bluuebunny/crossref_metadata_2025 huggingface dataset:
Translation, cross-cultural adaptation, and measurement properties of the Nepali version of the central sensitization inventory (CSI)
Authors: Sharma Saurab , Jha Jyoti , Pathak Anupa , Neblett Randy
Published: July 2020

Background

Central sensitization is thought to be an important contributing factor in many chronic pain disorders. The Central Sensitization Inventory (CSI) is a patient-reported measure frequently used to assess symptoms related to central sensitization. The aims of the study were to translate and cross-culturally adapt the CSI into Nepali (CSI-NP) and assess its measurement properties.

Methods

The CSI was translated into Nepali using recommended guidelines. The CSI-NP was then administered on 100 Nepalese adults with sub-acute and chronic musculoskeletal pain with additional demographic and pain-related questions. The CSI-Nepali was administered again about 2 weeks later. Four measurement properties of the CSI-NP were evaluated: (1) internal consistency using Cronbach’s alpha, (2) test-retest reliability using intraclass correlation coefficient (ICC2,1), (3) measurement errors, and (4) construct validity testing five a priori hypotheses. Confirmation of construct validity was determined if a minimum of 75% of the hypotheses were met.

Results

The CSI was successfully translated into Nepali. Internal consistency and test-retest reliability were both excellent (Cronbach’s alpha = 0.91, and ICC = 0.98). The standard error of measurement was 0.31 and the smallest detectable change was 0.86. Four out of five (80%) a priori hypotheses were met, confirming the construct validity: the CSI-NP correlated strongly with the Pain Catastrophizing Scale total scores (r = 0.50); moderately with the total number of pain descriptors (r = 0.35); weakly with the Numerical Rating Scale (r = 0.25); and women had significantly higher CSI scores than men. However, the CSI scores did not correlate significantly with the total duration of pain, as hypothesized (r = 0.10).

Conclusions

The Nepali translation of the CSI demonstrated excellent reliability and construct validity in adults with musculoskeletal pain. It is now available to Nepali health care providers to help assess central sensitization-related signs and symptoms in individuals with musculoskeletal pain in research or clinical practice to advance the understanding of central sensitization in Nepalese samples.
Recruitment, experience, and retention among women with HIV and hazardous drinking participating in a clinical trial
Authors: Canidate Shantrel S. , Cook Christa L. , Varma Deepthi , Carnaby Giselle D. , Ennis Nicole , Stetten Nichole E. , Cook Robert L.
Published: July 2020

Background

Despite efforts by the NIH to enhance the participation of women and minorities in clinical research, women with HIV continue to remain underrepresented in alcohol intervention research. The purpose of this study is to better understand the reasons why women with HIV and hazardous drinking participated in the WHAT-IF? study and to discuss their experience (positive or negative) in the study. The WHAT-IF? study was a randomized clinical trial that evaluated pharmacotherapy for a reduction in drinking among women with HIV.

Methods

Convenience and theoretical sampling were used to recruit women with HIV and hazardous drinking to complete qualitative interviews. These women had previously completed a clinical alcohol intervention trial and had consented to be contacted in the future for study-related purposes. The biopsychosocial model was used to frame the interview questions that assessed multiple determinants of drinking behavior and helped explain linkages to broader health constructs.

Results

A total of 20 women with HIV and hazardous drinking completed the qualitative interview. Several factors were identified by the women as influential in their decision to participate in the WHAT-IF? study, such as the ability to quit or reduce their drinking to nonhazardous levels (biological), the ability to gain knowledge or a greater understanding of the negative effects of hazardous drinking on HIV disease progression (psychological), and peer pressure and monetary compensation (social). Also, the women identified factors (positive or negative) associated with their clinical trial experience, such as the effects of the study medication on the woman’s body (biological), thoughts and feelings toward study procedures (i.e. medication, lab work, study assessments) and the length of the study (psychological), and the interactions with the WHAT-IF? study staff (social).

Conclusion

Recruiting and retaining women with HIV in alcohol intervention research remains a challenge. Findings from this study suggest that women with HIV who are hazardous drinkers may benefit from participating in research studies that could help them to reduce or quit their drinking, increase their knowledge about specific behavior changes, and earn monetary compensation. Also, positive staff interactions may be instrumental in retaining minority women in alcohol intervention research.
Gender and education differences in sedentary behaviour in Canada: an analysis of national cross-sectional surveys
Authors: Prince Stephanie A. , Roberts Karen C. , Melvin Alexandria , Butler Gregory P. , Thompson Wendy
Published: July 2020

Background

Canadians spend the majority of their days sedentary. Gender and education are important social determinants of health that impact health behaviours. There is evidence that gender and educational differences in sedentary behaviour exist. In Canada, while general trends suggest that leisure sedentary activities have changed; there has been no comprehensive assessment examining whether historical changes in sedentary behaviour differ by gender and education level. Our objective was to examine whether gender and educational differences in accelerometer-measured sedentary time and self-reported sedentary behaviours exist among Canadians and if differences are consistent across age groups, over time and across multiple survey sources.

