bluuebunny/crossref_metadata_2025 huggingface dataset:
Are Patient Experience and Outcomes for Home Health Agencies Related?
Authors: Schwartz Margot L. , Mroz Tracy M. , Thomas Kali S.
Published: October 2020

To facilitate home health agency (HHA) selection, CMS released patient experience star ratings on the Home Health Compare website in January 2016. Our objective was to understand the relationship between patient experience and outcomes in HHAs. We utilized publicly reported data to evaluate the relationships among patient experience star ratings, summary quality of care star ratings (comprised primarily of outcome measures), and individual outcome measures for 4,249 HHAs. Results indicate a weak correlation between patient experience and quality stars ( r = .13, p < .001). The difference between the lowest and highest rated HHAs for patient experience is associated with only a half-star improvement in quality stars. The associations between patient experience and individual outcome measures varied, with functional outcomes most strongly associated with patient experience. Findings highlight the importance of reporting separate quality domains; however, conflicting ratings may complicate the HHA selection process and introduce misaligned incentives for HHAs.
More Than Inconvenienced: The Unique Needs of U.S. College Students During the COVID-19 Pandemic
Authors: Lederer Alyssa M. , Hoban Mary T. , Lipson Sarah K. , Zhou Sasha , Eisenberg Daniel
Published: October 2020

U.S. college students are a distinct population facing major challenges due to the COVID-19 pandemic. Before the pandemic, students were already experiencing substantial mental health concerns, putting both their health and academic success in jeopardy. College students now face increasing housing and food insecurity, financial hardships, a lack of social connectedness and sense of belonging, uncertainty about the future, and access issues that impede their academic performance and well-being. There is also reason to believe that COVID-19 is exacerbating inequalities for students of color and low-income students. We provide several recommendations for institutions of higher education to mitigate these obstacles, including engaging in data-driven decision making, delivering clear and informative messaging to students, prioritizing and expanding student support services, and using an equity framework to guide all processes.
Hegemonic instability: complex interdependence and the dynamics of financial crisis in the contemporary international system
Authors: Ba Heather
Published: October 2020

International Relations scholars have long recognized the need to study the complex interdependencies of the international economy in order to understand the economic sources of national power and influence. Renewed interest in the patterns of international economic interdependencies and the structure of globalization has led scholars to a better, more empirically grounded understanding of the significance of complex interdependence for the evolution of international power. This paper examines the effect of one important and persistent characteristic of complex interdependence, American centrality within the international banking system, and argues that changes in the US financial cycle drive international financial volatility and crisis. These dynamics comprise the underbelly of American financial hegemony and pose a fundamental challenge to US leadership in the contemporary liberal international order. Financial stability is key to economic growth, which in turn perpetuates liberal political norms and institutions. Financial instability, on the other hand, breeds political discontent, which may take the form of populism or nationalism. The ability and willingness of the United States to reign in its own financial system may be key to ensuring that the liberal international system it established 75 years ago survives and thrives in the coming decades.
Let’s dance the news! How the news media are adapting to the logic of TikTok
Authors: Vázquez-Herrero Jorge , Negreira-Rey María-Cruz , López-García Xosé
Published: October 2020

The influence of TikTok has reached the news media, which has adapted to the logic of the platform, in a context marked by the incidental consumption of news, virality and the intermediation of technology in access to information. The popularity of this social network invites news outlets to address a young audience on a platform characterized by visual and short content and dynamics defined by algorithmic recommendations, trending hashtags and challenges. Based on an exploratory search of news media and programmes on TikTok from around the world, we selected 234 accounts and conducted a content analysis of the 19 news media and programmes identified with a verified profile and general thematic scope. The results point to a progressive incorporation of the media since 2019, with the purpose of informing, positioning their brand and adapting to the logic of TikTok in a new approach to journalism for younger generations.
Ludic Ethics: The Ethical Negotiations of Players in Online Multiplayer Games
Authors: Sparrow Lucy A. , Gibbs Martin , Arnold Michael
Published: October 2020

This study introduces the ludic ethics approach for understanding the moral deliberations of players of online multiplayer games. Informed by a constructivist paradigm that places players’ everyday ethical negotiations at the forefront of the analysis, this study utilises a novel set of game-related moral vignettes in a series of 20 in-depth interviews with players. Reflexive thematic analysis of these interviews produced four key themes by which participants considered the ethics of in-game actions: (1) game boundaries, (2) consequences for play, (3) player sensibilities, and (4) virtuality. These results support the conceptualisation of games as complex ethical sites in which players negotiate in-game ethics by referring extensively – although not exclusively – to a framework of ‘ludomorality’ that draws from the interpreted meanings associated with the ludic digital context.
Custody visiting: The watchdog that didn’t bark
Authors: Kendall John
Published: October 2020

This article argues that in qualitative research into the work of a regulator, it is as important to watch out for that regulator’s omissions and silences as it is to examine what the regulator does and says. The argument is illustrated by data drawn from a study of the Independent Custody Visiting Scheme, the purpose of which is (or should be) to safeguard detainees and to deter police from misconduct which might lead to deaths in custody. Research into the scheme included using the technique of watching out for what the visitors did not do and did not say. The data obtained by this method are interpreted through the lens of Lukes’ theory of power to suggest that this watchdog has been debarked as a result of the power of the police.
Dimethyl fumarate transfer into human milk
Authors: Ciplea Andrea I. , Datta Palika , Rewers-Felkins Kathleen , Baker Teresa , Gold Ralf , Hale Thomas W. , Hellwig Kerstin
Published: October 2020

