bluuebunny/crossref_metadata_2025 huggingface dataset:
Examination of fluoroscopy monitor as a source of indirect bacterial contamination in orthopaedic surgery
Authors: Radley Joseph M , Gloekler Daniel S , Krahe Mark A , Nechleba Jeffrey A
Published: May 2020

Background:

Surgical site infection is a well-documented complication of surgery. While contact with fomites represents a recognised source of contamination, electrostatic charge can cause contamination without surface contact as shown in previous studies evaluating operating room equipment. In cases requiring fluoroscopy, an intraoperative X-ray method, it is common for a surgeon to point to the associated monitor, particularly when teaching. This close proximity without direct contact poses a theoretical risk of contamination due to potential electrostatic forces.

Aim/Objective:

To assess whether a gloved finger could be contaminated by a fluoroscopy monitor without direct contact.

Methods:

Using a laser-guided level, a sterile, gloved finger was traversed side-to-side, top-to-bottom, across a fluoroscopy monitor used during surgery at distances of 1 cm, 2 cm, 4 cm and 8 cm. Two negative controls and a positive control were collected for comparison. Specimens were inoculated onto agar plates and incubated for 48 h at 37 °C. Following incubation, samples were analysed for growth and the number of colonies was recorded. This was repeated during 10 randomly selected operative cases using fluoroscopy for a total of 70 samples.

Results:

No bacterial growth was identified as a result of inoculation on any of the 70 experimental or control specimens.

Discussion:

We conclude that the practice of pointing to a fluoroscopy monitor for educational or other purposes is unlikely to increase the risk of glove contamination.
Avian diet and foraging ecology constrain foreign egg recognition and rejection
Authors: Luro Alec B , Hauber Mark E
Published: May 2020

Egg rejection is a common and effective defense against avian brood parasitism in which the host either marginalizes or removes the parasitic egg or deserts the parasitized clutch. The ability to recognize and reject a parasitic egg depends on bill morphology, sensory systems, and cognition, all of which are also shaped by other selective processes such as foraging. This begs the question whether specific phenotypes associated with different foraging strategies and diets may constrain or facilitate egg recognition and rejection. Here, we propose a novel hypothesis that host species phenotypes related to foraging ecology and diet may impose morphological and visual sensory constraints on the evolution of egg recognition and rejection. We conducted a comparative analysis of the adult diets and egg rejection rates of 165 current host and non-host species. We found that species have significantly higher egg rejection rates when they (1) consume an omnivorous or animal and fruit dominated diet rather than seeds and grains, (2) forage arboreally rather than aerially or on the ground, or (3) possess relatively larger body sizes. Although correlational in nature, as predicted, these results suggest phenotypes related to specific diets and foraging ecologies may differentially constrain or facilitate evolution of host egg rejection defenses against avian brood parasitism.
Divergent Strategies of Epiphytic Pteridophytes and Angiosperms Responding to Dry and Wet Seasons in a Tropical Cloud Forest
Authors: Li Xuanru , Long Wenxing , Zhang Hui , Huang Jin , Cheng Yikang , Jiang Huan , Liao Lingcong , Tan Zhaoyuan
Published: May 2020

Epiphyte is a unique component of forest diversity vulnerable to changing environments. Characterizing variations in functional traits of epiphytes across dry and wet seasons can enhance our understanding their strategies to environments. We measured and assessed variations of 14 leaf functional traits responding to water conditions for epiphytic pteridophytes (EP) and epiphytic angiosperms (EA) across dry and wet seasons in a tropical cloud forest. Results showed that leaf dry weight (LDW) and stomatal length (SL) of EP were significantly higher than EA, while leaf water content (LWC) of EA was significantly higher than EP. The SL, stomatal density (SD), upper epidermis thickness (UET), lower epidermis thickness (LET), palisade tissue thickness (PT), spongy tissue thickness (ST), and leaf thickness (LT) of EP and EA were significantly higher in wet season than dry season. The variance of stomatal and anatomical traits explained by season types (0.24–0.78) was higher than plant groups (0.0–0.25), while the variance of LDW and LWC explained by plant groups (0.12–0.40) was higher than season types (0.0–0.29). Principal component analysis and correlation analyses showed that SL, stomatal index, UET, ST, LET, and LT were the key traits reflecting epiphyte adaptation to dry season, as well as that LWC and leaf density were the key traits in wet season. Our results suggest that the different taxonomic groups exhibit divergent strategies responding to water differences. Great variations in leaf traits to dry seasons are predicted that vascular epiphytes, especially pteridophytes, are prone to disappear with drought events.
Benefits of the Subdural Evacuating Port System (SEPS) Procedure Over Traditional Craniotomy for Subdural Hematoma Evacuation
Authors: Golub Danielle , Ashayeri Kimberly , Dogra Siddhant , Lewis Ariane , Pacione Donato
Published: May 2020

Background:

There remains no consensus on the optimal primary intervention for subdural hematoma (SDH). Although historically favored, craniotomy carries substantial morbidity and incurs significant costs. Contrastingly, the subdural evacuating port system (SEPS) is a minimally invasive bedside procedure. We assessed the benefits of SEPS over traditional craniotomy for SDH evacuation.

