PLOS ONE: [sortOrder=DATE_NEWEST_FIRST, sort=Date, newest first, filterJournals=PLoSONE, q=subject:"Medical devices and equipment"]PLOShttps://journals.plos.org/plosone/webmaster@plos.orgaccelerating the publication of peer-reviewed sciencehttps://journals.plos.org/plosone/search/feed/atom?sortOrder=DATE_NEWEST_FIRST&unformattedQuery=subject:%22Medical+devices+and+equipment%22&sort=Date,+newest+first&filterJournals=PLoSONEAll PLOS articles are Open Access.https://journals.plos.org/plosone/resource/img/favicon.icohttps://journals.plos.org/plosone/resource/img/favicon.ico2024-03-29T01:53:32ZEtonogestrel-releasing subdermal contraceptive implant: Budget impact analysis based on the Brazilian private healthcare systemAgnaldo Lopes da Silva FilhoRicardo Luis Pereira BuenoYohanna RamiresLara Marina Cruz Lino10.1371/journal.pone.03012072024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Agnaldo Lopes da Silva Filho, Ricardo Luis Pereira Bueno, Yohanna Ramires, Lara Marina Cruz Lino</p>
High rates of unplanned pregnancies persist despite pharmacological developments and advancements in contraceptive methods. Here, we demonstrate that the etonogestrel-releasing subdermal contraceptive implant (IMP-ETN) may be an appropriate and cost-effective alternative to levonorgestrel-releasing intrauterine systems (LNG-IUSs) for women in Brazil. For our pharmacoeconomic analysis, we reviewed the literature on IMP-ETN regarding its acceptance, eligibility criteria, choice, relations with age, adverse events and, finally, the unmet need in the fee-for-service private healthcare sector. We considered qualitative observations in combination with quantitative analysis and performed a deterministic sensitivity analysis to investigate whether this technology can be self-sustainable over a period of five years. The target population for this analysis comprised 158,696 women. Compared with the continued use of LNG-IUSs, adopting the IMP-ETN can result in a cost avoidance of $ 7.640.804,02 in the first year and $ 82,455,254.43 in five years. Disseminating information among physicians will promote this change and strengthen the potential cost avoided by private health system payers. These savings can be used to improve other healthcare programs and strategies. Moreover, the principles of care can be promoted by improving and adapting healthcare systems and expanding treatment and follow-up strategies. This would also provide support to women’s reproductive rights and improve their quality of life. Our results suggest that the IMP-ETN has a favorable cost-effectiveness profile. Given all its advantages and negative incremental cost impact over a period of five years, the IMP-ETN may be a more favorable alternative to LNG-IUSs. Therefore, it should be offered to beneficiaries with a private healthcare plan. This analysis overcomes previous barriers to the use of cost-benefit models, and our results may help balance decision-making by policymakers, technical consultants, and researchers.The VertiGO! Trial protocol: A prospective, single-center, patient-blinded study to evaluate efficacy and safety of prolonged daily stimulation with a multichannel vestibulocochlear implant prototype in bilateral vestibulopathy patientsBernd L. VermorkenBenjamin VolpeStan C. J. van BoxelJoost J. A. StultiensMarc van HoofRik MarcellisElke LoosAlexander van SoestChris McCrumKenneth MeijerNils GuinandAngélica Pérez FornosVincent van RompaeyElke DevochtRaymond van de Berg10.1371/journal.pone.03010322024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Bernd L. Vermorken, Benjamin Volpe, Stan C. J. van Boxel, Joost J. A. Stultiens, Marc van Hoof, Rik Marcellis, Elke Loos, Alexander van Soest, Chris McCrum, Kenneth Meijer, Nils Guinand, Angélica Pérez Fornos, Vincent van Rompaey, Elke Devocht, Raymond van de Berg</p>
Background <p>A combined vestibular (VI) and cochlear implant (CI) device, also known as the vestibulocochlear implant (VCI), was previously developed to restore both vestibular and auditory function. A new refined prototype is currently being investigated. This prototype allows for concurrent multichannel vestibular and cochlear stimulation. Although recent studies showed that VCI stimulation enables compensatory eye, body and neck movements, the constraints in these acute study designs prevent them from creating more general statements over time. Moreover, the clinical relevance of potential VI and CI interactions is not yet studied. The VertiGO! Trial aims to investigate the safety and efficacy of prolonged daily motion modulated stimulation with a multichannel VCI prototype.