bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Affecting Factors on Patient Safety Culture in Public and Private Hospitals in Iran
Authors: khoshakhlagh amir hossein , Khatooni Elham , Akbarzadeh Isa , Yazdanirad Saeid , Sheidaei Ali
Published: December 2019

Background : Patient safety culture is one of the main components of the quality of health services and is one of the main priorities of health studies. Accordingly, this study aimed to determine and compare the views of healthcare staff on the patient safety culture and the impact of effective factors on patient safety culture in public and private hospitals in Tehran, Iran. Methods : This cross-sectional study was carried out on a sample of 1203 health care workers employed in three public and three private hospitals in Tehran, Iran. Stratified random sampling was used in this study. Data were collected using the Maslach burnout inventory and patient safety culture questionnaire (HSOPSC). IBM SPSS v22 and Amos v23 were used to perform path analysis. Results : 867 (72.57%) females and 747 (27.43%) males with a mean age of 33.88 ± 7.66 were included. The average percentage of positive responses to the safety culture questionnaire in public and private hospitals was 65.5% and 58.3%, respectively. The strengths of patient safety culture in public hospitals were in three dimensions including non-punitive response to errors (80%), organizational learning—continuous improvement (79.77%), and overall perceptions of patient safety (75.16%), and in private hospitals, were three dimensions including non-punitive responses to errors (71.41%), organizational learning & continuous improvement (69.24%), and teamwork within units (62.35%). The type of hospital and work-shift hours influenced the burnout and patient safety questionnaire scores (P-value <0.05). The path analysis results indicate the fitness of the proposed model (RMSEA= 0.024). The results showed a negative impact of a work shift (β= -0.791), occupational burnout (β= -0.554) and hospital type (β= -0.147) on the observance of patient safety culture. Conclusion: providing feedback on errors and requirements for the frequent incident reporting, and patient information exchange seem necessary to promote the patient safety culture. Also, considering the negative impact of the shift work and burnout on patient safety culture, by planning and managing these factors appropriately, correct actions could be designed to improve the safety culture. Keywords: Patient safety culture, shift work, job burnout, path analysis
A randomised controlled trial of hearing and vision support in dementia: Protocol for a process evaluation in the SENSE-Cog Trial
Authors: Leroi Iracema , Armitage Christopher J. , Collin Fidéline , Frison Eric , Hann Mark , Hooper Emma , Reeves David , Simkin Zoe , Wolski Lucas
Published: December 2019

Background: Optimising hearing and vision function may be important in improving a range of outcomes for people living with dementia (PwD) and their companions. The SENSE-Cog cross-national randomised controlled trial (RCT) is evaluating the effectiveness of a sensory intervention (SI) to improve quality of life for PwD with concurrent hearing and/or vision impairment, in five European countries. To ascertain how or why the intervention will, or will not, achieve its outcomes, we have designed a process evaluation to explore potential discrepancies between expected and observed outcomes. This will also help us to understand how context may influence the outcomes. Here we describe the protocol for this process evaluation, which is embedded within the RCT. Methods and analysis: We will use a mixed method approach with a theoretical framework derived from the UK Medical Research Council’s’ guidance on process evaluations. It will include the following: (1) evaluating how key aspects of the intervention will be delivered, which will be important to scale the intervention in real world populations; (2) characterising the contextual issues, which may shape the delivery and the impact of the intervention in different countries; and (3) investigating possible causal mechanisms through analyses of potential moderators and mediators. To avoid bias, we will analyse the process data before the analysis of the main effectiveness outcomes. Discussion: This evaluation will provide insight into how the complex SENSE-Cog SI will be tailored, enacted and received, across the different European contexts, all of which have unique health and social care economies. The findings will provide insight into the causal mechanisms effecting change, and will determine whether we should implement the intervention, if effective, on a wider scale for PwD and concurrent sensory impairment. Trial registration number: ISRCTN17056211. Registered on 19 February 2018. http://www.isrctn.com/ISRCTN17056211
Effect of climatic factors on the seasonal fluctuation of human brucellosis in Yulin, Northern China
Authors: Liu Kun , Yang Zurong , Liang Weifeng , Guo Tianci , Long Yong , Shao Zhongjun
Published: December 2019