Methods:

A single-center retrospective cohort study of SDH patients receiving craniotomy or SEPS between 2012 and 2017 was performed. Information regarding demographics, medical history, presentation, surgical outcomes, cost, and complications was collected. Pre- and postoperative hematoma volumes were calculated using 3D image segmentation using Vitrea software. Multivariate regression models were employed to assess the influence of intervention choice.

Results:

Of 107 patients, 68 underwent craniotomy and 39 underwent SEPS. There were no differences in age, sex, blood thinner use, platelet count, INR, hematoma lateralization, age, volume, or midline shift at presentation between intervention groups. Although there was no difference in percent residual hematoma volume 24-hour postintervention (44.1% vs 45.1%, P = .894), SEPS was associated with lower hospitalization costs ($108 391 vs $166 318, * P = .002), shorter length of stay (4.0 vs 5.8 days, * P = .0002), and fewer postoperative seizures (2.6% vs 17.7%, * P = .048). Reoperation rate was higher after SEPS overall (33.3% vs 13.2%, * P = .048) but comparable to craniotomy in chronic SDH (12.50% vs 7.69%, P = 1.000).

Conclusion:

In this retrospective cohort, SEPS was noninferior to craniotomy at reducing SDH hematoma volume. The SEPS procedure was also associated with decreased length of stay hospitalization costs, and postoperative seizures and demonstrated a comparable recurrence rate to craniotomy for chronic SDH in particular.
Bariatric Space, Technology, and Design: A Round Table
Authors: Gallagher Susan , Alexandrowiz Malene , Fritz Ronda , Kumpar Dee , Miller Merl , McNaughton Cynthia , Nowicki Tracy
Published: May 2020

Background: Planning and executing healthcare for the patient or resident living with obesity can be a challenging task that has implications to the occupational health professional. Methods: Leading global experts in the areas of occupational health, ergonomics, bariatrics, technology, and patient care were identified and invited to participate in a round table discussion. Questions posed to experts were based on literature that addressed patient handling and mobility, architectural design recommendations, clinical care of the person with obesity, and ergonomic guidelines. Findings: Experts agreed that special considerations must be in place to care for the person who is obese. These special considerations should address not only clinical care of the patient, but ways to protect workers from occupational injury associated with clinical care. Experts suggested that, in some situations, a bariatric training suit may be helpful in better understanding space and design challenges, as well as a better understanding of the physical limitations associated with a larger body habitus (although simulated). Further, experts agreed that insensitivities often stem from failure to have proper space, technology and design accommodations in place. Conclusions/Application to Practice: The occupational health professional is a key resource to teams charged with planning and executing healthcare for the patient or resident living with obesity. Interprofessional understanding and communication can lead to a more comprehensive approach to space, design and technology that not only addresses the patient, but the worker providing direct care.
Work-Related Asthma Among Certified Nurse Aides in Texas
Authors: Patel Jenil , Gimeno Ruiz de Porras David , Mitchell Laura E. , Patel Riddhi R. , De Los Reyes Joy , Delclos George L.
Published: May 2020

Background: Although nurses are well described as being at risk of work-related asthma, certified nurse aides (CNAs) are understudied. Using a statewide registry in Texas, we measured prevalence and risk factors for work-related asthma and bronchial hyperresponsiveness (BHR) symptoms among CNAs. Methods: For this cross-sectional study, a questionnaire was mailed to a random sample of CNAs ( n = 2,114) identified through the Texas Department of Aging and Disability Services registry, working in health care during 2016–2017, to collect data on job history, asthma symptoms, and sociodemographics. Two outcomes were defined: (a) new-onset asthma (NOA) after entry into the health care field and (b) BHR-related symptoms. Job exposures to cleaning compounds and tasks were assigned using an externally coded CNA-specific job-exposure matrix. Logistic regression modeling was used to measure associations between cleaning exposures and the two asthma outcomes. Findings: The final sample consisted of 413 CNAs (response rate 21.6%). The prevalence of NOA and BHR symptoms were 3.6% and 26.9%, respectively. In adjusted models, elevated odds for BHR symptoms were observed for patient care cleaning (odds ratio [OR] = 1.71, 95% confidence interval [CI] = [0.45, 6.51]), instrument cleaning (OR = 1.33, 95% CI = [0.66, 2.68]), building-surface cleaning (OR = 1.39, 95% CI = [0.35, 5.60]), exposure to glutaraldehyde/orthophthalaldehyde (OR = 1.33, 95% CI = [0.66, 2.68]), and latex glove use during 1992–2000 (OR = 1.62, 95% CI = [0.84, 3.12]). There were too few NOA cases to warrant meaningful regression analysis. Conclusion/Application to Practice: Although not statistically significant, we observed elevated odds of BHR symptoms among nurse aides, associated with cleaning exposures, suggesting this is an at-risk group of health care professionals for work-related respiratory disease, meriting further study.
Contact With an Ex-Partner Is Associated With Psychological Distress After Marital Separation
Authors: O’Hara Karey L. , Grinberg Austin M. , Tackman Allison M. , Mehl Matthias R. , Sbarra David A.
Published: May 2020

