bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Colon Microbial Diversity of African Ostriches at Different Ages
Authors: Li Peng , Zhang Yan , Yang Jie , Zhang Xiaoting , Ye Lixun , Li Baitao , Luo Qingping , Wang Jiaxiang
Published: December 2020

Background:The colon is the unique digestive organ of the African ostrich. It has a large microbial population, which plays an important role in the digestive process of the African ostriches. Methods: In order to understand the diversity of colon microbes in African ostriches, this study used metagenomics sequencing technology to sequence and analyze the colonic microbes of African ostriches at the age of 7, 30, 60 and 180 days. Results: The results showed that with the increase of age, the microbial richness index first increased and then decreased, the highest at 60 days of age (ACE 271.5, Chao1 274.097), while the microbial diversity gradually reduced with the increase of age, the highest at 7 days ( Shannon 3.203, Simpson 0.104). At the phylum level, the dominant bacteria phylum at 7 days of age is Firmicutes, while at 30 days of age, the phyla Firmicutes and Tenericutes are dominant phyla, and the abundance of Proteobacteria is highest at 60 days of age and 180 days of age. At the genus level, the dominant bacteria in the colon at 7 and 30 days are Anaeroplasma and Bacteroides. Acinetobacter is the dominant genus at 60 days, and the dominant genus at 180 days is Pseudomonas. PCA analysis showed that the microbial composition in the 180-day-old colon was very different from other days. The microbial composition in the anterior and middle part of the colon at 7-day-old was similar to that of 30-day-old, while the microbial composition in the latter part was similar to that of 60-day-old. Results of LEfSe analysis showed that there were 34, 37, and 36 differential flora in the colon at 7, 30, and 60 days, respectively, while there was only one differential flora at 180 days of age. Conclusion: The results of the study showed that the composition of the microbial community in the colon of African ostriches of different ages is different and there are different flora, but the microbes in the colon are still mainly concentrated in the phylum Firmicutes, Tenericutes, and Proteobacteria, which gives the intestinal tract and function of the African ostrich further research provides a theoretical basis.
Self-reported Sudden Onset Hyposmia: An Early Presentation of SARS CoV-2 Infection
Authors: Al-Naami Awaji Q. , Khan Liaqat A. , Zaidan Faisal I. , Hobani Abdulwahab I. , Hakami Anwar A. , Shaikh Ali H. , Ahmadini Mousa M. , Jafar Wejdan A. , Al-Neami Ibrahim A. , Damri Abdulrhman A.
Published: December 2020

The present outbreak of COVID-19 started in December 2019 in Wuhan, a city in Hubei province in China. The World health organization labeled the disease a global pandemic on March 11, 2020. The disease is caused by a virus called severe acute respiratory coronavirus-2 (SARS CoV-2). The individuals may remain asymptomatic or present with symptoms of infection. The common presenting symptoms include but are not limited to fever, dry or productive cough, malaise. Contrary to the typical clinical presentation of COVID-19, the patients may present with non-specific symptoms of olfactory or gustatory origin. The olfactory symptoms include hyposmia or anosmia. Physicians may be vigilant to screen and isolate patients with sudden onset hyposmia or anosmia, an early indication of infection that will minimize person-to-person transmission and will contain the virus spread.
Acting between checklists and reality. Managers’ balancing between standardization and adaptive behaviour in patient safety work- an interview study
Authors: Hedsköld Mats , Sachs Magna Andreen , Rosander Thorleif , von Knorring Mia , Harenstam Karin Pukk
Published: December 2020

Background: Safety culture can be described and understood through its manifestations in the organisation as artefacts, espoused values and basic underlying assumptions and is strongly related to leadership-yet it remains elusive as a concept. Even if the literature points to leadership as an important factor for creating and sustaining a mature safety culture, little is known about how the safety work of first line managers’ actually is done and how they balance the different and often conflicting organizational goals in everyday practice. The purpose of this study was to explore how health care first line managers perceive their role and how they promote patient safety and patient safety culture in their units. Methods: Interview study with first line managers in intensive care units in eight different hospitals located in the middle of Sweden. An inductive qualitative content analysis approach was used, this was then followed by a deductive analysis of the strategies informed by constructs from High reliability organizations. Results: We present how first line managers view their role in patient safety and exemplify concrete strategies by which managers promote patient safety in everyday work. Conclusions: Our study shows the central role of front-line managers in organizing for safe care and creating a culture for patient safety. Although promoted widely in Swedish healthcare at the time for the interviews, the HSOPSC was not mentioned by the managers as a central source of information on the unit’s safety culture.
Determinants of Macular Ganglion Cell–Inner Plexiform Layer Thickness in Normal Chinese Adults
Authors: Xu Xiaoyu , Xiao Hui , Lai Kunbei , Guo Xinxing , Luo Jingyi , Liu Xing
Published: December 2020