Methods

We summarize amounts of total accelerometer-measured sedentary time and self-reported sedentary activities (e.g., passive travel, television, computer, video games, screen, reading) by age (i.e. children: 6–11 years, youth: 12–17 years, adults: 18–34 years, 45–49 years, 50–64 years, and older adults: ≥ 65 years), gender (girls/women, boys/men) and household education level (< post-secondary vs. ≥ post-secondary) over time in the Canadian Community Health Survey, Canadian Health Measures Survey, General Social Survey, and the Health Behaviour in School-Aged Children study. Gender and education level differences are examined using independent sample t-tests or chi-square analyses.

Results

While few differences were found for total accelerometer-measured sedentary time, gender and education differences in self-reported, type-specific sedentary behaviour were identified. Among youth, data from all surveys consistently identified that boys engaged in more video/computer game play (e.g., boys: 0.35–2.68 vs. girls: 0.09–2.15 h/day), while girls engaged in more leisure reading (e.g., boys: 0.45–0.65 vs. girls: 0.71–0.99 h/day). Those with a higher education or household education often reported more leisure reading and passive travel. Education level differences in screen time were often age dependent, with leisure computer use greater in higher education groups in adults only and leisure television watching generally higher in lower education groups in children and adults, but not youth.

Conclusions

This information is valuable as it helps to identify segments of the population which may be at greater risk for engaging in higher volumes of sedentary behaviour. In turn, this information can identify target audiences and behaviours for policies and interventions. Future work is needed to further understand factors contributing to these differences (e.g., preferences, occupation, family structure).
Effectiveness of scoliosis-specific exercises for alleviating adolescent idiopathic scoliosis: a systematic review
Authors: Fan Yunli , Ren Qing , To Michael Kai Tsun , Cheung Jason Pui Yin
Published: July 2020

Background

Adolescent idiopathic scoliosis (AIS) is the most common pediatric spinal deformity with reported complications including pain, mental health concern and respiratory dysfunction. The scoliosis-specific exercise (SSE) is prescribed throughout pubertal growth to slow progression although effects are unclear. This review aims to establish the effectiveness of SSE for alleviating AIS in terms of reducing Cobb angle, improving trunk asymmetry and quality of life (QoL). Additionally, it aims to define the effects of age, skeletal maturity, curve magnitude and exercise compliance on the outcomes of SSE.

Methods

A systematic reviewed was conducted to net SSE articles. Searched databases included PubMed, MEDLINE, Cochrane Library, Scopus, CINAHL and Google scholar. The quality of study was critically appraised according to the PEDro scale.

Results

A total of ten trials with an average PEDro score of 6.9/10 were examined in this study. Two randomized controlled trials (RCTs) and two clinical controlled trials suggested that SSE alone and with bracing or traditional exercise had clinical significance in reducing Cobb angle more than 5°. One RCT specifically implicated no comparable effects between bracing and SSE in prevention of curve progression for moderate scoliosis. There was insufficient evidence to support the positive effects of SSE on improving truck asymmetry (n = 4) and QoL (n = 3). Five studies evaluated the interaction effects of age (n = 2), skeletal maturity (n = 1) and curve magnitude (n = 2) with SSE in reducing Cobb angle yet without drawing any firm conclusions.

Conclusions

Insufficient evidence is available to prove that SSE with or without other conservative treatments can reduce Cobb angle, improve trunk balance and QoL. The interaction effects of age, skeletal maturity, curve magnitude, and exercise compliance with SSE in reducing Cobb angle are not proven. Future studies should investigate the relationship of influencing factors and SSE in treating AIS but not only testing its effectiveness.

Trial registration

INPLASY202050100.
Large osteochondral defect in the lateral femoral condyle reconstructed by Atelocollagen-associated autologous chondrocyte implantation combined with anterior cruciate ligament reconstruction
Authors: Kaibara Takuma , Kondo Eiji , Matsuoka Masatake , Iwasaki Koji , Onodera Tomohiro , Momma Daisuke , Seito Naoki , Mikami Susumu , Iwasaki Norimasa
Published: July 2020

Background

Articular surface damage commonly associated with rupture of the anterior cruciate ligament (ACL). Large osteochondral defect, which consists of a severe depression fracture and a large cartilage defect, need to be treated due to deformation of the articular surface as it can impact the clinical outcome of ACL reconstruction. Although autologous chondrocyte implantation is one of the useful options in such cases, it can be questioned whether the reconstruction of the ACL and osteochondral defect should be performed in one procedure alone.

Case presentation

We report a case of a 38-year-old male with a deep depression fracture extending to the edge of the lateral femoral condyle associated with ACL injury after twisting his right knee while skiing. The patient was successfully treated with tissue-engineered cartilage transplantation covered by the periosteum with an iliac bone graft combined with anatomic double-bundle ACL reconstruction. Histopathological examination of the transplanted cartilage taken at second-look arthroscopy showed a cartilage-like tissue in the middle to deep zone in which the extracellular matrix was largely stained with Safranin O. The patient was able to return to his previous level of skiing activity without any experience of knee pain. Magnetic resonance imaging at 4 years after surgery showed that the graft integrated to the border zone and subchondral bone. The operated knee showed negative Lachman test and had a full range of motion.

