bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Electronic Medical Records and Health Claim Data to Develop a Patient Engagement Score for Patients With Multiple Chronic Conditions: An Exploratory Study
Authors: Ngorsuraches Surachat , Michael Semhar , Poudel Nabin , Djira Gemechis , Griese Emily , Selya Arielle , Da Rosa Patricia
Published: January 2021

The study objective was to (1) develop a statistical model that creates a novel patient engagement score (PES) from electronic medical records (EMR) and health claim data, and (2) validate this developed score using health-related outcomes and charges of patients with multiple chronic conditions (MCCs). This study used 2014-16 EMR and health claim data of patients with MCCs from Sanford Health. Patient engagement score was created based on selected patients’ engagement behaviors using Gaussian finite mixture model. The PES was validated using multiple logistic and linear regression analyses to examine the associations between the PES and health-related outcomes, and hospital charges, respectively. Patient engagement score was generated from 5095 patient records and included low, medium, and high levels of patient engagement. The PES was a significant predictor for low-density lipoprotein, emergency department visit, hemoglobin A1c, estimated glomerular filtration rate, hospitalization, and hospital charge. The PES derived from patient behaviors recorded in EMR and health claim data can potentially serve as a patient engagement measure. Further study is needed to refine and validate the newly developed score.
Centrifuge testing of soil–structure interaction effects on cyclic failure potential of fine-grained soil
Authors: Buenker Jason M , Brandenberg Scott J , Stewart Jonathan P
Published: January 2021

We describe two experiments performed on a 9-m-radius geotechnical centrifuge to evaluate dynamic soil–structure interaction effects on the cyclic failure potential of fine-grained soil. Each experiment incorporated three different structures with a range of mass and stiffness properties. Structures were founded on strip footings embedded in a thin layer of sand overlying lightly overconsolidated low-plasticity fine-grained soil. Shaking was applied to the base of the model container, consisting of scaled versions of recorded earthquake ground motions, sweep motions, and step waves. Data recorded during testing were processed and published on the platform DesignSafe. We describe the model configuration, sensor information, shaking events, and data processing procedures and present selected processed data to illustrate key model responses and to provide a benchmark for data use.
Investigation on Reduction of Pressure Fluctuation for a Double-Suction Centrifugal Pump
Authors: Li Qianqian , Li Shiyang , Wu Peng , Huang Bin , Wu Dazhuan
Published: January 2021

Double-suction centrifugal pumps have been applied extensively in many areas, and the significance of pressure fluctuations inside these pumps with large power is becoming increasingly important. In this study, a double-suction centrifugal pump with a high-demand for vibration and noise was redesigned by increasing the flow uniformity at the impeller discharge, implemented by combinations of more than two parameters. First, increasing the number of the impeller blades was intended to enhance the bounding effect that the blades imposed on the fluid. Subsequently, increasing the radial gap between the impeller and volute was applied to reduce the rotor-stator interaction. Finally, the staggered arrangement was optimized to weaken the efficacy of the interference superposition. Based on numerical simulation, the steady and unsteady characteristics of the pump models were calculated. From the fluctuation analysis in the frequency domain, the dimensionless pressure fluctuation amplitude at the blade passing frequency and its harmonics, located on the monitoring points in the redesigned pumps (both with larger radial gap), are reduced a lot. Further, in the volute of the model with new impellers staggered at 12°, the average value for the dimensionless pressure fluctuation amplitude decreases to 6% of that in prototype pump. The dimensionless root-mean-square pressure contour on the mid-span of the impeller tends to be more uniform in the redesigned models (both with larger radial gap); similarly, the pressure contour on the mid-section of the volute presents good uniformity in these models, which in turn demonstrating a reduction in the pressure fluctuation intensity. The results reveal the mechanism of pressure fluctuation reduction in a double-suction centrifugal pump, and the results of this study could provide a reference for pressure fluctuation reduction and vibration performance reinforcement of double-suction centrifugal pumps and other pumps.
Correlation of prostate volume with severity of lower urinary tract symptoms as measured by international prostate symptoms score and maximum urine flow rate among patients with benign prostatic hyperplasia
Authors: Awaisu Mudi , Ahmed Muhammed , Lawal Ahmad Tijjani , Sudi Abdullahi , Tolani Musliu Adetola , Oyelowo Nasir , Muhammad Muhammad Salihu , Bello Ahmad , Maitama Hussaini Yusuf
Published: January 2021

Background

The aim of the study is to find the correlation between the prostate volume and severity of lower urinary tract symptoms (LUTS) as measured by international prostate symptoms score and maximum urine flow rate among patients with benign prostatic hyperplasia (BPH).