Background: Demographic, systemic and ocular factors may impact macular ganglion cell–inner plexiform layer (GCIPL) thickness measurements. This study aimed to investigate the influences of multiple potential determinants of macular GCIPL thickness in normal Chinese adults.Methods: This was a retrospective study conducted on 225 normal eyes from 225 healthy Chinese adults. GCIPL thickness were obtained using Cirrus high-definition optical coherence tomography (OCT). The age, gender, laterality, spherical equivalent (SE) refractive error, intraocular pressure (IOP), axial length (AL), central cornea thickness (CCT), circumpapillary retinal nerve fibre layer (pRNFL) thickness and OCT signal strength were recorded and their respective effect on GCIPL thickness parameters were evaluated.Results: The mean (± SD) average, minimum, superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal GCIPL thickness was 84.56 ± 5.36, 81.32 ± 5.58, 83.08 ± 5.37, 85.70 ± 5.95, 87.15 ± 6.26, 85.07 ± 6.11, 82.46 ± 5.76, and 83.88 ± 5.59 μm, respectively. Determinants of thinner GCIPL thickness were older age (P = 0.001 - 0.117; effects enhanced if age over 40 years), thinner pRNFL (all P <0.001), and weaker signal strength (all P <0.001). No significant difference was found between males and females (P = 0.069 - 0.842), and between right eyes and the left eyes (P = 0.160 - 0.875) except that of superonasal GCIPL thickness (P < 0.001). There was no significant correlation between GCIPL thickness and SE, IOP, CCT, and AL (P = 0.135 - 0.968). Conclusions: Individual determinants associated with thinner GCIPL thickness were older age (particularly over 40 years of age), thinner pRNFL, and weaker OCT signal strength.
Unbiased RNA-Seq-driven identification and validation of reference genes for quantitative RT-PCR analyses of pooled cancer exosomes
Authors: Dai Yao , Cao Yumeng , Köhler Jens , Lu Aiping , Xu Shaohua , Wang Haiyun
Published: December 2020

Background: Exosomes are extracellular vesicles (EVs) derived from endocytic compartments of eukaryotic cells which contain various biomolecules like mRNAs or miRNAs. Exosomes influence the biologic behaviour and progression of malignancies and are promising candidates as non-invasive diagnostic biomarkers or as targets for therapeutic interventions. Usually, quantitative real-time polymerase chain reaction (qRT-PCR) is used to assess gene expression in cancer exosomes, however, the ideal reference genes for normalization yet remain to be identified.Results: In this study, we performed an unbiased analysis of high-throughput mRNA and miRNA-sequencing data from exosomes of patients with various cancer types and identify candidate reference genes and miRNAs in cancer exosomes. The expression stability of these candidate reference genes was evaluated by the coefficient of variation “CV” and the average expression stability value “M”. We subsequently validated these candidate reference genes in exosomes from an independent cohort of ovarian cancer patients and healthy control individuals by qRT-PCR.Conclusions: Our study identifies OAZ1 and hsa-miR-6835-3p as the most reliable individual reference genes for mRNA and miRNA quantification, respectively. For superior accuracy, we recommend the use of a combination of reference genes - OAZ1/SERF2/MPP1 for mRNA and hsa-miR-6835-3p/hsa-miR-4468-3p for miRNA analyses.
Comparative Study on Optic Disc Features of Premature Infants and full-term newborns
Authors: Feng Xiaofen , Nan Yan , Pan Jiandong , Zou Ruitao , Shen Lijun , chen feng
Published: December 2020

Background: To study optic disc features of premature infants and compare to that of term infants to explore the pattern and features of newborn optic disc development and provide the basis for the diagnosis of newborn optic disc disease. Methods: This was a prospective clinical research. Newborns underwent newborn fundus disease screening from January 1st, 2016 to October 31st, 2016 in the neonatal ward of Ruian City Maternal and Child Health Hospital were selected. RetCam 3 Version6.1.25.0 Wide-Field Digital Pediatric Retinal Imaging System developed by Clarity Medical Systems, Inc was adopted to conduct fundus examination on both eyes, 130 degree wide-angle lens was used to film the images centering optic disc. Results: For both premature infants and full-term newborns, vertical diameter of the optic disc to lateral diameter of the optic disc ratio was >1, and the shape of the optic disc was a vertical oval. The difference of each optic disc parameter between premature infants and full-term newborns was not statistically significant (P>0.05). There’s a difference of constitution of sclerotic ring type on optic disc between premature infants and full-term newborns. Among which, the proportion of single ring type and double ring type in premature infants was higher than that in full-term newborns (P<0.05). The proportion of no ring type in full-term newborns was higher than that in premature infants (P<0.05). The proportion of mixed type had no significant difference (P>0.05) between premature infants and full-term newborns.Conclusions: We found that The proportion of mature types (single ring type and double ring type) in full-term newborns was higher than that in premature infants. While there’s no statistical difference of the proportion of mixed types between premature infants and full-term newborns. Double ring type was a normal stage of the development of optic disc.
Knowledge, Attitude and Practice of Ethiopian Pediatricians concerning Childhood Eye Diseases
Authors: Regassa Tolosa Tufa , Daba Kumale Tolesa , Fabian Ido Didi , Mengesha Aemero Abateneh
Published: December 2020

