCGA Data for Key Biomarkers Related to Immune Microenvironment in Endometrial cancer by Immune Score and Weighted Correlation Network Analysis

Background: Endometrial cancer (EC) is one of the most lethal gynecological cancers around the world. The aim of this study is to identify the potential immune microenvironment-related biomarkers associated with the prognosis for EC.

Methods: RNA-seq data and clinical information of EC patients were derived from The Cancer Genome Atlas (TCGA). The immune score of each EC sample was obtained by ESTIMATE algorithm. Weighted gene co-expression network analysis (WGCNA) was used to identify the interesting module and potential key genes concerning the immune score. The expression patterns of the key genes were then verified via the GEPIA database. Finally, CIBERSORT was applied to evaluate the relative abundances of 22 immune cell types in EC.

Results: Immune scores were significantly associated with tumor grade and histology of EC, and high immune scores may exert a protective influence on the survival outcome for EC. WGCNA indicated that the black module was significantly correlated with the immune score. Function analysis revealed it mainly involved in those terms related to immune regulation and inflammatory response. Moreover, 11 key genes (APOL3, C10orf54, CLEC2B, GIMAP1, GIMAP4, GIMAP6, GIMAP7, GIMAP8, GYPC, IFFO1, TAGAP) were identified from the black module, validated by the GEPIA database, and revealed strong correlations with infiltration levels of multiple immune cell types, as was the prognosis of EC.

Conclusion: In this study, 11 key genes showed abnormal expressions and strong correlations with immune infiltration in EC, most of which were significantly associated with the prognosis of EC. These findings made them promising therapeutic targets for the treatment of EC.

An estimate of wild mammal roadkill in São Paulo state, Brazil

Roadkill estimates for different species and species groups are available for many countries and regions. However, there is a lack of information from tropical countries, including from Latin America. In this study, we analyzed medium and large-sized mammal roadkill data from 18 toll road companies (TRC) in São Paulo State (6,580 km of monitored toll roads), Brazil. We extrapolated these roadkill numbers to the entire system of major paved roads in the State (36,503 km). The TRC collected mammal-road- mortality data both before (2-lanes) and after (4-lanes) road reconstruction. We used the "before" data from the TRC to estimate annual mammal-road-mortality along 2-lane roads that remained public roads. Combined with the data for the new 4-lane highways, this allowed us to estimate annual mammal road mortality for all the paved roads in the State. During 10 years of roadkill monitoring along toll roads, a total of 37,744 roadkilled mammals were recorded, representing a total of 32 medium to large-sized mammal species (average number of roadkilled individuals/year = 3,774 ± 1,159; min = 1,932; max = 5,369; 0.6 individuals roadkilled/km/year). Most roadkilled species were common generalists, but there were also relatively high roadkill numbers of threatened and endangered species (4.3% of the data), which is a serious conservation concern. Most of the roadkill was reported occurred during the nocturnal period (66%, n = 14,189) and in the rainy months (October-March) (55%, n = 15,318). Reported mammal roadkill tended to increase between 2009 and 2014 (R2 = 0.614; p = 0.065), with an average increase of 313.5 individuals/year. Extrapolation of the results to the entire São Paulo State, resulted in an average estimate of 39,605 medium and large-sized mammals roadkilled per year. Our estimates of the number of roadkilled individuals can be used as one of the input parameters in population viability analyses to understand the extinction or extirpation risk, especially for threatened and endangered species.

Words Representing Numeric Probabilities in Medical Writing Are Ambiguous and Misinterpreted

Background and objective:

Words of estimative probability are used in medical writing. Authors know the number they intend the word to mean, readers do not. The objective of this study is to assess the variability of words having numeric meaning to medical doctors.

Design:

A survey of 131 American trained MD’s and DO’s was done regarding their interpretation of 27 commonly used words of the estimative probability they placed on each word.

Methods:

Statistical assessments were done to evaluate specific word meaning as a number or range to physicians and compared to each other’s interpretation.

Results:

For 19 of the 27 words had a 30% +/− (60% variance) of interpretation. Twenty-five of the 27 had less than 38% agreement on numeric meaning. Only two words had more than 74% numeric agreement.

Conclusion:

Words of estimative probability have widely varied interpretations to physicians. This makes interpretation of those words incomprehensible for scientific meaning resulting in communication without comprehension.

Estimating Length of Stay for Simple Gastroschisis

BACKGROUND

Length of stay (LOS) is an important measure of quality; however, estimating LOS for rare populations such as gastroschisis is problematic. Our objective was to identify explanatory variables for LOS and build a model to estimate LOS in neonates with simple gastroschisis.