</p> Methods <p>A single-center clinical trial will be carried out to evaluate prolonged VCI stimulation, assess general safety and explore interactions between the CI and VI. A single-blind randomized controlled crossover design will be implemented to evaluate the efficacy of three types of stimulation. Furthermore, this study will provide a proof-of-concept for a VI rehabilitation program. A total of minimum eight, with a maximum of 13, participants suffering from bilateral vestibulopathy and severe sensorineural hearing loss in the ear to implant will be included and followed over a five-year period. Efficacy will be evaluated by collecting functional (i.e. image stabilization) and more fundamental (i.e. vestibulo-ocular reflexes, self-motion perception) outcomes. Hearing performance with a VCI and patient-reported outcomes will be included as well.</p> Discussion <p>The proposed schedule of fitting, stimulation and outcome testing allows for a comprehensive evaluation of the feasibility and long-term safety of a multichannel VCI prototype. This design will give insights into vestibular and hearing performance during VCI stimulation. Results will also provide insights into the expected daily benefit of prolonged VCI stimulation, paving the way for cost-effectiveness analyses and a more comprehensive clinical implementation of vestibulocochlear stimulation in the future.</p> Trial registration <p>ClinicalTrials.gov: NCT04918745. Registered 28 April 2021.</p>Effects of the Momentum project on postpartum family planning norms and behaviors among married and unmarried adolescent and young first-time mothers in Kinshasa: A quasi-experimental studyAnastasia J. GageFrancine E. WoodRianne GayPierre Akilimali10.1371/journal.pone.03003422024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Anastasia J. Gage, Francine E. Wood, Rianne Gay, Pierre Akilimali</p>
This study evaluated the effect of Momentum–an integrated family planning, maternal and newborn health, and nutrition intervention–on postpartum family planning norms and behaviors among ever married and never-married first-time mothers age 15–24 in Kinshasa, Democratic Republic of the Congo. Using data collected in 2018 and 2020, we conducted an intent-to-treat analysis among 1,927 first-time mothers who were about six-months pregnant at enrollment. Difference-in-differences models were run for panel data and treatment effects models with inverse-probability weighting for endline-only outcomes. Average treatment effects (ATE) were estimated. Momentum had positive effects on partner discussion of family planning in the early postpartum period (ever married 15–19: ATE = 0.179, 95% CI = 0.098, 0.261; never married 15–19: ATE = 0.131, 95% CI = 0.029, 0.232; ever married 20–24: ATE = 0.233, 95% CI = 0.164, 0.302; never married 20–24: ATE = 0.241, 95% CI = 0.121, 0.362) and discussion with a health worker, and on obtaining a contraceptive method in the early postpartum period, except among never married adolescents. Among adolescents, intervention effects on modern contraceptive use within 12 months of childbirth/pregnancy loss were larger for the never married (ATE = 0.251, 95% CI = 0.122, 0.380) than the ever married (ATE = 0.114, 95% CI = 0.020, 0.208). Full intervention exposure had consistently larger effects on contraceptive behaviors than partial exposure, except among ever married adolescents. Momentum had no effect on normative expectations about postpartum family planning use among adolescents, and on descriptive norms and personal agency among those who were never married. Results for normative outcomes and personal agency underscored the intersectionality between young maternal age and marital status. Future programs should improve personal agency and foster normative change in support of postpartum family planning uptake and tailor interventions to different age and marital status subsets of first-time mothers.Confirming the attainment of maximal oxygen uptake within special and clinical groups: A systematic review and meta-analysis of cardiopulmonary exercise test and verification phase protocolsVictor A. B. CostaAdrian W. MidgleyJulia K. BaumgartSean CarrollTodd A. AstorinoGustavo Z. SchaunGuilherme F. FonsecaFelipe A. Cunha10.1371/journal.pone.02995632024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Victor A. B. Costa, Adrian W. Midgley, Julia K. Baumgart, Sean Carroll, Todd A. Astorino, Gustavo Z. Schaun, Guilherme F. Fonseca, Felipe A. Cunha</p>
Background and aim <p>A plateau in oxygen uptake (V˙O2) during an incremental cardiopulmonary exercise test (CPET) to volitional exhaustion appears less likely to occur in special and clinical populations. Secondary maximal oxygen uptake (V˙O2max) criteria have been shown to commonly underestimate the actual V˙O2max. The verification phase protocol might determine the occurrence of ‘true’ V˙O2max in these populations. The primary aim of the current study was to systematically review and provide a meta-analysis on the suitability of the verification phase for confirming ‘true’ V˙O2max in special and clinical groups. Secondary aims were to explore the applicability of the verification phase according to specific participant characteristics and investigate which test protocols and procedures minimise the differences between the highest V˙O2 values attained in the CPET and verification phase.