Conclusions

To our knowledge, this is the first report of anatomic double-bundle ACL reconstruction with tissue-engineered cartilage transplantation and an iliac bone graft to restore the lateral edge of the femoral condyle.
Social inequalities in cervical cancer screening: a discrete choice experiment among French general practitioners and gynaecologists
Authors: Raginel Thibaut , Grandazzi Guillaume , Launoy Guy , Trocmé Mélanie , Christophe Véronique , Berchi Célia , Guittet Lydia
Published: July 2020

Background

Cervical cancer screening is effective in reducing mortality due to uterine cervical cancer (UCC). However, inequalities in participation in UCC screening exist, especially according to age and social status. Considering the current situation in France regarding the ongoing organized UCC screening campaign, we aimed to assess general practitioners’ (GPs) and gynaecologists’ preferences for actions designed to reduce screening inequalities.

Methods

French physicians’ preferences to UCC screening modalities was assessed using a discrete choice experiment. A national cross-sectional questionnaire was sent between September and October 2014 to 500 randomly selected physicians, and numerically to all targeted physicians working in the French region Midi-Pyrénées. Practitioners were offered 11 binary choices of organized screening scenarios in order to reduce inequalities in UCC screening participation. Each scenario was based on five attributes corresponding to five ways to enhance participation in UCC screening while reducing screening inequalities.

Results

Among the 123 respondents included, practitioners voted for additional interventions targeting non-screened women overall (p <  0.05), including centralized invitations sent from a central authority and involving the mentioned attending physician, or providing attending physicians with the lists of unscreened women among their patients. However, they rejected the specific targeting of women over 50 years old (p <  0.01) or living in deprived areas (p <  0.05). Only GPs were in favour of allowing nurses to perform Pap smears, but both GPs and gynaecologists rejected self-collected oncogenic papillomavirus testing.

Conclusions

French practitioners tended to value the traditional principle of universalism. As well as rejecting self-collected oncogenic papillomavirus testing, their reluctance to support the principle of proportionate universalism relying on additional interventions addressing differences in socioeconomic status needs further evaluation. As these two concepts have already been recommended as secondary development leads for the French national organized screening campaign currently being implemented, the adherence of practitioners and the adaptation of these concepts are necessary conditions for reducing inequalities in health care.
Effectiveness of the Ready to Reduce Risk (3R) complex intervention for the primary prevention of cardiovascular disease: a pragmatic randomised controlled trial
Authors: Byrne Jo L. , Dallosso Helen M. , Rogers Stephen , Gray Laura J. , Waheed Ghazala , Patel Prashanth , Gupta Pankaj , Doherty Yvonne , Davies Melanie J. , Khunti Kamlesh
Published: July 2020

Background

Cardiovascular disease is responsible for 31% of all global deaths. Primary prevention strategies are needed to improve longer-term adherence to statins and healthy lifestyle behaviours to reduce risk in people at risk of cardiovascular disease.

Methods

Pragmatic randomised controlled trial recruited between May 2016 and March 2017 from primary care practices, England. Participants (n = 212) prescribed statins for primary prevention of cardiovascular disease with total cholesterol level ≥ 5 mmol/l were randomised: 105 to the intervention group and 107 to the control group, stratified by age and sex. The 3R intervention involved two facilitated, structured group education sessions focusing on medication adherence to statins, lifestyle behaviours and cardiovascular risk, with 44 weeks of medication reminders and motivational text messages and two supportive, coaching phone calls (at approximately 2 weeks and 6 months). The control group continued with usual clinical care. Both groups received a basic information leaflet. The primary outcome was medication adherence to statins objectively measured by a biochemical urine test. Self-reported adherence and practice prescription data provided additional measures. Secondary outcomes included cholesterol profile, blood pressure, anthropometric data, cardiovascular risk score, and self-reported lifestyle behaviours and psychological measures (health/medication beliefs, quality of life, health status). All outcomes were assessed at 12 months.

Results

Baseline adherence to statins was 47% (control) and 62% (intervention). No significant difference between the groups found for medication adherence to statins using either the urine test (OR 1.02, 95% CI 0.34 to 3.06, P = 0.968) or other measures. This may have been due to the higher than expected adherence levels at baseline. The adjusted mean difference between the groups (in favour of the intervention group) for diastolic blood pressure (− 4.28 mmHg (95% CI − 0.98 to − 1.58, P = 0.002)) and waist circumference (− 2.55 cm (95% CI − 4.55 to − 0.55, P = 0.012)). The intervention group also showed greater perceived control of treatment and more coherent understanding of the condition.

Conclusions

The 3R programme successfully led to longer-term improvements in important clinical lifestyle indicators but no improvement in medication adherence, raising questions about the suitability of such a broad, multiple risk factor approach for improving medication adherence for primary prevention of CVD.