Methods

The study was a prospective correlational study conducted between June 2016 and November 2017. A total of 290 patients who presented with LUTS suggestive of BPH and satisfied the inclusion criteria were consecutively recruited. Clinical evaluation including digital rectal examination of the prostate was done. Symptoms severity was assessed using the self-administered international prostate symptoms score (IPSS) questionnaire. Prostate volume was determined by transrectal ultrasound scan, and the urine flow rate was measured using uroflowmeter. Data were analyzed using SPSS version 20.0, andpvalue < 0.05 was taken to be statistically significant.

Results

The mean age of the patients was 64.22 ± 9.04 years with a range of 40 to 95 years. Most of the patients had moderate symptoms (55%) on IPSS with the mean IPSS value of 16.41 ± 7.43. The mean Qmax value was 16.55 ± 7.41 ml/s, and the median prostate volume (IQR) was 45.05 (35, 59). There was a positive significant correlation between prostate volume and IPSS (r = 0.179,p = 0.002) and a negative significant correlation between prostate volume and Qmax (r = − 0.176,p = 0.003).

Conclusion

This study showed a significant correlation between the prostate volume and IPSS, and also between prostate volume and maximum flow rate (Qmax).
Per- and polyfluoroalkyl substances (PFASs) in Chinese drinking water: risk assessment and geographical distribution
Authors: Liu Liquan , Qu Yingxi , Huang Jun , Weber Roland
Published: January 2021

Background

In recent years, the widespread presence of perfluoroalkyl and polyfluoroalkyl substances (PFASs) in the environment and the related exposures and adverse health effects has received increasing attention. However, PFASs are not routinely monitored in drinking water in many parts of the world, including China. PFAS data are mainly generated by research studies. This paper provides an overview of the available research studies on PFASs in Chinese drinking water to better understand the current status of PFAS contamination and the potential for exposure.

Results

The available studies provided PFAS data from 526 drinking water samples across 66 cities in China with a total of approximately 452 million inhabitants. We mapped the risk distribution associated with PFAS-contaminated drinking water in China by comparing the measured levels with recent international guidelines. The PFAS concentrations reported in more than 20% of the studied cities, likely affecting 98.5 million people, were above the maximum contaminant level issued by Vermont in 2019. Furthermore, we also investigated the human exposure to PFASs in drinking water by estimating total daily intakes based on Exposure Factors Handbook of Chinese Population. This study revealed that East China and the Southwest regions posed a relatively higher risk to the Chinese population and some cities in the Yangtze River basin such as Zigong, Jiujiang, Lianyungang and a considerable share of other cities have exceeded the health-based guidelines issued by EU and US agencies.

Conclusion

Drinking water in many cities and regions in China is contaminated with PFASs at levels of concern. PFAS elimination of PFASs from drinking water in contaminated cities and affected regions in China is urgently needed. PFAS releases from industries and other sources need better control and reduction. Further monitoring in remote Chinese regions is needed to overcome the knowledge gaps for a more comprehensive understanding of population exposure. The current risk assessment of PFASs in China should be re-evaluated considering the most recent toxicological studies, to clarify if the guidelines need to be lowered as recently done in Europe and the United States. This is necessary to have the best national base for risk assessment and a science-based driver for countermeasures.
The role of Zur-regulated lipoprotein A in bacterial morphology, antimicrobial susceptibility, and production of outer membrane vesicles in Acinetobacter baumannii
Authors: Kim Nayeong , Kim Hyo Jeong , Oh Man Hwan , Kim Se Yeon , Kim Mi Hyun , Son Joo Hee , Kim Seung Il , Shin Minsang , Lee Yoo Chul , Lee Je Chul
Published: January 2021

Background

Zinc uptake-regulator (Zur)-regulated lipoprotein A (ZrlA) plays a role in bacterial fitness and overcoming antimicrobial exposure in Acinetobacter baumannii. This study further characterized the zrlA gene and its encoded protein and investigated the roles of the zrlA gene in bacterial morphology, antimicrobial susceptibility, and production of outer membrane vesicles (OMVs) in A. baumannii ATCC 17978.

