bluuebunny/crossref_metadata_2025 huggingface dataset:
Disparities in Rates of Fusions in Lumbar Disc Pathologies
Authors: Kim Soobin , Ryoo James S. , Ostrov Philip B. , Reddy Abhinav K. , Behbahani Mandana , Mehta Ankit I.
Published: September 2020

Study Design:

Retrospective cohort study.

Objective:

To identify disparities in surgical decision making for lumbar disc pathologies based on patient demographics, hospital characteristics, and temporal characteristics of admission.

Methods:

A retrospective analysis of patients admitted for surgical intervention of disc herniation or degeneration was performed to observe the effect of demographic, hospital, and admission-related factors on the decision to perform an isolated decompression or decompression with single level fusion using the National Inpatient Sample.

Results:

Of 84 953 patients with lumbar disc pathologies, 69 975 patients were treated electively, and 14 978 patients were treated nonelectively. Hispanic and Asian/Pacific Islander patients were less likely to receive a fusion for elective cases compared with White patients (odds ratio [OR] 0.88, P = .004; OR 0.70, P < .001, respectively). In elective cases, privately insured and self-paying patients were less likely to receive a fusion compared with Medicare patients (OR 0.83, P < .001; OR 0.66, P < .001, respectively), while this effect was limited to self-pay patients in nonelective cases (OR 0.44, P < .001). Urban teaching and nonteaching hospitals were less likely to perform fusions compared with rural hospitals in nonelective cases (OR 0.47, P < .001; OR 0.58, P < .001, respectively). Private for-profit hospitals were associated with higher rates of fusion in both elective and nonelective cases (OR 1.16, P = .003; OR 1.94, P < .001).

Conclusion:

This study illustrates disparities in the modality of surgical intervention for lumbar disc pathologies in terms of demographics, hospital characteristics, and temporal characteristics of admission. The development of more evidence-based guidelines is warranted to reduce variability seen in treatment regimens for these conditions.
Challenges in Managing Acute Myocardial Infarction Associated With Infective Endocarditis: A Case Report
Authors: Faluk Mohammed Ali , Vuu Steven , Kathi Kiran , Abdelmaseih Ramy , Cignoni Christian , Tarasiuk-Rusek Aneta , Prashad Rakesh , Osian Omeni
Published: September 2020

Acute myocardial infarction (AMI) is a rare but recognized and potentially serious complication of infective endocarditis (IE). This case describes the challenges surrounding the management of AMI in the setting of septic coronary embolism, brain, spleen, and kidney infarcts due to septic emboli from native mitral valve IE.
Ergonomic Design is the Best Weapon to Reduce Risk
Authors: Cox Kate
Published: September 2020

“Do it by Design” written by Dick Sawyer and the CDRH work group is a premiere reference and introduction to human factors in medical devices published by HHS, FDA CDRH. In this publication, the relationship of device design to safe and effective use is described and then built upon in subsequent key industry standards such as ANSI/AAMI HE 75. Yet the importance of completing good design and considering all the possible usability aspects continues to be overlooked or under-represented in the design process.

Information for safety is required to be provided to medical device users (MDR 2017, FDA 21 CFR 801). However, risk mitigations in the form of training, labeling and instructions for use (IFU) are required to be used as a last resort, avoided or used sparingly (MDR 2017 and ISO 14971). Instead devices should be inherently safe by design and construction as well as implement adequate protection measures, such as alarms, for those risks that cannot be eliminated.

As often observed in usability studies, users disregard labeling and instructional information or do not even realize it is provided to them. In cases where information for safety is the risk control method, can it be considered effective in reducing risk and should they be acceptable to medical device manufacturers? This article discusses rules of thumb in good product design that limit or eliminate the reliance on instructions and when that’s not possible, the rules of design for instructional materials that provide solid support for users.
Healthcare and Aviation: Perspectives on Alerts, Machine Learning, and Future Directions
Authors: Hansen Christopher J. , DiCostanzo Dominic , Mumaw Randall J. , Patterson Emily S.
Published: September 2020

The fields of healthcare and aviation can learn from one another about alerts and their potential for effective application through predictive analytics. We conducted a series of interactive discussions between an expert in alerts in aviation cockpits and graduate students specializing in the application of machine learning in healthcare, and particularly with respect to image analysis. We present our findings regarding insights for healthcare on alerts and for aviation on machine learning. Our findings suggest that ‘opening up the black box’ is important for highly skilled pilots to be able to process recommendations from complex algorithms in aviation, and that considering whether an alert or alarm is ‘actionable’ is important when directing the attention of nurses caring for more than one patient at a time in a hospital environment.
An Analysis of FDA Adverse Event Reporting Data for Trends in Medical Device Use Error
Authors: Knisely Benjamin M. , Levine Camille , Kharod Kush C. , Vaughn-Cooke Monifa
Published: September 2020