Dimethyl fumarate (DMF) is approved for the treatment of relapsing-remitting multiple sclerosis. It is unknown whether DMF or its primary metabolite monomethyl fumarate (MMF) are excreted into human milk. We present two cases of lactating patients who donated milk samples to study the transfer of MMF into human milk following a week of 2 × 240 mg daily oral dose. Samples were analyzed using liquid chromatography mass spectrometry. The calculated relative infant dose was 0.019% and 0.007%. This is the first study to demonstrate that MMF is transferred into human milk, with only limited exposure to an infant.
Perspective sur la responsabilité de l’industrie pharmaceutique dans la promotion de la recherche pédiatrique et dans l’accès aux médicaments essentiels
Authors: Dahane Neyla , Godard Béatrice
Published: October 2020

Resumé :

L’industrie pharmaceutique a permis à de nombreux patients d’améliorer leur santé. Mais elle reste critiquée à cause d’un certain désengagement envers les maladies dans les pays en voie de développement et notamment les maladies pédiatriques. Considérant le cercle vicieux de la pauvreté et de la maladie affectant les enfants dans ces pays, il apparait primordial que les multinationales pharmaceutiques impliquent leur responsabilité à plusieurs niveaux : par la mise en place d’actions concrètes pour mener plus de recherches sur les enfants, vu leurs besoins ; puis en rendant les médicaments accessibles à un plus grand nombre d’enfants.
Posaconazole for the prophylaxis of invasive aspergillosis in acute myeloid leukemia: Is it still useful outside the clinical trial setting?
Authors: Chen Tsung-Chih , Wang Ren Ching , Lin Yu-Hui , Chang Kuang-Hsi , Hung Li-Ya , Teng Chieh-Lin Jerry
Published: October 2020

Background:

Posaconazole prophylaxis during remission induction chemotherapy not only decreases the incidence of invasive aspergillosis (IA) but also improves the overall survival rate among patients with acute myeloid leukemia (AML). However, it remains debatable whether this result applies to patients in a real-world setting.

Methods:

We retrospectively assessed 208 adult patients with newly diagnosed AML who underwent remission induction therapy. These 208 patients were stratified into the posaconazole prophylaxis group ( n = 58) and no antifungal prophylaxis group ( n = 150).

Results:

Multivariate analyses showed that induction failure significantly increased the risk of proven or probable IA during the first induction chemotherapy [hazard ratio (HR), 10.47; 95% confidence interval (CI), 1.73–63.45; p = 0.011] and the entire course of AML treatment (HR, 4.48; 95% CI, 1.71–11.75; p = 0.002). However, posaconazole prophylaxis did not reduce the risk of IA during the first induction chemotherapy (HR, 1.47; 95% CI, 0.14–15.04; p = 0.746) and during the entire course of AML treatment (HR, 1.09; 95% CI, 0.29–4.09; p = 0.896). Furthermore, there was no significant difference in overall survival between these two groups of patients (514 versus 689 days; p = 0.454).

Conclusion:

Successful induction remains fundamental to reducing the risk of IA among AML patients undergoing remission induction chemotherapy.
The relation between serum adipose differentiation-related protein and non-alcoholic fatty liver disease in type 2 diabetes mellitus
Authors: Fan Huaying , Diao Hongjie , Lu Yan , Xie Jing , Cheng Xingbo
Published: October 2020

Background:

Adipose differentiation-related protein (ADRP) is an adipokine. In vitro and animal studies have verified the role of ADRP in lipid metabolism and non-alcoholic fatty liver disease (NAFLD). The aim of this study was to evaluate the interaction between levels of ADRP and NAFLD in type 2 diabetes mellitus (T2DM).

Methods:

Cross-sectional design. A total of 142 patients with T2DM were assigned to NAFLD (Group-I) and non-NAFLD (Group-II). Anthropometric data were collected. Serum ADRP levels and biochemical parameters were also determined. t test or χ2 test was conducted to compare the data between two groups. Receiver operating characteristic (ROC) curve analysis and logistic regression models were used to assess the interaction between ADRP levels and NAFLD in T2DM. Pearson correlation analysis and linear regression model were used to assess the correlations between serum ADRP levels and other parameters.

Results:

The serum ADRP level was higher in Group-I than in Group-II. Further, binary logistic regression models demonstrated that ADRP was an independent risk factor related to NAFLD in patients with T2DM. Moreover, as the ADRP level elevated across its tertiles, the percentage of NAFLD in T2DM increased. Multivariate logistic regression models demonstrated that the odds ratio of NAFLD was 8.831 in the highest tertile of ADRP, after adjustment for potential confounders. Area under THE ROC curve of ADRP for predicting the presence of NAFLD in T2DM was 0.738. Finally, multiple stepwise regression analysis indicated that age, waist circumference (WC), homeostasis model assessment of insulin resistance index (HOMA-IR) and triglyceride (TG) were independent factors associated with ADRP levels.

