bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender and diet management in type 2 diabetes
Authors: Dimova Elena Dimcheva , Swanson Vivien , Evans Josie MM
Published: September 2019

Introduction

Type 2 diabetes is a chronic health condition that requires ongoing self-management. This often includes changes in diet, which may be open to influences from relatives. Family support in terms of diet may be linked with gender and the assumption that meal preparation is a traditionally female activity. This article looks at the role of gender in diet management in people with type 2 diabetes and their relatives.

Methods

Seventeen semi-structured interviews were conducted with 23 participants (10 people with type 2 diabetes, 13 relatives of people with type 2 diabetes) in Scotland, UK. The aim was to uncover changes people have made to their diet following diagnosis of type 2 diabetes in oneself or a family member. Data were analysed using Framework Approach. Findings: Female relatives were more likely to manage the patient’s diet while male relatives provided support but were less likely to monitor the person’s diet. Female patients may prioritise the needs of their family while male patients are more likely to rely on their female relatives in terms of diet management.

Discussion

The study findings have implications for family-based interventions as gender may play a crucial role in the management of type 2 diabetes.
The case for communication rights: A rights-based approach to media development
Authors: Uppal Charu , Sartoretto Paola , Cheruiyot David
Published: September 2019

From the 1980s, international organizations have devised strategies to develop national media systems to make them more diverse and inclusive so as to both exhibit and preserve local cultures. However, these strategies have not always been successful since information has become a commodity, because the interests of private actors prevent equal access to communication rights. This article outlines a perspective on media development from a rights-based approach, derived from a critique of dominant perspectives from international organizations with a strong focus on technology provisions. The article argues for media development based on the right to communication as an alternative to commodification of information. Through examples from Brazil and Kenya, the article illustrates that viewing communication as a basic right can lead to the inclusion of more voices in the public discourse. In addition, a model for media development is proposed, suggesting that the state and national civil society play a significant role in promoting diverse national public spheres.
Social Ambivalence and Disease (SAD): A Theoretical Model Aimed at Understanding the Health Implications of Ambivalent Relationships
Authors: Holt-Lunstad Julianne , Uchino Bert N.
Published: September 2019

The protective influence of social relationships on health is widely documented; however, not all relationships are positive, and negative aspects of relationships may be detrimental. Much less is known about the relationships characterized by both positivity and negativity (i.e., ambivalence). This article provides a theoretical framework for considering the influence of ambivalent relationships on physical health, including reasons why ambivalence should be considered separately from relationships characterized as primarily positive (supportive) or primarily negative (aversive). We introduce the social ambivalence and disease (SAD) model as a guide to understanding the social psychological antecedents, processes, and consequences of ambivalent relationships. We conclude by highlighting gaps in the literature and features of the SAD model that may serve as a guide to future research on potential health-relevant pathways of ambivalent relationships.
Analysing the short-term impact of substitutes vs. starters in international rugby
Authors: Michael Isaac , Serpell Benjamin G , Colomer Carmen M , Mara Jocelyn K
Published: September 2019

The aim of this study was to compare the short-term performance of substitute players to starting players during International Rugby Union matches and determine how this performance was influenced by playing position, the timing of the substitution and the score margin between teams. Individual player performances (n = 298) for substitutes and the starters they replaced were observed across 17 matches played between tier 1 rugby nations. Performance was categorised as the total number of involvements, the number of attacking and defensive involvements, as well as the effectiveness of a player's performance for each of the above involvement categories. Results revealed forward substitutes performed more total ( p = 0.001, ES = 0.61), attacking ( p = 0.026, ES = 0.32) and defensive ( p = 0.023, ES = 0.31) involvements than forward starters; however, there were no differences found for backs ( p = 0.819–0.911). In addition, it was observed that an increase in score margin at the time of substitution led to a decrease in the total and attacking involvements per minute that a substitute performed, but an increase in defensive involvements for both forwards and backs. These findings provide a platform for coaches to make tactical decisions regarding substitution patterns during International Rugby matches. Specifically, coaches should prioritise forward substitutions over back substitutions, and implement tactical changes earlier in the second half to gain an advantage over the opposition.
Associations between ground reaction force waveforms and sprint start performance
Authors: Colyer Steffi L , Graham-Smith Philip , Salo Aki IT
Published: September 2019

Ground reaction forces produced on the blocks determine an athlete’s centre of mass motion during the sprint start, which is crucial to sprint performance. This study aimed to understand how force waveforms are associated with better sprint start performance. Fifty-seven sprinters (from junior to world elite) performed a series of block starts during which the ground reaction forces produced by the legs and arms were separately measured. Statistical parametric mapping (linear regression) revealed specific phases of these waveforms where forces were associated with average horizontal external power. Better performances were achieved by producing higher forces and directing the force vector more horizontally during the initial parts of the block phase (17–34% and 5–37%, respectively). During the mid-push (around the time of rear block exit: ∼54% of the block push), magnitudes of front block force differentiated performers, but orientation did not. Consequently, the ability to sustain high forces during the transition from bilateral to unilateral pushing was a performance-differentiating factor. Better athletes also exhibited a higher ratio of forces on the front block in the latter parts of unilateral pushing (81–92% of the block push), which seemed to allow these athletes to exit the blocks with lower centre of mass projection angles. Training should reflect these kinetic requirements, but also include technique-based aspects to increase both force production and orientation capacities. Specific training focused on enhancing anteroposterior force production during the transition between double- to single-leg propulsion could be beneficial for overall sprint start performance.
Calibration of multiple sparsely distributed cameras using a mobile camera
Authors: Shishido Hidehiko , Kitahara Itaru
Published: September 2019