Background: Eye examination and vision assessment are vital for the detection of conditions that result in blindness. Childhood blindness seriously impacts the development, education, and future employment opportunities of affected children. Pediatricians’ knowledge of eye diseases is critical for the prevention of blindness through early diagnosis, allowing proper treatment and identification of conditions requiring referral to an ophthalmologist to preserve or restore vision. This study aimed to assess the knowledge, attitude, and practice of Ethiopian pediatricians concerning childhood eye diseases.Methods: We carried out a cross-sectional descriptive study of pediatricians working in various hospitals and clinics in Ethiopia. Participants were selected via a convenient sampling technique. Data were collected using both closed and open-ended semi-structured questionnaires. Responses were entered into EpiData 3.1 and transferred to SPSS version 21.0 software for analysis.Results: A total of 79 pediatricians participated in the study. Our findings showed that the attitude of all but 2 participants towards improving the management of childhood eye diseases was positive, even though this was not reflected in actual knowledge or practice. Even though attitudes were positive, knowledge was often poor and practice inadequate owing to barriers such as inadequate undergraduate training, lack of ophthalmology options during pediatric residency, and unavailability of ophthalmic equipment.Conclusions: Participants’ attitudes towards improving treatment for childhood eye diseases are positive, but their insufficient knowledge of eye diseases makes their practice poor in this respect.
Medical students’ self-reported gender discrimination and sexual harassment over time
Authors: Kisiel Marta Alina , Kühner Sofia , Stolare Karin , Lampa Erik , Wohlin Martin , Johnston Nina , Rask-Andersen Anna
Published: December 2020

Background Gender discrimination (GD) and sexual harassment (SH) occur at all academic institutions worldwide. Medical students report high prevalence of GD and SH, which may negatively affect their education and health. There are indications that policies and reforms on reducing GD/SH are insufficient. Swedish medical students’ experiences of GD/SH are monitored by course-evaluations and bi-annual student union evaluations; however, the response rate is usually low. The aim of this study was to compare the exposure to and context of self-reported GD/SH over an 11-year period amongst medical students at a Swedish university.Methods In 2002, a questionnaire (n=622) was mailed to medical students’ home addresses. It was repeated in 2013 and then distributed during mandatory lectures (n=856). The questions used a behavioristic approach and asked about specific GH/SH experiences. Participation was voluntary and anonymous. The changes in prevalence over time were calculated by sampling weights in order to obtain comparable estimates, representative of both cohorts.Results The response frequency was 55% (62% women) in 2002 and 81% (59% women) in 2013. The prevalence of GD tended to decrease for male and clinical students in comparison to female and pre-clinical peers. However, the prevalence of SH increased for female compared to male students. The ratio of SH for female pre-clinical students doubled in many instances; most often, the mistreatment occurred in the clinic. Medical doctors were indicated as perpetrators up to five times more often by all students in 2013.Conclusion Our results show a disproportional change in exposure to GD/SH between female and male medical students, resulting in a widening of the gender gap regarding prevalence of GD and SH between 2002 and 2013. In particular, personal experiences of SH increased for both sexes. It is proof that institutional efforts to fight mistreatment might be ineffective.
Efficient Masked Face Recognition Method during the COVID-19 Pandemic
Authors: Hariri Walid
Published: December 2020

The COVID-19 is an unparalleled crisis leading to a huge number of casualties and security problems. In order to reduce the spread of coronavirus, people often wear masks to protect themselves. This makes face recognition a very difficult task since certain parts of the face are hidden. A primary focus of researchers during the ongoing coronavirus pandemic is to come up with suggestions to handle this problem through rapid and efficient solutions. In this paper, we propose a reliable method based on discard masked region and deep learning-based features in order to address the problem of the masked face recognition process. The first step is to discard the masked face region. Next, we apply pre-trained deep Convolutional neural networks (CNN) to extract the best features from the obtained regions (mostly eyes and forehead regions). Finally, the Bag-of-features paradigm is applied on the feature maps of the last convolutional layer in order to quantize them and to get a slight representation comparing to the fully connected layer of classical CNN. Finally, Multilayer Perceptron (MLP) is applied for the classification process. Experimental results on Real-World-Masked-Face-Dataset show high recognition performance.
Combination of biomarker with clinical risk factors for prediction of severe acute kidney injury in critically ill patients
Authors: JIA LAN , Sheng Xiaohua , Zamperetti Anna , Xie Yun , Corradi Valentina , Chandel Shikha , De Cal Massimo , Montin Diego Pomarè , Caprara Carlotta , Ronco Claudio
Published: December 2020

Background: Acute kidney injury (AKI) occurs commonly in the intensive care unit (ICU). Insulin-like growth factor-binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinase-2 (TIMP-2), known as [TIMP-2] x [IGFBP7] (NephroCheck), have been identified as novel biomarkers for the prediction of AKI risk. However, the effective use of disease biomarkers is indispensable from an appropriate clinical context. We conducted a retrospective cohort study to find risk factors and assess the performance of the combination of NephroCheck with risk factors, so as to provide feasible information for AKI prediction.Methods: All patients who were admitted in the ICU ( from June 2016 to July 2017) participated in the study. The primary outcome was the detection of severe AKI within the first seven days after patients being admitted to the ICU. The predictors were separated into three categories: chronic risk factors, acute risk factors and biochemical indicators. Results: The study included 577 patients. 96 patients developed to severe AKI (16.6%) within seven days. In addition to NephroCheck (+) (OR=2.139, 95% CI (1.260-3.630), P =0.005), age >65 years (OR=1.961, 95% CI (1.153-3.336), P=0.013), CKD (OR=2.573, 95% CI (1.319-5.018), P=0.006) and PCT (+)(OR=3.223, 95% CI (1.643-6.321), P=0.001) were also the independent predictors of severe AKI within seven days. Compared to NephroCheck (+) only (AUC=0.66, 95% CI:0.60-0.72), the combination of NephroCheck (+) and risk factors (age>65years, CKD and PCT positive) (AUC=0.75, 95% CI:0.70-0.81) led to a significant increase in the area under ROC curve for severe AKI prediction within seven days.Conclusions: Although NephroCheck is an effective screening tool for recognizing high-risk patients, we found that combination with biomarker and risk factors (age>65years, CKD, procalcitonin positive) for risk assessment of AKI has the greatest significance to patients with uncertain disease trajectories.
Heart Rate Variability-Derived Features Based on Deep Neural Network for Distinguishing Different Anaesthesia States
Authors: Zhan Jian , Wu Zuo-xi , Duan Zhen-xin , Yang Gui-ying , Du Zhi-yong , Bao Xiao-hang , Li Hong
Published: December 2020