METHODS

In 73 neonates with simple gastroschisis (47% female, 67% White), statistical correlations for 31 potential explanatory variables for LOS were evaluated using multivariate linear regression. Poisson regression was used to estimate LOS in predetermined subpopulations, and a life table model was developed to estimate LOS for simple gastroschisis.

RESULTS

Female sex (-2.4 d), "time to silo placement" (0.9 d), total parenteral nutrition days (0.6 d), need for any nasogastric feedings (11.4 d) and at discharge (-7 d), "feeding tolerance" (0.4 d), days to first postoperative stool (-0.3 d), and human milk exposure (-3.4 d) associated with LOS in simple gastroschisis. Estimated LOS for preterm neonates was longer than term infants (5.4 versus 4.6 wk) but similar for estimates based on sex and race. Based on these associations, we estimate that >50% of neonates with simple gastroschisis will be discharged by hospital day 35.

CONCLUSIONS

We identified several associations that explained variations in LOS and developed a novel model to estimate LOS in simple gastroschisis, which may be applied to other rare populations.

Prediction of the outlet flow temperature in a flat plate solar collector using artificial neural network

In the current research, the efficiency of a solar flat plate collector (SFPC) was examined experimentally, while the system was modeled with an artificial neural network (ANN) under semi-arid weather conditions of Rafsanjan, Iran. Based on the backpropagation algorithm, a feedforward neural network was established to estimate and forecast the outlet flow temperature of SFPC. To identify the most appropriate model, the ANN topology hidden layer, the number of hidden neurons, iteration, and statistical indicators were analyzed. In the first ANN modeling (CASE I), five parameters, including solar radiation, inlet flow temperature, flow rate, ambient temperature, and wind speed, were applied in the input layer of the network, while the output flow temperature (subsequently efficiency) was in the output layer. In the second artificial neural network modeling (CASE II), the wind speed was omitted from the input of the ANN model. Results showed that the ANN with four inputs yields more accurate results for both estimation and prediction of outlet flow temperature.

Estimating actual foot size from a static bare foot print in a White British Population

In forensic intelligence-gathering it would be useful to be able to estimate the size of a perpetrator's foot from a standing bare footprint found at the scene of crime. Currently, the advice is to add a fixed amount to the length of the footprint (typically 1.5 or 2.0 cm), but there is little evidence for this approach. This study used measured footprint and actual foot lengths from 146 participants from the white British student population of a University in the UK. Data were analysed using multiple regression with foot length as the dependent (outcome) variable and footprint length and sex as the independent variable/factor respectively. Sex was not a significant predictor. The regression equation for the best estimate of the foot length is 19.89 + 0.95 × print length ± 8 mm.

Review of Glutamate Intake from Both Food Additive and Non-Additive Sources in the European Union

BACKGROUND

Intakes of glutamate can be derived from its natural occurrence as a constituent of proteins, from the presence of free glutamate in certain fermented foods, and from the addition of glutamic acid and glutamates to foods as flavor-enhancing additives.

SUMMARY

Intakes of glutamate following hydrolysis of dietary proteins can be as high as 440 mg/kg bw/day for toddlers and small children. High-level intakes of glutamate from its natural occurrence  in foods or from the use of food additives, given very conservative assumptions about conditions of use, are -similar at around 80 mg/kg bw/day for toddlers and small children. Key Messages: The use of glutamic acid and glutamates as food additives makes a marginal contribution to total intakes of glutamate from all sources.

Estimating the incidence of tuberculosis cases reported at a tertiary hospital in Ghana: a time series model approach

Background

The incidence of Tuberculosis (TB) differs among countries and contributes to morbidity and mortality especially in the developing countries. Trends and seasonal changes in the number of patients presenting with TB have been studied worldwide including sub-Saharan Africa. However, these changes are unknown at the Korle-Bu Teaching Hospital (KBTH). The aim of this study was to obtain a time series model to estimate the incidence of TB cases at the chest clinic of the Korle-Bu Teaching hospital.

Methods

A time series analysis using a Box-Jenkins approach propounded as an autoregressive moving average (ARIMA) was conducted on the monthly TB cases reported at the KBTH from 2008 to 2017. Various models were stated and compared and the best was found to be based on the Akaike Information Criterion and Bayesian Information Criterion.

Results

There was no evidence of obvious increasing or decreasing trend in the TB data. The log-transformed of the data achieved stationarity with fairly stable variations around the mean of the series. ARIMA (1, 0, 1) or ARMA (1,1) was obtained as the best model. The monthly forecasted values of the best model ranged from 53 to 55 for the year 2018; however, the best model does not always produce the best results with respect to the mean absolute and mean square errors.