Background: Brucellosis is a serious public health problem primarily affecting livestock workers. The strong seasonality of the disease indicates that climatic factors may play important roles in the transmission of the disease. However, the associations between climatic variability and human brucellosis are still poorly understood. Methods: Data for a 14-year series of human brucellosis cases and seven climatic factors were collected in Yulin City from 2005 to 2018, one of the most endemic areas in northern China. Using cross-correlation analysis, the Granger causality test, and a distributed lag non-linear model (DLNM), we assessed the quantitative relationships and exposure-lag-response effects between monthly climatic factors and human brucellosis.Results: A total of 7,103 cases of human brucellosis were reported from 2005 to 2018 in Yulin City with a distinct peak between April and July each year. Seasonal fluctuations in the transmission of human brucellosis were significantly affected by temperature, sunshine duration, and evaporation. The effects of climatic factors were non-linear over the 6-month period, and higher values of these factors usually increased disease incidence. The maximum separate relative risk (RR) was 1.36 (95% confidence interval [CI], 1.03–1.81) at a temperature of 17.4 °C, 1.12 (95% CI, 1.03–1.22) with 311 hours of sunshine, and 1.18 (95% CI, 0.94–1.48) with 314 mm of evaporation. In addition, the effects of these three climatic factors were cumulative, with the highest RRs of 2.27 (95% CI, 1.09–4.57), 1.54 (95% CI, 1.10–2.18), and 1.27 (95% CI, 0.73–2.14), respectively. Conclusions: In Yulin, northern China, variations in climatic factors, especially temperature, sunshine duration, and evaporation, contributed significantly to seasonal fluctuations of human brucellosis within 6 months. The key determinants of brucellosis transmission and the identified complex associations are useful references for developing strategies to reduce the disease burden.
Assessment of branch point prediction tools to predict physiological branch points and their alteration by variants
Authors: Leman Raphael , Tubeuf Hélène , Raad Sabine , Tournier Isabelle , Derambure Céline , Lanos Raphaël , Gaildrat Pascaline , Castelain Gaia , Hauchard Julie , Killian Audrey , Baert-Desurmont Stéphanie , Legros Angelina , Goardon Nicolas , Quesnelle Céline , Ricou Agathe , Castera Laurent , Vaur Dominique , Gac Gérald Le , Ka Chandran , Fichou Yann , Bonnet-Dorion Françoise , Sevenet Nicolas , Guillaud-Bataille Marine , Boutry-Kryza Nadia , Schultz Ines , Caux-Moncoutier Virginie , Rossing Maria , Walker Logan C , Spurdle Amanda B , Houdayer Claude , Martins Alexandra , Krieger Sophie
Published: December 2019

Background: Branch points (BPs) map within short motifs upstream of acceptor splice sites (3’ss) and are essential for splicing of pre-mature mRNA. Several BP-dedicated bioinformatics tools, including HSF, SVM-BPfinder, BPP, Branchpointer, LaBranchoR and RNABPS were developed during the last decade. Here, we evaluated their capability to detect the position of BPs, and also to predict the impact on splicing of variants occurring upstream of 3’ss.
Results: We used a large set of constitutive and alternative human 3’ss collected from Ensembl (n = 264,787 3’ss) and from in-house RNAseq experiments (n = 51,986 3’ss). We also gathered an unprecedented collection of functional splicing data for 120 variants (62 unpublished) occurring in BP areas of disease-causing genes. Branchpointer showed the best performance to detect the relevant BPs upstream of constitutive and alternative 3’ss (99.48 % and 65.84 % accuracies, respectively). For variants occurring in a BP area, BPP emerged as having the best performance to predict effects on mRNA splicing, with an accuracy of 89.17 %.
Conclusions: Our investigations revealed that Branchpointer was optimal to detect BPs upstream of 3’ss, and that BPP was most relevant to predict splicing alteration due to variants in the BP area.
Keywords: Branch Point, Prediction, RNA, Benchmark, HSF, SVM-BPfinder, BPP, Branchpointer, LaBranchoR, RNABPS, Variants
Superiority of mucosal incision-assisted biopsy over ultrasound-guided fine needle aspiration biopsy to diagnose small gastric subepithelial lesions:A propencity score matching analysis
Authors: Minoda Yosuke , Chinen Takatoshi , Osoegawa Takashi , Itaba Soichi , Haraguchi Kazuhiro , Akiho Hirotada , Aso Akira , Sumida Yorinobu , Komori Keishi , Ogino Haruei , Ihara Eikichi , Ogawa Yoshihiro
Published: December 2019

Background Gastric subepithelial lesions, including gastrointestinal stromal tumors, are often found during routine gastroscopy. While endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) has been the gold standard for diagnosing gastric subepithelial lesions, alternative open biopsy procedures, such as mucosal incision-assisted biopsy (MIAB) has been reported useful. The aim of this study is to evaluate the efficacy of MIAB for the diagnosis of gastric SELs compared with EUS-FNAB. Methods We retrospectively analyzed medical records of 177 consecutive patients with gastric SELs who underwent either MIAB or EUS-FNAB at five hospitals in Japan between January 2010 and January 2018. Diagnostic yield, procedural time, and adverse event rates for the two procedures were evaluated before and after propensity-score matching. Results No major procedure-related adverse events were observed in either group. Both procedures yielded highly-accurate diagnoses once large enough samples were obtained; however, such successful sampling was more often accomplished by MIAB than by EUS-FNAB, especially for small SELs. As a result, MIAB provided better diagnostic yields for SELs smaller than 20-mm diameter. The diagnostic yields of both procedures were comparable for SELs larger than 20-mm diameter; however, MIAB required significantly longer procedural time (approximately 13 minutes) compared with EUS-FNAB. Conclusions Although MIAB required longer procedural time, it outperformed EUS-FNAB when diagnosing gastric SELs smaller than 20-mm diameter.
Reduced serum levels of pro-inflammatory chemokines in Fragile X Syndrome
Authors: Dijck Anke Van , Barbosa Susana , Bermudez-Martin Patricia , Khalfallah Olfa , Gilet Cyprien , Martinuzzi Emanuela , Elinck Ellen , Kooy R Frank , Glaichenhaus Nicolas , Davidovic Laetitia
Published: December 2019