</p> Methods <p>Electronic databases (PubMed, Web of Science, SPORTDiscus, Scopus, and EMBASE) were searched using specific search strategies and relevant data were extracted from primary studies. Studies meeting inclusion criteria were systematically reviewed. Meta-analysis techniques were applied to quantify weighted mean differences (standard deviations) in peak V˙O2 from a CPET and a verification phase within study groups using random-effects models. Subgroup analyses investigated the differences in V˙O2max according to individual characteristics and test protocols. The methodological quality of the included primary studies was assessed using a modified Downs and Black checklist to obtain a level of evidence. Participant-level V˙O2 data were analysed according to the threshold criteria reported by the studies or the inherent measurement error of the metabolic analysers and displayed as Bland-Altman plots.</p> Results <p>Forty-three studies were included in the systematic review, whilst 30 presented quantitative information for meta-analysis. Within the 30 studies, the highest mean V˙O2 values attained in the CPET and verification phase protocols were similar (mean difference = -0.00 [95% confidence intervals, CI = -0.03 to 0.03] L·min<sup>-1</sup>, <i>p</i> = 0.87; level of evidence, LoE: strong). The specific clinical groups with sufficient primary studies to be meta-analysed showed a similar V˙O2max between the CPET and verification phase (<i>p</i> > 0.05, LoE: limited to strong). Across all 30 studies, V˙O2max was not affected by differences in test protocols (<i>p</i> > 0.05; LoE: moderate to strong). Only 23 (53.5%) of the 43 reviewed studies reported how many participants achieved a lower, equal, or higher V˙O2 value in the verification phase versus the CPET or reported or supplied participant-level V˙O2 data for this information to be obtained. The percentage of participants that achieved a lower, equal, or higher V˙O2 value in the verification phase was highly variable across studies (e.g. the percentage that achieved a higher V˙O2 in the verification phase ranged from 0% to 88.9%).</p> Conclusion <p>Group-level verification phase data appear useful for confirming a specific CPET protocol likely elicited V˙O2max, or a reproducible V˙O2peak, for a given special or clinical group. Participant-level data might be useful for confirming whether specific participants have likely elicited V˙O2max, or a reproducible V˙O2peak, however, more research reporting participant-level data is required before evidence-based guidelines can be given.</p> Trial registration <p>PROSPERO (CRD42021247658) https://www.crd.york.ac.uk/prospero.</p>Risk factors for catheter-associated bloodstream infection in hemodialysis patients: A meta-analysisHuajie GuoLing ZhangHua HeLili Wang10.1371/journal.pone.02997152024-03-27T14:00:00Z2024-03-27T14:00:00Z<p>by Huajie Guo, Ling Zhang, Hua He, Lili Wang</p>
Objective <p>This meta-analysis aimed to elucidate the risk factors contributing to catheter-associated bloodstream infection in hemodialysis patients.</p> Methods <p>Comprehensive literature searches were conducted in both English and Chinese databases, which encompassed PubMed, Cochrane Library, Embase, CNKI, Wanfang Data, VIP Database and China Biomedical Literature Database. The search timeframe extended from each database’s inception to March 8, 2023. Two independent researchers executed literature screening, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Statistical analysis of the data was performed using RevMan 5.3 software, facilitating the identification of significant risk factors associated with catheter-related bloodstream infections in hemodialysis patients. This meta-analysis is registered with PROSPERO under the registration number CRD42023406223.</p> Results <p>Forty-nine studies were incorporated into this meta-analysis, from which 22 risk factors were examined. Through the analysis, 17 risk factors exhibited statistical significance (<i>P</i> < 0.05): age (OR = 1.52, 95% CI [0.49, 4.68]), diabetes (OR = 2.52, 95% CI [1.95, 3.25]), kidney disease (OR = 3.45, 95% CI [1.71, 6.96]), history of catheter-associated infection (OR = 2.79, 95% CI [1.96, 3.98]), hypertension (OR = 1.43, 95% CI [1.08, 1.91]), dialysis duration (OR = 3.06, 95% CI [1.70, 5.50]), catheter placement site (OR = 1.91, 95%CI [1.35, 2.70]), catheter duration (OR = 2.06, 95% CI [1.17, 3.60]), number of catheterizations (OR = 4.22, 95% CI [3.32, 5.37]), catheter types (OR = 3.83, 95% CI [2.13, 6.87]), CD4<sup>+</sup> cells (OR = 0.33, 95% CI [0.18, 0.63]), albumin (ALB, OR = 2.12, 95% CI [1.15, 3.91]), C-reactive protein (CRP, OR = 1.73, 95% CI [1.47, 2.03]), hemoglobin (Hb, OR = 1.48, 95% CI [0.54, 4.07]), procalcitonin (PCT, OR = 1.05, 95% CI [1.03, 1.06]), inadequate hand hygiene (OR = 5.32, 95% CI [1.07, 26.37]), and APACHE II scores (OR = 2.41, 95% CI [1.33, 4.37]).