In sports science research, there are many topics that utilize the body motion of athletes extracted by motion capture system, since motion information is valuable data for improving an athlete’s skills. However, one of the unsolved challenges in motion capture is extraction of athletes’ motion information during the actual game or match, as placing markers on athletes is a challenge during game play. In this research, the authors propose a method for acquisition of motion information without attaching a marker, utilizing computer vision technology. In the proposed method, the three-dimensional world joint position of the athlete’s body can be acquired using just two cameras without any visual markers. Furthermore, the athlete’s three-dimensional joint position during game play can also be obtained without complicated preparations. Camera calibration that estimates the projective relationship between three-dimensional world and two-dimensional image spaces is one of the principal processes for the respective three-dimensional image processing, such as three-dimensional reconstruction and three-dimensional tracking. A strong-calibration method, which needs to set up landmarks with known three-dimensional positions, is a common technique. However, as the target space expands, landmark placement becomes increasingly complicated. Although a weak-calibration method does not need known landmarks, the estimation precision depends on the accuracy of the correspondence between image captures. When multiple cameras are arranged sparsely, sufficient detection of corresponding points is difficult. In this research, the authors propose a calibration method that bridges multiple sparsely distributed cameras using mobile camera images. Appropriate spacing was confirmed between the images through comparative experiments evaluating camera calibration accuracy by changing the number of bridging images. Furthermore, the proposed method was applied to multiple capturing experiments in a large-scale space to verify its robustness. As a relevant example, the proposed method was applied to the three-dimensional skeleton estimation of badminton players. Subsequently, a quantitative evaluation was conducted on camera calibration for the three-dimensional skeleton. The reprojection error of each part of the skeletons and standard deviations were approximately 2.72 and 0.81 mm, respectively, confirming that the proposed method was highly accurate when applied to camera calibration. Consequently, a quantitative evaluation was conducted on the proposed calibration method and a calibration method using the coordinates of eight manual points. In conclusion, the proposed method stabilizes calibration accuracy in the vertical direction of the world coordinate system.
Repeated low-dose rituximab treatment based on the assessment of circulating B cells in patients with refractory myasthenia gravis
Authors: Choi Kyomin , Hong Yoon-Ho , Ahn So-Hyun , Baek Seol-Hee , Kim Jun-Soon , Shin Je-Young , Sung Jung-Joon
Published: September 2019

Background:

The objective of this study was to evaluate the efficacy and safety of repeated low-dose rituximab treatment guided by monitoring circulating CD19+ B cells in patients with refractory myasthenia gravis (MG).

Methods:

Patients with refractory MG who had received rituximab treatment at two teaching hospitals between September 2013 and January 2017 were reviewed retrospectively. The treatment protocol consisted of an induction treatment with low-dose rituximab (375 mg/m2 twice with a 2-week interval), followed by retreatment (375 mg/m2 once). Retreatment was based on either circulating CD19+ B-cell repopulation or clinical relapse. Outcome measures included the MG Foundation of America (MGFA) clinical classification and postintervention status, prednisolone dose, CD19+ B-cell counts, clinical relapse, and adverse effects.

Results:

Of 17 patients, 11 (65%) achieved the primary endpoint, defined as the minimal manifestation or better status with prednisolone ⩽5 mg/day, after median 7.6 months (range, 2–17 months) following rituximab treatment. Over a median follow up of 24 months (range, 7–49 months), a total of 30 retreatments were undertaken due to clinical relapse without B-cell repopulation ( n = 6), on the basis of B-cell repopulation alone ( n = 16) and both ( n = 8). B-cell recovery appeared to be in parallel with clinical relapse on the group level, although the individual-level association appeared to be modest, with B-cell repopulation observed only at 57% (8/14) of clinical relapses.

Conclusions:

The repeated low-dose rituximab treatment based on the assessment of circulating B-cell depletion could be a cost-effective therapeutic option for refractory MG. Further studies are needed to verify the potentially better cost-effectiveness of low-dose rituximab, and to identify biomarkers that help optimize treatment in MG patients.
Foot Patrols Enhance Conservation Efforts in Threatened Forest Reserves of Coastal Côte d’Ivoire
Authors: Gonedelé Bi Sery , Bitty Eloi Anderson , Yao Alphonse K. , McGraw William Scott
Published: September 2019