Results

In silico and polymerase chain reaction analyses showed that the zrlA gene was conserved among A. baumannii strains with 97–100% sequence homology. Recombinant ZrlA protein exhibited a specific enzymatic activity of D-alanine-D-alanine carboxypeptidase. Wild-type A. baumannii exhibited more morphological heterogeneity than a ΔzrlA mutant strain during stationary phase. The ΔzrlA mutant strain was more susceptible to gentamicin than the wild-type strain. Sizes and protein profiles of OMVs were similar between the wild-type and ΔzrlA mutant strains, but the ΔzrlA mutant strain produced 9.7 times more OMV particles than the wild-type strain. OMVs from the ΔzrlA mutant were more cytotoxic in cultured epithelial cells than OMVs from the wild-type strain.

Conclusions

The present study demonstrated that A. baumannii ZrlA contributes to bacterial morphogenesis and antimicrobial resistance, but its deletion increases OMV production and OMV-mediated host cell cytotoxicity.
Genome-wide identification and characterization of NBS-encoding genes in Raphanus sativus L. and their roles related to Fusarium oxysporum resistance
Authors: Ma Yinbo , Chhapekar Sushil Satish , Lu Lu , Oh Sangheon , Singh Sonam , Kim Chang Soo , Kim Seungho , Choi Gyung Ja , Lim Yong Pyo , Choi Su Ryun
Published: January 2021

Background

The nucleotide-binding site–leucine-rich repeat (NBS-LRR) genes are important for plant development and disease resistance. Although genome-wide studies of NBS-encoding genes have been performed in several species, the evolution, structure, expression, and function of these genes remain unknown in radish (Raphanus sativus L.). A recently released draft R. sativus L. reference genome has facilitated the genome-wide identification and characterization of NBS-encoding genes in radish.

Results

A total of 225 NBS-encoding genes were identified in the radish genome based on the essential NB-ARC domain through HMM search and Pfam database, with 202 mapped onto nine chromosomes and the remaining 23 localized on different scaffolds. According to a gene structure analysis, we identified 99 NBS-LRR-type genes and 126 partial NBS-encoding genes. Additionally, 80 and 19 genes respectively encoded an N-terminal Toll/interleukin-like domain and a coiled-coil domain. Furthermore, 72% of the 202 NBS-encoding genes were grouped in 48 clusters distributed in 24 crucifer blocks on chromosomes. The U block on chromosomes R02, R04, and R08 had the most NBS-encoding genes (48), followed by the R (24), D (23), E (23), and F (17) blocks. These clusters were mostly homogeneous, containing NBS-encoding genes derived from a recent common ancestor. Tandem (15 events) and segmental (20 events) duplications were revealed in the NBS family. Comparative evolutionary analyses of orthologous genes among Arabidopsis thaliana, Brassica rapa, and Brassica oleracea reflected the importance of the NBS-LRR gene family during evolution. Moreover, examinations of cis-elements identified 70 major elements involved in responses to methyl jasmonate, abscisic acid, auxin, and salicylic acid. According to RNA-seq expression analyses, 75 NBS-encoding genes contributed to the resistance of radish to Fusarium wilt. A quantitative real-time PCR analysis revealed that RsTNL03 (Rs093020) and RsTNL09 (Rs042580) expression positively regulates radish resistance to Fusarium oxysporum, in contrast to the negative regulatory role for RsTNL06 (Rs053740).

Conclusions

The NBS-encoding gene structures, tandem and segmental duplications, synteny, and expression profiles in radish were elucidated for the first time and compared with those of other Brassicaceae family members (A. thaliana, B. oleracea, and B. rapa) to clarify the evolution of the NBS gene family. These results may be useful for functionally characterizing NBS-encoding genes in radish.
Association between normalized lactate load and mortality in patients with septic shock: an analysis of the MIMIC-III database
Authors: Chen Han , Gong Shu-Rong , Yu Rong-Guo
Published: January 2021

Background

An index of dynamic lactate change that incorporates both the magnitude of change and the time interval of such change, termed “normalized lactate load,” may reflect the hypoxic burden of septic shock. We aimed to evaluate the association between normalized lactate load and 28-day mortality in adult septic shock patients.