</p> Conclusion <p>This meta-analysis suggests that age, diabetes, kidney disease, history of catheter-associated infection, hypertension, dialysis duration, catheter placement site, catheter duration, number of catheterizations, catheter type, CD4<sup>+</sup> cells, albumin, C-reactive protein, hemoglobin, procalcitonin, inadequate hand hygiene, and APACHE II scores significantly influence the incidence of catheter-associated bloodstream infection in hemodialysis patients.</p>The motivations and experiences of specialists who provide outreach services in rural operating rooms: A survey study from British ColumbiaAnshu ParajuleeKathrin StollNancy HumberSean EbertKim WilliamsJude Kornelsen10.1371/journal.pone.02987572024-03-27T14:00:00Z2024-03-27T14:00:00Z<p>by Anshu Parajulee, Kathrin Stoll, Nancy Humber, Sean Ebert, Kim Williams, Jude Kornelsen</p>
Introduction <p>Outreach care has long been used in Canada to address the lack of access to specialist care in rural settings, but research on the experiences of specialists providing these services is lacking. This descriptive survey study aimed to understand 1) specialists’ motivation for engaging in outreach work, (2) their perceptions of the quality of care at their rural outreach hospital, and (3) the supports they receive for their outreach work, in order to create a supportive framework to encourage specialist outreach contributions.</p> Methods <p>In July 2022, specialist physicians who provide outreach operating room services at rural hospitals participating in the Rural Surgical and Obstetrical Networks initiative in the province of British Columbia were invited to complete an anonymous survey.</p> Results <p>21 of 45 invited outreach specialists completed the survey (47% response rate). Three-quarters of respondents had a surgical specialty. The opportunity to deliver care to underserved patients was the most common motivator for outreach work. Rural hospitals received high ratings from respondents on overall safety and various aspects of communication and teamwork. Postoperative care was a concern for a minority (one-fifth) of respondents, and about half had experienced unnecessary delays between procedures some or most of the time. Generally, respondents felt integrated into rural teams and reported receiving adequate nursing and anesthetic support. The two most common desired additional supports were better/more equipment and space and additional staffing. All 19 respondents not planning to retire soon intended to provide outreach services for at least three more years.</p> Conclusion <p>Specialists providing outreach OR services in small volume rural hospitals in BC usually have altruistic motives for outreach work. For the most part, these specialists have positive experiences in rural hospitals, but they can be better supported through investment in infrastructure and health human resources. Specialists intend to provide outreach services long-term, indicating a stable outreach workforce. More research on the facilitators and barriers of specialist outreach work is needed.</p>Effects of injectable contraception with depot medroxyprogesterone acetate or norethisterone enanthate on estradiol levels and menstrual, psychological and behavioral measures relevant to HIV risk: The WHICH randomized trialMandisa Singata-MadlikiJenni SmitMags BeksinskaYusentha BalakrishnaChanel AvenantIvana BeeshamIshen SeocharanJoanne BattingJanet P. HapgoodG. Justus Hofmeyr10.1371/journal.pone.02957642024-03-26T14:00:00Z2024-03-26T14:00:00Z<p>by Mandisa Singata-Madliki, Jenni Smit, Mags Beksinska, Yusentha Balakrishna, Chanel Avenant, Ivana Beesham, Ishen Seocharan, Joanne Batting, Janet P. Hapgood, G. Justus Hofmeyr</p>
Background <p>Observational data suggest lower HIV risk with norethisterone enanthate (NET-EN) than with depo-medroxyprogesterone acetate intramuscular (DMPA-IM) injectable contraceptives. If confirmed, a switch between these similar injectable methods would be programmatically feasible and could impact the trajectory of the HIV epidemic. We aimed in this paper to investigate the effects of DMPA-IM and NET-EN on estradiol levels, measures of depression and sexual activity and menstrual effects, relevant to HIV risk; and to ascertain whether these measures are associated with estradiol levels.</p> Methods <p>This open-label trial conducted at two sites in South Africa from 5 November 2018 to 30 November 2019, randomized HIV-negative women aged 18–40 to DMPA-IM 150 mg intramuscular 12-weekly (n = 262) or NET-EN 200 mg intramuscular 8-weekly (n = 259). Data were collected on hormonal, behavioral and menstrual effects at baseline and at 25 weeks (25W).