Conclusion:

High serum ADRP level may be used as an independent risk factor for NAFLD in T2DM. The expression of ADRP may be affected by age, WC, HOMA-IR and TG.
Thrill and Agony at Ultimate Fighting Championship
Authors: Yiu Chiu Man , Liu Xiaotong , Shi Hengfang , Zhao W. Guillaume
Published: October 2020

This case study seeks to make evident the imperative of better stakeholder management for contemporary competition by examining the evolving corporate social responsibility (CSR) strategies at the Ultimate Fighting Championship (UFC), a world leading sports entertainment firm, over its 29-year history. Specifically, this case study illuminates that while CSR is becoming increasingly understood as indispensable for a firm’s overall strategy, corporate strategists need to design and implement CSR with dual vigilance that, (1) stakeholders’ expectations on CSR would heighten over time and (2) internal stakeholders’ needs, though often trivialized in many CSR strategies, need authentic accommodations that move beyond lip service. In addition to unpacking the issues of CSR (and) authenticity for the UFC’s stakeholder management, this case study also draws on insights gleaned from mainstream stakeholder management and CSR research and provides evidence-based analysis and recommendations for enhancing firms’ CSR strategies.
Study design and baseline characteristics of a population-based prospective cohort study of dementia in Japan: the Japan Prospective Studies Collaboration for Aging and Dementia (JPSC-AD)
Authors:   on behalf of the JPSFC-AD Study Group, Ninomiya Toshiharu , Nakaji Shigeyuki , Maeda Tetsuya , Yamada Masahito , Mimura Masaru , Nakashima Kenji , Mori Takaaki , Takebayashi Minoru , Ohara Tomoyuki , Hata Jun , Kokubo Yoshihiro , Uchida Kazuhiro , Taki Yasuyuki , Kumagai Shuzo , Yonemoto Koji , Yoshida Hisako , Muto Kaori , Momozawa Yukihide , Akiyama Masato , Kubo Michiaki , Ikeda Manabu , Kanba Shigenobu , Kiyohara Yutaka
Published: October 2020

Background

The burden of dementia is growing rapidly and has become a medical and social problem in Japan. Prospective cohort studies have been considered an effective methodology to clarify the risk factors and the etiology of dementia. We aimed to perform a large-scale dementia cohort study to elucidate environmental and genetic risk factors for dementia, as well as their interaction.

Methods

The Japan Prospective Studies Collaboration for Aging and Dementia (JPSC-AD) is a multisite, population-based prospective cohort study of dementia, which was designed to enroll approximately 10,000 community-dwelling residents aged 65 years or older from 8 sites in Japan and to follow them up prospectively for at least 5 years. Baseline exposure data, including lifestyles, medical information, diets, physical activities, blood pressure, cognitive function, blood test, brain magnetic resonance imaging (MRI), and DNA samples, were collected with a pre-specified protocol and standardized measurement methods. The primary outcome was the development of dementia and its subtypes. The diagnosis of dementia was adjudicated by an endpoint adjudication committee using standard criteria and clinical information according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd Revised Edition. For brain MRI, three-dimensional acquisition of T1-weighted images was performed. Individual participant data were pooled for data analyses.

Results

The baseline survey was conducted from 2016 to 2018. The follow-up surveys are ongoing. A total of 11,410 individuals aged 65 years or older participated in the study. The mean age was 74.4 years, and 41.9% were male. The prevalence of dementia at baseline was 8.5% in overall participants. However, it was 16.4% among three sites where additional home visit and/or nursing home visit surveys were performed. Approximately two-thirds of dementia cases at baseline were Alzheimer’s disease.

Conclusions

The prospective cohort data from the JPSC-AD will provide valuable insights regarding the risk factors and etiology of dementia as well as for the development of predictive models and diagnostic markers for the future onset of dementia. The findings of this study will improve our understanding of dementia and provide helpful information to establish effective preventive strategies for dementia in Japan.
Economic impact of autonomous vehicles in Spain
Authors: Alonso Efrén , Arpón Cristina , González María , Fernández Ramón Ángel , Nieto Mariano
Published: October 2020

Background

Pollution, traffic accidents, and congestion are huge problems in most urban areas. Autonomous and electric vehicles are leading our society to a new mobility model, also known as the New Era of Transportation (NERTRA). Mobility is a strategic issue for any country, and this change of model will mean, in addition to a great technological revolution, an economic revolution.

Methodology

The purpose of this work is to carry out a study of the main economic sectors affected in Spain and evaluate the economic impact that autonomous vehicles will have on each one. Data from this sector have been collected, analyzing the economic and technological factors that will affect to a greater or lesser extent and made evolution forecasts.