The Dassioko Sud and Port Gauthier Forest Reserves are important wildlife refuges in southern Côte d’Ivoire, harboring several endangered mammalian taxa. Between July 2012 and June 2016, foot patrols were conducted in these reserves by teams consisting of local villagers, Société de Développement des Forêts employees, law enforcement personnel, and the authors. The purpose of the patrols was to help curb poaching and illegal farming/logging and to collect information on wildlife. Over the length of the patrol period, both reserves experienced significant declines in illegal activities, including prior to the 2014 EBOLA outbreak. Both reserves continue to be pressured by persons living in surrounding villages; however, our results demonstrate that foot patrols involving local personnel can lead to significant declines in illegal activity inside such conservation areas.
Enhanced antibacterial activity of titanium by surface modification with polydopamine and silver for dental implant application
Authors: Choi Soo-Hyoen , Jang Yong-Seok , Jang Jong-Hwa , Bae Tae-Sung , Lee Sook-Jeong , Lee Min-Ho
Published: September 2019

Background:

Biofilm formation and microbial colonization on the surface of implant devices may cause dental caries and peri-implantitis. Therefore, various surface treatments have been developed to improve the antibacterial activity of titanium implant.

Methods:

Silver-loaded polydopamine coating was formed by immersing pure titanium in dopamine hydrochloride/HCl buffer solution for 24 h in 50 mL silver nitrate solutions with different concentrations for 30 min. Microbial growth inhibition and microbial growth curve analyses for bacterial solutions of Streptococcus mutans and Porphyromonas gingivalis incubated with the specimens were respectively conducted by counting the numbers of colonies on agar solid medium and by measuring absorbance using enzyme-linked immunosorbent assay reader.

Results:

Silver nanoparticles were uniformly distributed over the whole surface of the polydopamine and silver-coated titanium specimens. The numbers of microbial colonies for both bacteria cultured with surface-modified titanium were significantly lower than those cultured with uncoated titanium. When Streptococcus mutans and Porphyromonas gingivalis were cultured with surface-modified titanium, the lag phase of the growth curves for both bacteria was continually maintained, whereas the lag phase for Streptococcus mutans and Porphyromonas gingivalis changed to exponential phase after 9 and 15 h, respectively, when both bacteria were cultured with uncoated titanium.

Conclusion:

It was confirmed that the coating of polydopamine and silver on the surface of titanium effectively retards the microbial growth, which can cause the formation of biofilm and pathogenesis of gum disease in the mouth.
Gradual correction of proximal tibia deformity for Blount disease in adolescent and young adults
Authors: Saw Aik , Phang Zi Hao , Alrasheed Mohammed Khalid , Gunalan Roshan , Albaker Mohammed Ziyad , Shanmugam Rukmanikanthan
Published: September 2019

Purpose:

Management of Blount disease in adolescents and young adults is complex and associated with high risk of morbidities. Gradual correction with external fixator can minimize soft tissue injury and allow subsequent adjustment in degree of correction. This study investigates the surgical outcome and complication rate of gradual correction of neglected Blount disease through single-level extra-articular corticotomy.

Methods:

Patients treated for Blount disease using external fixator from 2002 to 2016 were recruited for the study. We used Ilizarov and Taylor Spatial Frame (TSF) external fixator to perform simultaneous correction of all the metaphyseal deformities without elevating the tibia plateau. Surgical outcome was evaluated using mechanical axis deviation (MAD), tibial femoral angle (TFA), and femoral condyle tibial shaft angle (FCTSA).

Results:

A total of 22 patients with 32 tibias have been recruited for the study. The mean MAD improved from 95 ± 51.4 mm to 9.0 ± 37.7 mm (medial to midpoint of the knee), mean TFA improved from 31 ± 15° varus to 2 ± 14° valgus, and mean FCTSA improved from 53 ± 14° to 86 ± 14°. Mean duration of frame application is 9.4 months. Two patients developed pathological fractures over the distracted bones, one developed delayed consolidation and other developed overcorrection.

Conclusions:

Correction of Blount disease can be achieved by gradual correction using Ilizarov or TSF external fixator with low risk of soft tissue complication. Longer duration of frame application should be considered to reduce the risk of pathological fracture or subsequent deformation of the corrected bone.
Clinical and functional outcomes of a novel transosseous device to treat rotator cuff tears: A minimum 2-year follow-up
Authors: Arican Mehmet , Turhan Yalçın , Karaduman Zekeriya Okan , Ayanoğlu Tacettin
Published: September 2019

Purpose:

Despite the improvements in the repair equipment techniques of rotator cuff, a gold standard method has not been defined yet and transosseous fixation through deltoid-splitting (mini-open) approach is still regarded as a good option. The primary purpose of this study is to present satisfactory clinical and functional outcomes with a novel transosseous device in full-thickness rotator cuff tear through deltoid-splitting.

Materials and Methods:

This retrospective study was performed on 70 consecutive patients who underwent surgery by a single surgeon from June 2014 to June 2016 for a full-thickness rotator cuff tear and was managed with a novel transosseous device. Total number of patients, mean age, percentage of male and female patients, mean duration of follow-up, percentage of involvement of the dominant extremity, affected shoulder, and tear size were recorded. Functional and clinical outcomes were assessed baseline and postoperatively at 3 and 6 months and final follow-up using Disabilities of the Arm, Shoulder and Hand (Q-DASH) and Constant-Murley scores.