</p> Results <p>At 25W, median 17β estradiol levels were substantially lower than at baseline (p<0.001) for both methods: 76.5 pmol/L (interquartile range (IQR) 54.1 to 104.2) in the DMPA-IM group (n = 222), and 69.8 pmol/L (IQR: 55.1 to 89.3) in the NET-EN group (n = 225), with no statistical difference between the two methods (p = 0.450). Compared with DMPA-IM, NET-EN users reported significantly less amenorrhoea, fewer sexual acts, fewer users reporting at least one act of unprotected sex, more condom use with steady partner, more days with urge for sexual intercourse, more days feeling partner does not love her, and more days feeling sad for no reason. We did not find a clear association between estradiol levels and sexual behavior, depression and menstrual effects. Behavioral outcomes suggest less sexual exposure with NET-EN than DMPA-IM. The strength of this evidence is high due to the randomized study design and the consistency of results across the outcomes measured.</p> Conclusions <p>Estradiol levels were reduced to postmenopausal levels by both methods. Secondary outcomes suggesting less sexual exposure with NET-EN are consistent with reported observational evidence of less HIV risk with NET-EN. A randomized trial powered for HIV acquisition is feasible and needed to answer this important question.</p> Trial registration <p>PACTR 202009758229976.</p>Impact of extracorporeal membrane oxygenation-related complications on in-hospital mortalityEunae ByunPil Je KangSung Ho JungSeo Young ParkSang Ah LeeTae-Won KwonYong-Pil Cho10.1371/journal.pone.03007132024-03-25T14:00:00Z2024-03-25T14:00:00Z<p>by Eunae Byun, Pil Je Kang, Sung Ho Jung, Seo Young Park, Sang Ah Lee, Tae-Won Kwon, Yong-Pil Cho</p>
Introduction <p>Although extracorporeal membrane oxygenation (ECMO) is a well-established treatment for supporting severe cardiopulmonary failure, the morbidity and mortality of patients requiring ECMO support remain high. Evaluating and correcting potential risk factors associated with any ECMO-related complications may improve care and decrease mortality. This study aimed to assess the predictors of ECMO-related vascular and cerebrovascular complications among adult patients and to test the hypothesis that ECMO-related complications are associated with higher in-hospital mortality rates.</p> Methods <p>This single-center, retrospective study included 856 ECMO runs administered via cannulation of the femoral vessels of 769 patients: venoarterial (VA) ECMO (<i>n</i> = 709, 82.8%) and venovenous (VV) ECMO (<i>n</i> = 147, 17.2%). The study outcomes included the occurrence of ECMO-related vascular and cerebrovascular complications and in-hospital death. The association of ECMO-related complications with the risk of in-hospital death was analyzed.</p> Results <p>The incidences of ECMO-related vascular and cerebrovascular complications were 20.2% and 13.6%, respectively. The overall in-hospital mortality rate was 48.7%: 52.8% among VA ECMO runs and 29.3% among VV ECMO runs. Multivariable analysis indicated that age (<i>P</i> < 0.01), cardiopulmonary cerebral resuscitation (<i>P</i> < 0.01), continuous renal replacement therapy (<i>P</i> < 0.01), and initial platelet count [<50×10<sup>3</sup>/μL (<i>P</i> = 0.02) and 50–100(×10<sup>3</sup>)/μL (<i>P</i> < 0.01)] were associated with an increased risk of in-hospital death. ECMO-related vascular and cerebrovascular complications were not independently associated with higher in-hospital mortality rates for VA or VV ECMO runs.</p> Conclusion <p>ECMO-related vascular and cerebrovascular complications were not associated with an increased risk of in-hospital death among adult patients.</p>Clinical challenges of biomechanical performance of narrow-diameter implants in maxillary posterior teeth in aging patients: A finite element analysisSaranyoo PrasitwuttisakNattapon ChantarapanichKomsan ApinyauppathamKopchai PoomparnichSamroeng Inglam10.1371/journal.pone.02998162024-03-25T14:00:00Z2024-03-25T14:00:00Z<p>by Saranyoo Prasitwuttisak, Nattapon Chantarapanich, Komsan Apinyauppatham, Kopchai Poomparnich, Samroeng Inglam</p>
This study evaluated the biomechanical performance of narrow-diameter implant (NDI) treatment in atrophic maxillary posterior teeth in aging patients by finite element analysis. The upper left posterior bone segment with first and second premolar teeth missing obtained from a patient’s cone beam computed tomography data was simulated with cortical bone thicknesses of 0.5 and 1.0 mm. Three model groups were analyzed. The Regimen group had NDIs of 3.3 × 10 mm in length with non-splinted crowns. Experimental-1 group had NDIs of 3.0 × 10 mm in length with non-splinted crowns and Experimental-2 group had NDIs of 3.0 × 10 mm in length with splinted crowns. The applied load was 56.9 N in three directions: axial (along the implant axis), oblique at 30° (30° to the bucco-palatal plane compared to the vertical axis of the tooth), and lateral load at 90° (90° in the bucco-palatal plane compared to the vertical axis of the tooth). The results of the von Mises stress on the implant fixture, the elastic strain, and principal value of stress on the crestal marginal bone were