Results

The study presents three different scenarios depending on how the transition progresses. The results are presented by each sector in each of these scenarios. These results have great value for the industry itself and the professionals affected, as well as for the authorities of the country to take the appropriate measures from the beginning of the transition. The sectors directly affected by this change represent more than 38% of the gross domestic product of Spain. Key factors, such as technological innovation in vehicles, and the emergence of new business and mobility models determine drastic changes in some important sectors. It is important to make quick decisions both from administrations and from the industry itself to adapt to new mobility.
ConCysFind: a pipeline tool to predict conserved amino acids of protein sequences across the plant kingdom
Authors: Moore Marten , Wesemann Corinna , Gossmann Nikolaj , Sahm Arne , Krüger Jan , Sczyrba Alexander , Dietz Karl-Josef
Published: October 2020

Background

Post-translational modifications (PTM) of amino acid (AA) side chains in peptides control protein structure and functionality. PTMs depend on the specific AA characteristics. The reactivity of cysteine thiol-based PTMs are unique among all proteinaceous AA. This pipeline aims to ease the identification of conserved AA of polypeptides or protein families based on the phylogenetic occurrence in the plant kingdom. The tool is customizable to include any species.
The degree of AA conservation is taken as indicator for structural and functional significance, especially for PTM-based regulation. Further, this pipeline tool gives insight into the evolution of these potentially regulatory important peptides.

Results

The web-based or stand-alone pipeline tool Conserved Cysteine Finder (ConCysFind) was developed to identify conserved AA such as cysteine, tryptophan, serine, threonine, tyrosin and methionine. ConCysFind evaluates multiple alignments considering the proteome of 21 plant species. This exemplar study focused on Cys as evolutionarily conserved target for multiple redox PTM. Phylogenetic trees and tables with the compressed results of the scoring algorithm are generated for each Cys in the query polypeptide. Analysis of 33 translation elongation and release factors alongside of known redox proteins from Arabidopsis thaliana for conserved Cys residues confirmed the suitability of the tool for identifying conserved and functional PTM sites. Exemplarily, the redox sensitivity of cysteines in the eukaryotic release factor 1-1 (eRF1-1) was experimentally validated.

Conclusion

ConCysFind is a valuable tool for prediction of new potential protein PTM targets in a broad spectrum of species, based on conserved AA throughout the plant kingdom. The identified targets were successfully verified through protein biochemical assays. The pipeline is universally applicable to other phylogenetic branches by customization of the database.
simplePHENOTYPES: SIMulation of pleiotropic, linked and epistatic phenotypes
Authors: Fernandes Samuel B. , Lipka Alexander E.
Published: October 2020

Background

Advances in genotyping and phenotyping techniques have enabled the acquisition of a great amount of data. Consequently, there is an interest in multivariate statistical analyses that identify genomic regions likely to contain causal mutations affecting multiple traits (i.e., pleiotropy). As the demand for multivariate analyses increases, it is imperative that optimal tools are available to assess their performance. To facilitate the testing and validation of these multivariate approaches, we developed simplePHENOTYPES, an R/CRAN package that simulates pleiotropy, partial pleiotropy, and spurious pleiotropy in a wide range of genetic architectures, including additive, dominance and epistatic models.

Results

We illustrate simplePHENOTYPES’ ability to simulate thousands of phenotypes in less than one minute. We then provide two vignettes illustrating how to simulate sets of correlated traits in simplePHENOTYPES. Finally, we demonstrate the use of results from simplePHENOTYPES in a standard GWAS software, as well as the equivalence of simulated phenotypes from simplePHENOTYPES and other packages with similar capabilities.

Conclusions

simplePHENOTYPES is a R/CRAN package that makes it possible to simulate multiple traits controlled by loci with varying degrees of pleiotropy. Its ability to interface with both commonly-used marker data formats and downstream quantitative genetics software and packages should facilitate a rigorous assessment of both existing and emerging statistical GWAS and GS approaches. simplePHENOTYPES is also available at https://github.com/samuelbfernandes/simplePHENOTYPES.
Improved cytokine–receptor interaction prediction by exploiting the negative sample space
Authors: Nath Abhigyan , Leier André
Published: October 2020

Background

Cytokines act by binding to specific receptors in the plasma membrane of target cells. Knowledge of cytokine–receptor interaction (CRI) is very important for understanding the pathogenesis of various human diseases—notably autoimmune, inflammatory and infectious diseases—and identifying potential therapeutic targets. Recently, machine learning algorithms have been used to predict CRIs. “Gold Standard” negative datasets are still lacking and strong biases in negative datasets can significantly affect the training of learning algorithms and their evaluation. To mitigate the unrepresentativeness and bias inherent in the negative sample selection (non-interacting proteins), we propose a clustering-based approach for representative negative sample selection.

Results

We used deep autoencoders to investigate the effect of different sampling approaches for non-interacting pairs on the training and the performance of machine learning classifiers. By using the anomaly detection capabilities of deep autoencoders we deduced the effects of different categories of negative samples on the training of learning algorithms. Random sampling for selecting non-interacting pairs results in either over- or under-representation of hard or easy to classify instances. When K-means based sampling of negative datasets is applied to mitigate the inadequacies of random sampling, random forest (RF) together with the combined feature set of atomic composition, physicochemical-2grams and two different representations of evolutionary information performs best. Average model performances based on leave-one-out cross validation (loocv) over ten different negative sample sets that each model was trained with, show that RF models significantly outperform the previous best CRI predictor in terms of accuracy (+ 5.1%), specificity (+ 13%), mcc (+ 0.1) and g-means value (+ 5.1). Evaluations using tenfold cv and training/testing splits confirm the competitive performance.