Humans can contribute to error at all stages of the medical device product life-cycle. Use error associated with medical devices can result in catastrophic consequences for end users and inefficient use of healthcare system resources. Industry-wide statistics about medical device use error has the potential to aid in identifying opportunities for human factors intervention, however publicly available statistics are sparse. The Food and Drug Administration (FDA) requires medical device manufactures, importers, and device user facilities to track and report adverse events for post-market surveillance through medical device reports (MDRs). This data is available in an online database: Manufacturer and User Facility Experience (MAUDE). This study provides a comprehensive evaluation of use error adverse events in MAUDE (2010-2018) based on device class, device operator, and event outcome, to address the lack of industry-wide statistics on medical device use error. Results indicate that use error is significantly represented in adverse event reporting, constituting 28.1% of reports labeled with device problem codes. Events associated with patient device operators were predominately associated with diabetes-related medical devices, while provider operators were associated with a wider array of devices. Additionally, it was found that most use error reports were attributed to issues with device output; using the device in accordance with manufacturer expectations; and physically activating, positioning, or separating device components. This work demonstrates the viability of using MAUDE to attain industry wide statistics on medical device use error for later integration in industry-wide or device-specific risk mitigation strategies.
A Macroergonomic Study of Hospice and Life-Prolonging Treatment in the UK
Authors: Rantanen Petra A.
Published: September 2020

This research explored how people attribute meanings to care in a hospice and life-prolonging treatment and in what ways these two types of care can coexist in the British hospice model. The objectives of this research were to understand the commonality of life-prolonging treatment in conjunction with care in a hospice in the UK and patient awareness of this possibility; to understand patient decisions to receive or not receive care in a hospice and to receive or not receive life-prolonging treatment; and to understand physician decision-making when recommending a hospice and/or life-prolonging treatment to a patient. In-depth semi-structured interviews were conducted with seventeen palliative care physicians working in hospices or hospitals and oncologists in the London area. The results indicate that negative meanings attached to hospice by patients, the general public, and physicians are prevalent; that improved communication between hospice physicians, palliative care physicians, and treating physicians is necessary to decrease these meanings; that patient attitudes often shift positively once a patient is receiving care in a hospice; that patients may choose to opt out of life-prolonging treatment once they are in hospice for a variety of reasons; and that opting out may lead to further shifts in attitude. This research has implications for policies surrounding hospice care in both the UK and the United States.
The Need for Machine Fitness Assessment: Enabling Joint Human-Machine Performance in Consumer Health Technologies
Authors: Rayo Michael F. , Fitzgerald Morgan C. , Gifford Ryan C. , Morey Dane A. , Reynolds Morgan E. , D’Annolfo Kassidy , Jefferies Christine M.
Published: September 2020

We introduce the concept of machine fitness assessment, which is the process of correctly determining the degree of fit between a machine’s inferences on a specific world and the world itself. We describe its importance in complex, high-stakes worlds, including healthcare, and how it will be critically important to realize the potential of consumer health technologies that promise institutional-quality health diagnosis and planning in decidedly non-institutional settings (e.g., our homes, offices, or anywhere else).
Who is in Charge Here? Negotiating Fluid Leadership and Team Protocols in a Hybrid Cardiac Operating Room
Authors: Watterworth Anna , Clarke Barbara , MacLean Greg , Chetcuti Stanley J. , Rooney Deborah M. , Seagull F Jacob
Published: September 2020

When an unexpected event occurs in a hybrid cardiac operating room, a minimally invasive heart surgery may need to be transitioned to open-heart surgery emergently. In such cases, an interspecialty team must dynamically shift roles quickly and seamlessly, without compromising patient safety. During this transition, appropriate response can be delayed because there are multiple teams carrying out critical, urgent, interdependent tasks. This paper describes human-factors efforts that employed task analysis, cognitive in-situ walk-throughs, and in-situ simulation to develop operational protocols to address the high-risk event. This series of interventions helped to create safe, effective protocols for seamless transition of leadership in this complex procedure.
Practical Optimal Scheduling for Surgery
Authors: Allen Theodore T. , Hernandez Olivia K. , Roychowdhury Sayak , Patterson Emily S.
Published: September 2020

There is a great need for creating schedules that are optimized. Yet, some individuals have had less than desirable experiences with “optimal” scheduling. This could have been due to prioritization of the wrong criteria, leading to schedules that did not make practical sense, or that were math-intensive and were not able to be easily interpreted. Also, there are many types of optimization problem formulations and solution methods. Here, we divide the formulations into two major types: batched and online scheduling classes are discussed. A different technique has been created that allows schedules to be made that are not only optimal, based on the formulations or framing, but that are actually useful. Here, we discuss two types of methods, one batched called Genetic Algorithms with an Earliest Due Date encoding Method (GAGEDD) and the other online called Markov Decision Processes and Reinforcement Learning extensions. These methods are already being employed to create practical and optimal schedules that can include many different constraints and are able to instantly take into account new scheduling requests and take optimal actions regardless of what state the system is currently in. Especially with current world events (COVID-19), it is important to intelligently schedule patients.
Evaluation of medication adherence and predictors of sub-optimal adherence among pre-dialysis patients with chronic kidney disease
Authors: Okoro Roland Nnaemeka , Ummate Ibrahim , Ohieku John David , Yakubu Sani Ibn , Adibe Maxwell Ogochukwu , Okonta Mathew Jegbefume
Published: September 2020

Background:

Multiple medications are required to effectively manage chronic kidney disease (CKD) and associated complications, posing the risk of poor medication adherence.