Methods

Patients with septic shock were identified from the Medical Information Mart for Intensive Care (MIMIC)-III database. Lactate load was defined as the sum of the area under the curve (AUC) of serial lactate levels using the trapezoidal rule, and normalized lactate load was defined as the lactate load divided by time. Receiver-operating characteristic curves were constructed to determine the performance of initial lactate, maximum lactate and normalized lactate load in predicting 28-day mortality.

Results

A total of 1371 septic shock patients were included, and the 28-day mortality was 39.8%. Non-survivors had significantly higher initial lactate (means ± standard deviations: 3.9 ± 2.9 vs. 2.8 ± 1.7 mmol/L), maximum lactate (5.8 ± 3.8 vs. 4.3 ± 2.2 mmol/L), lactate load (94.3 ± 71.8 vs. 61.1 ± 36.4 mmol·hr./L) and normalized lactate load (3.9 ± 3.0 vs. 2.5 ± 1.5 mmol/L, all p <  0.001). The AUCs of initial lactate, maximum lactate and normalized lactate load were 0.623 (95% confidence interval: 0.596–0.648, with a cut-off value of 4.4 mmol/L), 0.606 (0.580–0.632, with a cut-off value of 2.6 mmol/L) and 0.681 (0.656–0.706, with a cut-off value of 2.6 mmol/L), respectively. The AUC of normalized lactate load was significantly greater than both initial lactate and maximum lactate (all p <  0.001). In the multivariate logistic regression model, normalized lactate load was identified as an independent risk factor for 28-day mortality.

Conclusions

Normalized lactate load is an independent risk factor for 28-day mortality in adult septic shock patients. Normalized lactate load had better accuracy than both initial and maximum lactate in determining the prognosis of septic shock patients.
The association of erythropoietin-stimulating agents and increased risk for AV-fistula dysfunction in hemodialysis patients. A retrospective analysis
Authors: Wärme Anna , Hadimeri Henrik , Nasic Salmir , Stegmayr Bernd
Published: January 2021

Background

Patients in maintenance hemodialysis (HD) need a patent vascular access for optimal treatment. The recommended first choice is a native arteriovenous fistula (AVF). Complications of AVF are frequent and include thrombosis, stenosis and infections leading to worsening of dialysis efficacy. Some known risk factors are age, gender and the presence of diabetes mellitus. The aim was to investigate if further risk variables are associated with dysfunctional AVF.

Methods

This retrospective observational study included 153 chronic HD patients (Cases) referred to a total of 473 radiological investigations due to clinically suspected complications of their native AVF. Another group of chronic HD patients (n = 52) who had a native AVF but were without history of previous complications for at least 2 years were controls. Statistical analyses included ANOVA, logistic regression, parametric and non-parametric methods such as Student’s T-test and Mann-Whitney test.

Results

Among Cases, at least one significant stenosis (> 50% of the lumen) was detected in 348 occasions. Subsequent PTA was performed in 248 (71%). Median erythropoiesis-stimulating agent (ESA) weekly doses were higher in Cases than in Controls (8000 vs 5000 IU,p < 0.001). Cases received higher doses of intravenous iron/week than the Controls before the investigation (median 50 mg vs 25 mg,p = 0.004) and low molecular weight heparin (LMWH,p = 0.028). Compared to Controls, Cases had a lower level of parathyroid hormone (median 25 vs 20 ρmol/L,p = 0.009). In patients with diabetes mellitus, HbA1c was higher among Cases than Controls (50 vs 38 mmol/mol,p < 0.001). Multiple regression analysis revealed significant associations between Cases and female gender, prescription of doxazocin, and doses of ESA and LMWH.

There was no difference between the groups regarding hemoglobin, CRP or ferritin.