Background: Fragile X syndrome (FXS) is the most frequent cause of inherited intellectual disability and the most commonly identified monogenic cause of autism. Recent studies have shown that long-term pathological consequences of FXS are not solely confined to the central nervous system (CNS) but rather extend to other physiological dysfunctions in peripheral organs. To gain insights into possible immune dysfunctions in FXS, we profiled a large panel of immune-related biomarkers in the serum of FXS patients and healthy controls. Methods: We have used a sensitive and robust Electro Chemi Luminescence (ECL)-based immunoassay to measure the levels of 52 cytokines in the serum of n=25 FXS patients and n=29 healthy controls. We then used univariate statistics and multivariate analysis, as well as an advanced unsupervised clustering method, to identify combinations of immune-related biomarkers that could discriminate FXS patients from healthy individuals. Results: While the majority of the tested cytokines were present at similar levels in FXS patients and healthy individuals, nine chemokines, CCL2, CCL3, CCL4, CCL11, CCL13, CCL17, CCL22, CCL26 and CXCL10, were present at much lower levels in FXS patients. Using robust regression, we show that six of these biomarkers (CCL2, CCL3, CCL11, CCL22, CCL26 and CXCL10) were negatively associated with FXS diagnosis. Finally, applying the K-sparse unsupervised clustering method to the biomarker dataset allowed for the identification of two subsets of individuals, which essentially matched the FXS and healthy control categories. Conclusions: Our data show that FXS patients exhibit reduced serum levels of several chemokines and may therefore exhibit impaired immune responses. The present study also highlights the power of unsupervised clustering methods to identify combinations of biomarkers for diagnosis and prognosis in medicine.
Are matching patterns of male and female flowers in response to nutrient supply and pollen concentration optimal for fruit and seed growth?
Authors: Gao Lei , Zhai Jun Jie , Yu Guo Zhu , Li Wei Hua , Peng Chang Lian
Published: December 2019

Background: Changes in the proportions of male and female flowers in monoecious plants in response to external environmental conditions are directly related to the reproductive fitness of plants. The monoecious cucumber plant was used in this study to assess the responses of sex differentiation and the breeding process to nutrient supply and the degree of artificial pollination using pollen solutions of different concentrations. Results: We found that the nutrient supply significantly increased the number of female flowers, although the number of female flowers did not increase with the strength of the pollination. The number of male flowers did not decrease even under the low nutrient concentration; consequently, the matching pattern of male and female flowers reflects the response of plants to nutrients and nutrient resources during flowering stage. Pollination treatment affected the fruit growth, seed set, and fruit yield. However, the number of fruit, fruit set percentage, and total seeds per plant did not increase with the pollination level, although individual fruit weight and seed number in one fruit did increase. Conclusions: It is concluded that the response of cucumber flowering to external factors is direct and instantaneous, and this matching pattern of male and female flowers may not be optimal for fruit development and seed formation. Keywords: Cucumber, Plant fitness, Sex differentiation, Monoecious, Pollen resource
Comparative transcriptomic and metabolic analysis of wild and domesticated wheat genotypes reveals differences in chemical and physical defense responses against aphids
Authors: Batyrshina Zhaniya S , Yaakov Beery , Shavit Reut , Singh Anuradha , Tzin Vered
Published: December 2019

Background: Young wheat plants are continuously exposed to herbivorous insect attack. To reduce insect damage and maintain their growth, plants evolved different defense mechanisms, including the biosynthesis of deterrent compounds named benzoxazinoids, and/or trichome formation that provides physical barriers. It is unclear whether both of these mechanisms are equally critical in providing an efficient defense for wheat seedlings against aphids—an economically costly pest in cereal production.
Results: In this study, we compared the transcriptome, metabolome, benzoxazinoids, and trichome density of three selected wheat genotypes, with a focus on differences related to defense mechanisms. We chose diverse wheat genotypes: two tetraploid wheat genotypes, domesticated durum ‘Svevo’ and wild emmer ‘Zavitan,’ and one hexaploid bread wheat, ‘Chinese Spring.’ The full transcriptomic analysis revealed a major difference between the three genotypes, while the clustering of significantly different genes suggested a higher similarity between the two domesticated wheats than between either and the wild wheat. A pathway enrichment analysis indicated that the genes associated with primary metabolism, as well as the pathways associated with defense such as phytohormones and specialized metabolites, were different between the three genotypes. Measurement of benzoxazinoid levels at the three time points (11, 15, and 18 days after germination) revealed high levels in the two domesticated genotypes, while in wild emmer wheat, they were below detection level. In contrast to the benzoxazinoid levels, the trichome density was dramatically higher in the wild emmer than in the domesticated wheat. Lastly, we tested the bird cherry-oat aphid’s ( Rhopalosiphum padi ) performance and found that Chinese Spring is more resistant than the tetraploid genotypes.
Conclusions: Our results show that benzoxazinoids play a more significant defensive role than trichomes. Differences between the abundance of defense mechanisms in the wild and domesticated plants were observed in which wild emmer possesses high physical defenses while the domesticated wheat genotypes have high chemical defenses. These findings provide new insights into the defense adaptations of wheat plants against aphids.
A retrospective genomic analysis of drug-resistant strains of M. tuberculosis in a high-burden setting, with an emphasis on comparative diagnostics and reactivation and reinfection status.
Authors: Wollenberg Kurt , Harris Michael , Gabrielian Andrei , Ciobanu Nelly , Chesov Dumitru , Long Alyssa , Taaffe Jessica , Hurt Darrell , Rosenthal Alex , Tartakovsky Michael , Crudu Valeriu
Published: December 2019