Trial registration

International Standard Randomized Controlled Trial Number (ISRCTN16863160), March 11, 2006.
Implementing parasite genotyping into national surveillance frameworks: feedback from control programmes and researchers in the Asia–Pacific region
Authors: Noviyanti Rintis , Miotto Olivo , Barry Alyssa , Marfurt Jutta , Siegel Sasha , Thuy-Nhien Nguyen , Quang Huynh Hong , Anggraeni Nancy Dian , Laihad Ferdinand , Liu Yaobao , Sumiwi Maria Endang , Trimarsanto Hidayat , Coutrier Farah , Fadila Nadia , Ghanchi Najia , Johora Fatema Tuj , Puspitasari Agatha Mia , Tavul Livingstone , Trianty Leily , Utami Retno Ayu Setya , Wang Duoquan , Wangchuck Kesang , Price Ric N. , Auburn Sarah
Published: July 2020

The Asia–Pacific region faces formidable challenges in achieving malaria elimination by the proposed target in 2030. Molecular surveillance of Plasmodium parasites can provide important information on malaria transmission and adaptation, which can inform national malaria control programmes (NMCPs) in decision-making processes. In November 2019 a parasite genotyping workshop was held in Jakarta, Indonesia, to review molecular approaches for parasite surveillance and explore ways in which these tools can be integrated into public health systems and inform policy. The meeting was attended by 70 participants from 8 malaria-endemic countries and partners of the Asia Pacific Malaria Elimination Network. The participants acknowledged the utility of multiple use cases for parasite genotyping including: quantifying the prevalence of drug resistant parasites, predicting risks of treatment failure, identifying major routes and reservoirs of infection, monitoring imported malaria and its contribution to local transmission, characterizing the origins and dynamics of malaria outbreaks, and estimating the frequency of Plasmodium vivax relapses. However, the priority of each use case varies with different endemic settings. Although a one-size-fits-all approach to molecular surveillance is unlikely to be applicable across the Asia–Pacific region, consensus on the spectrum of added-value activities will help support data sharing across national boundaries. Knowledge exchange is needed to establish local expertise in different laboratory-based methodologies and bioinformatics processes. Collaborative research involving local and international teams will help maximize the impact of analytical outputs on the operational needs of NMCPs. Research is also needed to explore the cost-effectiveness of genetic epidemiology for different use cases to help to leverage funding for wide-scale implementation. Engagement between NMCPs and local researchers will be critical throughout this process.
CD36-mediated uptake of myelin debris by macrophages and microglia reduces neuroinflammation
Authors: Grajchen Elien , Wouters Elien , van de Haterd Britt , Haidar Mansour , Hardonnière Kévin , Dierckx Tess , Van Broeckhoven Jana , Erens Celine , Hendrix Sven , Kerdine-Römer Saadia , Hendriks Jerome J. A. , Bogie Jeroen F. J.
Published: July 2020

Background

The presence of foamy macrophages and microglia containing intracellular myelin remnants is a pathological hallmark of neurodegenerative disorders such as multiple sclerosis (MS). Despite the importance of myelin internalization in affecting both central nervous system repair and neuroinflammation, the receptors involved in myelin clearance and their impact on the phagocyte phenotype and lesion progression remain to be clarified.

Methods

Flow cytometry, quantitative PCR, and immunohistochemistry were used to define the mRNA and protein abundance of CD36 in myelin-containing phagocytes. The impact of CD36 and nuclear factor erythroid 2–related factor 2 (NRF2) on the phagocytic and inflammatory features of macrophages and microglia was assessed using a pharmacological CD36 inhibitor (sulfo-N-succinimidyl oleate) and Nrf2−/− bone marrow-derived macrophages. Finally, the experimental autoimmune encephalomyelitis (EAE) model was used to establish the impact of CD36 inhibition on neuroinflammation and myelin phagocytosis in vivo.

Results

Here, we show that the fatty acid translocase CD36 is required for the uptake of myelin debris by macrophages and microglia, and that myelin internalization increased CD36 expression through NRF2. Pharmacological inhibition of CD36 promoted the inflammatory properties of myelin-containing macrophages and microglia in vitro, which was paralleled by a reduced activity of the anti-inflammatory lipid-sensing liver X receptors and peroxisome proliferator-activated receptors. By using the EAE model, we provide evidence that CD36 is essential for myelin debris clearance in vivo. Importantly, CD36 inhibition markedly increased the neuroinflammatory burden and disease severity in the EAE model.

Conclusion

Altogether, we show for the first time that CD36 is crucial for clearing myelin debris and suppressing neuroinflammation in demyelinating disorders such as MS.
Passive-elastic knee-ankle exoskeleton reduces the metabolic cost of walking
Authors: Etenzi Ettore , Borzuola Riccardo , Grabowski Alena M.
Published: July 2020

Background

Previous studies have shown that passive-elastic exoskeletons with springs in parallel with the ankle can reduce the metabolic cost of walking. We developed and tested the use of an unpowered passive-elastic exoskeleton for walking that stores elastic energy in a spring from knee extension at the end of the leg swing phase, and then releases this energy to assist ankle plantarflexion at the end of the stance phase prior to toe-off. The exoskeleton uses a system of ratchets and pawls to store and return elastic energy through compression and release of metal springs that act in parallel with the knee and ankle, respectively. We hypothesized that, due to the assistance provided by the exoskeleton, net metabolic power would be reduced compared to walking without using an exoskeleton.