Background: Estimating the depth of anaesthesia (DoA) is critical in modern anaesthetic practice. Multiple DoA monitors based on electroencephalograms (EEGs) have been widely used for DoA monitoring; however, these monitors may be inaccurate under certain conditions. In this work, the hypothesis that heart rate variability (HRV)-derived features based on a deep neural network can distinguish different anaesthesia states was investigated.Methods: A novel method of distinguishing different anaesthesia states was developed based on four HRV-derived time and frequency domain features combined with a deep neural network. Four features were extracted from an electrocardiogram, including the HRV high-frequency power, low-frequency power, high-to-low-frequency power ratio, and sample entropy. Next, these features were used as inputs for the deep neural network, which used the expert assessment of consciousness level as the reference output. Finally, the deep neural network was compared with the logistic regression, support vector machine, and decision tree models. The datasets of 23 anaesthesia patients were used to assess the proposed method.Results: The accuracies of the four models, in distinguishing the anaesthesia states, were 86.2% (logistic regression), 87.5% (support vector machine), 87.2% (decision tree), and 90.1% (deep neural network). The accuracy of deep neural network was higher than those of the logistic regression (p < 0.05), support vector machine (p < 0.05), and decision tree (p < 0.05) approaches. Our method outperformed the logistic regression, support vector machine, and decision tree methods.Conclusions: The incorporation of four HRV-derived time and frequency domain features and a deep neural network could accurately distinguish between different anaesthesia states; however, this study is a pilot of a feasibility study, providing a method to supplement DoA monitoring based on EEG features to improve the accuracy of DoA estimation.
Accuracy of self-perceived risk perception of breast cancer development in Iranian women
Authors: Hajian-Tilaki Karimollah , Nikpour Maryam
Published: December 2020

Backgrand: The accuracy of subjective risk perception is a
matter of concern in breast cancer development. The objective of
this study was to evaluate the accuracy of self-perceived risk
assessment compared to actual risk.

Methods: The demographic, clinical, and reproductive
characteristics of 800 women aged 35-85 years were collected with
an in-person interview. The self-perceived risk was assessed using
the visual analog scale (VAS) and the actual risk was calculated
from the Gail model. Gail’s cutoff of 1.66% risk was used to
categorize the estimated 5-year actual risk as low/average risk
(<1.66%) and high risk (≥1.66). In low/average risk, if the
self-perceived risk> actual risk, then individuals were
categorized as overestimating. Similarly, in high-risk women, if
the perceived risk<actual risk, then, the subjects were labeled
as under-estimate; otherwise, it was labeled as accurate. The Kappa
statistics were used to determine the agreement between
self-perceived risk and actual risk. ROC analysis was applied to
determine the accuracy of self-perceived risk in the prediction of
actual risk.

Results: The perceived risk was significantly higher than
actual risk (p=0.001, 0.01 for 5-year and lifetime risk
respectively). Both in low and high-risk groups about half of the
women over-estimate and underestimate the risk by subjective risk
perception. For a 5-year risk assessment, there was no agreement at
all between perceived risk and actual risk (Kappa=0.00, p=0.98) but
a very low agreement between them in lifetime risk assessment
(Kappa=0.09, p=0.005). The performance of accuracy of risk
perception versus actual risk was very low (AUC=0.53, 95%CI:
0.44-0.61 and AUC=0.58, 95%CI: 0.54-0.62 for the 5- year risk and
lifetime risk respectively).

Conclusion: The clinical performance of risk perception based
on VAS is very poor. Thus, the efforts of the public health
education program should focus on the correct perception of breast
cancer risk among Iranian women.
Increased P450 aromatase levels in post-menopausal women after acute ischemic stroke
Authors: Manwani Bharti , Fall Pamela , Zhu Liang , O’Reilly Meaghan Roy , Conway Sarah , Staff Ilene , McCullough Louise D.
Published: December 2020