Conclusions

Irregular fluctuations were observed in the 10 -year data studied. The model equation to estimate the expected monthly TB cases at KBTH produced an AR coefficient of 0.971 plus an MA coefficient of − 0.826 with a constant value of 4.127. The result is important for developing a hypothesis to explain the dynamics of TB occurrence so as to outline prevention programmes, optimal use of resources and effective service delivery.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6221-z) contains supplementary material, which is available to authorized users.

Prevalence and incidence of hyperkalaemia in the Spanish population with heart failure with reduced ejection fraction: a systematic review and populational relevance

BACKGROUND AND OBJECTIVES

Hyperkalaemia (K⁺ levels≥5.5mmol/L) is a severe ion imbalance that occurs in patients who have heart failure (HF) with reduced ejection fraction (HFrEF) and increases the risk of ventricular fibrillation. Given that there are no estimates on the number of patients with this complication, the aim of this study was to estimate the prevalence and incidence of hyperkalaemia in patients with HFrEF in Spain.

MATERIAL AND METHODS

Based on a systematic literature search and through a meta-analysis, we calculated an HFrEF prevalence of ≤40% in the European and U.S.

POPULATION

Based on another systematic literature search, we calculated the prevalence of hyperkalaemia in patients with HF and its annual incidence rate. Considering the previous values and the Spanish population pyramid in 2016, we estimated the number of individuals with HFrEF who currently have hyperkalaemia and those who develop it each year in Spain.

RESULTS

Approximately 17,100 (10,000 men and 7100 women) of the 508,000 patients with HFrEF in Spain have hyperkalaemia. Furthermore, approximately 14,900 patients with HFrEF (9500 men and 5400 women) develop hyperkalaemia each year.

CONCLUSIONS

Approximately 1 of every 30 patients with HFrEF has plasma potassium values >5.5 mmol/L.

History and Prospect of Muslims in Western Europe

The birth of Islam over fourteen centuries ago was a monumental event in human history with an everlasting effect on humanity. For centuries researchers contemplated on the growth and distribution of Muslims throughout the world. The purpose of this manuscript is to present a reliable estimate of the Muslim population in Western Europe since the inception of Islam at the start of the seventh century to the end of the twenty-first century. The considered region consists of nine countries and territories: Andorra, Belgium, France, Gibraltar, Luxembourg, Monaco, the Netherlands, Portugal and Spain. A centennial data estimate for these countries from 600AD to 2100AD (approximately 1H-1500H) of the total population, and corresponding Muslim population and its percentage are provided. Furthermore, the same data in decennial order from 1790 to 2100 (or 1210H-1520H) are provided for each country. These data are summarized to be a reference for other studies and discussions related to the Muslim population.

Robust passive control for a class of uncertain neutral systems based on sliding mode observer

The passivity-based sliding mode control (SMC) problem for a class of uncertain neutral systems with unmeasured states is investigated. Firstly, a particular non-fragile state observer is designed to generate the estimations of the system states, based upon which a novel integral-type sliding surface function is established for the control process. Secondly, a new sufficient condition for robust asymptotic stability and passivity of the resultant sliding mode dynamics (SMDs) is obtained in terms of linear matrix inequalities (LMIs). Thirdly, the finite-time reachability of the predesigned sliding surface is ensured by resorting to a novel adaptive SMC law. Finally, the validity and superiority of the scheme are justified via several examples.

Comparison of HIV incidence estimated in clinical trial and observational cohort settings in a high risk fishing population in Uganda: Implications for sample size estimates

BACKGROUND

Clinical trial participants may differ from the source population due to the demands of trial participation and self-selection, inadvertent selection of a lower-risk group, or both. We investigated the HIV risk status of volunteers in a Simulated Vaccine Efficacy Trial (SiVET) nested within a prospective observational cohort of fisher folks in South Western Uganda.

METHODS

Volunteers aged 18-49 years, at high risk for HIV from fishing communities in Masaka district were recruited into an observational cohort and followed quarterly. High risk was defined as a self-report, of at least one of the following in the past three months; sexually transmitted infections, unprotected sex with >1 partner or a new sexual partner, use of recreational drugs, weekly alcohol use, and/or frequent travel. Volunteers who had at least three months of follow-up in the observational cohort were consecutively enrolled in SiVET, administered Hepatitis B vaccine at months (0, 1, 6) and followed-up three days post vaccinations to mimic a vaccine trial schedule. HIV incidence over the next 12 months was compared between SiVET and the observational cohort studies.

RESULTS

Between January 2012 and February 2013, 575 individuals were enrolled in the observational cohort, of whom 282 were enrolled in SiVET between July 2012 and February 2013. Despite similar pattern of reported risk behaviour in both studies, HIV incidence was higher in observational cohort, 11.4 cases/100 PYO [95% CI: 7.4-17.7] compared to 3.8 [95% CI: 2.0-7.0] in SiVET (p<0.01). SiVET volunteers tended to be men, having some education and longer-term residents, all factors that are also associated with lower HIV risk.