Methods

We compared the net metabolic power required to walk when the exoskeleton only acts at the knee to resist extension at the end of the leg swing phase, to that required to walk when the stored elastic energy from knee extension is released to assist ankle plantarflexion at the end of the stance phase prior to toe-off. Eight (4 M, 4F) subjects walked at 1.25 m/s on a force-measuring treadmill with and without using the exoskeleton while we measured their metabolic rates, ground reaction forces, and center of pressure.

Results

We found that when subjects used the exoskeleton with energy stored from knee extension and released for ankle plantarflexion, average net metabolic power was 11% lower than when subjects walked while wearing the exoskeleton with the springs disengaged (p = 0.007), but was 23% higher compared to walking without the exoskeleton (p < 0.0001).

Conclusion

The use of a novel passive-elastic exoskeleton that stores and returns energy in parallel with the knee and ankle, respectively, has the potential to improve the metabolic cost of walking. Future studies are needed to optimize the design and elucidate the underlying biomechanical and physiological effects of using an exoskeleton that acts in parallel with the knee and ankle. Moreover, addressing and improving the exoskeletal design by reducing and closely aligning the mass of the exoskeleton could further improve the metabolic cost of walking.
Oxygen: viral friend or foe?
Authors: Gan Esther Shuyi , Ooi Eng Eong
Published: July 2020

The oxygen levels organ and tissue microenvironments vary depending on the distance of their vasculature from the left ventricle of the heart. For instance, the oxygen levels of lymph nodes and the spleen are significantly lower than that in atmospheric air. Cellular detection of oxygen and their response to low oxygen levels can exert a significant impact on virus infection. Generally, viruses that naturally infect well-oxygenated organs are less able to infect cells under hypoxic conditions. Conversely, viruses that infect organs under lower oxygen tensions thrive under hypoxic conditions. This suggests that in vitro experiments performed exclusively under atmospheric conditions ignores oxygen-induced modifications in both host and viral responses. Here, we review the mechanisms of how cells adapt to low oxygen tensions and its impact on viral infections. With growing evidence supporting the role of oxygen microenvironments in viral infections, this review highlights the importance of factoring oxygen concentrations into in vitro assay conditions. Bridging the gap between in vitro and in vivo oxygen tensions would allow for more physiologically representative insights into viral pathogenesis.
Morphologic evaluation of root resorption after miniscrew assisted en mass retraction in adult bialveolar protrusion patients
Authors: Chen Yu , Liu Dongxu
Published: July 2020

Background

Bialveolar protrusion is one of the most common chief complaints from the Asian orthodontic patients. Typical orthodontic treatment includes extraction of the bimaxillary premolars and en mass retraction of anterior tooth with maximum anchorage by placing miniscrews. However, excessive pursuit of profile improvement by retraction and intrusion of anterior teeth may result in root resorption, alveolar bone loss, even dehiscence. Thus this retrospective, analytical study was to evaluate the root resorption of anterior teeth after miniscrew assisted en mass retraction in adult bialveolar protrusion patients.

Materials and methods

Thirty six adult patients with bimaxillary protrusion had four first premolars extracted, and then miniscrews were placed to provide anchorage. CBCT scans were performed before (T1) and posttreatment (T2). A new improvement project introduced for 3D CBCT registration assessment of root morphology. The paired t-test was used to compare changes from T1 to T2. The relationship between the root resorption and the movement of anterior teeth were assessed by Pearson correlation coefficient analysis.

Results

The significant differences were only found in apical third of root and the largest resorption in apical third of the root is always noted in the palatal and distal sectors. Significant correlations were observed in the loss of root in distal and palatal sectors, the root length and volume decrease with the amount of anterior teeth retraction and intrusion.

Conclusion

The new 3D registration assessment of root morphology will be helpful for the clinicians. Pursuit of large retraction and intrusion leads to obvious anterior teeth root resorption.
Plasma lipid profiling for the prognosis of 90-day mortality, in-hospital mortality, ICU admission, and severity in bacterial community-acquired pneumonia (CAP)
Authors: Banoei Mohammad M. , Vogel Hans J. , Weljie Aalim M. , Yende Sachin , Angus Derek C. , Winston Brent W.
Published: July 2020

Introduction

Pneumonia is the most common cause of mortality from infectious diseases, the second leading cause of nosocomial infection, and the leading cause of mortality among hospitalized adults. To improve clinical management, metabolomics has been increasingly applied to find specific metabolic biopatterns (profiling) for the diagnosis and prognosis of various infectious diseases, including pneumonia.

Methods

One hundred fifty bacterial community-acquired pneumonia (CAP) patients whose plasma samples were drawn within the first 24 h of hospital admission were enrolled in this study and separated into two age- and sex-matched cohorts: non-survivors (died ≤ 90 days) and survivors (survived > 90 days). Three analytical tools, 1H-NMR spectroscopy, GC-MS, and targeted DI-MS/MS, were used to prognosticate non-survivors from survivors by means of metabolic profiles.