Background: Sex differences in stroke have been attributed to the neuroprotective effects of estrogen, yet most clinical trials of estrogen supplementation for stroke prevention have failed. The contribution of sex hormones to stroke outcome remains a subject of debate. Aromatization of testosterone to estradiol in neural tissue leads to sexual differentiation. Emerging data suggests aromatase activity increases in response to brain injury, and increased aromatase expression is seen in the ischemic penumbra in animal models. The objective of this study was to examine the levels of endogenous sex steroids after acute ischemic stroke and determine if levels of sex steroids were associated with acute stroke outcomes. Methods: Peripheral blood from ischemic stroke patients and controls was collected under an approved IRB within 24 hours of symptom onset. 17-β estradiol, testosterone and aromatase levels were measured in the serum of both men and women using ELISA. Hormone levels were compared in men vs. women in stroke and control groups and correlated with outcomes (NIHSS and change in the modified Rankin Scale (mRS), defined as difference of premorbid and discharge mRS) using multivariate regression. Results: We found no significant change in estradiol levels 24 hours after stroke in men (p=0.86) or women (p=0.10). In men, testosterone significantly decreased after stroke as compared with controls (1.83±0.12 vs 2.86±0.65, p=0.01). Aromatase levels were significantly higher in women after stroke as compared with controls (2.27±0.22 vs 0.97±0.22, p=0.002), but not in men (p=0.84). Estradiol levels positively correlated with change in mRS in both women (r=0.38, p=0.02) and men (r=0.3, p=0.04).Conclusions: Estradiol levels correlated with functional outcomes (change in mRS) in both men and women, at least in the acute phase (24 hours) of stroke. However, no significant change in estradiol levels is seen 24 hours post stroke in men or women. Testosterone levels decrease at 24 hours after stroke in men. As seen in animal models, aromatase levels increase after acute ischemic stroke, but this was only true for women. These indicate an active aromatization process in post-menopausal women after acute ischemic stroke.
Comparison of Risk Allele Frequencies of Single Nucleotide Polymorphisms Associated With Age-Related Macular Degeneration in Different Ethnic Groups
Authors: Shin Hyun-Tae , Yoon Byung Woo , SEO JEHYUN
Published: December 2020

Background: The prevalence of age-related macular degeneration (AMD) varies from 6.8% to 18.3% for all forms of AMD and from 0.6% to 2.6% for late AMD according to race, suggesting the existence of genetic differences among races. The purpose of this study was to determine the genetic causes of differences in the prevalence of AMD among individuals of different races.Methods: We collected 138 AMD-associated single nucleotide polymorphisms (SNPs) from a genome-wide association studies catalog. Their population-level allele frequencies were derived based on the 1000 Genomes Project and Korean Reference Genome Database. We used Fisher’s exact tests to assess whether the effect allele at a given SNP was significantly enriched or depleted in the database.Results: European, American, and South Asian populations showed similar heatmap patterns, whereas East Asian, and Korean populations had distinct patterns. Korean populations exhibited patterns that were different from those of the other groups; rs5754227 (SYN3), rs1626340 (TGFBR1/COL15A1), rs3750846(ARMS2/HTRA1), and rs9564692 (B3GALTL) were enriched, whereas rs2230199 (C3) and rs73036519 (EXOC3L2/MARK4) were depleted in Koreans; these SNPs are associated with late AMD. The genetic risk score calculated from allele frequencies was not less in East Asians than in Europeans.Conclusion: The prevalence of AMD is lower in Asians than in Europeans. However, our study showed that genetic risk scores in East Asians were similar to those in Europeans, which may explain why the global projected number of people with AMD by 2040 is in largest for East Asians, including Koreans.
Social Justice in Health System; a Neglected Component of Academic Nursing Education: A Qualitative Study
Authors: Habibzadeh Hosein , Jasemi Madineh , Hosseinzadegan Fariba
Published: December 2020

Background: In recent decades, increasing social and health inequalities all over the world has highlighted the importance of social justice as a core nursing value. Therefore, proper education of nursing students is necessary for preparing them to comply with social justice in health systems. This study is aimed to identify the main factors for teaching the concept of social justice in the nursing curriculum.Method: This is a qualitative study, in which the conventional content analysis approach was employed to analyze a sample of 13 participants selected using purposive sampling method. Semi-structured interviews were conducted to collect and analyze the data.Results: Analysis of the interviews indicated that insufficient education content, incompetency of educators, and inappropriate education approaches made social justice a neglected component in the academic nursing education. These factors were the main sub-categories of the study and showed the negligence of social justice in academic nursing education.Conclusion: Research findings revealed the weaknesses in teaching the concept of social justice in the nursing education. Accordingly, it is necessary to modify the content of nursing curriculum and education approaches in order to convey this core value. Since nursing educators act as role models for students, especially in practical and ethical areas, more attention should be paid to competency of nursing educators, specially training in the area of ethical ideology and social justice.
Effect of corneal refractive surgery on accommodative and binocular dysfunctions among civilian pilots in Southwest China
Authors: Wu Ye , Zhang Zhen , Liao Meng , Li Qi , Tang XueLin , Liu Longqian
Published: December 2020