In this study, we examined the association between naturalistically observed in-person contact with an ex-partner and separation-related psychological distress (SRPD). One hundred twenty-two recently separated adults were assessed using the Electronically Activated Recorder on three occasions across 5 months. The association between in-person contact with an ex-partner, as a between-person variable, and concurrent SRPD was not reliably different from zero, nor was the time-varying effect of in-person contact. However, more frequent in-person contact with an ex-partner predicted higher SRPD 2 months later, above and beyond the variance accounted for by concurrent in-person contact, demographic, relationship, and attachment factors. Follow-up analyses showed that this effect was present only for people without children; a 1 SD increase in in-person contact offset and slowed the predicted decline in SRPD over 2 months by 112%. In our discussion, we emphasize new ways to think about the role of in-person contact in shaping adults’ psychological adjustment to separation over time.
The Challenge of Teaching Mission in an Increasingly Mobile and Complex World
Authors: Rynkiewich Michael A.
Published: May 2020

In a time when old groupings are breaking up, when people are on the move or fleeing conflict and settling elsewhere, when many people are multilingual and are competent in several cultural settings, doing mission has become an ever greater challenge than simple cross-cultural communication. How does one engage in mission on the run? How does one conduct missiological research in ephemeral community that is here today and gone tomorrow? How does one train new missionaries for work in a field that will certainly morph into something else before they get there? Changing times call for new perspectives on mission. This article is based on the twentieth Louis J. Luzbetak, SVD, Lecture on Mission and Culture, given at Catholic Theological Union, Chicago. October 7, 2019 (available online at https://learn.ctu.edu/2019-luzbetak-lecture/ ).
Preventing Summer Reading Slide: Examining the Effects of Two Computer-Assisted Reading Programs
Authors: Pindiprolu Sekhar S. , Marks Lori J.
Published: May 2020

Students who display reading difficulties/disabilities at the end of third grade are less likely to succeed in content areas and graduate from high school than their reading-proficient peers. Literature suggests that students in rural school districts lag behind their suburban peers in terms of their reading levels and accessibility to resources. Furthermore, students from low socioeconomic status (SES) households and those who have disabilities exhibit greater learning loss during the summer break. This exploratory study examined the effects of two parent-implemented computer-based reading programs on the reading skills of 20 students at-risk for reading failure during a summer break. Parental and students’ perceptions regarding the effectiveness and desirability of the programs were elicited. Results suggested that both programs facilitated gains in phonemic awareness and phonics. Furthermore, students in the Funnix group exhibited large gains in vocabulary and oral reading fluency, and the students in the PLATO group exhibited large gains in comprehension. Most of the students indicated they liked the programs and the programs helped them read. Similarly, most of the parents agreed that the programs were useful, and they were comfortable using the programs. A description of the computer programs, results, implications, and limitations of the study are discussed.
TS: a powerful truncated test to detect novel disease associated genes using publicly available gWAS summary data
Authors: Zhang Jianjun , Guo Xuan , Gonzales Samantha , Yang Jingjing , Wang Xuexia
Published: May 2020

Background

In the last decade, a large number of common variants underlying complex diseases have been identified through genome-wide association studies (GWASs). Summary data of the GWASs are freely and publicly available. The summary data is usually obtained through single marker analysis. Gene-based analysis offers a useful alternative and complement to single marker analysis. Results from gene level association tests can be more readily integrated with downstream functional and pathogenic investigations. Most existing gene-based methods fall into two categories: burden tests and quadratic tests. Burden tests are usually powerful when the directions of effects of causal variants are the same. However, they may suffer loss of statistical power when different directions of effects exist at the causal variants. The power of quadratic tests is not affected by the directions of effects but could be less powerful due to issues such as the large number of degree of freedoms. These drawbacks of existing gene based methods motivated us to develop a new powerful method to identify disease associated genes using existing GWAS summary data.

Methods and Results

In this paper, we propose a new truncated statistic method (TS) by utilizing a truncated method to find the genes that have a true contribution to the genetic association. Extensive simulation studies demonstrate that our proposed test outperforms other comparable tests. We applied TS and other comparable methods to the schizophrenia GWAS data and type 2 diabetes (T2D) GWAS meta-analysis summary data. TS identified more disease associated genes than comparable methods. Many of the significant genes identified by TS may have important mechanisms relevant to the associated traits. TS is implemented in C program TS, which is freely and publicly available online.

Conclusions

The proposed truncated statistic outperforms existing methods. It can be employed to detect novel traits associated genes using GWAS summary data.
Comparative analysis of similarity measurements in miRNAs with applications to miRNA-disease association predictions
Authors: Chen Hailin , Guo Ruiyu , Li Guanghui , Zhang Wei , Zhang Zuping
Published: May 2020

Background

As regulators of gene expression, microRNAs (miRNAs) are increasingly recognized as critical biomarkers of human diseases. Till now, a series of computational methods have been proposed to predict new miRNA-disease associations based on similarity measurements. Different categories of features in miRNAs are applied in these methods for miRNA-miRNA similarity calculation. Benchmarking tests on these miRNA similarity measures are warranted to assess their effectiveness and robustness.

Results

In this study, 5 categories of features, i.e. miRNA sequences, miRNA expression profiles in cell-lines, miRNA expression profiles in tissues, gene ontology (GO) annotations of miRNA target genes and Medical Subject Heading (MeSH) terms of miRNA-associated diseases, are collected and similarity values between miRNAs are quantified based on these feature spaces, respectively. We systematically compare the 5 similarities from multi-statistical views.