Results:

A total of 70 (49 (70%) female, 21 (30%) male) patients whose mean age was 58.66 ± 9.19 (38–77) years were included. The mean surgery time was 35.33 ± 5.34 (28–55) min. The mean follow-up time was 28.31 ± 3.03 (24–36) months. According to the DeOrio and Cofield classification, 15 (21.43%) tears were small, 33 (47.14%) medium, 16 (22.86%) large, and 6 (8.57%) massive. By the final follow-up, the mean Constant-Murley score had significantly improved from 27.67 ± 7.46 (13–41) to 81.25 ± 3.77 (74–87; p = 0.0001) and the Q-DASH score had decreased from 82.34 ± 10.37 (65.91–100) to 10.28 ± 6.88 (0–23.45; p = 0.0001). There were no significant differences in the Constant-Murley or Q-DASH score at baseline–final follow-up between the small, medium, large, and massive tear groups ( p > 0.05).

Conclusions:

Treatment of full-thickness rotator cuff tear using this novel transosseous device significantly improved functional and clinical scores. However, further long-term prospective randomized multicenter trials involving comparative studies are necessary to confirm these findings.
Some advantages of three-layer medium-density fibreboard as compared to the traditional single-layer one
Authors: Akbulut Turgay , Ayrilmis Nadir
Published: September 2019

The aim of the study was to develop three-layer medium-density fibreboard (MDF) manufacture by adding the coarse fibres in the middle layer, like three-layer particleboard. The liquid urea–formaldehyde (UF) resin was reduced from 10.5 to 6.5 wt% in the middle layer of the MDFs. The UF resin content was kept constant at 10 wt% in the surface layers of all the MDFs. Moreover, the average density of MDFs was decreased from 730 to 650 kg/m3. The internal bond strength of three-layer MDFs decreased with decreasing UF resin content (10.5 to 8.5 wt%) in the middle layer. However, the decreases in the internal bond strength were statistically not significant. The internal bond strength values of the MDFs having density between 730 and 675 kg/m3 did not show significant differences. The cost savings of the resin were 20% when the amount of resin was reduced from 10.5 to 8.5 wt%. Three-layer MDFs had lower resin consumption at lower densities over traditional single-layer MDFs produced in the same plant with the same material components without decreasing their technological properties. In conclusion, it can be said that three-layer MDF could be produced at a lower cost than traditional single-layer MDF.
Assessing the leaching behavior of different gunshot materials in natural spring waters
Authors: Fäth Julian , Göttlein Axel
Published: September 2019

Background

Owing to the high environmental risk of lead-based gunshot, especially as the main source of acute lead poisoning in waterfowl, restrictions on its use in European wetlands are being put into place. In order to assess potential risks of alternative gunshot pellets to aquatic systems, we validated a recently published study that compared the leaching behavior of different game shot materials in an artificial solution and their toxicological effects to Daphnia magna. We therefore investigated the altered leaching of shot materials in natural spring waters.

Results

The different water conditions (geology/redox conditions) had a strong influence on the leaching behavior of the examined shot types. Spring water originating from siliceous bedrock showed the highest concentrations of nearly all leached metals under aerobic conditions. The results were similar to the former study, which used an artificial standardized medium for daphnids.

Conclusions

According to the conducted leaching tests, Cu- and Zn-based as well as Zn-coated gunshot should be avoided by reason of the high risks they pose to the aquatic environment. Furthermore, the use of Pb-based and Ni-alloyed or -coated game shot also should be hampered owing to their impact on birds or other wildlife. Since some of these shot materials are still on the European market, an effective toxicity screening of alternative gunshot materials is necessary. By conducting standardized leaching tests, in addition to chemical compositional standards and toxicity tests regarding birds, the environmental risks of each game shot would entirely be assessed. The method presented in this study provides a further step for initial ecotoxicological risk assessment of gunshot for aquatic systems, since it additionally assesses minor components, like thin coatings, which also can have a high impact to these ecosystems.
Adverse drug reaction detection via a multihop self-attention mechanism
Authors: Zhang Tongxuan , Lin Hongfei , Ren Yuqi , Yang Liang , Xu Bo , Yang Zhihao , Wang Jian , Zhang Yijia
Published: September 2019

Background

The adverse reactions that are caused by drugs are potentially life-threatening problems. Comprehensive knowledge of adverse drug reactions (ADRs) can reduce their detrimental impacts on patients. Detecting ADRs through clinical trials takes a large number of experiments and a long period of time. With the growing amount of unstructured textual data, such as biomedical literature and electronic records, detecting ADRs in the available unstructured data has important implications for ADR research. Most of the neural network-based methods typically focus on the simple semantic information of sentence sequences; however, the relationship of the two entities depends on more complex semantic information.

Methods

In this paper, we propose multihop self-attention mechanism (MSAM) model that aims to learn the multi-aspect semantic information for the ADR detection task. first, the contextual information of the sentence is captured by using the bidirectional long short-term memory (Bi-LSTM) model. Then, via applying the multiple steps of an attention mechanism, multiple semantic representations of a sentence are generated. Each attention step obtains a different attention distribution focusing on the different segments of the sentence. Meanwhile, our model locates and enhances various keywords from the multiple representations of a sentence.