Objectives:

To measure medication adherence levels and to investigate the potential predictors of sub-optimal medication adherence in pre-dialysis patients with CKD.

Methods:

A prospective study was conducted in the medical and nephrology outpatients’ clinics in Maiduguri. Non-dialysis patients with CKD stages 1–4 aged 18 years and above were recruited through their physicians. The level of medication adherence was determined using Morisky Medication Adherence Scale. Descriptive statistics were used to summarize patients’ background characteristics. Multivariate binary logistic regression analyses were performed to investigate the significantly potential predictors of sub-optimal medication adherence at a p < 0.05.

Results:

There were 107 participants (48.6%) who had high medication adherence, while 97 (44.1%), and 16 (7.3%) of them had moderate adherence, and low adherence, respectively. The univariate analysis revealed that medication adherence level differed significantly with the number of medications taken daily by patients ( p < 0.05). Multivariate logistic regression analyses did not reveal a significant independent predictor of sub-optimal medication adherence.

Conclusion:

A majority of the participants reported sub-optimal medication adherence. The independent variables considered did not significantly predict sub-optimal medication adherence in the study population. Nevertheless, the study findings highlight the importance of clinical pharmacists’ CKD management supportive care to help improve medication adherence.
Married at Birth: Regulation of Cellular Fat Metabolism by ER–Lipid Droplet Crosstalk
Authors: Cao Zhe , Mak Ho Yi
Published: September 2020

The endoplasmic reticulum (ER) is a hub that coordinates neutral lipid synthesis, storage, and export. To fulfill this role, the ER maintains close contact with lipid droplets (LDs), which are evolutionarily conserved organelles for the storage of neutral lipids. Decades of biochemical evidence points to fatty acid modification and neutral lipid synthesis in the ER. Conceptually, lipid export into extracellular space or lipid retention intracellularly require the subsequent remodeling of an ER membrane leaflet that faces the lumen or cytoplasm, respectively. This is because LDs and very-low-density lipoprotein particles are all structures surrounded by a phospholipid monolayer. While the export of neutral lipids via very-low-density lipoprotein production is well characterized, there has been increasing interest in the mechanisms that underlie neutral lipid retention in LDs. Structural determination, in vitro reconstitution, and localization of key proteins by advanced microscopy techniques collectively enrich models of ER-LD engagement. In this review, we consider current concepts on how LDs emerge from the ER in a directional manner and how sustained ER-LD contacts support LD expansion.
Microstructures and dynamic processes within the five-phase system: regarding COVID-19 as a complex system
Authors: Wang Fengbin , Zhang Xue
Published: September 2020

The research uses the development of COVID-19 in the human body as an example to explore the microstructures and dynamic processes of a concise complex system from the lens of the five-phase system. Based on the structural balance theory and system dynamics, the research finds that transitive triads and cyclic triads in the five-phase system are both imbalanced. The integration of these differentiated triads comprises of a balanced intermediate form in the shape of quadrangular cycles. These cycles serve as microstructures of the five-phase system, due to the inherent balancing feedback mechanism, and support the generation of resultants. The alternation of quadrangular cycles drives the spiraling development of the whole system. By orderly and regular interweaving of signed directed links, the research provides a holistic, process-oriented demonstration for the development processes of COVID-19. It clarifies that the essence of the five-phase system is phase-transition processes with the quadrangular cycle as carrier and supporter, rather than the static aggregation of five elements. The research deepens the understanding of system nonlinearity by visualizing the circular causality and promotes the academic dialogue between the Western process theory and the Chinese inherited notion of the five-phase system.
A preliminary PET radiomics study of brain metastases using a fully automatic segmentation method
Authors: Stefano Alessandro , Comelli Albert , Bravatà Valentina , Barone Stefano , Daskalovski Igor , Savoca Gaetano , Sabini Maria Gabriella , Ippolito Massimo , Russo Giorgio
Published: September 2020

Background

Positron Emission Tomography (PET) is increasingly utilized in radiomics studies for treatment evaluation purposes. Nevertheless, lesion volume identification in PET images is a critical and still challenging step in the process of radiomics, due to the low spatial resolution and high noise level of PET images. Currently, the biological target volume (BTV) is manually contoured by nuclear physicians, with a time expensive and operator-dependent procedure.

This study aims to obtain BTVs from cerebral metastases in patients who underwent L-[11C]methionine (11C-MET) PET, using a fully automatic procedure and to use these BTVs to extract radiomics features to stratify between patients who respond to treatment or not. For these purposes, 31 brain metastases, for predictive evaluation, and 25 ones, for follow-up evaluation after treatment, were delineated using the proposed method. Successively, 11C-MET PET studies and related volumetric segmentations were used to extract 108 features to investigate the potential application of radiomics analysis in patients with brain metastases. A novel statistical system has been implemented for feature reduction and selection, while discriminant analysis was used as a method for feature classification.