Furthermore, we adopt a rule-based inference method to test their performance on miRNA-disease association predictions with the similarity measurements. Comprehensive comparison is made based on leave-one-out cross-validations and a case study. Experimental results demonstrate that the similarity measurement using MeSH terms performs best among the 5 measurements. It should be noted that the other 4 measurements can also achieve reliable prediction performance. The best-performed similarity measurement is used for new miRNA-disease association predictions and the inferred results are released for further biomedical screening.

Conclusions

Our study suggests that all the 5 features, even though some are restricted by data availability, are useful information for inferring novel miRNA-disease associations. However, biased prediction results might be produced in GO- and MeSH-based similarity measurements due to incomplete feature spaces. Similarity fusion may help produce more reliable prediction results. We expect that future studies will provide more detailed information into the 5 feature spaces and widen our understanding about disease pathogenesis.
Intravenous dexmedetomidine versus tramadol for treatment of shivering after spinal anesthesia: a meta-analysis of randomized controlled trials
Authors: Wang Jinguo , Wang Zaitang , Liu Junyan , Wang Na
Published: May 2020

Background

Shivering is a frequent complication after spinal anesthesia. Increasing studies have compared the effect of intravenous dexmedetomidine and intravenous tramadol on shivering after spinal anesthesia, hence we performed a meta-analysis of randomized controlled trials to compare dexmedetomidine with tramadol on the treatment of post-spinal anesthesia shivering.

Methods

PubMed, Embase, Cochrane library, Web of Science and Google Scholar were searched to find the eligible studies comparing the effect of dexmedetomidine and tramadol on the treatment of shivering after spinal anesthesia. Mean difference (MD) or risk ratio (RR) along with 95% confidence interval (CI) was used to analyze the outcomes. I2test was conducted to assess the heterogeneity of the included trials. We utilized Review Manager 5.3 to perform statistical analyses.

Results

Thirteen randomized controlled trials including 864 subjects were included. Dexmedetomidine had higher effective rate of shivering control (RR =1.03; 95%CI [1.01, 1.06],P = 0.01, I2 = 14%), shorter time to cease shivering (MD = -2.14; 95%CI [− 2.79, − 1.49],P < 0.00001, I2 = 98%), lower recurrent rate of shivering (RR = 0.45; 95%CI [0.27, 0.73],P = 0.001, I2 = 0%), lower incidences of nausea (RR = 0.10; 95%CI [0.05, 0.19], P < 0.00001, I2 = 48%), and vomiting (RR = 0.13; 95%CI [0.06, 0.30], P < 0.00001, I2 = 0%), higher incidence of sedation (RR = 2.48; 95%CI [1.32, 4.65],P = 0.005, I2 = 82%), hypotension (RR = 2.50; 95%CI [1.24, 5.03],P = 0.01, I2 = 0%) and bradycardia (RR = 4.78; 95%CI [1.76, 13.00],P = 0.002, I2 = 0%), compared with tramadol.

Conclusions

Dexmedetomidine is superior to tramadol for shivering treatment, due to higher effective rate of shivering control, earlier onset of action and lesser recurrence of shivering with higher incidence of sedation and lower incidences of nausea and vomiting. However, dexmedetomidine is also associated with higher incidences of hypotension and bradycardia than tramadol.
Efficacy and safety of pulsed radiofrequency as a method of dorsal root ganglia stimulation for treatment of non-neuropathic pain: a systematic review
Authors: Vuka Ivana , Došenović Svjetlana , Marciuš Tihana , Ferhatović Hamzić Lejla , Vučić Katarina , Sapunar Damir , Puljak Livia
Published: May 2020

Background

We systematically reviewed the evidence on the efficacy and safety of dorsal root ganglion (DRG) targeted pulsed radiofrequency (PRF) versus any comparator for treatment of non-neuropathic pain.

Methods

We searched MEDLINE, CINAHL, Embase, PsycINFO, clinicaltrials.gov and WHO clinical trial register until January 8, 2019. All study designs were eligible. Two authors independently conducted literature screening. Primary outcomes were pain intensity and serious adverse events (SAEs). Secondary outcomes were any other pain-related outcome and any other safety outcome that was reported. We assessed the risk of bias using the Cochrane tool and Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I). We conducted narrative evidence synthesis and assessed the conclusiveness of included studies regarding efficacy and safety.

Results

We included 17 studies with 599 participants, which analyzed various pain syndromes. Two studies were randomized controlled trials; both included participants with low back pain (LBP). Non-randomized studies included patients with the following indications: LBP, postsurgical pain, pain associated with herpes zoster, cervicogenic headache, complex regional pain syndrome type 1, intractable vertebral metastatic pain, chronic scrotal and inguinal pain, occipital radiating pain in rheumatoid arthritis and chronic migraine. In these studies, the PRF was usually initiated after other treatments have failed. Eleven studies had positive conclusive statements (11/17) about efficacy; the remaining had positive inconclusive statements. Only three studies provided conclusiveness of evidence statements regarding safety – two indicated that the evidence was positive conclusive, and one positive inconclusive. The risk of bias was predominantly unclear in randomized and serious in non-randomized studies.