Conclusions

A comparative analysis was performed to assess the effect of three different sampling methods (random, K-means and uniform sampling) on the training of learning algorithms using different evaluation methods. Models trained on K-means sampled datasets generally show a significantly improved performance compared to those trained on random selections—with RF seemingly benefiting most in our particular setting. Our findings on the sampling are highly relevant and apply to many applications of supervised learning approaches in bioinformatics.
Neurologic effects of short-term treatment with a soluble epoxide hydrolase inhibitor after cardiac arrest in pediatric swine
Authors: O’Brien Caitlin E. , Santos Polan T. , Kulikowicz Ewa , Lee Jennifer K. , Koehler Raymond C. , Martin Lee J.
Published: October 2020

Background

Cardiac arrest (CA) is the most common cause of acute neurologic insult in children. Many survivors have significant neurocognitive deficits at 1 year of recovery. Epoxyeicosatrienoic acids (EETs) are multifunctional endogenous lipid signaling molecules that are involved in brain pathobiology and may be therapeutically relevant. However, EETs are rapidly metabolized to less active dihydroxyeicosatrienoic acids by soluble epoxide hydrolase (sEH), limiting their bioavailability. We hypothesized that sEH inhibition would improve outcomes after CA in an infant swine model. Male piglets (3–4 kg, 2 weeks old) underwent hypoxic-asphyxic CA. After resuscitation, they were randomized to intravenous treatment with an sEH inhibitor (TPPU, 1 mg/kg; n = 8) or vehicle (10% poly(ethylene glycol); n = 9) administered at 30 min and 24 h after return of spontaneous circulation. Two sham-operated groups received either TPPU (n = 9) or vehicle (n = 8). Neurons were counted in hematoxylin- and eosin-stained sections from putamen and motor cortex in 4-day survivors.

Results

Piglets in the CA + vehicle groups had fewer neurons than sham animals in both putamen and motor cortex. However, the number of neurons after CA did not differ between vehicle- and TPPU-treated groups in either anatomic area. Further, 20% of putamen neurons in the Sham + TPPU group had abnormal morphology, with cell body attrition and nuclear condensation. TPPU treatment also did not reduce neurologic deficits.

Conclusion

Treatment with an sEH inhibitor at 30 min and 24 h after resuscitation from asphyxic CA does not protect neurons or improve acute neurologic outcomes in piglets.
Atrial matrix remodeling in atrial fibrillation patients with aortic stenosis
Authors: Fragão-Marques Mariana , Miranda I. , Martins D. , Barroso I. , Mendes C. , Pereira-Neves A. , Falcão-Pires I. , Leite-Moreira A.
Published: October 2020

Background

This study aimed to evaluate atrium extracellular matrix remodeling in atrial fibrillation (AF) patients with severe aortic stenosis, through histological fibrosis quantification and extracellular matrix gene expression analysis, as well as serum quantification of selected protein targets.

Methods

A posthoc analysis of a prospective study was performed in a cohort of aortic stenosis patients. Between 2014 and 2019, 56 patients with severe aortic stenosis submitted to aortic valve replacement surgery in a tertiary hospital were selected.

Results

Fibrosis was significantly increased in the AF group when compared to sinus rhythm (SR) patients (p = 0.024). Moreover, cardiomyocyte area was significantly higher in AF patients versus SR patients (p = 0.008). Conversely, collagen III gene expression was increased in AF patients (p = 0.038). TIMP1 was less expressed in the atria of AF patients. MMP16/TIMP4 ratio was significantly decreased in AF patients (p = 0.006). TIMP1 (p = 0.004) and TIMP2 (p = 0.012) were significantly increased in the serum of AF patients. Aortic valve maximum (p = 0.0159) and mean (p = 0.031) gradients demonstrated a negative association with serum TIMP1.

Conclusions

Atrial fibrillation patients with severe aortic stenosis present increased atrial fibrosis and collagen type III synthesis, with extracellular matrix remodelling demonstrated by a decrease in the MMP16/TIMP4 ratio, along with an increased serum TIMP1 and TIMP2 proteins.
Home-based palliative care management: what are the useful resources for general practitioners? a qualitative study among GPs in France
Authors: Boudy Carol-Anne , Bouchez Tiphanie , Caprini Didier , Pourrat Isabelle , Munck Stéphane , Barbaroux Adriaan
Published: October 2020

Background

Most French people (71%) would like to die at home, but only one out of four actually do. While the difficulties inherent in the practice of home-based palliative care are well described, few studies highlight the resources currently used by general practitioners (GPs) in real life. We have therefore sought to highlight the resources actually used by GPs providing home-based palliative care.

Methods

Twenty-one GPs of different ages and practice patterns agreed to participate to this qualitative study based upon semi-structured interviews. They were recruited according to a purposive sampling. Transcripts analysis was based upon General Inductive Analysis.

Results

The resources highlighted have been classified into two main categories according to whether they were internal or external to the GPs. The internal resources raised included the doctor’s practical experience and continuous medical education, personal history, work time organization and a tacit moral contract related to the referring GP’s position. External resources included resource personnel, regional assistance platforms and health facilities, legislation.