Results

Our model was evaluated by using two ADR corpora. It is shown that the method has a stable generalization ability. Via extensive experiments, our model achieved F-measure of 0.853, 0.799 and 0.851 for ADR detection for TwiMed-PubMed, TwiMed-Twitter, and ADE, respectively. The experimental results showed that our model significantly outperforms other compared models for ADR detection.

Conclusions

In this paper, we propose a modification of multihop self-attention mechanism (MSAM) model for an ADR detection task. The proposed method significantly improved the learning of the complex semantic information of sentences.
Isolation and characterization of a sequence type 25 carbapenem-resistant hypervirulent Klebsiella pneumoniae from the mid-south region of China
Authors: Li Jun , Huang Zi-Yan , Yu Ting , Tao Xiao-Yan , Hu Yong-Mei , Wang Hai-Chen , Zou Ming-Xiang
Published: September 2019

Background

The molecular characterization of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) isolates is not well studied. Our goal was to investigate the molecular epidemiology of CR-hvKP strains that were isolated from a Chinese hospital.

Results

All clinical carbapenem-resistant K. pneumoniae (CR-KP) isolates were collected and identified from patient samples between 2014 and 2017 from a Chinese hospital. The samples were subjected to screening for CR-hvKP by string test and the detection of the aerobactin gene. CR-hvKP isolates were further confirmed through neutrophil phagocytosis and a mice lethality assay. The CR-hvKP isolates were investigated for their capsular genotyping, virulence gene profiles, and the expression of carbapenemase genes by PCR and DNA sequencing. Multilocus sequence type (MLST) and pulsed-field gel electrophoresis (PFGE) were performed to exclude the homology of these isolates. Twenty strains were identified as CR-hvKP. These strains were resistant to imipenem and several other antibiotics, however, most were susceptible to amikacin. Notably, two isolates were not susceptible to tigecycline. Capsular polysaccharide synthesis genotyping revealed that 17 of the 20 CR-hvKP strains belonged to the K2 serotype, while the others belonged to serotypes other than K1, K2, K5, K20, and K57. The strains were found to be positive for 10 types of virulence genes and a variety of these genes coexisted in the same strain. Two carbapenemase genes were identified: blaKPC-2 (13/20) and blaNDM-1 (1/20). PFGE typing revealed eight clusters comprising isolates that belonged to MLST types ST25, ST11 and ST375, respectively. PFGE cluster A was identified as the main cluster, which included 11 isolates that belong to ST25 and mainly from ICU department.

Conclusions

Our findings suggest that hospital-acquired infections may contribute in part to the CR-hvKP strains identified in this study. It also suggests that ST25 CR-hvKP strain has a clonal distribution in our hospital. Therefore, effective surveillance and strict infection control strategies should be implemented to prevent outbreak by CR-hvKP strains in hospitals setting.
Conserved residues in the wheat (Triticum aestivum) NAM-A1 NAC domain are required for protein binding and when mutated lead to delayed peduncle and flag leaf senescence
Authors: Harrington Sophie A. , Overend Lauren E. , Cobo Nicolas , Borrill Philippa , Uauy Cristobal
Published: September 2019

Background

NAC transcription factors contain five highly conserved subdomains which are required for protein dimerisation and DNA binding. Few residues within these subdomains have been identified as essential for protein function, and fewer still have been shown to be of biological relevance in planta. Here we use a positive regulator of senescence in wheat, NAM-A1, to test the impact of missense mutations at specific, highly conserved residues of the NAC domain on protein function.

Results

We identified missense mutations in five highly conserved residues of the NAC domain of NAM-A1 in a tetraploid TILLING population. TILLING lines containing these mutations, alongside synonymous and non-conserved mutation controls, were grown under glasshouse conditions and scored for senescence. Four of the five mutations showed a significant and consistent delay in peduncle senescence but had no consistent effects on flag leaf senescence. All four mutant alleles with the delayed senescence phenotype also lost the ability to interact with the homoeolog NAM-B1 in a yeast two-hybrid assay. Two of these residues were previously shown to be involved in NAC domain function in Arabidopsis, suggesting conservation of residue function between species. Three of these four alleles led to an attenuated cell death response compared to wild-type NAM-A1 when transiently over-expressed in Nicotiana benthamiana. One of these mutations was further tested under field conditions, in which there was a significant and consistent delay in both peduncle and leaf senescence.

Conclusions

We combined field and glasshouse studies of a series of mutant alleles with biochemical analyses to identify four residues of the NAC domain which are required for NAM-A1 function and protein interaction. We show that mutations in these residues lead to a gradient of phenotypes, raising the possibility of developing allelic series of mutations for traits of agronomic importance. We also show that mutations in NAM-A1 more severely impact peduncle senescence, compared to the more commonly studied flag leaf senescence, highlighting this as an area deserving of further study. The results from this integrated approach provide strong evidence that conserved residues within the functional domains of NAC transcription factors have biological significance in planta.
Health systems readiness to provide geriatric friendly care services in Uganda: a cross-sectional study
Authors: Ssensamba Jude Thaddeus , Mukuru Moses , Nakafeero Mary , Ssenyonga Ronald , Kiwanuka Suzanne N.
Published: September 2019

Background

As ageing emerges as the next public health threat in Africa, there is a paucity of information on how prepared its health systems are to provide geriatric friendly care services. In this study, we explored the readiness of Uganda’s public health system to offer geriatric friendly care services in Southern Central Uganda.