Conclusion

Poor quality and few participants characterize evidence about benefits and harms of DRG PRF in patients with non-neuropathic pain. Results from available studies should only be considered preliminary. Not all studies have reported data regarding the safety of the intervention, but those that did, indicate that the intervention is relatively safe. As the procedure is non-destructive and early results are promising, further comparative studies about PRF in non-neuropathic pain syndromes would be welcomed.
How do older adults understand and manage distress? A qualitative study
Authors: Moult Alice , Kingstone Tom , Chew-Graham Carolyn A.
Published: May 2020

Background

Distress is an expected emotional response to a negative life event. Experiences common in later life may trigger distress such as bereavement or loss of physical mobility. Distress is considered to be distinct to anxiety and/or depression and is not diagnostically labelled as a mental health problem. Older adults will often manage their own distress. Previous literature has focused on how younger adults self-manage mental health problems, however little research has explored the self-management strategies used by older people. There is a need to clarify the role of primary care in the context of distressed older adults who may consult healthcare services. This study seeks to address these gaps through qualitative methods.

Methods

Keele University’s ethical review panel approved this study. We recruited older adults who self-identified as distressed from community groups in North Staffordshire, England. Data were generated through semi-structured interviews and analysed thematically using constant comparison methods. A patient and public involvement and engagement group contributed to development of the research questions and methods, and offered their perspectives on the findings.

Results

After 18 interviews data saturation was achieved. Key themes were: experiences of distress, actions taken, help-seeking from healthcare services and perceptions of treatments offered in primary care. Various forms of loss contributed to participants’ distress. Participants initiated their own self-management strategies which included: pursuing independent activities, seeking social support and attending community groups and church. Five participants reported having consulted a GP when distressed but described a lack of acceptable treatments offered.

Conclusions

To support older adults who are distressed, healthcare professionals in primary care should consider exploring how patients currently manage their mood problems, provide a broad range of information about potential management options and consider sign-posting older adults to community resources.
Quality of life among caregivers of people with end-stage kidney disease managed with dialysis or comprehensive conservative care
Authors: Shah Karan K. , Murtagh Fliss E. M. , McGeechan Kevin , Crail Susan M. , Burns Aine , Morton Rachael L.
Published: May 2020

Background

To measure health-related and care-related quality of life among informal caregivers of older people with end-stage kidney disease (ESKD), and to determine the association between caregiver quality of life and care recipient’s treatment type.

Methods

A prospective cross-sectional study was conducted. Three renal units in the UK and Australia were included. Informal caregivers of people aged ≥75 years with ESKD managed with dialysis or comprehensive conservative non-dialytic care (estimated glomerular filtration (eGFR) ≤10 mL/min/1.73m2) participated. Health-related quality of life (HRQoL) was assessed using Short-Form six dimensions (SF-6D, 0–1 scale) and care-related quality of life was assessed using the Carer Experience Scale (CES, 0–100 scale). Linear regression assessed associations between care-recipient treatment type, caregiver characteristics and the SF-6D utility index and CES scores.

Results

Of 63 caregivers, 49 (78%) were from Australia, 26 (41%) cared for an older person managed with dialysis, and 37 (59%) cared for an older person managed with comprehensive conservative care. Overall, 73% were females, and the median age of the entire cohort was 76 years [IQR 68–81]. When adjusted for caregiver sociodemographic characteristics, caregivers reported significantly worse carer experience (CES score 15.73, 95% CI 5.78 to 25.68) for those managing an older person on dialysis compared with conservative care. However, no significant difference observed for carer HRQoL (SF-6D utility index − 0.08, 95% CI − 0.18 to 0.01) for those managing an older person on dialysis compared with conservative care.

Conclusions

Our data suggest informal caregivers of older people on dialysis have significantly worse care-related quality of life (and therefore greater need for support) than those managed with comprehensive conservative care. It is important to consider the impact on caregivers’ quality of life when considering treatment choices for their care recipients.
NAD(P)-dependent steroid dehydrogenase-like is involved in breast cancer cell growth and metastasis
Authors: Yoon So-Hyun , Kim Hoe Suk , Kim Ryong Nam , Jung So-Youn , Hong Bok Sil , Kang Eun Ji , Lee Han-Byoel , Moon Hyeong-Gon , Noh Dong-Young , Han Wonshik
Published: May 2020

Background

The cholesterol biosynthesis pathway is typically upregulated in breast cancer. The role of NAD(P)-dependent steroid dehydrogenase-like (NSDHL) gene, which is involved in cholesterol biosynthesis, in breast cancer remains unknown. This study aimed to uncover the role of NSDHL in the growth and metastasis of breast cancer.

Methods

After NSDHL knockdown by transfection of short interfering RNA into human breast cancer cell lines (MCF-7, MDA-MB-231 and BT-20) and human breast epithelial cell line (MCF10A), cell proliferation assay, cell cycle analysis, three-dimensional cell culture, clonogenic assay, transwell migration and invasion assays, and wound healing assay were performed. Erlotinib was used as the target drug for epidermal growth factor receptor. Immunodeficient mice (NOD.Cg-Prkdcscid Il2rgtm1wjl /SzJ) were used as orthotropic breast tumor models by injecting them with NSDHL-knockdown MDA-MB-231 cells using lentivirus-carrying NSDHL short hairpin RNA. Clinical data from 3951 breast cancer patients in Gene Expression Omnibus databases were used to investigate the potential prognostic role of NSDHL by survival analysis.