Conclusion

In conclusion, the present study indicated that the factors associated with AVF problems were high doses of ESA, iron administration, and tendency of thromboembolism (indicated by high LMWH doses); the use of doxazocin prescription, however, requires further investigation.
Evolution of body composition following successful kidney transplantation is strongly influenced by physical activity: results of the CORPOS study
Authors: Moreau Karine , Desseix Aurélie , Germain Christine , Merville Pierre , Couzi Lionel , Thiébaut Rodolphe , Chauveau Philippe
Published: January 2021

Background

Weight gain (mainly gain of fat mass) occurs quickly after successful kidney transplantation and is associated with metabolic complications (alterations of glycaemic control, hyperlipidaemia). Determinants of weight gain are multifactorial and are mainly related to the transplant procedure itself (glucocorticoid use, increased appetite). In the modern era of transplantation, one challenge is to limit these metabolic alterations by promoting gain of muscle mass rather than fat mass. This prospective study was performed to assess determinants of fat mass, fat-free mass and body cell mass changes after kidney transplantation with a focus on physical activity and nutritional behaviour before and after transplantation.

Methods

Patients were included at the time of listing for deceased donor kidney transplantation. Body composition was determined using dual X-ray absorptiometry and bioimpedance spectroscopy to assess fat mass, fat-free mass and body cell mass (= fat-free mass − extracellular water) at the time of inclusion, 12 months later, and 1, 6, 12 and 24 months after transplantation. Recall dietary data and physical activity level were also collected.

Results

Eighty patients were included between 2007 and 2010. Sixty-five had a complete 24-month follow-up after kidney transplantation. Fat mass, fat-free mass and body cell mass decreased during the waiting period and early after kidney transplantation. The nadirs of body cell mass and fat-free mass occurred at 1 month and the nadir for fat mass occurred at 6 months. Maximum levels of all parameters of body composition were seen at 12 months, after which body cell mass and fat-free mass decreased, while fat mass remained stable. In multivariate analysis, male recipients, higher physical activity level and lower corticosteroid dose were significantly associated with better body cell mass recovery after kidney transplantation.

Conclusions

Lifestyle factors, such as physical activity level, together with low dose of corticosteroids seem to influence body composition evolution following kidney transplantation with recovery of body cell mass. Specific strategies to promote physical activity in kidney transplant recipients should be provided before and after kidney transplantation.
Integrated analysis of mRNA and miRNA profiles revealed the role of miR-193 and miR-210 as potential regulatory biomarkers in different molecular subtypes of breast cancer
Authors: Evangelista Adriane F. , Oliveira Renato J. , O. Silva Viviane A. , D. C. Vieira Rene A. , Reis Rui M. , C. Marques Marcia M.
Published: January 2021

Background

Breast cancer is the most frequently diagnosed malignancy among women. However, the role of microRNA (miRNA) expression in breast cancer progression is not fully understood. In this study we examined predictive interactions between differentially expressed miRNAs and mRNAs in breast cancer cell lines representative of the common molecular subtypes. Integrative bioinformatics analysis identified miR-193 and miR-210 as potential regulatory biomarkers of mRNA in breast cancer. Several recent studies have investigated these miRNAs in a broad range of tumors, but the mechanism of their involvement in cancer progression has not previously been investigated.

Methods

The miRNA-mRNA interactions in breast cancer cell lines were identified by parallel expression analysis and miRNA target prediction programs. The expression profiles of mRNA and miRNAs from luminal (MCF-7, MCF-7/AZ and T47D), HER2 (BT20 and SK-BR3) and triple negative subtypes (Hs578T e MDA-MB-231) could be clearly separated by unsupervised analysis using HB4A cell line as a control. Breast cancer miRNA data from TCGA patients were grouped according to molecular subtypes and then used to validate these findings. Expression of miR-193 and miR-210 was investigated by miRNA transient silencing assays using the MCF7, BT20 and MDA-MB-231 cell lines. Functional studies included, xCELLigence system, ApoTox-Glo triplex assay, flow cytometry and transwell inserts were performed to determine cell proliferation, cytotoxicity, apoptosis, migration and invasion, respectively.

Results

The most evident effects were associated with cell proliferation after miR-210 silencing in triple negative subtype cell line MDA-MB-231. Using in silico prediction algorithms, TNFRSF10 was identified as one of the potential regulated downstream targets for both miRNAs. The TNFRSF10C and TNFRSF10D mRNA expression inversely correlated with the expression levels of miR-193 and miR210 in breast cell lines and breast cancer patients, respectively. Other potential regulated genes whose expression also inversely correlated with both miRNAs were CCND1, a known mediator on invasion and metastasis, and the tumor suppressor gene RUNX3.