Background Recurrence of drug-resistant tuberculosis (DR-TB) after treatment occurs through relapse of the initial infection or reinfection by a new drug-resistant strain. Outbreaks of DR-TB in high burden regions present unique challenges in determining recurrence status for effective disease management and treatment. In the Republic of Moldova the burden of DR-TB is exceptionally high, with many cases presenting as recurrent.Methods We performed a retrospective analysis of Mycobacterium tuberculosis from Moldova to better understand the genomic basis of drug resistance and its effect on the determination of recurrence status in a high DR-burden environment. To do this we analyzed genomes from 278 isolates collected from 189 patients, including 87 patients with longitudinal samples. These pathogen genomes were sequenced using Illumina technology, and SNP panels were generated for each sample for use in phylogenetic and network analysis. Discordance between genomic resistance profiles and clinical drug-resistance test results was examined in detail to assess the possibility of mixed infection.Results There were clusters of multiple patients with 10 or fewer differences among DR-TB samples, which is evidence of person-to-person transmission of DR-TB. Analysis of longitudinally collected isolates revealed that many infections exhibited little change over time, though 35 patients demonstrated reinfection by divergent (number of differences > 10) lineages. Additionally, several same-lineage sample pairs were found to be more divergent than expected for a relapsed infection. Network analysis of the H3/4.2.1 clade found very close relationships among 61 of these samples, making differentiation of reactivation and reinfection difficult. There was discordance between genomic profile and clinical drug sensitivity test results in twelve samples, and four of these had low level (but not statistically significant) variation at DR SNPs suggesting low-level mixed infections.Conclusions Whole-genome sequencing provided a detailed view of the genealogical structure of the DR-TB epidemic in Moldova, showing that reinfection may be more prevalent than currently recognized. We also found increased evidence of mixed infection, which could be more robustly characterized with deeper levels of genomic sequencing.
Information needs and information seeking behaviour of people with dementia and their non-professional caregivers: a scoping review
Authors: Soong Aijia , Au Shu Ting , Kyaw Bhone Myint , Theng Yin Leng , Car Lorainne Tudor
Published: December 2019

Background Patients with dementia often require full-time caregivers especially in the later stages of their condition. Patients and caregivers’ access to reliable information on dementia is essential as it may have an important impact on patient care and quality of life. This study aims to provide an overview of the information needs and information seeking behaviour of dementia patients and their caregivers.Methods We conducted a scoping review of the literature and searched four electronic databases for eligible studies published up to August 2018. Two reviewers independently screened studies and extracted data. Information needs were classified according to emerging themes in the literature, and information seeking behaviour was categorized using Wilson’s model of information behaviour.Results Twenty studies with a total of 4,140 participants, were included in this review. Reported information needs focused on: (i) disease; (ii) patient care provision; (iii) healthcare services; and (iv) caregiver self-care. The most commonly reported information need was on healthcare service-related information. Characteristics found to influence information needs were the severity of dementia as well as patient and caregiver status. Dementia patients and caregivers mainly displayed active searching information seeking behaviour and preferred using electronic sources to obtain health information.Conclusion Current dementia information sources available in English are extensive in the information they offer, but more emphasis needs to be placed on healthcare service-related information. All studies originated from high income countries and focused on information needs of caregiver only. The only variable found to significantly influence information needs was severity of dementia condition. The information needs identified in this review can be used to inform development and design of future dementia resources for patients and their caregivers.
A qualitative analysis of junior doctors’ journeys to preparedness in acute care
Authors: Burridge Samuel , Shanmugalingam Thurkaa , Nawrozzadeh Fatima , Leedham-Green Kathleen , Sharif Amar
Published: December 2019