Results

NSDHL knockdown in BT-20, and MDA-MB-231 resulted in a significant decrease in their viability, colony formation, migration, and invasion abilities (p < 0.05). Total cholesterol levels were observed to be significantly decreased in NSDHL-knockdown BT-20 and MDA-MB-231 (p < 0.0001). NSDHL knockdown significantly increased the rate of erlotinib-induced cell death, especially in MDA-MB-231 (p = 0.01). NSDHL knockdown led to significantly decreased tumor growth and lung metastasis in the MDA-MB-231 xenograft model (p < 0.01). Clinically, high NSDHL expression in tumors of patients with breast cancer was associated with significantly reduced recurrence-free survival (p < 0.0001).

Conclusions

NSDHL might have a role in promoting breast cancer progression. The usage of NSDHL as a therapeutic target in breast cancer needs to be clarified in further studies.
Application of group smoothly clipped absolute deviation method in identifying correlates of psychiatric distress among college students
Authors: Arayeshgari Mahya , Tapak Leili , Roshanaei Ghodratollah , Poorolajal Jalal , Ghaleiha Ali
Published: May 2020

Background

College students are at an increased risk of psychiatric distress. So, identifying its important correlates using more reliable statistical models, instead of inefficient traditional variable selection methods like stepwise regression, is of great importance. The objective of this study was to investigate correlates of psychiatric distress among college students in Iran; using group smoothly clipped absolute deviation method (SCAD).

Methods

A number of 1259 voluntary college students participated in this cross-sectional study (Jan-May 2016) at Hamadan University of Medical Sciences, Iran. The data were collected using a self-administered questionnaire consisting of demographic information, a behavioral risk factors checklist and the GHQ-28 questionnaire (with a cut-off of 23 to measure psychiatric distress, recommended by the Iranian version of the questionnaire). Penalized logistic regression with a group-SCAD regularization method was used to analyze the data (α = 0.05).

Results

The majority of students were aged 18–25 (87.61%), and 60.76% of them were female. About 41% of students had psychiatric distress. Significant correlates of psychiatric distress among college students selected by group-SCAD included the average grade, educational level, being optimistic about future, having a boy/girlfriend, having an emotional breakup, the average daily number of cigarettes, substance abusing during previous month and having suicidal thoughts ever (P < 0.05).

Conclusions

Penalized logistic regression methods such as group-SCAD and group-Adaptive-LASSO should be considered as plausible alternatives to stepwise regression for identifying correlates of a binary response. Several behavioral variables were associated with psychological distress which highlights the necessity of designing multiple factors and behavioral changes in interventional programs.
Seeking care in the context of social health insurance in Kenya and Ghana
Authors: Suchman Lauren , Hashim Catherine Verde , Adu Joseph , Mwachandi Rita
Published: May 2020

Background

Social Health Insurance (SHI) is widely used by countries attempting to move toward Universal Health Coverage (UHC). While evidence suggests that SHI is a promising strategy for achieving UHC, low-income countries often struggle to implement and sustain SHI systems. It is therefore important to understand how SHI enrollees use health insurance and how it affects their health-seeking behavior. This paper examines how SHI affects patient decision-making regarding when and where to seek care in Kenya and Ghana, two countries with established SHI systems in sub-Saharan Africa.

Methods

This paper draws from two datasets collected under the African Health Markets for Equity (AHME) program. One dataset, collected in 2013 and 2017 as part of the AHME qualitative evaluation, consists of 106 semi-structured clinic exit interviews conducted with patients in Ghana and Kenya. This data was analyzed using an inductive, thematic approach. The second dataset was collected internally by the AHME partner organizations. It derives from a cross-sectional survey of social franchise clients at three social franchise networks supported by AHME. Data collection took place from February – May 2018 and in December 2018.

Results

Many clients appreciated that insurance coverage made healthcare more affordable, reported seeking care more frequently when covered with SHI. Clients also noted that the coverage gave them access to a wider variety of providers, but rarely sought out SHI-accredited providers specifically. However, clients sometimes were charged for services that should have been covered by insurance. Due to a lack of understanding of SHI benefits, clients rarely knew they had been charged inappropriately.

Conclusions

Clients and providers would benefit from education on what is included in the SHI package. Providers should be monitored and held accountable for charging clients inappropriately; in Ghana this should be accompanied by reforms to make government financing for SHI sustainable. Since clients valued provider proximity and both Kenya and Ghana have a dearth of providers in rural areas, both countries should incentivize providers to work in these areas and prioritize accrediting rural facilities into SHI schemes to increase accessibility and reach.
Lack of sexual behavior disclosure may distort STI testing outcomes
Authors: Kumar Navin , Forastiere Laura , Zhang Tiange , Yang Fan , Li Katherine T. , Tang Weiming , Tucker Joseph D. , Christakis Nicholas A. , Alexander Marcus
Published: May 2020

Background

Men who have sex with men (MSM) globally have a high burden of curable sexually transmitted infections (STIs). MSM do not frequently receive rectal STI testing because of several barriers, such as not being out (disclosure of sexual behavior). We evaluate whether Chinese MSM select an STI test (rectal vs urethral) appropriate for their sexual behavior (insertive and/or receptive), and the interactions with being out.