Results

For predictive evaluation, 3 features (asphericity, low-intensity run emphasis, and complexity) were able to discriminate between responder and non-responder patients, after feature reduction and selection. Best performance in patient discrimination was obtained using the combination of the three selected features (sensitivity 81.23%, specificity 73.97%, and accuracy 78.27%) compared to the use of all features. Secondly, for follow-up evaluation, 8 features (SUVmean, SULpeak, SUVmin, SULpeakprod-surface-area, SUVmeanprod-sphericity, surface mean SUV 3, SULpeakprod-sphericity, and second angular moment) were selected with optimal performance in discriminant analysis classification (sensitivity 86.28%, specificity 87.75%, and accuracy 86.57%) outperforming the use of all features.

Conclusions

The proposed system is able i) to extract 108 features for each automatically segmented lesion and ii) to select a sub-panel of 11C-MET PET features (3 and 8 in the case of predictive and follow-up evaluation), with valuable association with patient outcome. We believe that our model can be useful to improve treatment response and prognosis evaluation, potentially allowing the personalization of cancer treatment plans.
MAIRA- real-time taxonomic and functional analysis of long reads on a laptop
Authors: Albrecht Benjamin , Bağcı Caner , Huson Daniel H.
Published: September 2020

Background

Advances in mobile sequencing devices and laptop performance make metagenomic sequencing and analysis in the field a technologically feasible prospect. However, metagenomic analysis pipelines are usually designed to run on servers and in the cloud.

Results

MAIRA is a new standalone program for interactive taxonomic and functional analysis of long read metagenomic sequencing data on a laptop, without requiring external resources. The program performs fast, online, genus-level analysis, and on-demand, detailed taxonomic and functional analysis. It uses two levels of frame-shift-aware alignment of DNA reads against protein reference sequences, and then performs detailed analysis using a protein synteny graph.

Conclusions

We envision this software being used by researchers in the field, when access to servers or cloud facilities is difficult, or by individuals that do not routinely access such facilities, such as medical researchers, crop scientists, or teachers.
BITS2019: the sixteenth annual meeting of the Italian society of bioinformatics
Authors: Urso Alfonso , Fiannaca Antonino , La Rosa Massimo , La Paglia Laura , Lo Bosco Giosue’ , Rizzo Riccardo
Published: September 2020

The 16th Annual Meeting of the Bioinformatics Italian Society was held in Palermo, Italy, on June 26-28, 2019. More than 80 scientific contributions were presented, including 4 keynote lectures, 31 oral communications and 49 posters. Also, three workshops were organised before and during the meeting. Full papers from some of the works presented in Palermo were submitted for this Supplement of BMC Bioinformatics. Here, we provide an overview of meeting aims and scope. We also shortly introduce selected papers that have been accepted for publication in this Supplement, for a complete presentation of the outcomes of the meeting.
Detection of mutations in the rpoB gene of rifampicin-resistant Mycobacterium tuberculosis strains inhibiting wild type probe hybridization in the MTBDR plus assay by DNA sequencing directly from clinical specimens
Authors: Sinha Pallavi , Srivastava G. N. , Tripathi Rajneesh , Mishra Mukti Nath , Anupurba Shampa
Published: September 2020

Background

The potential of genetic testing for rapid and accurate diagnosis of drug-resistant Mycobacterium tuberculosis strains is vital for efficient treatment and reduction in dissemination. MTBDR plus assays rapidly detect mutations related to drug resistance and wild type sequences allied with susceptibility. Although these methods are promising, the examination of molecular level performance is essential for improved assay result interpretation and continued diagnostic development. Therefore this study aimed to determine novel mutations that were inhibiting wild type probe hybridization in the Line probe assay by DNA sequencing. Using data collected from Line Probe assay (GenoType MTBDRplus assay) the contribution of absent wild type probe hybridization to the detection of rifampicin resistance was assessed via comparison to a reference standard method i.e. DNA sequencing.

Results

Sequence analysis of the rpoB gene of 47 MTB resistant strains from clinical specimens showed that 37 had a single mutation, 9 had double mutations and one had triple mutations in the ropB gene.

Conclusions

The absence of wild type probe hybridization without mutation probe hybridization was mainly the result of the failure of mutation probe hybridization and the result of the novel or rare mutations. Additional probes are necessary to be included in the Line probe assay to improve the detection of rifampicin-resistant Mycobacterium tuberculosis strains.
Effect of divalent ions on cariogenic biofilm formation
Authors: Steiger Elena Laura , Muelli Julia Rahel , Braissant Olivier , Waltimo Tuomas , Astasov-Frauenhoffer Monika
Published: September 2020

Background

Divalent cations are able to interact with exopolysaccharides (EPS) and thus are capable to modify the structure and composition of dental biofilm. At the moment, little is known about the adsorption of metals by cariogenic EPS; thus, the aim of the present study was to evaluate the effect of divalent ions (calcium, magnesium, and zinc) on the growth and biofilm formation of mutans streptococci and on the dissolution of hydroxyapatite as well as to investigate their binding to the bacterial EPS.