Conclusion

This study provides a simple list that is easy to share and pragmatic solutions for GPs and policymakers. Home-based palliative care practice can simultaneously be burdensome and yet a fulfilling, meaningful activity, depending on self-efficacy and professional exhaustion (burnout), perhaps to a greater extent than on medical knowledge. Home-based palliative care promotion is a matter of social responsibility. The availability of multidisciplinary teams such as regional assistance platforms and Hospitalization at Home is particularly important for the management of palliative care. Policymakers should consolidate these specific resources out of hospitals, in community settings where the patients wish to end their life.
Impact of morbidity on care need increase and mortality in nursing homes: a retrospective longitudinal study using administrative claims data
Authors: Reber Katrin C. , Lindlbauer Ivonne , Schulz Claudia , Rapp Kilian , König Hans-Helmut
Published: October 2020

Background

A growing number of older people are care dependent and live in nursing homes, which accounts for the majority of long-term-care spending. Specific medical conditions and resident characteristics may serve as risk factors predicting negative health outcomes. We investigated the association between the risk of increasing care need and chronic medical conditions among nursing home residents, allowing for the competing risk of mortality.

Methods

In this retrospective longitudinal study based on health insurance claims data, we investigated 20,485 older adults (≥65 years) admitted to German nursing homes between April 2007 and March 2014 with care need level 1 or 2 (according to the three level classification of the German long-term care insurance). This classification is based on required daily time needed for assistance. The outcome was care level change. Medical conditions were determined according to 31 Charlson and Elixhauser conditions. Competing risks analyses were applied to identify chronic medical conditions associated with risk of care level change and mortality.

Results

The probability for care level change and mortality acted in opposite directions. Dementia was associated with increased probability of care level change compared to other conditions. Patients who had cancer, myocardial infarction, congestive heart failure, cardiac arrhythmias, renal failure, chronic pulmonary disease, weight loss, or recent hospitalization were more likely to die, as well as residents with paralysis and obesity when admitted with care level 2.

Conclusion

This paper identified risk groups of nursing home residents which are particularly prone to increasing care need or mortality. This enables focusing on these risk group to offer prevention or special treatment. Moreover, residents seemed to follow specific trajectories depending on their medical conditions. Some were more prone to increased care need while others had a high risk of mortality instead. Several conditions were neither related to increased care need nor mortality, e.g., valvular, cerebrovascular or liver disease, peripheral vascular disorder, blood loss anemia, depression, drug abuse and psychosis. Knowledge of functional status trajectories of residents over time after nursing home admission can help decision-makers when planning and preparing future care provision strategies (e.g., planning of staffing, physical equipment and financial resources).
Prevalence of and risk factors for HBV and HCV among incarcerated people who inject drugs in Iran: A cross sectional study
Authors: Moradi Ghobad , Mohamadi Parvin , Zareie Bushra , Rasouli Mohammad Aziz , Gouya Mohammad Mehdi , Jafari Saeede
Published: October 2020

Background

This study aimed at determining the prevalence of and risk factors for hepatitis B virus (HBV) and hepatitis C virus (HCV) among incarcerated people who inject drugs (PWID) in Iran in 2015–16.

Methods

The required data was collected from a database provided by Iranian national bio-behavioral surveillance surveys (BBSSs) on 11,988 prisoners selected from among 55 prisons in 19 provinces in 2015–16. The data on demographics and behavioral variables were collected through interviews and the status of exposure to HBV and HCV were determined using ELISA blood test. A total of 1387 individuals with a history of drug injection in their lifetime were enrolled into the study. Data were analyzed using the survey package in Stata/SE software, Version 14.0. Univariate and multivariate logistic regression tests were used to investigate the relationships between risk factors and outcomes.

Results

The mean age of the incarcerated PWID was 36.83 ± 8.13 years. Of all the studied subjects, 98.46% were male and 50.97% were married. The prevalence of HCV and HBV among the subjects were 40.52 and 2.46%, respectively. The prevalence of HCV was associated with age ≥ 30 years, being single, illiteracy and low level of education, prison term> 5 years, history of piercing, and extramarital sex in lifetime (P < 0.05).

Conclusions

The prevalence of HCV is alarmingly high. In general, it is recommended to adopt measures to screen and treat patients with HCV and vaccinat incarcerated PWID without a history of vaccination against HBV.
A novel PIK3R1 mutation of SHORT syndrome in a Chinese female with diffuse thyroid disease: a case report and review of literature
Authors: Sun Liying , Zhang Qianwen , Li Qun , Tang Yijun , Wang Yirou , Li Xin , Li Niu , Wang Jian , Wang Xiumin
Published: October 2020

Background

SHORT syndrome is a rare genetic disease named with the acronyms of short stature, hyper-extensibility of joints, ocular depression, Rieger anomaly and teething delay. It is inherited in an autosomal dominant manner confirmed by the identification of heterozygous mutations in PIK3R1. This study hereby presents a 15-year-old female with intrauterine growth restriction, short stature, teething delay, characteristic facial gestalts who was identified a novel de novo nonsense mutation in PIK3R1.

Case presentation

The proband was admitted to our department due to irregular menstrual cycle and hirsutism with short stature, who had a history of intrauterine growth restriction and presented with short stature, teething delay, characteristic facial gestalts, hirsutism, and thyroid disease. Whole-exome sequencing and Sanger sequencing revealed c.1960C > T, a novel de novo nonsense mutation, leading to the termination of protein translation (p. Gln654*).