analyzed. The axial load direction was comparable in the von Mises stress values in all groups, which indicated it was not necessary to use splinted crowns. The elastic strain values in the axial and oblique directions were within the limits of Frost’s mechanostat theory. The principal value of stress in all groups were under the threshold of the compressive stress and tensile strength of cortical bone. In the oblique and lateral directions, the splinted crown showed better results for both the von Mises stress, elastic strain, and principal value of stress than the non-splinted crown. In conclusion, category 2 NDIs can be used in the upper premolar region of aging patients in the case of insufficient bone for category 3 NDI restorations.Radiographic assessment of maxillary sinus membrane and lateral wall thickness using cone-beam CT in different facial types in southwestern Saudi ArabiaShahabe Saquib AbullaisSaad M. AlQahtaniSalman AlqahtaniAbdulrahman AlaamriAli Azhar DawasazAbdulelah AlqahtaniPrasad V. Dhadse10.1371/journal.pone.02984032024-03-25T14:00:00Z2024-03-25T14:00:00Z<p>by Shahabe Saquib Abullais, Saad M. AlQahtani, Salman Alqahtani, Abdulrahman Alaamri, Ali Azhar Dawasaz, Abdulelah Alqahtani, Prasad V. Dhadse</p>
The anatomy of the edentulous posterior maxilla and maxillary sinus possess unique challenges in implant dentistry. The purpose of this study was to assess maxillary sinus membrane thickness (MT) and lateral wall thickness (LWT) in different facial index profiles and to describe the clinical implications. A retrospective image analysis of 75 CBCT scans was done, which yielded a total of 150 sinus images. The facial index was calculated as per the formula given in the text and grouped as euryprosopic, mesoprosopic and leptoprosopic. The images obtained were of 36 women (48%) and 39 men (52%), with maximum subjects in 30–39 years age group. MT and LWT were measured at three different points on the radiograph at every 3mm from the base of the sinus floor in premolar and molar regions of each image. Results showed females had significant differences from males in LWT in both premolar and molar regions (p = 0.018 and 0.032 respectively). Subjects in 40–49 years of age had significant differences (p = 0.021) in MT in premolar region only. Also, difference in MT in premolar and molar regions were also statistically significant. Lastly, the present study did not find any statistically significant difference in MT and LWT in all three facial indices groups. It can be concluded that different facial indices have no positive correlation with maxillary sinus membrane thickness and lateral wall thickness. Hence, surgical complications are avoidable with proper detailed knowledge and appropriate identification of the anatomic structures characteristic to the maxillary sinus.Optimizing immunization services: A Data Envelopment Analysis (DEA) of child immunization facilities in PakistanTaimoor AhmadMuhammad IbrahimOlan NazMujahid AbdullahAyesha KhanMaisam AliElizabeth BundeSoumya AlvaWendy ProsserAdnan Ahmad Khan10.1371/journal.pone.02983082024-03-22T14:00:00Z2024-03-22T14:00:00Z<p>by Taimoor Ahmad, Muhammad Ibrahim, Olan Naz, Mujahid Abdullah, Ayesha Khan, Maisam Ali, Elizabeth Bunde, Soumya Alva, Wendy Prosser, Adnan Ahmad Khan</p>
Introduction <p>Child immunization, though cost-beneficial, experiences varying costs influenced by individual facility-level factors. A real-time solution is to optimize resources and enhance vaccination services through proper method to measure immunization facility efficiency using existing data. Additionally, examine the impact of COVID-19 on facility efficiency, with the primary goal of comprehensively assessing child immunization facility efficiency in Pakistan.</p> Methods <p>Utilizing survey data collected in four rounds from May 2018 to December 2020, the research focuses on doses administered and stock records for the preceding six months in each phase. In the initial stage, Data Envelopment Analysis (DEA) is utilized to compute facility efficiency, employing two models with varied outputs while maintaining consistent inputs. Model 1 assesses doses administered, encompassing three outputs (pentavalent vaccine 1, 2, and 3). Meanwhile, Model 2, focuses on stock used featuring a single output (total doses used). The inputs considered in both models include stock availability, staff members, cold chain equipment, vaccine carriers, and vaccine sessions. The second stage involves the application of two competing regression specifications (Tobit and Simar-Wilson) to explore the impact of the COVID-19 pandemic and external factors on the efficiency of these facilities.</p> Results <p>In 12 districts across Punjab and Sindh, we assess 466 facilities in Model 1 and 455 in Model 2. Model 1 shows 59% efficiency, and Model 2 shows 70%, indicating excess stock. Stock of vaccines need to be reduced by from 36% to 43%. In the stage, COVID-19 period reduced efficiency in Model 1 by 10%, however, insignificant in Model 2.