Background: To analyze whether corneal refractive surgery (CRS) is associated with the distribution of different accommodative dysfunctions (ADs) and binocular dysfunctions (BDs) in civilian pilots. A further aim was to analyze the percentages and visual symptoms associated with ADs and/or BDs in this population.Methods: One hundred and eight civilian pilots who underwent CRS from January 2001 to July 2012 (age: 30.33±4.60 years) were enrolled, the mean preoperative SE was −1.51±1.15 D (range: −1.00- −5.00 D). Ninety-nine emmetropic civilian pilots (age: 29.64±3.77 years) who were age- and sex-matched to the CRS group were also enrolled. Refractive status, accommodative and binocular tests of each subject were performed. Visually related symptoms were quantified using the 19-item College of Optometrists in Vision Development Quality of Life (COVD-QOL) questionnaire. The 19 items were summed to obtain visual symptom scores that might indicate visual dysfunctions. The chi-square test was used to analyze differences in percentages of ADs and/or BDs between the CRS and emmetropic groups. The Mann-Whitney U test was used to compare visual symptom scores between pilots with ADs and/or BDs and pilots with normal binocular vision.Results: No significant difference was observed between the CRS and emmetropic groups in the overall prevalence of ADs and BDs (15.7% and 15.2% in the CRS and emmetropic groups, respectively; P=0.185). ADs were present in 4.63% and 3.03% of the CRS and emmetropic group, respectively. BDs were observed in 11.1% and 12.1% of the CRS and emmetropic group, respectively, yielding no significant differences between the groups in the prevalence of ADs or BDs (AD: P=0.094; BD: P=0.105). Pilots with ADs and/or BDs had significantly more visual symptoms than pilots with normal binocular vision (p < 0.001). Conclusions: CRS for civilian pilots with low-moderate myopia might not impact binocular functions. ADs and/or BDs commonly occur in both emmetropia pilots and pilots who undergo CRS, and pilots with ADs and/or BDs are associated with increased symptoms. This study confirms the importance of a full assessment of binocular visual functions in detecting and remedying these dysfunctions in this specific population.
Clinical utility of liquid biopsy for EGFR driver, T790M mutation and EGFR amplification in plasma in patients with acquired resistance to afatinib
Authors: Oya Yuko , Yoshida Tatsuya , Asada Kazuhiro , Oguri Tetsuya , Inui Naoki , Morikawa Sayako , Ito Kentaro , Kimura Tomoki , Kunii Eiji , Matsui Takashi , Kubo Akihito , Kato Tatsuo , Abe Takashi , Tsuda Takeshi , Hida Toyoaki
Published: December 2020

Background: Cell-free DNA (cfDNA) genotyping in plasma using the cobas EGFR Mutation Test v2 (cobas) is the first liquid biopsy as a companion diagnosis to identify the EGFR T790M mutation (T790M) after the failure of treatment of EGFR-tyrosine kinase inhibitors (TKIs) (1st generation, gefitinib [G] and erlotinib [E] and 2nd generation, afatinib [A]). This study investigated the clinical utility of a liquid biopsy for patients who acquired resistance to afatinib.Methods: We prospectively collected plasma from 51 patients who had acquired resistance to afatinib between April 2015 and November 2016 to evaluate the frequency of T790M by cobas and digital droplet PCR (UMIN000025112). Additionally, we retrospectively reviewed 38 patients who tested by cobas in plasma after G/E failure to compare for T790M detection between A and with G/E.Results: The detection rate of EGFR-driver and T790M in plasma in patients treated with A (A group) as a first-line EGFR-TKI was lower than with G/E followed by A (G/E→A group), although the differences were not significant (EGFR-driver: 41% [A] vs. 67% [G/E→A], P=0.1867; and T790M: 8% [A] vs. 17% [G/E→A], P=0.5798). In first-line setting, the detection rate for EGFR-driver and T790M in plasma by cobas was lower in A group than in G/E group, although there was no significant difference (EGFR-driver: 34% [A] vs. 52% [G/E], P=0.2072; and T790M: 10% [A] vs. 27% [G/E], P=0.1161).Conclusion: The detection of EGFR-driver and T790M in plasma by cobas in patients treated with afatinib might be lower than with G/E in a real-world setting.
Impact of simulation-based teamwork training on COVID-19 distress in healthcare professionals
Authors: Beneria Anna , Arnedo Mireia , Contreras Sofia , Pérez-Carrasco Marcos , Garcia-Ruiz Itziar , Rodríguez-Carballeira Mónica , Raduà Joaquim , Bañeras Jordi
Published: December 2020

Context Non-technical skills such as leadership, communication, or situation awareness should lead to effective teamwork in a crisis. This study aimed to analyse the role of these skills in the emotional response of health professionals to the COVID-19 pandemic.Methods Before the COVID-19 outbreak, 48 doctors and 48 nurses participated in a simulation-based teamwork training program based on teaching non-technical skills through simulation. In May 2020, this group of professionals from a COVID-19 referral hospital was invited to participate in a survey exploring stress, anxiety, and depression, using the PSS-14 (Perceived Stress Scale) and the HADS (Hospital Anxiety and Depression Scale) measures. A control group that did not receive the training was included. We conducted a logistic regression to assess whether having attended a simulation-based teamwork training program modified the probability of presenting psychological distress (PSS-14>18 or HADS>12).Results A total of 141 healthcare professionals were included, 77 in the intervention group and 64 in the control group. Based on the PSS-14, 70.1% of the intervention group and 75% of the control group (p=0.342) had symptoms of stress. Having contact with COVID-19 patients [OR 4.16(1.64–10.52)]; having minors in charge [OR 2.75 (1.15–6.53)]; working as a doctor [0.39(0.16 – 0.95)], and being a woman [OR 2.94(1.09–7.91)] were related with PSS14 symptoms. Based on the HADS, 54.6% of the intervention group and 42.2% of the control group (p=0.346) had symptoms of anxiety or depression. Having contact with COVID-19 patients [OR 2.17(1.05 – 4.48)] and having minors in charge [OR 2.14(1.06 – 4.32)] were related to HADS symptoms. Healthcare professionals who attended COVID-19 patients showed higher levels of anxiety and depression [OR 2.56(1.03 – 6.36) (p=0.043)].Conclusion Healthcare professionals trained in non-technical skills through simulation tended towards higher levels of anxiety and depression and fewer levels of stress, during the COVID-19 pandemic.
4P Model for Dynamic Prediction of the Covid-19: A Statistical and Machine Learning Approach
Authors: Hasan Khandaker Tabin , Rahman Mohammed Mostafizur , Ahmmed Md. Mortuza , Chowdhury Anjir Ahmed , Islam Mohammad Khairul
Published: December 2020