Conclusions

In summary, our findings identify miR-193 and miR-210 as potential regulatory miRNA in different molecular subtypes of breast cancer and suggest that miR-210 may have a specific role in MDA-MB-231 proliferation. Our results highlight important new downstream regulated targets that may serve as promising therapeutic pathways for aggressive breast cancers
Increase of central foveal and temporal choroidal thickness in patients with inactive thyroid eye disease
Authors: Kim Joohyun , Yoon Sumin , Baek Sehyun
Published: January 2021

Background

In this study, we aimed to compare the choroidal thickness between a group of Korean patients with inactive thyroid eye disease (TED) and a control group of Korean patients and to analyze the variables affecting choroidal thickness.

Methods

Patients diagnosed with inactive TED and without TED who underwent optical coherence tomography and axial length measurements were included and classified into the TED group and control group. Choroidal thickness was measured using images acquired in enhanced depth imaging (EDI) mode by cirrus HD-OCT (Carl Zeiss Meditec Inc., Dublin, CA, UAS) at the central fovea and points 1.5 mm nasal and 1.5 mm temporal from the central fovea using a caliper tool provided by OCT software.

Results

The mean central foveal choroidal thickness was 294.2 ± 71.4 µm and 261.1 ± 47.4 µm in the TED and control groups, respectively, while the mean temporal choroidal thickness was 267.6 ± 67.5 µm and 235.7 ± 41.3 µm in the TED and control groups, respectively, showing significant differences between the two groups (P = 0.011, P = 0.008). The mean nasal choroidal thickness was 232.1 ± 71.7 µm and 221.1 ± 59.9 µm in the TED and control groups, respectively, showing no significant difference between the two groups (P = 0.421). Multivariate regression analysis showed the factors affecting central foveal choroidal thickness were age, axial length, and degree of exophthalmos, and factors affecting temporal choroidal thickness were age and degree of exophthalmos.

Conclusions

Central foveal and temporal choroidal thickness were significantly thicker in patients with inactive TED than in control subjects, while age, axial length, and degree of exophthalmos were identified as major factors affecting choroidal thickness.
The prevalence of liquid chromatography-tandem mass spectrometry confirmed paediatric poisoning at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
Authors: Washaya Norbertta , Evans Alicia , Muloiwa Rudzani , Smith Peter , Buys Heloise
Published: January 2021

Background

Paediatric poisoning is a common presentation to emergency departments worldwide. There is a paucity of data on the role of liquid chromatography-tandem mass spectrometry (LC-MS/MS), in the management of paediatric poisoning in low-and middle-income countries (LMICs). In high-income countries, most studies are retrospective, and few include children.

Objective

The study describes the prevalence of liquid chromatography-tandem mass spectrometry confirmed paediatric poisoning at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa.

Methods

Children admitted with suspected poisoning between 1 January 2017 and 31 December 2017, were recruited. All patients had a urine and/or blood sample sent for LC-MS/MS toxicology. Data collected included demographic data, clinical features, investigations, management, outcome and social interventions.

Results

One hundred fifty-two children, with median age of 39 (IQR 25–61) months were enrolled of which 128 (84%) were poisoning cases. Of the 128 poisoning cases, 88 (69%) presented with a history of ingesting a known substance, 16 (12%) an unknown substance and 24 (19%) were cases of occult poisoning. LC-MS/MS was able to identify a substance in 92% of the cases of occult poisoning. In those who had presented with a seemingly known substance, LC-MS/MS found a different substance in 15 cases. LC-MS/MS was also able to detect multiple drugs in 40 patients. Of the poisoning cases, six (5%) cases were attempted homicide cases and 5 (4%) cases were attempted suicide cases. No children died. Individualized social interventions were instituted in poisoning cases. Emergency placement safety reasons was required in 6 children.