Methods

This was a secondary analysis of data from a cross sectional MSM survey conducted at a multisite randomized controlled trial (RCT) (December 2018 to January 2019) around uptake of gonorrhea and chlamydia testing among Chinese MSM (N = 431). We collected socio demographics, relevant medical and sexual history, and disclosure of sexual behavior (outness). We estimated the decision to test and test choice, and the extent to which disclosure plays a role in decision making.

Results

Among 431 MSM, mean age was 28 years (SD = 7.10) and 65% were out to someone. MSM who indicated versatile sexual behavior and were out to someone had a 26.8% (95%CI = 6.1, 47.5) increased likelihood for selecting the rectal test vs the ure thral test, compared to those versatile and not out. Versatile MSM out to their health provider outside of the study context had a 29.4% (95%CI = 6.3, 52.6) greater likelihood for selecting the rectal STI test vs the urethral test, compared to versatile MSM not out to their health provider.

Conclusions

Sexual behavior and outness may affect gonorrhea and chlamydia testing provision. Apart from clinicians, community based efforts may reduce stigma based barriers to testing.
A randomized, controlled, repeat-dose study of batefenterol/fluticasone furoate compared with placebo in the treatment of COPD
Authors: Crim Courtney , Gotfried Mark , Spangenthal Selwyn , Watkins Michael , Emmett Amanda , Crawford Catriona , Baidoo Charlotte , Castro-Santamaria Ramiro
Published: May 2020

Background

Batefenterol (BAT) is a bi-functional molecule with both muscarinic antagonist and β2-adrenoceptor agonist pharmacology. This Phase II, randomized, placebo-controlled, double-blind study evaluated the safety and tolerability of BAT 300 μg with fluticasone furoate (FF) 100 μg administered via the ELLIPTA inhaler (BAT/FF 300/100).

Methods

Subjects with stable chronic obstructive pulmonary disease were randomized 2:1 to receive BAT/FF 300/100 or placebo once daily for 6 weeks. The primary endpoint was change from baseline in 0–4-h weighted mean (WM) heart rate (HR, measured by electrocardiogram [ECG]) on Day 42. Other endpoints included WM and maximum 0–4-h corrected QT interval (ECG on Days 1, 28, and 42), HR measured by Holter monitoring (Day 42), and standard safety assessments. Study protocol was approved by an Investigational Review Board.

Results

Sixty-two patients were randomized and received ≥1 dose of study medication (BAT/FF 300/100 n = 42; placebo n = 20). Mean age was 62.5 years (standard deviation [SD] 8.17). Study completion rates were 83% (BAT/FF 300/100) and 100% (placebo). Screening mean (SD) post-bronchodilator percentage-predicted forced expiratory volume in 1 s was 57.57 (11.42) in the BAT/FF 300/100 group and 55.68 (14.03) in the placebo group. BAT/FF 300/100 was non-inferior to placebo for the primary endpoint, treatment difference: − 2.2 beats per minute (bpm), 95% confidence interval [CI]: − 6.2, 1.7). There were no clinically relevant differences between treatment groups in WM or maximum 0–4-h corrected QT interval, or mean HR based on Holter monitoring on Day 42 (BAT/FF 300/100: 76.3 bpm [SD 11.38]; placebo: 84.8 bpm [SD 9.87]). Adverse events (AEs) occurred in 38% (BAT/FF 300/100) and 35% (placebo) of patients. AEs in ≥2 subjects with BAT/FF 300/100 were dysgeusia (10%), diarrhea (7%), nasopharyngitis (7%), and cough (5%). AEs leading to discontinuation occurred in two subjects who received BAT/FF 300/100: post-treatment severe pneumonia (serious AE) and non-serious AEs of moderate vomiting and severe gastroenteritis; both were not considered drug-related. No deaths occurred.

Conclusions

Six weeks of BAT/FF 300/100 treatment was non-inferior to placebo for change from baseline in HR, with no new clinically relevant general or cardiovascular safety signals.

Trial registration

Clinicaltrials.gov: NCT02573870 (submitted October 12, 2015).
The usefulness of intraoperative neurological monitoring for esophageal cancer with double aortic arch; a case report
Authors: Mushiake Shu , Taniguchi Kohei , Lee Sang-Woong , Shimizu Tetsunosuke , Imai Yoshiro , Tanaka Ryo , Honda Kotaro , Tashiro Keitaro , Kawai Masaru , Uchiyama Kazuhisa
Published: May 2020

Background

Double aortic arch (DAA) is a congenital anomaly of the aorta. Esophageal cancer with DAA is rare, and consequently, the appropriate surgical approach has not been standardized. Herein, we report the utilization of intraoperative neurological monitoring (IONM) system to preserve the function of the recurrent laryngeal nerve.