Introduction: Around the world, scientists are racing hard to understand how Covid-19 epidemic is spreading and growing, thus trying to find ways to prevent it before medications come to pass. Many different models have been proposed so far correlating different factors. Some of them are too localized to indicate a general trend of the pandemic while some others have established transient correlations only.Methods: Hence, in this study, a 4P model has been proposed based on four probabilities (4P) which has been found to be true for all affected countries taking Bangladesh as a case. Efficiency scores have been estimated from survey analysis not only for governing authorities on managing the situation (P(G)) but also for the compliance of the citizens ((P(P)). Since the immune responses of all the people are not uniform to a specific pathogen, the probability of a person getting infected ((P(I)) after being exposed has also been estimated. And the vital one is the probability of Test Positivity ((P(T)) which is a strong indicator of how effectively the infected people are diagnosed and isolated from the rest of the group that affects the rate of growth.Results and Conclusion: All the four parameters have been fitted in a non-linear exponential model that partly updates itself periodically with everyday facts. Along with the model, all the four probabilistic parameters are engaged to train a recurrent neural network using Long-Short Term Memory neural network and the followed trial confirmed a ruling functionality of the 4Ps.
Social Listening – Revealing Parkinson’s Disease over Day and Night
Authors: Zhang Hui , Meng Fanwen , Li Xingyu , Ning Yali , Cai Meng
Published: December 2020

Background: Nocturnal symptoms in Parkinson’s disease are often treated after management of daytime manifestations. In order to better understand the unmet needs of nocturnal symptoms management, we analyzed the characteristics and burden of nocturnal symptoms from patients’ perspectives and explored their changes over time. Overall symptoms (occurring at day or night) were collected to compare whether the unmet needs related to nocturnal symptoms and to overall symptoms are different. Methods: We used a Social Listening big-data technique to analyze large amounts of Parkinson’s disease symptoms in dialogues available from social media platforms in 2016 to 2018. These symptoms were classified as either overall symptoms or nocturnal symptoms. We used share of voice (SOV) of symptoms as a proportion of total dialogues per year to reflect the characteristics of symptoms. Negative sentiment score of symptoms was analyzed to find out their related burden. Results: We found the SOV for overall motor symptoms was 79% and had not increased between 2016 and 2018 (79%, p = 0.5). The SOV for non-motor symptoms was 69% and had grown by 7% in 2018 (p < 0.01). The SOV for motor complications was 9% and had increased by 6% in 2018 (p < 0.01). The SOV of motor symptoms was larger than non-motor symptoms and motor complications (p < 0.01). The SOV of non-motor symptoms was larger than motor complications (p < 0.01). For nocturnal symptoms, 45% of the analyzed PD population reported nocturnal symptoms in 2018, growing by 6% (p < 0.01). The SOV for nocturnal-occurring motor symptoms was higher than most non-motor symptoms. However, non-motor symptoms had the higher increases and evoked higher negative sentiment regardless of whether they occurred during the day or night. For symptoms that can occur at either day or night, each nocturnal symptom was rated with a higher negative sentiment score than the same symptom during the day. Conclusions: The growing SOV and the greater negative sentiment of nocturnal symptoms suggest management of nocturnal symptoms is an unmet need of patients. A greater emphasis on detecting and treating nocturnal symptoms with 24-hour care is encouraged.
Clinical Impact of an Analytic Tool for Predicting the Fall Risk in Inpatients: Controlled Interrupted Time Series
Authors: Cho Insook , Jin Insun , Park Hyunchul , Dykes Patricia C.
Published: December 2020

Background: Patient falls remain a common cause of harm in acute-care hospitals worldwide. Despite the availability of a considerable body of literature on risk factors of inpatient falls, it is a difficult, complex, and common problem requiring a great deal of nurses’ time, attention, and effort in practice. With recent rapid expansion of health care predictive analytic application along with growing availability of electronic health record data, a patient-level electronic analytic tool for predicting fall risk was developed.Objectives: The purpose of this study was to explore how an electronic analytics tool for predicting fall risk affect patient and process outcomes. Methods: A controlled interrupted time series (CITS) experiment was conducted in 12 medical-surgical nursing units at a public hospital between May 2017 and April 2019. The intervention was the provision of patient-level risk predictions generated by an analytic tool using routinely obtained from the hospital’s electronic health record system. The primary outcome was the fall rate, and secondary outcomes included fall-related injuries and predefined process indicators. Results: During the study there were 42,476 admissions, while 707 falls and 134 fall injuries occurred. Allowing for differences in the patients’ characteristics and baseline process outcomes, the fall rate was significantly low in the intervention group (1.79 vs. 2.11, t = 2.13, P = .038). The CITS analysis revealed that the immediate reduction was 29.73% in the intervention group (z = –2.06, P = .039) and 16.58% in the control group (z = –1.28, P = .200), but no ongoing effect. The injury rates did not differ significantly (0.42 vs. 0.31, t = –1.54, P = .131). Patient-level-adjusted logistic regression showed a significant group effect on falls. Process outcomes related to multifactorial interventions including risk-targeted interventions increased significantly in the intervention group over time.Conclusion: The effectiveness of IN@SIGHT was supported only by the before-after comparison. However, it demonstrated the potential to contribute to improvement of patient outcomes, leading to positive changes in process outcomes over time. Further research is needed for this new approach.
Pathological Responses to Low-Dose Irradiation and Pepleomycin in Oral Squamous Cell Carcinoma are Predictive of Locoregional Control
Authors: Katagiri Tomohiro , Ohyama Yoshio , Miyamoto Hideo , Egawa Yuki , Moriki Toshiaki , Hasegawa Kazuki
Published: December 2020