Results

S. mutans strains used in this study show the highest tolerance towards calcium of the ions tested. Growth parameters showed no differences to control condition for both strains up to 100 mM; revealing natural tolerance to higher concentration of calcium in the surroundings. Although excessive levels of calcium did not impair the growth parameters, it also did not have a positive effect on biofilm formation or its binding affinity to EPS. Magnesium-saturated environment proved to be counterproductive as strains were able to dissolve more Ca2+ from the tooth surface in the presence of magnesium, therefore releasing excessive amounts of Ca2+ in the environment and leading to the progression of the disease. Thus, this supports the idea of self-regulation, when more Ca2+ is released, more calcium is bound to the biofilm strengthening its structure and however, also less is left for remineralization. Zinc inhibited bacterial adhesion already at low concentrations and had a strong antibacterial effect on the strains as well as on calcium dissolution; leading to less biofilm and less EPS. Additionally, Zn2+ had almost always the lowest affinity to all EPS; thus, the unbound zinc could also still remain in the surrounding environment and keep its antimicrobial properties.

Conclusion

It is important to maintain a stable relationship between calcium, magnesium and zinc as excessive concentrations of one can easily destroy the balance between the three in cariogenic environment and lead to progression of the disease.
Intraductal papillary mucinous neoplasm complicated with intraductal bleeding in a young woman mimicked a cystic solid pseudo-papillary tumor: a case report
Authors: Wu Jianman , Lin Yin , Wu Jingwen
Published: September 2020

Background

There are only 6 cases of intraductal papillary mucinous neoplasm (IPMN) complicated with intraductal hemorrhage have been reported in English literatures. All these 6 cases of IPMN occurred in the old people. The present rare case of IPMN complicated with intraductal hemorrhage occurred in a young woman, and mimicked a cystic solid pseudo-papillary neoplasm (SPN) on preoperative imaging findings.

Case presentation

A 29-year-old young woman complained of a sustained mild right upper quadrant abdominal pain. CT and MRI showed a lobulated, partly ill-defined cystic lesion located in the pancreatic head. Spotted calcification within cystic wall was seen on CT. The lesion was demonstrated as predominantly homogeneous hyperattenuation on CT and homogeneous high signal without decreased signal on fat suppression sequence on T1WI. After contrast administration, the cystic wall and septa of lesion was showed gradually mild to moderate degree of enhancement over time both on CT and MRI. No communication between lesion and the main duct was found on MRCP and the main pancreatic duct and common bile duct were not dilated. Considering patient’s age, gender and manifestations of lesion on CT and MRI (calcification, bleeding and gradually enhanced pattern), the present case mimicked as a cystic SPN. The lesion was pathologically confirmed a branch type IPMN after surgical resection.

Conclusion

We propose that IPMN may need to be taken into account in the differential diagnosis when pancreatic cystic lesions occur in young women with bleeding, calcification, progressive enhancement of cystic wall and no communication with the main pancreatic duct.
Person-centred care in practice: perspectives from a short course regimen for multi-drug resistant tuberculosis in Karakalpakstan, Uzbekistan
Authors: Horter Shona , Stringer Beverley , Gray Nell , Parpieva Nargiza , Safaev Khasan , Tigay Zinaida , Singh Jatinder , Achar Jay
Published: September 2020

Introduction

Person-centred care, an internationally recognised priority, describes the involvement of people in their care and treatment decisions, and the consideration of their needs and priorities within service delivery. Clarity is required regarding how it may be implemented in practice within different contexts. The standard multi-drug resistant tuberculosis (MDR-TB) treatment regimen is lengthy, toxic and insufficiently effective. 2019 World Health Organisation guidelines include a shorter (9–11-month) regimen and recommend that people with MDR-TB be involved in the choice of treatment option. We examine the perspectives and experiences of people with MDR-TB and health-care workers (HCW) regarding person-centred care in an MDR-TB programme in Karakalpakstan, Uzbekistan, run by Médecins Sans Frontières and the Ministry of Health.

Methods

A qualitative study comprising 48 interviews with 24 people with MDR-TB and 20 HCW was conducted in June–July 2019. Participants were recruited purposively to include a range of treatment-taking experiences and professional positions. Interview data were analysed thematically using coding to identify emerging patterns, concepts, and categories relating to person-centred care, with Nvivo12.

Results

People with MDR-TB were unfamiliar with shared decision-making and felt uncomfortable taking responsibility for their treatment choice. HCW were viewed as having greater knowledge and expertise, and patients trusted HCW to act in their best interests, deferring the choice of appropriate treatment course to them. HCW had concerns about involving people in treatment choices, preferring that doctors made decisions. People with MDR-TB wanted to be involved in discussions about their treatment, and have their preference sought, and were comfortable choosing whether treatment was ambulatory or hospital-based. Participants felt it important that people with MDR-TB had knowledge and understanding about their treatment and disease, to foster their sense of preparedness and ownership for treatment. Involving people in their care was said to motivate sustained treatment-taking, and it appeared important to have evidence of treatment need and effect.