Methods

Four districts with the highest proportion of old persons in Southern Central Uganda were purposively selected, and a cross-section of 18 randomly selected health facilities (HFs) were visited and assessed for availability of critical items deemed important for provision of geriatric friendly services; as derived from World Health Organization’s Age-friendly primary health care centres toolkit. Data was collected using an adapted health facility geriatric assessment tool, entered into Epi-data software and analysed using STATA version 14. Kruskal-Wallis and Dunn’s post hoc tests were conducted to determine any associations between readiness, health facility level, and district.

Results

The overall readiness index was 16.92 (SD ±4.19) (range 10.8–26.6). This differed across districts; Lwengo 17.91 (SD ±3.15), Rakai 17.63 (SD ±4.55), Bukomansimbi 16.51 (SD ±7.18), Kalungu 13.74 (SD ±2.56) and facility levels; Hospitals 26.62, Health centers four (HCIV) 20.05 and Health centers three (HCIII) 14.80. Low readiness was due to poor scores concerning; leadership (0%), financing (0%), human resources (1.7%) and health management information systems (HMIS) (11.8%) WHO building blocks. Higher-level HFs were statistically significantly friendlier than lower-level HFs (p = 0.015). The difference in readiness between HCIIIs and HCIVs was 2.39 (p = 0.025).

Conclusion

There is a low readiness for public health facilities to provide geriatric friendly care services in Uganda. This is due to gaps in all of the health system building blocks. There is a need for health system reforms in Uganda to adequately cater for service provision for older adults if the 2020 global healthy ageing goal is to be met.
Use of a mobile application for Ebola contact tracing and monitoring in northern Sierra Leone: a proof-of-concept study
Authors: Danquah Lisa O. , Hasham Nadia , MacFarlane Matthew , Conteh Fatu E. , Momoh Fatoma , Tedesco Andrew A. , Jambai Amara , Ross David A. , Weiss Helen A.
Published: September 2019

Background

The 2014–2016 Ebola epidemic in West Africa was the largest Ebola epidemic to date. Contact tracing was a core surveillance activity. Challenges with paper-based contact tracing systems include incomplete identification of contacts, delays in communication and response, loss of contact lists, inadequate data collection and transcription errors.

The aim of this study was to design and evaluate an electronic system for tracing contacts of Ebola cases in Port Loko District, Sierra Leone, and to compare this with the existing paper-based system. The electronic system featured data capture using a smartphone application, linked to an alert system to notify the District Ebola Response Centre of symptomatic contacts.

Methods

The intervention was a customised three-tier smartphone application developed using Dimagi’s CommCare platform known as the Ebola Contact Tracing application (ECT app). Eligible study participants were all 26 Contact Tracing Coordinators (CTCs) and 86 Contact Tracers (CTs) working in the 11 Chiefdoms of Port Loko District during the study period (April–August 2015). Case detection was from 13th April to 17th July 2015. The CTCs and their CTs were provided with smartphones installed with the ECT app which was used to conduct contact tracing activities. Completeness and timeliness of contact tracing using the app were compared with data from April 13th-June 7th 2015, when the standard paper-based system was used.

Results

For 25 laboratory-confirmed cases for whom paper-based contact tracing was conducted, data for only 39% of 408 contacts were returned to the District, and data were often incomplete. For 16 cases for whom app-based contact tracing was conducted, 63% of 556 contacts were recorded as having been visited on the app, and the median recorded duration from case confirmation to first contact visit was 70 h.

Conclusion

There were considerable challenges to conducting high-quality contact tracing in this setting using either the paper-based or the app-based system. However, the study demonstrated that it was possible to implement mobile health (mHealth) in this emergency setting. The app had the benefits of improved data completeness, storage and accuracy, but the challenges of using an app in this setting and epidemic context were substantial.
Rapid development of HIV elite control in a patient with acute infection
Authors: Morley Deirdre , Lambert John S. , Hogan Louise E. , De Gascun Cillian , Redmond Niamh , Rutishauser Rachel L. , Thanh Cassandra , Gibson Erica A. , Hobbs Kristen , Bakkour Sonia , Busch Michael P. , Farrell Jeremy , McGetrick Padraig , Henrich Timothy J.
Published: September 2019

Background

Elite controllers (EC), a small subset of the HIV-positive population (< 1%), suppress HIV viremia below the limit of quantification of clinical viral load assays in the absence of antiretroviral therapy (ART). However, there is a paucity of longitudinal data detailing the viral and immune dynamics or HIV reservoir seeding during acute infection in individuals that go on to become Elite Controllers.