Conclusions

This is the first case report of SHORT syndrome complicated with thyroid disease in China, identifying a novel de novo heterozygous nonsense mutation in PIK3R1 gene (p. Gln654*). The phenotypes are mildly different from other cases previously described in the literature, in which our patient presents with lipoatrophy, facial feature, and first reported thyroid disease. Thyroid disease may be a new clinical symptom of patients with SHORT syndrome.
Independent associations of urinary albumin-to-creatinine ratio and serum cystatin C with carotid intima-media thickness in community-living Taiwanese adults
Authors: Liu Chiu-Shong , Li Chia-Ing , Guo Yuh-Cherng , Lin Chih-Hsueh , Lin Wen-Yuan , Liu Chung-Hsiang , Wang Mu-Cyun , Yang Chuan-Wei , Yang Shing-Yu , Li Tsai-Chung , Lin Cheng-Chieh
Published: October 2020

Background

Renal function is a key factor of cardiovascular disease. Carotid intima-media thickness (IMT) has been widely used as a marker of early subclinical atherosclerosis. The determinants of cystatin C, a novel marker of renal function, have not been extensively studied in the Asian population. This study aimed to assess the determinants of cystatin C and explore whether carotid thickening was associated with urinary albumin-creatinine ratio and cystatin C in community-living Taiwanese adults.

Methods

A cross-sectional study was conducted on participants from Taichung City, Taiwan. All the participants underwent carotid ultrasonography. Carotid IMT-mean and IMT-maximum were derived. Kidney biomarkers were measured on the basis of urinary albumin-to-creatinine ratio (ACR) and cystatin C. Multiple linear regression analysis was used.

Results

A total of 1032 individuals were recruited, and 469 (45.44%) of them were men. An increased cystatin C level was significantly associated with older age, male gender, lack of physical activity, low HDL cholesterol, abdominal obesity, high hs-CRP, and high ACR. The multivariate-adjusted mean carotid IMT-mean and IMT-maximum values significantly increased by 80.49 and 195.23 μm for every one unit of increase in cystatin C level and by 0.07 and 0.14 μm for every one unit of increase in ACR, respectively (all p < 0.001 except ACR on IMT-maximum with p < 0.01). Lack of physical activity, low HDL, abdominal obesity, high hs-CRP, and high ACR were the determinants of cystatin C.

Conclusion

Cystatin C and ACR were strongly and linearly associated with carotid thickening, a marker of subclinical atherosclerosis.
Effectiveness of a psycho-educational intervention for expecting parents to prevent postpartum parenting stress, depression and anxiety: a randomized controlled trial
Authors: Missler Marjolein , van Straten Annemieke , Denissen Jaap , Donker Tara , Beijers Roseriet
Published: October 2020

Background

The first months postpartum can be challenging for parents, leading to elevated symptoms of parenting stress, depression and anxiety. In turn, distressed parents are at higher risk for providing suboptimal quality of caregiving. As psychoeducational interventions can be effective in reducing psychological distress, the goal of this randomized controlled trial was to examine the effectiveness of low-intensity universal psychoeducational program to prevent postpartum parenting stress, and to enhance parental well-being and caregiving quality.

Method

Between 26 and 34 weeks of pregnancy, 138 pregnant women and 96 partners were randomized to the intervention or a waitlist control group. The intervention consisted of a booklet, a video, a home visit, and a telephone call. Information was provided on (1) sensitive responsiveness, adapting to the parental role, and attending to own needs; (2) crying patterns; (3) feeding (arrangements); and (4) sleeping (arrangements). The primary outcome was parenting stress postpartum. Secondary outcomes were additional measures of distress (depression and anxiety), parental well-being, and caregiving quality.

Results

Both groups showed a rise in distress after birth. No between-group differences were observed on parenting stress, nor on the secondary outcomes. The intervention was rated as useful and of added value by the parents.

Conclusion

This study offered no evidence that our universal prevention program was effective in decreasing parental distress or in increasing caregiving quality. However, parents found aspects of the intervention useful. More research is needed, including a longer period of follow-up as well as observational measures of parents’ responsiveness.

Trial registration

This trial has been registered on 15 September 2016 in the Netherlands National Trial Register, ID: NTR6065,https://www.trialregister.nl/trial/5782.
A gene-based survival score for lung adenocarcinoma by multiple transcriptional datasets analysis
Authors: Xiong Yanlu , Lei Jie , Zhao Jinbo , Lu Qiang , Feng Yangbo , Qiao Tianyun , Xin Shaowei , Han Yong , Jiang Tao
Published: October 2020

Background

Lung adenocarcinoma (LUAD) remains a crucial factor endangering human health. Gene-based clinical predictions could be of great help for cancer intervention strategies. Here, we tried to build a gene-based survival score (SS) for LUAD via analyzing multiple transcriptional datasets.

Methods

We first acquired differentially expressed genes between tumors and normal tissues from intersections of four LUAD datasets. Next, survival-related genes were preliminarily unscrambled by univariate Cox regression and further filtrated by LASSO regression. Then, we applied PCA to establish a comprehensive SS based on survival-related genes. Subsequently, we applied four independent LUAD datasets to evaluate prognostic prediction of SS. Moreover, we explored associations between SS and clinicopathological features. Furthermore, we assessed independent predictive value of SS by multivariate Cox analysis and then built prognostic models based on clinical stage and SS. Finally, we performed pathway enrichments analysis and investigated immune checkpoints expression underlying SS in four datasets.