Conclusions

There is a preference for doctors choosing the treatment regimen, linked to shared decision-making unfamiliarity and practitioner-patient knowledge imbalance. Involving people in their care, through discussions, information, and preference-seeking could foster ownership and self-responsibility, supporting sustained engagement with treatment.
Distribution of maternal red cell antibodies and the risk of severe alloimmune haemolytic disease of the foetus in a Chinese population: a cohort study on prenatal management
Authors: Li Si , He Zhiming , Luo Yanmin , Ji Yanli , Luo Guangping , Fang Qun , Gao Yu
Published: September 2020

Background

Haemolytic disease of the foetus and newborn (HDFN) is the most common aetiology of haemolytic anaemia and hyperbilirubinaemia in foetuses and neonates. Studies on the distribution of antibodies that cause haemolytic disease of the foetus (HDF) in China are limited, and the effects of multiple antibodies on the severity of HDF need further evaluation.

Methods

An observational cohort study from January 2005 to December 2019 was conducted in two hospitals affiliated with Sun Yat-sen University. Maternal red cell alloimmunization was identified by the Guangzhou Blood Centre. In total, 268 pregnant woman-foetus pairs were divided into four groups according to the type of maternal alloantibodies: anti-D, anti-D combined with other antibodies, other single-antibody and other multiple antibodies. The obstetric history, antibody characteristics, incidence of severe HDF and foetal outcomes were collected and compared. Logistic regression analysis of the risk factors for HDF and survival analysis of the severe HDF-free interval were conducted.

Results

Anti-D was the most common cause of HDF, followed by anti-M. No anti-K- or isolated anti-c-associated HDF was found. The incidence of severe HDF was higher in the group with anti-D combined with other antibodies than in the group with anti-D alone (P = 0.025), but no significant difference was found in haemoglobin level and reticulocyte count in the anaemic foetuses between these two groups. Foetuses in the other single-antibody group had a lower reticulocyte count (P = 0.007), more IUTs (P = 0.007) and an earlier onset of severe HDF (P = 0.012). The maximum antibody titre was significantly lower in the other single-antibody group than in the anti-D group (P < 0.001). A high maternal antibody titre (P < 0.001), multiple affected pregnancies (P < 0.001) and other single-antibody (P = 0.042) were independent risk factors for HDF. A higher reticulocyte count (P = 0.041) was an independent risk factor for severe HDF in anaemia foetuses affected by Rh(D) alloimmunization.

Conclusions

The distribution of HDF-associated antibodies in China is different from that in Western countries. Other single non-Rh(D) antibodies could increase the risk of HDF, and anti-D combined with other antibodies would not influence the severity of foetal anaemia compared with anti-D alone.
Coverage of the WHO’s four essential elements of newborn care and their association with neonatal survival in southern Nepal
Authors: Bryce Emily , Mullany Luke C. , Khatry Subarna K. , Tielsch James M. , LeClerq Steven C. , Katz Joanne
Published: September 2020

Background

Despite recent improvements in child survival, neonatal mortality continues to decline at a slower rate and now represents 47% of under-five deaths globally. The World Health Organization developed core indicators to better monitor the quality of maternal and newborn health services. One such indicator for newborn health is “the proportion of newborns who received all four elements of essential care”. The four elements are immediate and thorough drying, skin to skin contact, delayed cord clamping, and early initiation of breastfeeding. Although there is existing evidence demonstrating an association with decreased neonatal mortality for each element individually, the cumulative impact has not yet been examined.

Methods

This analysis uses data from a randomized trial to examine the impact of sunflower versus mustard seed oil massage on neonatal mortality and morbidity in the Sarlahi district in Southern Nepal from 2010 to 2017. The proportion of newborn infants receiving an intervention was the exposure and neonatal mortality was the outcome in this analysis. Neonatal mortality was defined as a death between three hours and less than 28 days of age. Associations between neonatal mortality and the essential elements were estimated by Cox proportion hazards models. The hazard ratios and corresponding 95% confidence intervals were reported.

Results

28,121 mother-infant pairs and 753 neonatal deaths were included. The percent receiving the individual elements ranged from 19.5% (skin to skin contact) to 68.2% (delayed cord clamping). The majority of infants received one or two of the elements of essential care, with less than 1% receiving all four. Skin to skin contact and early initiation of breastfeeding were associated with lower risk of neonatal mortality (aHR = 0.64 [0.51, 0.81] and aHR = 0.72 [0.60, 0.87], respectively). The risk of mortality declined as the number of elements received increased; receipt of one element compared to zero was associated with a nearly 50% reduction in risk of mortality and receipt of all four elements resulted in a 72% decrease in risk of mortality.

Conclusions

The receipt of one or more of the four essential elements of newborn care was associated with improved neonatal survival. The more elements of care received, the more survival improved.
Nomogram for predicting the overall survival and cancer-specific survival of patients with extremity liposarcoma: a population-based study
Authors: Ye Lin , Hu Chuan , Wang Cailin , Yu Weiyang , Liu Feijun , Chen Zhenzhong
Published: September 2020

Background

Extremity liposarcoma represents 25% of extremity soft tissue sarcoma and has a better prognosis than liposarcoma occurring in other anatomic sites. The purpose of this study was to develop two nomograms for predicting the overall survival (OS) and cancer-specific survival (CSS) of patients with extremity liposarcoma.