Case presentation

In this report, we describe a case of a 42 year old woman diagnosed during acute infection who rapidly and permanently suppressed her viremia in the absence of antiretroviral therapy (ART). Rapid antibody/antigen testing was either negative or equivocal during acute infection, despite subsequent viral load testing at that time point with 71,550 plasma HIV RNA copies/mL, making initial diagnosis challenging. The patient subsequently developed detectable anti-HIV antibodies and an increase in HIV-specific CD8+ T cell responses to overlapping subtype C HIV gag peptide; very low-level plasma viremia (0.84 RNA copies/mL) was detected by an ultrasensitive assay 2 years following infection. Subsequently, she was started on ART for multifocal furunculosis despite continued suppression of virus and stable CD4+ T cell counts. Following ART initiation, CD8+ T cell responses increased, but no HIV DNA or RNA was able to be isolated from large numbers of peripheral blood CD4+ T cells.

Conclusion

This case provides important information regarding the establishment of elite HIV control during acute infection and also demonstrates an increase in HIV-specific immune responses following ART despite undetectable peripheral blood cellular measures of HIV persistence. This case also highlights the challenges in diagnosing acute HIV infection without the use of viral load testing in this rare elite controller phenotype.
Intensive phase treatment outcome and associated factors among patients treated for multi drug resistant tuberculosis in Ethiopia: a retrospective cohort study
Authors: Molie Teklu , Teklemariam Zelalem , Klinkenberg Eveline , Dessie Yadeta , Kumsa Andargachew , Mohammed Hussen , Debebe Adisalem , Assefa Dawit , Habte Abebe , Bedru Ahmed , Fiseha Daniel , Seyoum Berhanu
Published: September 2019

Background

Multi-drug resistant Tuberculosis (MDR-TB) is a strain of Mycobacterium tuberculosis that is resistant to at least Rifampicin and Isoniazid drugs. The treatment success rate for MDR-TB cases is lower than for drug susceptible TB. Globally only 55% of MDR-TB patients were successfully treated. Monitoring the early treatment outcome and better understanding of the specific reasons for early unfavorable and unknown treatment outcome is crucial for preventing the emergence of further drug-resistant tuberculosis. However, this information is scarce in Ethiopia. Therefore, this study aimed to determine the intensive phase treatment outcome and contributing factors among patients treated for MDR-TB in Ethiopia.

Methods

A 6 year retrospective cohort record review was conducted in fourteen TICs all over the country. The records of 751 MDR-TB patients were randomly selected using simple random sampling technique. Data were collected using a pre-tested and structured checklist. Multivariable multinomial logistic regression was undertaken to identify the contributing factors.

Results

At the end of the intensive phase, 17.3% of MDR-TB patients had an unfavorable treatment outcome, while 16.8% had an unknown outcome with the remaining having a favorable outcome. The median duration of the intensive phase was 9.0 months (IQR 8.04–10.54). Having an unfavorable intensive phase treatment outcome was found significantly more common among older age [ARRR = 1.047, 95% CI (1.024, 1.072)] and those with a history of hypokalemia [ARRR = 0.512, 95% CI (0.280, 0.939)]. Having an unknown intensive phase treatment outcome was found to be more common among those treated under the ambulatory care [ARRR = 3.2, 95% CI (1.6, 6.2)], rural dwellers [ARRR = 0.370, 95% CI (0.199, 0.66)], those without a treatment supporter [ARRR = 0.022, 95% CI (0.002, 0.231)], and those with resistance to a limited number of drugs.

Conclusion

We observed a higher rate of unfavorable and unknown treatment outcome in this study. To improve favorable treatment outcome more emphasis should be given to conducting all scheduled laboratory monitoring tests, assignment of treatment supporters for each patient and ensuring complete recording and reporting which could be enhanced by quarterly cohort review. Older aged and rural patients need special attention. Furthermore, the sample referral network should be strengthened.
An exploratory pilot study evaluating the supplementation of standard antibiotic therapy with probiotic lactobacilli in south African women with bacterial vaginosis
Authors: Marcotte Harold , Larsson Per Göran , Andersen Kasper Krogh , Zuo Fanglei , Mikkelsen Lasse Sommer , Brandsborg Erik , Gray Glenda , Laher Fatima , Otwombe Kennedy
Published: September 2019

Background

To reduce acquisition and relapse of bacterial vaginosis (BV), lactobacilli must be maintained in the vaginal microbiome. Probiotic lactobacilli may aid this purpose. We investigated whether vaginal probiotics (containing Lactobacillus rhamnosus DSM 14870 and Lactobacillus gasseri DSM 14869) would result in vaginal colonisation with lactobacilli in women with and without BV.

Methods

This prospective, partially randomised, exploratory pilot study was conducted in Soweto, South Africa. Thirty-nine sexually-active, HIV negative women were enrolled from October 2014 to May 2016 into three arms. Women who did not have BV (Group 1, n = 13) self-administered probiotic capsules vaginally once daily for 30 days, then once a week until Day 190. Women diagnosed with BV were randomized into Group 2 (n = 12) or Group 3 (n = 14) and treated with the triple oral antibiotic combination for vaginal discharge syndrome per South African guidelines (cefixime 400 mg stat, doxycycline 100 mg BD for 7 days and metronidazole 2 g stat). Immediately after antibiotic treatment, women in Group 2 self-administered probiotic capsules vaginally once daily for 30 days then vaginally once a week until Day 190. Women in Group 3 were not given lactobacilli.