Conclusion

When the limitations are known, LC-MS/MS is useful in identifying cases of occult poisoning, identifying patients who have ingested multiple substances and/or an unknown substance and when targeted towards child protection. As LC-MS/MS is an expensive test, it should be used judiciously in LMICs.
Depression, risk factors, and coping strategies in the context of social dislocations resulting from the second wave of COVID-19 in Japan
Authors: Fukase Yuko , Ichikura Kanako , Murase Hanako , Tagaya Hirokuni
Published: January 2021

Background

Social dislocations resulting from coronavirus disease 2019 (COVID-19) pandemic have been prolonged, which has led to general population social suppression. The present study aimed to reveal risk factors associated with mental health problems and suggest concrete coping strategies in the context of COVID-19.

Methods

A web-based survey was conducted in July when Japan was experiencing a second wave of COVID-19. Demographics, Patient Health Questionnaire-9 (PHQ-9), state anger, anger control, and the Brief Coping Orientation to Problems Experienced were measured. Multivariate logistic regression analysis on PHQ-9 scores by set variables was conducted.

Results

The participants were 2708 individuals, and 18.35% of them were depressed. Logistic regression analysis showed that in the order of odds ratios (ORs), underlying disease (OR = 1.96, 95% confidence interval (CI) = 1.32–2.92), not working (OR = 1.85, CI = 1.22–2.80), negative economic impact (OR = 1.33, CI = 1.01–1.77), state anger (OR = 1.17, CI = 1.14–1.21), anger control (OR = 1.08, CI = 1.04–1.13), age (OR = 0.97, CI = 0.96–0.98), high income (OR = 0.45, CI = 0.25–0.80), and being married (OR = 0.53, CI = 0.38–0.74) were predictors of depressive symptoms. Regarding coping strategies, planning (OR = 0.84, CI = 0.74–0.94), use of instrumental support (OR = 0.85, CI = 0.76–0.95), denial (OR = 0.88, CI = 0.77–0.99), behavioural disengagement (OR = 1.28, CI = 1.13–1.44), and self-blame (OR = 1.47, CI = 1.31–1.65) were associated with probable depression.

Conclusions

During prolonged psychological distress caused by COVID-19 pandemic, the prevalence of depressive symptoms in Japan was two to nine times as high as before the COVID-19 pandemic, even though Japan was not a lockdown country. Although some coping strategies were useful for maintaining mental health, such as developing ways, alone or with others, to address or avoid social dislocations, the influence of demographics was more powerful than these coping strategies, and medical treatments are needed for high-risk individuals.
Developing a whole-school mental health and wellbeing intervention through pragmatic formative process evaluation: a case-study of innovative local practice within The School Health Research network
Authors: Gobat Nina , Littlecott Hannah , Williams Andy , McEwan Kirsten , Stanton Helen , Robling Michael , Rollnick Stephen , Murphy Simon , Evans Rhiannon
Published: January 2021

Background

The evidence-base for whole school approaches aimed at improving student mental health and wellbeing remains limited. This may be due to a focus on developing and evaluating de-novo, research-led interventions, while neglecting the potential of local, contextually-relevant innovation that has demonstrated acceptability and feasibility. This study reports a novel approach to modelling and refining the programme theory of a whole-school restorative approach, alongside plans to scale up through a national educational infrastructure in order to support robust scientific evaluation.

Methods

A pragmatic formative process evaluation was conducted of a routinized whole-school restorative approach aimed at improving student mental health and wellbeing in Wales.

Results

The study reports the six phases of the pragmatic formative process evaluation. These are: 1) identification of innovative local practice; 2) scoping review of evidence-base to identify potential programme theory; outcomes; and contextual characteristics that influence implementation; 3) establishment of a Transdisciplinary Action Research (TDAR) group; 4) co-production and confirmation of an initial programme theory with stakeholders; 5) planning to optimise intervention delivery in local contexts; and 6) planning for feasibility and outcome evaluation. The phases of this model may be iterative and not necessarily sequential.