Results

We show that quantitative lipid profiling using DI-MS/MS can predict the 90-day mortality and in-hospital mortality among patients with bacterial CAP compared to 1H-NMR- and GC-MS-based metabolomics. This study showed that the decreased lysophosphatidylcholines and increased acylcarnitines are significantly associated with increased mortality in bacterial CAP. Additionally, we found that decreased lysophosphatidylcholines and phosphatidylcholines (> 36 carbons) and increased acylcarnitines may be used to predict the prognosis of in-hospital mortality for bacterial CAP as well as the need for ICU admission and severity of bacterial CAP.

Discussion

This study demonstrates that lipid-based plasma metabolites can be used for the prognosis of 90-day mortality among patients with bacterial CAP. Moreover, lipid profiling can be utilized to identify patients with bacterial CAP who are at the highest risk of dying in hospital and who need ICU admission as well as the severity assessment of CAP.
Provision of ECPR during COVID-19: evidence, equity, and ethical dilemmas
Authors: Worku Elliott , Gill Denzil , Brodie Daniel , Lorusso Roberto , Combes Alain , Shekar Kiran
Published: July 2020

The use of extracorporeal cardiopulmonary resuscitation (ECPR) to restore circulation during cardiac arrest is a time-critical, resource-intensive intervention of unproven efficacy. The current COVID-19 pandemic has brought additional complexity and significant barriers to the ongoing provision and implementation of ECPR services. The logistics of patient selection, expedient cannulation, healthcare worker safety, and post-resuscitation care must be weighed against the ethical considerations of providing an intervention of contentious benefit at a time when critical care resources are being overwhelmed by pandemic demand.
Characterisation of an inflammation-related epigenetic score and its association with cognitive ability
Authors: Stevenson Anna J. , McCartney Daniel L. , Hillary Robert F. , Campbell Archie , Morris Stewart W. , Bermingham Mairead L. , Walker Rosie M. , Evans Kathryn L. , Boutin Thibaud S. , Hayward Caroline , McRae Allan F. , McColl Barry W. , Spires-Jones Tara L. , McIntosh Andrew M. , Deary Ian J. , Marioni Riccardo E.
Published: July 2020

Background

Chronic systemic inflammation has been associated with incident dementia, but its association with age-related cognitive decline is less clear. The acute responses of many inflammatory biomarkers mean they may provide an unreliable picture of the chronicity of inflammation. Recently, a large-scale epigenome-wide association study identified DNA methylation correlates of C-reactive protein (CRP)—a widely used acute-phase inflammatory biomarker. DNA methylation is thought to be relatively stable in the short term, marking it as a potentially useful signature of exposure.

Methods

We utilise a DNA methylation-based score for CRP and investigate its trajectories with age, and associations with cognitive ability in comparison with serum CRP and a genetic CRP score in a longitudinal study of older adults (n= 889) and a large, cross-sectional cohort (n= 7028).

Results

We identified no homogeneous trajectories of serum CRP with age across the cohorts, whereas the epigenetic CRP score was consistently found to increase with age (standardisedβ= 0.07 and 0.01) and to do so more rapidly in males compared to females. Additionally, the epigenetic CRP score had higher test-retest reliability compared to serum CRP, indicating its enhanced temporal stability. Higher serum CRP was not found to be associated with poorer cognitive ability (standardisedβ= − 0.08 and − 0.05); however, a consistent negative association was identified between cognitive ability and the epigenetic CRP score in both cohorts (standardisedβ= − 0.15 and − 0.08).

Conclusions

An epigenetic proxy of CRP may provide a more reliable signature of chronic inflammation, allowing for more accurate stratification of individuals, and thus clearer inference of associations with incident health outcomes.
Targeting PPARα in the rat valproic acid model of autism: focus on social motivational impairment and sex-related differences
Authors: Scheggi Simona , Guzzi Francesca , Braccagni Giulia , De Montis Maria Graziella , Parenti Marco , Gambarana Carla
Published: July 2020

Background

The social motivational theory of autism spectrum disorder (ASD) focuses on social anhedonia as key causal feature of the impaired peer relationships that characterize ASD patients. ASD prevalence is higher in boys, but increasing evidence suggests underdiagnosis and undertreatment in girls. We showed that stress-induced motivational anhedonia is relieved by repeated treatment with fenofibrate (FBR), a peroxisome proliferator-activated receptor α (PPARα) agonist. Here, we used the valproic acid (VPA) model of ASD in rats to examine male and female phenotypes and assess whether FBR administration from weaning to young adulthood relieved social impairments.

Methods

Male and female rats exposed to saline or VPA at gestational day 12.5 received standard or FBR-enriched diet from postnatal day 21 to 48–53, when behavioral tests and ex vivo neurochemical analyses were performed. Phosphorylation levels of DARPP-32 in response to social and nonsocial cues, as index of dopamine D1 receptor activation, levels of expression of PPARα, vesicular glutamatergic and GABAergic transporters, and postsynaptic density protein PSD-95 were analyzed by immunoblotting in selected brain regions.