Results

During the study, L. rhamnosus DSM 14870 or L. gasseri DSM 14869, were isolated in 5/13 (38.5%) women in Group 1 compared to 10/12 (83.3%) women in Group 2 (p = 0.041). The 1-month and 6-month BV cure rates were similar (P >  0.05) between Group 2 (42 and 25%) compared to Group 3 (36 and 25%). In Group 2, no correlation was observed between the frequency of isolation of the two Lactobacillus strains and the 1-month or 6-month cure rate.

Conclusions

Supplementation with vaginal probiotic capsules resulted in colonisation of the vagina by the Lactobacillus strains (L. rhamnosus DSM 14870 and L. gasseri DSM 14869) contained in the capsules. We observed low initial cure rates of BV after a stat dose of metronidazole and that the probiotic did not improve BV cure rates or alleviate recurrence which could be due to treatment failure or very limited power of the study.

Trial registration

Registered at the Pan African Clinical Trial Registry (www.pactr.org) on April 13, 2018 (retrospectively registered). Trial identification number: PACTR201804003327269.
Incidence and predictors of lost to follow-up among drug-resistant tuberculosis patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: a retrospective follow-up study
Authors: Kassa Getahun Molla , Teferra Alemayehu Shimeka , Wolde Haileab Fekadu , Muluneh Atalay Goshu , Merid Mehari Woldemariam
Published: September 2019

Background

The emergence of Drug-Resistance Tuberculosis (DR-TB) is an increasing global public health problem. Lost to Follow-up (LTFU) from DR-TB treatment remains a major barrier to tuberculosis epidemic control and better treatment outcome. In Ethiopia, evidences on the incidence and predictors of LTFU are scarce. Thus, this study aimed to determine the incidence and identify the predictors of LTFU among DR-TB patients.

Methods

A retrospective follow-up study was conducted among a total of 332 DR-TB patients at the University of Gondar comprehensive specialized hospital. Data were retrieved from patient records from September 2010 to December 2017 and entered in to Epi-data 4.2.0.0 and analysed using Stata14.1 software. The risk was estimated using the Nelson-Aalen cumulative hazard curve. A log-rank test was used for survival comparisons between categories of independent variables. The Gompertz regression model was fitted, and hazard ratio with a 95% confidence interval (CI) was used to measure the strength of associations. Variables with less than 0.05 p-values in the multivariable model were considered as significantly associated with LTFU.

Results

Among a total of 332 patient records reviewed, 206 (62.05%) were male. The median age was 30 years (Inter Quartile Range (IQR): 23–40). Forty-one (12.35%) of the participants had no history of TB treatment, while a quarter of were TB-HIV co-infected. Closely all (92.17%) of the patients had pulmonary tuberculosis. The median follow up time was 20.37 months (IQR: 11.02, 21.80). Thirty-six (10.84%) patients were lost from follow-up with an incidence rate of 6.47 (95% CI: 4.67, 8.97)/1000 Person Months (PM). Homelessness (Adjusted Hazard Ratio (AHR) =2.51, 95%CI: 1.15, 5.45) and treatment enrolment year from 2013 to 2014 (AHR = 3.25, 95% CI: 1.30, 8.13) were significant predictors of LTFU.

Conclusion

This study indicated that LTFU among DR-TB registered patients was high in the first six months compared to subsequent months. Homelessness and year of treatment enrolment were independent predictors of LTFU, requiring more economic support to patients in order to ensure treatment completion. This result can be generalized to patients who are using DR-TB treatment in similar settings.
Maternal complications in twin pregnancies in Finland during 1987–2014: a retrospective study
Authors: Rissanen Annu-Riikka S. , Jernman Riina M. , Gissler Mika , Nupponen Irmeli , Nuutila Mika E.
Published: September 2019

Background

To investigate the trends and changes in the incidence and overall outcome of twin pregnancies in Finland, a retrospective study was conducted with emphasis on maternal complications, covering a 28-year study period.

Methods

All 23,498 twin pregnancies with 46,363 live born and 633 stillborn children in Finland during 1987–2014 were included in the study. Data were collected from the national Medical Birth Register and the Care Register on Hospital Care (Finnish Institute for Health and Welfare, Finland) regarding the parturients’ characteristics and incidences of several pregnancy and childbirth complications. The incidences of twin pregnancies and maternal complications during pregnancy and childbirth are the main outcome measures of the study. The results are expressed in percentages, means, medians, ranges and standard deviations (SD), when appropriate.

Results

Twins comprised 1.4% of all births in Finland in 1987–2014. Parturients’ mean age has remained stable, but the share of over 35 year-old parturients is increasing. The incidences of pre-eclampsia, intrahepatic cholestasis of pregnancy, gestational diabetes and postpartum haemorrhage have risen during the study period. Almost half (44.9%) of twins were born preterm, almost half via Caesarean section (47.1%), and 27.7% of twin labours were induced.

Conclusions

Several pregnancy complications increased during the study period. Advanced maternal age among twin parturients has risen, enhancing the risks for developing complications in a pregnancy already of a high-risk category, and predisposing to preterm delivery. National and international guidelines are necessary to improve the overall outcome of twin pregnancies.