Background New doctors are expected to assess and manage acutely deteriorating patients from their first days in the hospital. However, current evidence suggests that medical graduates are not prepared for this. We aimed to explore junior doctors’ first experiences with unwell patients and how they developed preparedness over time. Methods We conducted seven semi-structured interviews with doctors in their first postgraduate year. The interview transcripts underwent inductive thematic analysis using consensual qualitative research approaches. Themes identified were categorised into early experiences of unpreparedness, first experiences of genuine preparedness, and making sense of how they became prepared. Reflection on how participants progressed between the two was facilitated through a sorting and ranking exercise. Results Most participants initially felt unprepared when responding to acutely unwell patients. They described feeling overwhelmed, apprehensive and challenged. Two main challenges involved knowing when to escalate, and feeling expected to perform beyond their level of competency. A lack of acute care exposure at medical school was a common thread. All participants felt prepared to respond to unwell patients three to six months after starting work. Hands-on experience, reflection, simulation and multidisciplinary team-working were consistently ranked as the most useful learning experiences. Conclusions Starting work as a doctor is a challenging time and preparedness to manage an acutely deteriorating patient is a common area of concern. As preparedness in acute care ranks poorly compared to other outcomes, we see this as an important area for improvement. Our findings suggest that undergraduates may lack sufficient opportunities for scaffolded decision making in acute care, and that increasing the intensity of clinical shadowing may improve preparedness and should inform future educational interventions.
Linking crop traits to transcriptome differences in a progeny population of tetraploid potato
Authors: Alexandersson Erik , Kushwaha Sandeep , Subedi Aastha , Weighill Deborah , Climer Sharlee , Jacobson Daniel , Andreasson Erik
Published: December 2019

Background Potato is the third most consumed crop in the world. Breeding for traits such as yield, product quality and pathogen resistance are main priorities. Identifying molecular signatures of these and other important traits is important in future breeding efforts. In this study, a progeny population from a cross between a breeding line, SW93-1015, and a cultivar, Désirée, was studied by trait analysis and RNA-seq in order to develop understanding of segregating traits at the molecular level and identify transcripts with expressional correlation to these traits. Transcript markers with predictive value for field performance applicable under controlled environments would be of great value for plant breeding. Results A total of 34 progeny lines from SW93-1015 and Désirée were phenotyped for 17 different traits in a field in Nordic climate conditions and controlled climate settings. A master transcriptome was constructed with all 34 progeny lines and the parents through a de novo assembly of RNA-seq reads. Gene expression data obtained in a controlled environment from the 34 lines was correlated to traits by different similarity indices, including Pearson and Spearman, as well as DUO, which calculates the co-occurrence between high and low values for gene expression and trait. Our study linked transcripts to traits such as yield, growth rate, high laying tubers, late and tuber blight, tuber greening and early flowering. We found several transcripts associated to late blight resistance and transcripts encoding receptors were associated to Dickeya solani susceptibility. Transcript levels of a UBX-domain protein was negatively associated to yield and a GLABRA2 expression modulator was negatively associated to growth rate. Conclusion In our study, we identify 100’s of transcripts, putatively linked based on expression with 17 traits of potato, representing both well-known and novel associations. This approach can be used to link the transcriptome to traits. We explore the possibility of associating the level of transcript expression from controlled, optimal environments to traits in a progeny population with different methods introducing the application of DUO for the first time on transcriptome data. We verify the expression pattern for five of the putative transcript markers in another progeny population.
Genetic diversity among cultivated beets (Beta vulgaris) assessed via population-based whole genome sequences
Authors: Galewski Paul J. , McGrath J. Mitchell
Published: December 2019

Diversification on the basis of utilization is a hallmark of Beta vulgaris (beet). Crop improvement and management activities are segregated by crop type, preserving unique genome diversity and differentiation, with occasional introgressions between diverged lineages for specific traits. Full interfertility is typically retained in crosses between these groups and more traits may be accessible if the genetic basis of crop type lineage were known, along with available genetic markers to effect efficient transfer (e.g., via backcrossing). Beta vulgaris L. (2n =18) is a species complex composed of diverged lineages (e.g., crop types), including table, leaf (chard), fodder, and sugar beet. Using population genetic and statistical methods with whole genome sequence data from pooled samples of 23 beet cultivars and breeding lines, relationships were determined between populations based on identity-by-state and shared genetic variation among lineages. Distribution of genetic variation within and between crop types showed extensive shared (e.g. non-unique) genetic variation. Lineage specific variation (e.g. apomorphy) within crop types supported a shared demographic history within each crop type, while principal components analysis revealed strong crop type differentiation. Relative contributions of specific chromosomes to genome wide differentiation were ascertained, with each chromosome revealing a different pattern of differentiation with respect to crop type. Inferred population size history inferences for each crop type helped integrate selection history for each lineage, and highlighted potential genetic bottlenecks in the development of cultivated beet lineages. A complex evolutionary history of cultigroups in Beta vulgaris was demonstrated, involving lineage divergence as a result of selection and reproductive isolation. Clear delineation of crop types was obfuscated by historical gene flow and common ancestry (e.g. admixture and introgression, and sorting of ancestral polymorphism) which served to share genome variation between crop types and, likely, important phenotypic characters. Table beet was well differentiated as a crop type, and shared more genetic variation within than among crop types. The sugar beet group was not quite as well differentiated as the table beet group. Fodder and chard groups were intermediate between the table and chard groups, perhaps the result of less intensive selection for their end use.
In search of universal health coverage – highlighting the accessibility of health care to students with disabilities in Ghana: a qualitative study
Authors: Abodey Eric , Vanderpuye Irene , Mensah Isaac , Badu Eric
Published: December 2019