Case presentation

A 79-year-old man with esophageal cancer was diagnosed with DAA incidentally. The descending aorta was located on the right side of the thoracic vertebrae. Safe dissection of the mediastinal lymph nodes was difficult using the right transthoracic approach because of the anatomical abnormalities. During surgery, we used cervical mediastinoscopy combined with the IONM system to preserve the bilateral recurrent laryngeal nerves. Severe complications, including recurrent nerve palsy, were not observed postoperatively.

Conclusion

IONM may be useful for evaluation of the function of the recurrent laryngeal nerve, and it would be suitable for atypical cases of esophageal cancer.
Effect of palliative care training on perceived self-efficacy of the nurses
Authors: Dehghani Fatemeh , Barkhordari-Sharifabad Maasoumeh , Sedaghati-kasbakhi Maryam , Fallahzadeh Hossein
Published: May 2020

Background

Nurses are involved in providing end-of-life care for end stage individuals and their self-efficacy is one of the key factors bearing on such care. The purpose of this study was to determine the effect of palliative care on perceived self-efficacy of the nurses.

Methods

This is a quasi-experimental study with pretest-posttest design. Sampling was randomized and included 40 individuals. The intervention consisted of palliative care training for four sessions, each lasting 45 min. Data were collected using demographic and perceived self-efficacy questionnaires completed before and after the intervention. Data were then analyzed by SPSS 16 software using descriptive and inferential statistics.

Results

The mean age of the participants was 38.6 and their work experience was 14.25 years. The majority of the participants were female (85%) and had a bachelor level of education (92.5%). The findings showed that “perceived self-efficacy”, “psychosocial support” and “symptom management” improved significantly after intervention (p < 0.05).

Conclusion

Based on the results, palliative care education has the potential to increase nurses’ perceived self-efficacy. Since all members of the health care team Including nurses play an important role in providing palliative care, nursing managers can take an effective step to maximize the capacity of nurses by planning and supporting training in this regard.
Crowdfunding abortion: an exploratory thematic analysis of fundraising for a stigmatized medical procedure
Authors: Zenone Marco Antonio , Snyder Jeremy
Published: May 2020

Background

Medical crowdfunding is the process of using a crowdfunding platform to raise funds for medical treatment and associated expenses, such as missing work or transportation costs to access care. This type of crowdfunding has become increasingly popular, and is an effective tool to raise financing for medical treatment in the absence of insurance. However, it is accompanied by questions of which diseases or treatments are viewed as worthy to fund and which do not fit the criteria of worthiness. In the context of an abortion, a legitimate and important medical procedure, there is a lack of research that determines if campaigners can successfully utilize GoFundMe to pay for abortions and abortion related services and costs given the social stigma around this procedure. Here, we explore the outcomes of crowdfunding campaigns for stigmatized needs and conditions by examining campaigns related to abortion.

Methods

A total of 211 campaigns that utilized the term “abortion” were retrieved on the medical-section of the GoFundMe crowdfunding platform. These results were thematically analyzed by each author and two distinctive categories were identified to group the campaigns.

Results

The categories of campaigns using the term “abortion” were: campaigns seeking funds to access abortion related services (n = 84) and campaigns using the choice not to terminate pregnancy or the harms of abortion as a reason to give (n = 127). The number of donors, number of Facebook shares, campaign location, funding requested, funding pledged, campaign creation date, relation between the recipient and campaigner, and proposed use for the funds were recorded for each included campaign.

Conclusions

This study suggests that certain conditions or diseases may be less successful in medical crowdfunding based on perceived features of worthiness, such as in the case of abortion. In the categories we identified, campaigns seeking funds to access abortion-related services were less successful than campaigns using choosing not to terminate a pregnancy or the harms of abortion as a reason to give. This is an area of concern in medical crowdfunding – that certain medical needs will not be funded equitably.
A combination of two methods for evaluating the usability of a hospital information system
Authors: Khajouei Reza , Farahani Fatemeh
Published: May 2020

Background

None of the evaluation methods can identify all the usability problems of information systems. So far, no study has sufficiently investigated the potential of a combination of these methods to identify usability problems. The present study aimed at examining the potential for combining two commonly utilized user-based and expert-based methods to evaluate the usability of a hospital information system.

Methods

Think aloud (TA) and Heuristic evaluation (HE) methods were used to identify the usability problems of two subsystems of the Social Security Electronic System in Iran. To this end, the problems were categorized into five groups based on ISO-Nielsen usability attributes. The Chi-square test was applied to compare the intended methods based on the total number of problems and the number of problems within each group, followed by utilizing the Mann-Whitney U test to compare the mean severity scores of these methods.

Results

The evaluation by combining these methods yielded 423 problems of which 75% varied between the methods. The two methods were significantly different in terms of the total number of problems, the number of problems in each usability group, and the mean severity of two satisfaction and efficiency attributes (P < 0.05). However, no significant difference was observed between the two methods based on the mean severity of problems and severity scores related to three usability attributes i.e., effectiveness, learnability, and error prevention (P > 0.05). In addition, the mean severity of problems identified by each method was at the “Major” level.

Conclusion

Based on the results, although the mean severity scores of the identified problems were not significantly different, these methods identify heterogeneous problems. HE mainly identifies problems related to satisfaction, learnability, and error prevention while TA detects problems related to effectiveness and efficiency attributes. Therefore, using a combination of these two methods can identify a wider range of usability problems.