</p> Conclusions <p>The proposed methodology, utilizing DEA, emerges as a valuable tool for immunization facilities seeking to improve resource utilization and overall efficiency. Model 1, focusing on doses administered indicates facilities low efficiency at average 59% and proves more pertinent for efficiency analysis as it directly correlates with the number of children vaccinated. The prevalent issue of overstocking across all facilities significantly impacts efficiency. This study underscores the critical importance of optimizing resources through the redistribution of excess stock with low efficiency.</p>Mortality in patients with normal left ventricular function requiring emergency VA-ECMO for postcardiotomy cardiogenic shock due to coronary malperfusionJagdip KangMateo Marin-CuartasAnna Flo FornerPriya R. MenonAndré GintherDiyar SaaedSuzanne de WahaMassimiliano MeineriJörg EnderMichael A. Borger10.1371/journal.pone.03005682024-03-21T14:00:00Z2024-03-21T14:00:00Z<p>by Jagdip Kang, Mateo Marin-Cuartas, Anna Flo Forner, Priya R. Menon, André Ginther, Diyar Saaed, Suzanne de Waha, Massimiliano Meineri, Jörg Ender, Michael A. Borger</p>
Objectives <p>To analyze outcomes in patients with normal preoperative left ventricular ejection fraction (LVEF) undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy due to postcardiotomy cardiogenic shock (PCCS) related to coronary malperfusion.</p> Methods <p>Retrospective single-center analysis in patients with normal preoperative LVEF treated with VA-ECMO for coronary malperfusion-related PCCS between May 1998 and May 2018. The primary outcome was 30-day mortality, which was compared using the Kaplan-Meier method and the log-rank test. Multivariable logistic regression was performed to identify predictors of mortality.</p> Results <p>During the study period, a total of 62,125 patients underwent cardiac surgery at our institution. Amongst them, 59 patients (0.1%) with normal preoperative LVEF required VA-ECMO support due to coronary malperfusion-related PCCS. The mean duration of VA-ECMO support was 6 days (interquartile range 4–7 days). The 30-day mortality was 50.8%. Under VA-ECMO therapy, a complication composite outcome of bleeding, re-exploration for bleeding, acute renal failure, acute liver failure, and sepsis occurred in 51 (86.4%) patients. Independent predictors of 30-day mortality were lactate levels > 9.9 mmol/l before VA-ECMO implantation (odds ratio [OR]: 3.3; 95% confidence interval [CI] 1.5–7.0; p = 0.002), delay until revascularization > 278 minutes (OR: 2.9; 95% CI 1.3–6.4; p = 0.008) and peripheral arterial artery disease (OR: 3.3; 95% 1.6–7.5; p = 0.001).</p> Conclusions <p>Mortality rates are high in patients with normal preoperative LVEF who develop PCCS due to coronary malperfusion. The early implantation of VA-ECMO before the development of profound tissue hypoxia and early coronary revascularization increases the likelihood of survival. Lactate levels are useful to define optimal timing for the VA-ECMO initiation.</p>A quantitative comparison between the mHand Adapt passive adjustable hand prosthesis and its predecessor, the Delft Self-Grasping HandSpyros L. L. KrinisAlix ChadwellLaurence KenneyGerwin Smit10.1371/journal.pone.03004692024-03-21T14:00:00Z2024-03-21T14:00:00Z<p>by Spyros L. L. Krinis, Alix Chadwell, Laurence Kenney, Gerwin Smit</p>
Introduction <p>The Delft Self-Grasping Hand (SGH) is an adjustable passive hand prosthesis that relies on wrist flexion to adjust the aperture of its grasp. The mechanism requires engagement of the contralateral hand meaning that hand is not available for other tasks. A commercialised version of this prosthesis, known as the mHand Adapt, includes a new release mechanism, which avoids the need to press a release button, and changes to the hand shape. This study is the first of its kind to compare two passive adjustable hand prostheses on the basis of quantitative scoring and contralateral hand involvement.</p> Methods <p>10 anatomically intact participants were asked to perform the Southampton Hand Assessment Procedure (SHAP) with the mHand. Functionality and contralateral hand involvement were recorded and compared against SGH data originating from a previous trial involving a nearly identical testing regime.</p> Results <p>mHand exhibited higher functionality scores and less contralateral hand interaction time, especially during release-aiding interactions. Additionally, a wider range of tasks could be completed using the mHand than the SGH.</p> Discussion <p>Geometric changes make the mHand more capable of manipulating smaller objects. The altered locking mechanism means some tasks can be performed without any contralateral hand involvement and a higher number of tasks do not require contralateral involvement when releasing. Some participants struggled with achieving a good initial grip due to the inability to tighten the grasp once already formed.</p> Conclusion <p>The mHand offers the user higher functionality scores with less contralateral hand interaction time and the ability to perform a wider range of tasks. However, there are some design trade-offs which may make it slightly harder to learn to use.</p>Effective volume of rebreathed air during breathing with facepieces increases with protection class and decreases with ambient airflowHelen NgoJohannes SpaethStefan Schumann10.1371/journal.pone.02999192024-03-21T14:00:00Z2024-03-21T14:00:00Z<p>by Helen Ngo, Johannes Spaeth, Stefan Schumann</p>