Background: Accessibility of health care to students with disabilities is a global concern. This is no less important in Ghana, however, to date, no study has been undertaken regarding access to health care to students with disabilities. This study, therefore, aims to explore the accessibility of health care to students with disabilities, in the quest of achieving universal health coverage in Ghana. Methods: Qualitative methods, involving in-depth interviews were employed to collect data from 54 participants (29 students with disabilities, 17 health workers and 8 school mothers), selected through purposive sampling. Thematic analysis was used to analyze the data. Results : The study identified three themes – accessibility, adequacy, and affordability. The study findings highlighted that universal health coverage for students with disabilities has not been achieved due to barriers in accessing health care. The barriers faced by students with disabilities were unfriendly physical environments, structures, equipment, limited support services and poor health insurance policy to finance health care. Conclusion : The study concludes that the government should prioritize disability-related issues in health policy formulation, implementation and monitoring. The current provisions and requirements in the disability act should be prioritized, enforced and monitored to ensure adequate inclusion of disability issues in health services. Further, the current exemption policy under the National Health Insurance Scheme should be revised to adequately address the needs of people with disabilities.
Glucagon-like peptide-1 (GLP-1) receptor agonists and cardiovascular events in patients with type 2 diabetes mellitus: A meta-analysis of double-blind, randomized, placebo-controlled clinical trials
Authors: Qin Jing , Song Li
Published: December 2019

Background The cardiovascular effects of glucagon-like peptide-1 (GLP-1) receptor agonists are still controversial in the treatment of type 2 diabetes mellitus (T2DM) patients. The purpose of this study was to evaluate the risk of cardiovascular events of GLP-1 (albiglutide, exenatide, liraglutide, semaglutide, lixisenatide and dulaglutide) receptor agonists in T2DM patients. Methods PubMed and Embase were searched to find relevant randomized controlled trials (RCTs) from inception to June 2019 that evaluated the effect of GLP-1 receptor agonists on cardiovascular events in patients with T2DM. The T2DM patients of all the eligible trials received either GLP-1 therapy or placebo, and the cardiovascular outcomes included death from cardiovascular causes, fatal or non-fatal myocardial infarction and fatal or non-fatal stroke. Results We included 6 multinational double-blind randomized placebo-control trials that included a total of 52821 T2DM patients. The results indicated that GLP-1 receptor agonists reduced the risk of death from cardiovascular causes (RR: 0.90; 95% CI: 0.83-0.97; P=0.004) and fatal or non-fatal stroke (RR: 0.85; 95% CI: 0.77-0.94; P = 0.001) compared with the placebo controls. But GLP-1 receptor agonists did not significantly alter the fatal or non-fatal myocardial infarction compared with the placebo (RR:0.91; 95% CI: 0.82-1.01; P=0.06). Conclusion We concluded that GLP-1 receptor agonist therapy could reduce the risk of death from cardiovascular causes and fatal or non-fatal stroke compared with the placebo in the treatment of T2DM patients in trials with cardiovascular outcomes.
Urinary continence outcomes of four years of follow-up and predictors of early and late urinary continence in patients undergoing robot-assisted radical prostatectomy
Authors: Li Xing , Zhang Huan , Jia Zhuo , Wang Yunpeng , Song Yong , Liao Limin , Zhang Xu
Published: December 2019

Background: Although the wide application of robot-assisted radical prostatectomy (RARP) in recent years, studies about long urinary continence were few. In this study, we aimed to examine the outcomes of continence rates (CRs) and determine the risk and protective factors of early and late urinary continence in patients with prostate cancer (PCa) undergoing RARP. Methods: This retrospective study included 650 patients treated with RARP who completed perioperative data and at least one year of follow-up from January 2009 to November 2017. We analyzed the preoperative, intraoperative, and postoperative parameters of the patients. Continence was defined as no pad use. CRs from one to 48 months postoperatively were examined. Logistic regression analysis was performed to evaluate the associations between the predictive factors and urinary continence in the early and late stages. Results: CRs of the patients at one, three, six, 12, 24, 36, and 48 months postoperatively were 40.62%, 60.92%, 71.38%, 78.77%, 79.96%, 79.51%, and 76.50%, respectively. There were no significant differences in CR from 12 to 48 months postoperatively (P=0.766). Logistic regression analysis proved that pelvic lymph node dissection (PLND) was a significant risk factor of urinary continence at one month. Nerve sparing (NS) was a significant protective factor of urinary continence at one, three and six months. Age was an independent risk factor of urinary continence at six, 12 and 24 months. Other variables were not statistically significant predictors. Conclusions: Our results demonstrated that CR gradually improved with time within one year and stabilized one year after the surgery. PLND, NS and age were significant determinants of continence in the early and late stages, respectively. These parameters could be used for preoperatively identifying patients at high risk for urinary incontinence and counselling about postoperative expectations for urinary continence.
Genome-wide identification of loci associated with growth in rainbow trout
Authors: Ali Ali , Al-Tobasei Rafet , Lourenco Daniela , Leeds Tim , Kenney Brett , Salem Mohamed
Published: December 2019