Methods

A total of 2170 patients diagnosed with primary extremity liposarcoma between 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox analyses were performed to explore the independent prognostic factors and establish two nomograms. The area under the curve (AUC), C-index, calibration curve, decision curve analysis (DCA), Kaplan-Meier analysis, and subgroup analyses were used to evaluate the nomograms.

Results

Six variables were identified as independent prognostic factors for both OS and CSS. In the training cohort, the AUCs of the OS nomogram were 0.842, 0.841, and 0.823 for predicting 3-, 5-, and 8-year OS, respectively, while the AUCs of the CSS nomogram were 0.889, 0.884, and 0.859 for predicting 3-, 5-, and 8-year CSS, respectively. Calibration plots and DCA revealed that the nomogram had a satisfactory ability to predict OS and CSS. The above results were also observed in the validation cohort. In addition, the C-indices of both nomograms were significantly higher than those of all independent prognostic factors in both the training and validation cohorts. Stratification of the patients into high- and low-risk groups highlighted the differences in prognosis between the two groups in the training and validation cohorts.

Conclusion

Age, sex, tumor size, grade, M stage, and surgery status were confirmed as independent prognostic variables for both OS and CSS in extremity liposarcoma patients. Two nomograms based on the above variables were established to provide more accurate individual survival predictions for extremity liposarcoma patients and to help physicians make appropriate clinical decisions.
The mediation effect of contraceptive use and women’s autonomy on the relationship between intimate partner violence and unintended pregnancy in Ethiopia
Authors: Tiruye Tenaw Yimer , Harris Melissa L. , Chojenta Catherine , Holliday Elizabeth , Loxton Deborah
Published: September 2020

Background

Intimate partner violence (IPV) affects one in every three women globally. Previous studies have revealed that women’s experiences of different forms of IPV are significantly associated with a higher rate of unintended pregnancy, reduced uptake of contraception, and reduced ability to make decisions regarding their fertility. The aim of this study was to investigate whether previously observed relationships between IPV and unintended pregnancy in Ethiopia are mediated by contraceptive use and women’s autonomy.

Methods

This study was performed using nationally representative data from the 2016 Ethiopian Demographic and Health Survey (EDHS). A subsample of married women of reproductive age reporting a pregnancy within the 5 years preceding 2016 and who participated in the domestic violence sub-study of the survey were included in analyses. Logistic regression models, together with the product of coefficients method, were used to estimate direct and mediated effects.

Results

Twenty six percent of participants reported an unintended pregnancy in the 5 years preceding the survey. Sixty-four percent reported having ever experienced IPV (a composite measure of physical, sexual, emotional abuse, and partner controlling behaviour). After adjusting for potential confounding factors, unintended pregnancy was significantly positively associated with reporting sexual IPV, emotional IPV, IPV (a composite measure of physical, sexual, or emotional abuse), and multiple partner controlling behaviour. However, IPV (as a composite of all four forms), physical IPV, and partner control (single act) were not significantly associated with unintended pregnancy. Women’s autonomy, but not contraception use, had a significant partial mediation effect in the relationships between some forms of IPV and unintended pregnancy. Women’s autonomy mediated about 35, 35, and 43% of the total effect of emotional IPV, IPV (physical, sexual, and/or emotional), and multiple partner control on unintended pregnancy respectively.

Conclusion

Women’s autonomy appears to play a significant role in mediating the effect of IPV on unintended pregnancy in Ethiopia. Maternal health service interventions in Ethiopia could incorporate measures to improve women’s decision-making power to reduce the negative reproductive health effects of IPV.
Correction to: Neighborhood socioeconomic disadvantage is associated with multimorbidity in a geographically-defined community
Authors: Chamberlain Alanna M. , Finney Rutten Lila J. , Wilson Patrick M. , Fan Chun , Boyd Cynthia M. , Jacobson Debra J. , Rocca Walter A. , St Sauver Jennifer L.
Published: September 2020

An amendment to this paper has been published and can be accessed via the original article.
Supporting migrants and refugees with posttraumatic stress disorder: development, pilot implementation, and pilot evaluation of a continuing interprofessional education for healthcare providers
Authors: Jobst Stefan , Windeisen Matthias , Wuensch Alexander , Meng Michael , Kugler Christiane
Published: September 2020

Background

Refugees and migrants face an increased risk of developing posttraumatic stress disorder (PTSD). Adequate care can be insufficient due to language barriers, cultural differences, and knowledge deficits of health service providers. Therefore, professional associations requested that healthcare providers to be educated to provide culturally sensitive care. An evidence-based educational intervention in the form of a continuing interprofessional education (CIPE) for healthcare providers on the topic of PTSD in migrants and refugees was developed, pilot-implemented, and evaluated according to the first two levels of the Kirkpatrick evaluation model (reaction and learning).

Methods

The development of a curriculum for the CIPE intervention was based on a narrative literature review. Its content was validated by experts (N = 17) in an online survey and analyzed using both the Content Validity Index and a thematic analysis. The evaluation of the CIPE intervention was performed by conducting a pilot study with a quasi-experimental single group, using a pre-posttest design. In total, there were 39 participants distributed among three pilot courses. We collected and analyzed data on satisfaction, knowledge, and feasibility.