Results

FBR administration relieved social impairment and perseverative behavior in VPA-exposed male and female rats, but it was only effective on female stereotypies. Dopamine D1 receptor signaling triggered by social interaction in the nucleus accumbens shell was blunted in VPA-exposed rats, and it was rescued by FBR treatment only in males. VPA-exposed rats of both sexes exhibited an increased ratio of striatal excitatory over inhibitory synaptic markers that was normalized by FBR treatment.

Limitations

This study did not directly address the extent of motivational deficit in VPA-exposed rats and whether FBR administration restored the likely decreased motivation to operate for social reward. Future studies using operant behavior protocols will address this relevant issue.

Conclusions

The results support the involvement of impaired motivational mechanisms in ASD-like social deficits and suggest the rationale for a possible pharmacological treatment. Moreover, the study highlights sex-related differences in the expression of ASD-like symptoms and their differential responses to FBR treatment.
Large-diameter trees dominate snag and surface biomass following reintroduced fire
Authors: Lutz James A. , Struckman Soren , Furniss Tucker J. , Cansler C. Alina , Germain Sara J. , Yocom Larissa L. , McAvoy Darren J. , Kolden Crystal A. , Smith Alistair M. S. , Swanson Mark E. , Larson Andrew J.
Published: July 2020

The reintroduction of fire to landscapes where it was once common is considered a priority to restore historical forest dynamics, including reducing tree density and decreasing levels of woody biomass on the forest floor. However, reintroducing fire causes tree mortality that can have unintended ecological outcomes related to woody biomass, with potential impacts to fuel accumulation, carbon sequestration, subsequent fire severity, and forest management. In this study, we examine the interplay between fire and carbon dynamics by asking how reintroduced fire impacts fuel accumulation, carbon sequestration, and subsequent fire severity potential. Beginning pre-fire, and continuing 6 years post-fire, we tracked all live, dead, and fallen trees ≥ 1 cm in diameter and mapped all pieces of deadwood (downed woody debris) originating from tree boles ≥ 10 cm diameter and ≥ 1 m in length in 25.6 ha of anAbies concolor/Pinus lambertianaforest in the central Sierra Nevada, California, USA. We also tracked surface fuels along 2240 m of planar transects pre-fire, immediately post-fire, and 6 years post-fire. Six years after moderate-severity fire, deadwood ≥ 10 cm diameter was 73 Mg ha−1, comprised of 32 Mg ha−1that persisted through fire and 41 Mg ha−1of newly fallen wood (compared to 72 Mg ha−1pre-fire). Woody surface fuel loading was spatially heterogeneous, with mass varying almost four orders of magnitude at the scale of 20 m × 20 m quadrats (minimum, 0.1 Mg ha−1; mean, 73 Mg ha−1; maximum, 497 Mg ha−1). Wood from large-diameter trees (≥ 60 cm diameter) comprised 57% of surface fuel in 2019, but was 75% of snag biomass, indicating high contributions to current and future fuel loading. Reintroduction of fire does not consume all large-diameter fuel and generates high levels of surface fuels ≥ 10 cm diameter within 6 years. Repeated fires are needed to reduce surface fuel loading.
Correction to: Assessment of post ischemic stroke infections
Authors: Gamal Reda Mohammad A L-Bahy M. , EL-Hady Ashraf E L-Sherbiny Abd , Gad Hassan Kawashty , Aboelmakarem Mohammad Abd E L-Hady M. , Nowar Amir Abdel-Ghaffar Mohammady , Hegazy Haytham Khalifa
Published: July 2020

An amendment to this paper has been published and can be accessed via the original article.
Qualitative Assessment of Factors Influencing Implementation Effectiveness and Sustainability of Strategies for Increasing Tobacco Use Treatment in Vietnam Health Centers
Authors: VanDevanter Nancy , Vu Milkie , Nguyen Ann , Nguyen Trang , Van Minh Hoang , Nguyen Nam T. , Shelley Donna R.
Published: July 2020

PURPOSE

Effective strategies are needed to increase the implementation and sustainability of evidence-based tobacco dependence treatment (TDT) in public health systems in low- and middle-income countries. Our cluster randomized controlled trial (VQuit) found that a multicomponent implementation strategy was effective in increasing provider adherence to TDT guidelines in community health centers (CHCs) in Vietnam. In this paper, we present findings from a postimplementation qualitative assessment of factors that influence implementation effectiveness and program sustainability.

METHODS

We conducted semistructured qualitative interviews (N = 52) with 13 CHC medical directors (ie, physicians), 25 CHC health care providers, and 14 village health workers (VHWs) in 13 study sites. Interviews were transcribed and translated into English.

RESULTS

Facilitators of implementation effectiveness included training that increased confidence and skill, satisfaction with point-of-service tools, increasing patient demand for TDT, and, for the intervention arm, the value of a VHW referral system that reduced provider burden. The primary challenge to sustainability is the competing priorities driven by the Vietnam Ministry of Health, which may result in fewer resources for TDT compared with other health programs. However, providers and VHWs described several options for adapting the implementation strategies to address challenges and increase the engagement of local government committees and other sectors to sustain gains.