Background Growth is a major economic production trait in aquaculture. Improvements in growth performance will reduce time and cost for fish to reach market size. However, genes underlying growth have not been fully explored in rainbow trout. Results A previously developed 50K gene-transcribed SNP chip, containing ~21K SNPs showing allelic imbalances potentially associated with important aquaculture production traits including body weight, muscle yield, was used for genotyping a total of 789 fish with available phenotypic data for bodyweight gain. Genotyped fish were obtained from two consecutive generations produced in the NCCCWA growth-selection breeding program. Weighted single-step GBLUP (WssGBLUP) was used to perform a genome-wide association (GWA) analysis to identify quantitative trait loci (QTL) associated with bodyweight gain. Using genomic sliding windows of 50 adjacent SNPs, 247 SNPs associated with bodyweight gain were identified. SNP-harboring genes were involved in cell growth, cell proliferation, cell cycle, lipid metabolism, proteolytic activities, chromatin modification, and developmental processes. Chromosome 14 harbored the highest number of SNPs (n = 50). An SNP window explaining the highest additive genetic variance for bodyweight gain (~6.4%) included a nonsynonymous SNP in a gene encoding inositol polyphosphate 5-phosphatase OCRL-1. Additionally, based on a single-marker GWA analysis, 46 SNPs were identified in association with bodyweight gain. The highest SNP associated with this trait was identified in a gene coding for thrombospondin-1 (THBS1) (R 2 = 0.09). Conclusion The majority of SNP-harboring genes, including OCRL-1 and THBS1, were involved in developmental processes. Our results suggest that development-related genes are important determinants for growth and could be prioritized and used for genomic selection in breeding programs.
Vigorous cool room treadmill training to improve walking ability in people with Multiple Sclerosis who use ambulatory assistive devices: A feasibility study.
Authors: Devasahayam Augustine J , Chaves Arthur R , Lasisi Wendy O , Curtis Marie E , Wadden Katie P , Kelly Liam P , Pretty Ryan , Chen Alice , Wallack Elizabeth M , Newell Caitlin J , Williams John B , Kenny Hannah , Downer Matthew B , McCarthy Jason , Moore Craig S , Ploughman Michelle
Published: December 2019

Background: Aerobic training has the potential to restore function, stimulate brain repair, and reduce inflammation in people with Multiple Sclerosis (MS). However, disability, fatigue, and heat sensitivity are major barriers to exercise for people with MS. We aimed to determine the feasibility of conducting vigorous harness-supported treadmill training in a room cooled to 16°C (10 weeks; 3times/week) and examine the longer-term effects on markers of function, brain repair, and inflammation among those using ambulatory aids. Methods: Ten participants (9 females) aged 29 to 74 years with an Expanded Disability Status Scale ranging from 6 to 7 underwent training (40 to 65% heart rate reserve) starting at 80% self-selected walking speed. Feasibility of conducting vigorous training was assessed using a checklist, which included attendance rates, number of missed appointments, reasons for not attending, adverse events, safety hazards during training, reasons for dropout, tolerance to training load, subjective reporting of symptom worsening during and after exercise, and physiological responses to exercise. Functional outcomes were assessed before, after, and 3 months after training. Walking ability was measured using Timed 25 Foot Walk test and on an instrumented walkway at both fast and self-selected speeds. Fatigue was measured using fatigue/energy/vitality sub-scale of 36-Item Short-Form (SF-36) Health Survey, Fatigue Severity Scale, modified Fatigue Impact Scale. Aerobic fitness (maximal oxygen consumption) was measured using maximal graded exercise test (GXT). Quality-of-life was measured using SF-36 Health Survey. Serum levels of neurotrophin (brain-derived neurotrophic factor) and cytokine (interleukin-6) were assessed before and after GXT. Results: Eight of the ten participants completed training (attendance rates >80%). No adverse events were observed. Fast walking speed (cm/s), gait quality (double-support (%)) while walking at self-selected speed, fatigue (modified Fatigue Impact Scale), fitness (maximal workload achieved during GXT), and quality-of-life (physical functioning sub-scale of SF-36) improved significantly after training, and improvements were sustained after 3-months. Improvements in fitness (maximal respiratory exchange ratio and maximal oxygen consumption during GXT) were associated with increased brain-derived neurotrophic factor and decreased interleukin-6. Conclusion: Vigorous cool room training is feasible and can potentially improve walking, fatigue, fitness, and quality-of-life among people with moderate to severe MS-related disability.
Postoperative collateral formation after indirect bypass for hemorrhagic moyamoya disease
Authors: Ge Peicong , Zhang Qian , Ye Xun , Liu Xingju , Deng Xiaofeng , Wang Jia , Wang Rong , Zhang Yan , Zhang Dong , Zhao Jizong
Published: December 2019