CONCLUSION

We observed a lower HIV incidence in SiVET than in the observational cohort. The two populations differed significantly in demographics but not in reported risk. HIV incidence estimates from observational cohorts must be used with caution to estimate the trial study size.

Total Diet Study: For a Closer-to-real Estimate of Dietary Exposure to Chemical Substances

Recent amendment on the Food Sanitation Act in Korea mandated the Minister of Food & Drug Safety to secure the scientific basis for management and reevaluation of standards and specifications of foods. Especially because the current food safety control is limited within the scope of 'Farm to Market' covering from production to retail in Korea, safety control at the plane of true 'Farm to Fork' scope is urgently needed and should include 'total diet' of population instead of individual food items. Therefore, 'Total Diet Study (TDS)' which provides 'closer-to-real' estimates of exposure to hazardous materials through analysis on table-ready (cooked) samples of foods would be the solution to more comprehensive food safety management, as suggested by World Health Organization and Food and Agriculture Organization of the United Nations. Although the protection of diets from hazards must be considered as one of the most essential public health functions of any country, we may need to revisit the value of foods which has been too much underrated by the meaningless amount of some hazardous materials in Korea. Considering the primary value of foods lies on sustaining life, growth, development, and health promotion of human being, food safety control should be handled not only by the presence or absence of hazardous materials but also by maximizing the value of foods via balancing with the preservation of beneficial components in foods embracing total diet. In this regard, this article aims to provide an overview on TDS by describing procedures involved except chemical analysis which is beyond our scope. Also, details on the ongoing TDS in Korea are provided as an example. Although TDS itself might not be of keen interest for most readers, it is the main user of the safety reference values resulted from toxicological research in the public health perspective.

Estimating municipal solid waste generation by different activities and various resident groups in five provinces of China

The quantities and composition of municipal solid waste (MSW) are important factors in the planning and management of MSW. Daily human activities were classified into three groups: maintenance activities (meeting the basic needs of food, housing and personal care, MA); subsistence activities (providing the financial support requirements, SA); and leisure activities (social and recreational pursuits, LA). A model, based on the interrelationships of expenditure on consumer goods, time distribution, daily activities, residents groups, and waste generation, was employed to estimate MSW generation by different activities and resident groups in five provinces (Zhejiang, Guangdong, Hebei, Henan and Sichuan) of China. These five provinces were chosen for this study and the distribution patterns of MSW generated by different activities and resident groups were revealed. The results show that waste generation in SA and LA fluctuated slightly from 2003 to 2008. For general waste generation in the five provinces, MA accounts for more than 70% of total MSW, SA approximately 10%, and LA between 10% and 16% by urban residents in 2008. Females produced more daily MSW than males in MA. Males produced more daily MSW than females in SA and LA. The wastes produced at weekends in MA and LA were far greater than on weekdays, but less than on weekdays for SA wastes. Furthermore, one of the model parameters (the waste generation per unit of consumer expenditure) is inversely proportional to per-capita disposable income of urban residents. A significant correlation between gross domestic product (GDP) and waste generation by SA was observed with a high coefficient of determination.

Clinical and programming pattern of patients with impending deep brain stimulation power failure: a retrospective chart review

BACKGROUND

It is important to prevent complications of implanted pulse generators (IPG) depletion by replacing the IPG in time.

METHODS

We reviewed the charts of all patients with deep brain stimulation treated movement disorders who were seen at our institution over a period of 6 months. Among these, we retained for analyses those who had undergone IPG replacement within the previous 3 years.

RESULTS

A total of 55 IPG replacements (from 38 patients) were reviewed. Electrodes were implanted in the subthalamic nucleus in all Parkinson's disease patients, in the ventral intermedius nucleus of the thalamus in all essential tremor patients and in the globus pallidus interna in all dystonia patients. Replacements were preceded by a voltage increase due to worsened symptoms in 27.3% (15/55); 25.5% (14/55) had full IPG depletion or had too low IPG reserve to allow for any voltage adjustment; and 21.7% (12/55) did not get a needed voltage increase either for safety reasons (eg: concern for increase in falls with higher voltages) or because the surgery date for IPG replacement was close. Only 25.5% (14/55) remained clinically well-controlled prior to IPG replacement, all of whom had IPG longevity estimates available. Clinical deterioration was noted prior to IPG replacement in 100% of patients without available longevity estimates versus 61% of patients with available longevity estimates (p < 0.001).

CONCLUSION

Despite best efforts, clinical deterioration prior to IPG replacement can be seen frequently. Routine estimation of IPG life, along with symptom assessment at every follow-up visit may prevent it.