Background The prognosis of advanced oral cancer remains dismal. While multimodal therapy is beneficial, maintaining the quality of life of long-term survivors is important. Therefore, risk-adapted treatment regimens need to be designed. We herein investigated whether pathological responses in oral cancer patients treated with preoperative chemoradiotherapy predict locoregional recurrence.Methods We retrospectively reviewed the data of 51 oral cancer patients who received preoperative radiotherapy and concurrent pepleomycin, followed by curative surgery at our institution between January 2009 and June 2018. Each patient received preoperative external beam irradiation to the primary tumor and lymphatics (2 Gy per day for approximately 3 weeks) concurrent with pepleomycin (2.5 mg/day). Surgery was performed approximately 3-4 weeks after the completion of preoperative chemoradiotherapy. Pathological responses were defined based on the grading system of Oboshi and Shimosato.Results Eight, 22, 16, and 5 patients had Oboshi and Shimosato grades 2a, 2b, 3, and 4, respectively. Favorable pathological responses (grades 3 and 4) were observed in 41.2% of patients (21 out of 51 patients). The pathological response and number of pathological lymph node metastases were identified as signiﬁcant prognostic factors for locoregional control in the univariate analysis. Three-year locoregional control rates were 100% and 56.6% in patients with favorable and unfavorable pathological responses, respectively.Conclusions The present study demonstrated that pathological tumor responses to preoperative chemoradiotherapy are a useful predictive factor for locoregional control.
Ovarian fibrosarcoma: A single-institution experience and a review of the literature
Authors: Sun Tingting , Cheng Ning-Hai , Cao Dong-Yan , Peng Peng
Published: December 2020

Ovarian fibrosarcoma is an extremely rare and malignant sex cord-stromal tumor. Due to its low incidence and poor prognosis, until now, very few cases have been reported, and most of the reported cases have been sporadic. Therefore, the treatments and prognostic factors of ovarian fibrosarcoma are still debatable. Here, we report 5 cases of ovarian fibrosarcoma that presented at Peking Union Medical College Hospital over the past 20 years. The 5 patients were 41, 51, 54, 76, and 76 years of age when initial symptoms of pelvic mass or pain appeared. On ultrasound, this disease usually manifests as unilateral pelvic masses, within which uneven echo enhancement and some blood flow signals are observed. No significant increase was observed in the levels of preoperative tumor markers, such as serum CA125 and sex hormones. The final diagnosis depends on postoperative histopathological results since these tumors are easily misdiagnosed when intraoperative frozen sections are used for examination. Pathologic examinations showed that the tumor cells were spindle-shaped with moderate to severe atypia and high mitotic counts. The immunohistochemistry profile is not specific, but the positive rate of Ki-67 was consistent with the degree of malignancy and the prognosis of patients with this tumor. In addition, the tumor may also be positive for Vimentin, α-inhibin, SMA, estrogen receptor and progesterone receptor. Significant differences were observed in the surgical methods used, and no unified chemotherapy regimen has been established. The overall survival was >15, >7, >6, <1, and <1 year for each patient. After reviewing the literature, evidence-based large-scale case studies were lacking. For treatments, complete cytoreductive surgery plus regimens typically used against malignant sex cord-stromal tumors, as described in the NCCN guidelines, are recommended. Due to its low incidence, both multicenter clinical studies and molecular studies are required to provide gynecologists with a better understanding and guidance for future management of patients with ovarian fibrosarcoma.
Disaster Safety Assessment in Primary Healthcare Facilities: A Cross-Sectional Study, Kurdistan, Iran
Authors: Yari Arezoo , Zarezadeh Yadolah , Fatemi Farin , Ardalan Ali , Vahedi Siamak , Khoshsabeghe Homa Yousefi- , Boubakran Mohsen Soufi , Bidarpoor Farzam , Motlagh Mohamad Esmaeil
Published: December 2020

Primary Healthcare facilities in Iran deliver health services at all levels nationwide. Resiliency and flexibility of such facilities is important when a disaster occurs. Thus, evaluating functional, structural, and non-structural aspects of safety of these facilities is essential. In this cross-sectional study, using the safety evaluation checklist of primary healthcare centers provided by the Ministry of Health and Medical Education, 805 health centers in Kurdistan Province were evaluated in terms of functional, structural, and non-structural safety. The levels of total, functional, structural, and non-structural safety were equal to 28.7, 23.8, 20.2, and 42.3 out of 100 respectively. Regarding the functional preparedness, the highest score was related to rapid response team, while the lowest score was belonged to financial affairs. Nevertheless, in structural and non-structural areas, the scores of different items were almost similar to one another. Both Iran and Kurdistan Province are disaster-prone areas. This study concluded that the safety score of primary healthcare facilities in total was unsatisfactory. Thus, promoting preparedness, resilience and continuity of service delivery is essential during disasters and emergencies. The finding of this study could be beneficial for national and provincial decision-makers and policymakers in this regard