Wearing facepieces is discussed in the context of increasing the volume of rebreathed air. We hypothesized that rebreathed air volume increases with increasing filtering facepiece (FFP) class and that persons breathing via facepieces compensate for the additional dead-space. We have determined the effective amount of rebreathed air for a surgical masks and FFP2 and FFP3 respirators in a physical model and determined tidal volumes, breathing frequency, blood oxygen saturation, and transcutaneously measured blood carbon dioxide partial pressure (PCO<sub>2</sub>) in lung-healthy subjects breathing without and with facepieces at rest and during exercising on a recumbent ergometer. Rebreathed air volume increased with the facepieces’ protection class and with increasing inspiration volume by 45 ± 2 ml to 247 ± 1 ml. Ambient airflow reduced rebreathed air volume by 17% up to 100% (all p < 0.001). When wearing facepieces, subjects increased tidal volume (p < 0.001) but not breathing frequency. Oxygen saturation was not influenced by facepieces. With FFP3 respirators PCO<sub>2</sub> increased by up to 3.2 mmHg (p < 0.001) at rest but only up to 1.4 mmHg (p < 0.001) when exercising. Discomfort of breathing increased with increasing protection class of the facepiece but was consistently perceived as tolerable. We conclude that the amount of rebreathed air increases with increasing protection class of facepieces. Healthy adults were capable to compensate the facepieces’ dead-space by adapting tidal volume at rest and during physical activity; thereby they tolerated moderate increases in PCO<sub>2</sub>. Ambient airflow may considerably reduce the amount of facepiece related rebreathed air.Human-Prosthetic Interaction (HumanIT): A study protocol for a clinical trial evaluating brain neuroplasticity and functional performance after lower limb lossElke LathouwersBruno TassignonAlexandre MaricotAhmed RadwanMaarten NaeyaertHubert RaeymaekersPeter Van SchuerbeekStefan SunaertJohan De MeyKevin De Pauw10.1371/journal.pone.02998692024-03-21T14:00:00Z2024-03-21T14:00:00Z<p>by Elke Lathouwers, Bruno Tassignon, Alexandre Maricot, Ahmed Radwan, Maarten Naeyaert, Hubert Raeymaekers, Peter Van Schuerbeek, Stefan Sunaert, Johan De Mey, Kevin De Pauw</p>
Background <p>Lower limb amputation contributes to structural and functional brain alterations, adversely affecting gait, balance, and overall quality of life. Therefore, selecting an appropriate prosthetic ankle is critical in enhancing the well-being of these individuals. Despite the availability of various prostheses, their impact on brain neuroplasticity remains poorly understood.</p> Objectives <p>The primary objective is to examine differences in the degree of brain neuroplasticity using magnetic resonance imaging (MRI) between individuals wearing a new passive ankle prosthesis with an articulated ankle joint and a standard passive prosthesis, and to examine changes in brain neuroplasticity within these two prosthetic groups. The second objective is to investigate the influence of prosthetic type on walking performance and quality of life. The final objective is to determine whether the type of prosthesis induces differences in the walking movement pattern.</p> Methods <p>Participants with a unilateral transtibial amputation will follow a 24-week protocol. Prior to rehabilitation, baseline MRI scans will be performed, followed by allocation to the intervention arms and commencement of rehabilitation. After 12 weeks, baseline functional performance tests and a quality of life questionnaire will be administered. At the end of the 24-week period, participants will undergo the same MRI scans, functional performance tests and questionnaire to evaluate any changes. A control group of able-bodied individuals will be included for comparative analysis.</p> Conclusion <p>This study aims to unravel the differences in brain neuroplasticity and prosthesis type in patients with a unilateral transtibial amputation and provide insights into the therapeutic benefits of prosthetic devices. The findings could validate the therapeutic benefits of more advanced lower limb prostheses, potentially leading to a societal impact ultimately improving the quality of life for individuals with lower limb amputation.</p> Trial registration <p>NCT05818410 (Clinicaltrials.gov).</p>