Results

The curriculum for a half-day course, consisting of 8 modules, showed almost excellent content validity (S-CVI = 0.92). In the pilot-implementation phase, participants were “very satisfied” with the pilot courses and a positive effect on their knowledge was detected. No correlation between satisfaction and knowledge gain was found.

Conclusions

The CIPE intervention can be considered feasible and seems promising in its effects on satisfaction and knowledge. The insights gained in this study can be used to adapt and optimize the educational intervention, whereby the feedback from course attendees is particularly useful. Future studies need to further examine the effects in larger samples and more robust study designs.
Correction to: General practitioners’ and out-of-hours doctors’ role as gatekeeper in emergency admissions to somatic hospitals in Norway: registry-based observational study
Authors: Blinkenberg Jesper , Pahlavanyali Sahar , Hetlevik Øystein , Sandvik Hogne , Hunskaar Steinar
Published: September 2020

An amendment to this paper has been published and can be accessed via the original article.
Genetic modifiers ameliorate endocytic and neuromuscular defects in a model of spinal muscular atrophy
Authors: Walsh Melissa B. , Janzen Eva , Wingrove Emily , Hosseinibarkooie Seyyedmohsen , Muela Natalia Rodriguez , Davidow Lance , Dimitriadi Maria , Norabuena Erika M. , Rubin Lee L. , Wirth Brunhilde , Hart Anne C.
Published: September 2020

Background

Understanding the genetic modifiers of neurodegenerative diseases can provide insight into the mechanisms underlying these disorders. Here, we examine the relationship between the motor neuron disease spinal muscular atrophy (SMA), which is caused by reduced levels of the survival of motor neuron (SMN) protein, and the actin-bundling protein Plastin 3 (PLS3). Increased PLS3 levels suppress symptoms in a subset of SMA patients and ameliorate defects in SMA disease models, but the functional connection between PLS3 and SMN is poorly understood.

Results

We provide immunohistochemical and biochemical evidence for large protein complexes localized in vertebrate motor neuron processes that contain PLS3, SMN, and members of the hnRNP F/H family of proteins. Using aCaenorhabditis elegans(C. elegans) SMA model, we determine that overexpression of PLS3 or loss of theC. eleganshnRNP F/H ortholog SYM-2 enhances endocytic function and ameliorates neuromuscular defects caused by decreased SMN-1 levels. Furthermore, either increasing PLS3 or decreasing SYM-2 levels suppresses defects in aC. elegansALS model.

Conclusions

We propose that hnRNP F/H act in the same protein complex as PLS3 and SMN and that the function of this complex is critical for endocytic pathways, suggesting that hnRNP F/H proteins could be potential targets for therapy development.
Mitochondrial DNA copy number and incident atrial fibrillation
Authors: Zhao Di , Bartz Traci M. , Sotoodehnia Nona , Post Wendy S. , Heckbert Susan R. , Alonso Alvaro , Longchamps Ryan J. , Castellani Christina A. , Hong Yun Soo , Rotter Jerome I. , Lin Henry J. , O’Rourke Brian , Pankratz Nathan , Lane John A. , Yang Stephanie Y. , Guallar Eliseo , Arking Dan E.
Published: September 2020

Background

Mechanistic studies suggest that mitochondria DNA (mtDNA) dysfunction may be associated with increased risk of atrial fibrillation (AF). The association between mtDNA copy number (mtDNA-CN) and incident AF in the general population, however, remains unknown.

Methods

We conducted prospective analyses of 19,709 participants from the Atherosclerosis Risk in Communities Study (ARIC), the Multi-Ethnic Study of Atherosclerosis (MESA), and the Cardiovascular Health Study (CHS). mtDNA-CN from the peripheral blood was calculated from probe intensities on the Affymetrix Genome-Wide Human single nucleotide polymorphisms (SNP) Array 6.0 in ARIC and MESA and from multiplexed real-time quantitative polymerase chain reaction (qPCR) in CHS. Incident AF cases were identified through electrocardiograms, review of hospital discharge codes, Medicare claims, and death certificates.

Results

The median follow-up time was 21.4 years in ARIC, 12.9 years in MESA, and 11.0 years in CHS, during which 4021 participants developed incident atrial fibrillation (1761 in ARIC, 790 in MESA, and 1470 in CHS). In fully adjusted models, participants with the lowest quintile of mitochondria DNA copy number had an overall 13% increased risk (95% CI 1 to 27%) of incident atrial fibrillation compared to those with the highest quintile. Dose-response spline analysis also showed an inverse association between mitochondria DNA copy number and hazard for atrial fibrillation for all three cohorts. These associations were consistent across subgroups.

Conclusions

Mitochondria DNA copy number was inversely associated with the risk of AF independent of traditional cardiovascular risk factors. These findings implicate mitochondria DNA copy number as a novel risk factor for atrial fibrillation. Further research is warranted to understand the underlying mechanisms and to evaluate the role of mitochondria DNA copy number in the management of atrial fibrillation risk.