CONCLUSION

Our findings offer insight into how a multicomponent implementation strategy influenced changes in the delivery of evidence-based TDT. In addition, these results illustrate the dynamic interplay between barriers to and facilitators of sustaining TDT at the policy and community/practice level, particularly in the context of centralized public health systems, like that of Vietnam. Sustaining gains in practice improvement and clinical outcomes will require strategies that include ongoing engagement with policymakers and other stakeholders at the national and local level, as well as planning for adaptations and subsequent resource allocations, to meet Article 14 goals.
Feasibility of Developing a Community-Based Cancer Registry in Kawa Township in Myanmar
Authors: Oo Yin Thet Nu , Linn Thanda , Nwe Khine Pwint , Naing Win Pa Pa , Mon Ssu Wynn , Theingi Hsu , Mon Nan Cho Nwe , Shwe Kaung Myat , Win Soe Myat , Aye Khin Saw , Thant Kyaw Zin
Published: July 2020

PURPOSE

The objectives of this implementation research were to implement an innovative approach by basic health staff (BHS) using a cancer registry mobile application for continuous data reporting and to evaluate the process of establishing a community-based cancer registry.

METHODS

Eighty BHS in Kawa township, Bago region, were trained on the mobile application based on locally adapted CanReg5 software, common cancers and symptoms, and plans for implementation and monitoring. Required information of confirmed cancer cases was collected by the focal persons among local BHS using the application installed on their mobile devices and reported online to a database accessed by researchers. Two focus group discussions with BHS were conducted to identify challenges encountered during implementation and their suggested practical solutions.

RESULTS

A total of 74 confirmed cancer cases were registered during the 6-month implementation period. The most common cancers registered were breast cancer (20 cases), followed by GI cancers (18 cases) and lung cancers (9 cases). This finding was consistent with common cancers from regional hospital reports. Some data incompleteness was observed in topography, staging, and treatment information. In qualitative discussions, BHS reported technical difficulties in becoming familiar with morphologic codes, in saving registered cases in their phones, and in reading biopsy results and clinical notes. BHS approached family members mostly to obtain the hospital/laboratory records of patients with confirmed cases and some faced reluctance as family members did not want to inform the patients about their diagnosis. BHS could not register some cases when documents were not present, although they definitely knew the cases, including expired cases. The patient and/or caregiver expected financial or other support when they were registered. Once cancer is highly suspected or diagnosed, patients stop seeking proper care and turn to traditional healers. This is a result of the lack of knowledge about cancer. The cost of cancer health care is also a factor that influences whether treatment is sought.

CONCLUSION

A community-based cancer registry by BHS is feasible to a certain extent with some improvements. More community participation and proper referral to facilitate care are needed, as well as addressing technical difficulties.
Psychosocial Influences on Medical Help Seeking for Cancer Symptoms and Treatment in Low- and Middle-Income Countries: A Meta-Analysis and Mixed Methods Systematic Review
Authors: McCutchan Grace , Brain Kate , Quinn-Scoggins Harriet , Dao Anh , Downs Tom , Ho Ha , Lam Trung , Emery Jon , Weiss Bahr
Published: July 2020

PURPOSE

Cancer disproportionately affects people living in low- and middle-income countries (LMICs), partly because of delayed medical help-seeking behavior (HSB). Our mixed-methods systematic review synthesized existing studies in LMICs to understand psychosocial influences on cancer-related medical HSB to inform the development of effective interventions to promote earlier HSB for cancer.

METHODS

We searched peer-reviewed literature databases for quantitative, qualitative, and mixed-methods studies exploring barriers/facilitators to medical HSB for cancer symptoms in adults living in LMICs. Study exclusion criteria were low methodologic quality, non-English language publication, non–peer-reviewed publication, and studies conducted in high-income countries. Study findings were synthesized using meta-analysis, meta-ethnography, and narrative synthesis methods, according to individual study design.

RESULTS

Fifty studies were included. Many studies used nonstandardized measures/designs, which increased the difficulty integrating findings. Preliminary findings indicate that the use of traditional healers is a key barrier to prompt medical HSB in LMICs. Use of traditional healers for cancer symptoms/treatment was influenced by causal beliefs about symptoms, familial pressure, ease of access, affordability, and a preference to avoid biomedical treatment, which was perceived as invasive, ineffective, and expensive. Additional psychosocial barriers included shame and stigma associated with cancer, such as fear of marital rejection/divorce; limited knowledge of cancer and associated symptoms; financial and access barriers associated with travel and appointments; and cultural barriers, such as women needing permission from the family network.

CONCLUSION

Such barriers as low symptom knowledge and negative beliefs about cancer are universal barriers to cancer HSB in high-income countries and LMICs, whereas the use of traditional healers and women needing permission to seek medical help seem to be unique to LMICs. Intervention developers should work with local communities to appropriately tailor cancer awareness interventions in LMICs, taking into account cultural influences on HSB. Future evaluations would benefit from using validated measures and robust study designs.