Background: The research on postoperative collateral formation for hemorrhagic moyamoya disease (MMD) evaluated by using digital subtraction angiography (DSA) is limited. Our study objective was to investigate the postoperative collateral formation after indirect bypass for hemorrhagic MMD. Methods: All consecutive inpatients with hemorrhagic MMD who received indirect bypass at Beijing Tiantan Hospital, Capital Medical University from January 2010 through December 2018 were screened. The site of the hemorrhage was classified as either anterior or posterior. Postoperative collateral formation was evaluated on lateral views using the Matsushima scale. Univariate and multivariate logistic regression analyses were carried out to determine the factors influencing postoperative collateral formation. Results: Six-four patients (64 hemispheres) were included in this study. After a median 8.5 months DSA follow-up, 14 (21.9%) hemispheres had grade A collateral circulation, 13 (20.3%) had grade B, and 37 (57.8%) had grade C. Twenty-seven (43.2%) hemispheres had good postoperative collateral formation and 37 (57.8%) had poor postoperative collateral formation. The univariate logistic regression analyses showed that age at operation (OR, 0.954; 95% CI, 0.908–1.003; p=0.066), hemorrhagic site (OR, 4.694; 95% CI, 1.582–13.923; p=0.005), and PCA involvement (OR, 3.474; 95% CI, 0.922–13.086; p=0.066) may effect postoperative collateral formation. The multivariate logistic regression analyses showed that only anterior hemorrhage (OR, 5.222; 95% CI, 1.605–16.987; p=0.006) was significantly related to good postoperative collateral formation. Conclusion: Anterior hemorrhage was significantly related to good postoperative collateral formation after indirect bypass.
Chronic hepatitis and HIV risks amongst Pakistani migrant men in a French suburb and insights into health promotion interventions: the ANRS Musafir qualitative study
Authors: Cailhol Johann , Khan Nichola
Published: December 2019

Objectives Seine-Saint-Denis is a deprived departement (French administrative unit) in the North-East of Paris, France, hosting the majority of South Asian migrants in France. In recent years, the number of migrants from Pakistan, which has the second highest prevalence of hepatitis C globally, increased. As a corollary, this study addressed the high proportion of Pakistani patients in the infectious diseases clinic of a local hospital, diagnosed with hepatitis C, but also hepatitis B and Human Immunodeficiency Virus (HIV). It explored genealogies and beliefs about hepatitis and HIV transmission in Pakistan, including community, sexual and blood risk behaviours. The aim was to understand the ways these risk factors reduce or intensify both en route and once in France, in order to devise specific forms of community health intervention. Design The study took place at Avicenne University-Hospital in Seine-Saint-Denis, and its environs, between July and September 2018. The design of the study was qualitative, combining interviews, a focus group discussion, and ethnographic observations. Semi-structured interviews were conducted with a sample of 13 Pakistani male participants diagnosed with chronic hepatitis C, B, and/or HIV, who had arrived after 2010 in Seine-St-Denis. Results All participants were young men from rural Punjab province. Most took the Eastern Mediterranean human smuggling route. Findings suggest that vulnerabilities to hepatitis and HIV transmission, in many cases originating in Pakistan, are intensified along the migration route and perpetuated in France. They reveal multiple overlapping factors including cohabitation conditions, cultural norms, and a lack of knowledge about transmission. Participants also suggested a number of culturally-acceptable health promotion interventions in the community. Conclusions This in-depth analysis of individual and community risks among recently-arrived migrant men from a country with high hepatitis C prevalence is significant for developing new perspectives on health prevention and promotion interventions. These are clearly needed in regard to Europe’s new migrant and refugee populations.
The application of Pressure-regulated volume controlled ventilation mode in Video-assisted Thoracoscopic Surgery pulmonary segmentectomy
Authors: han qian , Yao Wenyu , Zhang Chuansuo , Wu Shuishui , Chen Haijun
Published: December 2019

Background: Pressure-regulated capacity control volume controlled (PRVC) ventilation mode is a new type of ventilation mode, which could reduce the occurrence of ventilator-related lung injury. The aim of this study was to explore PRVC mode on airway pressure, oxygenation index, pulmonary inflammatory index and prognosis in patients with one-lung ventilation during pulmonary segmentectomy.Methods: Eighty ASA Ⅱ-Ⅲ Patients with moderate to severe pulmonary dysfunction, ready to receive segmentectomy were randomly divided into VC and PRVC group, which included 40 patients in each group. PRVC ventilation mode was performed for patients in VC-group in the first 5 minutes after OLV, and then ventilation mode was transformed into VC ventilation mode till the end of operation. In PRVC-group, ventilation modes were performed in opposite order. The changes of airway peak pressure, airway platform pressure, pulmonary static compliance, blood gas analysis results and hemodynamics in the two groups under different ventilation modes were recorded. The whole blood samples and bronchoalveolar lavage fluid (BALF) in ventilated lung were collected to determine the level of TNF-α, IL-1β, IL-6 and IL-8 after the surgery. Results: Both static lung compliance and the peak expiratory pressure in PRVC-group were significantly lower than those in VC-group (P=0.023). But there were no difference in hemodynamic parameters such as heart rate, blood pressure. The arterial blood gas analysis (pH, pO2 and pCO2) between the two groups during, as well as postoperative pulmonary complications and length of hospital stay also did not show difference. However, the levels of TNF-α, IL-6, IL-8 and IL-10 in BALF in VC-group were significantly higher than that in PRVC-group (P=0.01). Conclusion: PRVC ventilation mode during intraoperative one-lung ventilation can effectively relieve airway pressure and reduce the secretion of inflammatory factors in the lung, which is a safe and protective ventilation mode for patients with poor preoperative pulmonary function who undergo pulmonary segmentectomy.