Results

We established a 13 gene-based SS, which could precisely predict OS and PFS of LUAD. Close relations were elicited between SS and canonical malignant indictors. Furthermore, SS could serve as an independent risk factor for OS and PFS. Besides, the predictive efficacies of prognostic models were also reasonable (C-indexes: OS, 0.7; PFS, 0.7). Finally, we demonstrated enhanced cell proliferation and immune escape might account for high clinical risk of SS.

Conclusions

We built a 13 gene-based SS for prognostic prediction of LUAD, which exhibited wide applicability and could contribute to LUAD management.
Preoperative circulating tumor cells to predict microvascular invasion and dynamical detection indicate the prognosis of hepatocellular carcinoma
Authors: Zhou Jiangmin , Zhang Zhiwei , Zhou Honghao , Leng Chao , Hou Bingwu , Zhou Chenyang , Hu Xinsheng , Wang Jinlin , Chen Xiaoping
Published: October 2020

Background

This study explored the diagnostic power of preoperative circulating tumor cells (CTCs) for the presence of microvascular invasion (MVI) and the relationship between dynamic changes in postoperative CTCs and prognosis.

Methods

A total of 137 patients were recruited for the study. Preoperative blood samples were collected from all patients to detect CTCs. The time points for blood collection were before the operation, during the operation, and at 1 week, 1 month, 2 months, 3 months, 6 months, and 1 year after surgery. The predictive power of CTC count for the presence of MVI was analyzed by receiver operating characteristic (ROC) curve analysis. According to recurrence status, 137 patients were divided into three groups: no recurrence, early recurrence, and non-early recurrence groups.

Results

A threshold CTC count of 5 showed the most significant power for predicting the existence of MVI. In multivariate analysis, the parameters of preoperative CTC count, alpha-fetoprotein (AFP) and tumor diameter were independent predictors of MVI (P <  0.05). A CTC count greater than or equal to 5 had better predictive value than AFP > 400 μg/L and tumor diameter > 5 cm. The number of intraoperative CTCs in the three groups did not increase compared to that before surgery (P > 0.05). The number of CTCs in the nonrecurrence group and the non-early recurrence group decreased significantly 1 week after surgery compared with the intraoperative values (P <  0.001), although there was no significant difference in the early recurrence group (P = 0.95). Patients with mean CTC count ≥5 had significantly worse long-term outcomes than those with mean CTC count < 5 (P <  0.001).

Conclusion

The preoperative CTC counts in the peripheral blood of patients with HCC are closely correlated with MVI. The intraoperative manipulation of the lesion by the surgeon does not increase the number of CTCs in peripheral blood. Surgical removal of the tumor decreases the number of CTCs. The persistence of CTCs at a high level (≥ 5) after surgery suggests a risk of early recurrence.

Clinical trial registration

Registration number is ChiCTR-OOC-16010183, date of registration is 2016-12-18.
Diagnostic value of serum HER2 levels in breast cancer: a systematic review and meta-analysis
Authors: Shamshirian Amir , Aref Amir Reza , Yip George W. , Ebrahimi Warkiani Majid , Heydari Keyvan , Razavi Bazaz Sajad , Hamzehgardeshi Zeinab , Shamshirian Danial , Moosazadeh Mahmood , Alizadeh-Navaei Reza
Published: October 2020

Background

Measurement of serum human epidermal growth factor receptor-2 (HER-2/neu) levels might play an essential role as a diagnostic/screening marker for the early selection of therapeutic approaches and predict prognosis in breast cancer patients. We aimed to undertake a systematic review and meta-analysis focusing on the diagnostic/screening value of serum HER-2 levels in comparison to routine methods.

Methods

We performed a systematic search via PubMed, Scopus, Cochrane-Library, and Web of Science databases for human diagnostic studies reporting the levels of serum HER-2 in breast cancer patients, which was confirmed using the histopathological examination. Meta-analyses were carried out for sensitivity, specificity, accuracy, area under the ROC curve (AUC), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR).

Results

Fourteen studies entered into this investigation. The meta-analysis indicated the low sensitivity for serum HER2 levels (Sensitivity: 53.05, 95%CI 40.82–65.28), but reasonable specificity of 79.27 (95%CI 73.02–85.51), accuracy of 72.06 (95%CI 67.04–77.08) and AUC of 0.79 (95%CI 0.66–0.92). We also found a significant differences for PPV (PPV: 56.18, 95%CI 44.16–68.20), NPV (NPV: 76.93, 95%CI 69.56–84.31), PLR (PLR: 2.10, 95%CI 1.69–2.50) and NLR (NLR: 0.58, 95%CI 0.44–0.71).

Conclusion

Our findings revealed that although serum HER-2 levels showed low se nsitivity for breast cancer diagnosis, its specificity, accuracy and AUC were reasonable. Hence, it seems that the measurement of serum HER-2 levels can play a significant role as a verification test for initial negative screening test results, especially in low-income regions due to its cost-effectiveness and ease of implementation.