Conclusions

Formative, pragmatic process evaluations can support researchers, policy-makers and practitioners in developing robust scientific evidence-bases for acceptable and feasible local innovations that do not already have a clear evidence base. The case of a whole-school restorative approach provides a case example of how such an evaluation may be undertaken.
Adherence to walking exercise prescription during pulmonary rehabilitation in COPD with a commercial activity monitor: a feasibility trial
Authors: Ward Sarah , Orme Mark , Zatloukal Jakub , Singh Sally
Published: January 2021

Background

Regular exercise is important in the management of COPD. Pulmonary rehabilitation (PR) facilitates a more physically active lifestyle through exercise participation, ideally without compromising non-exercise physical activity (PA). During PR patients are advised to perform exercise defined by duration and intensity. The extent to which PR attendees participate in unsupervised exercise bouts and their adherence to the exercise prescription provided during PR is unclear. Commercially available devices have the potential to support patients to exercise at their individually prescribed intensity. Study aims were to (1) assess how adherent patients are to their prescribed walking intensity; (2) examine the pattern of overall PA and walking exercise during the course of PR; (3) determine the feasibility of prescribing exercise to PR attendees using an activity monitor; and (4) explore the relationship between exercise and non-exercise PA with routine PR outcome measures.

Methods

19 patients wore an activity monitor during routine walking tests and 6 weeks of PR, recording in a diary when they exercised. Exercise intensity (cadence) was prescribed from the Endurance Shuttle Walk Test. Patients completed questionnaires, walking tests and a lower limb strength test before and after PR. Repeated ANOVA compared changes in outcomes between weeks 1–6.

Results

Patients wore the monitor every day during PR (median 42 days). Exercise steps increased by 56% (Δ332 [95% CI 54–611] steps/day, p = 0.009) between weeks 1 and 6, with no significant change in non-exercise steps (Δ79 [95% CI − 22 to − 179] steps/day, p = 0.13). Patients reported exercising on 70% of days. Adherence to prescribed cadence was achieved 55% of time spent exercising, and did not change across the 6 weeks (p = 0.907). Change in total daily steps was associated with improved dyspnea (p = 0.027), Chronic Respiratory Questionnaire (CRQ) Dyspnea domain (p = 0.019), CRQ Emotional Functioning domain (p = 0.001) and CRQ Mastery domain scores (p = 0.001) but not with exercise capacity or lower limb muscle strength.

Conclusions

Improvements in exercise participation, not at the expense of non-exercise PA, throughout a PR course was observed in attendees provided with a commercially available activity monitor. Wearable technology may be able to support effective remote walking exercise prescription and participation during PR.

Trial registration (retrospectively registered):http://www.isrctn.com/ISRCTN15892972.
Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease
Authors: Son Seong , Yoo Chan Jong , Yoo Byung Rhae , Kim Woo Seok , Jeong Tae Seok
Published: January 2021

Background

Trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscope and a holmium YAG laser is one of the minimally invasive surgical options for lumbar disc herniation. However, the learning curve of SELD and the effect of surgical proficiency on clinical outcome have not yet been established. We investigated patients with lumbar disc herniation undergoing SELD to report the clinical outcome and learning curve.

Methods

Retrospective analysis of clinical outcome and learning curve were performed at a single center from clinical data collected from November 2015 to November 2018. A total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Based on the findings that the cut-off of familiarity was 20 cases according to the cumulative study of operation time, patients were allocated to two groups: early group (n = 20) and late group (n = 62). The surgical, clinical, and radiological outcomes were retrospectively evaluated between the two groups to analyze the learning curve of SELD.

Results

According to linear and log regression analyses, the operation time was obtained by the formula: operation time = 58.825–(0.181 × [case number]) (p < 0.001). The mean operation time was significantly different between the two groups (mean 56.95 min; 95% confidence interval [CI], 49.12–64.78 in the early group versus mean 45.34 min; 95% CI, 42.45–48.22 in the late group; p = 0.008, non-parametric Mann–Whitney U test). Baseline characteristics, including demographic data, clinical factors, and findings of preoperative magnetic resonance imaging, did not differ between the two groups. Also, there was no significant difference in terms of surgical outcomes, including complication and failure rates, as well as clinical and radiological outcomes between the two groups.

Conclusion

The learning curve of SELD was not as steep as that of other minimally invasive spinal surgery techniques, and the experience of surgery was not an influencing factor for outcome variation.
Impact of a pandemic on surgical neuro-oncology—maintaining functionality in the early phase of crisis
Authors: Hameed N. U. Farrukh , Ma Yixin , Zhen Zili , Wu Shuai , Feng Rui , Li Weiping , Huang Guodong , Wu Jinsong , Chen Zhongping
Published: January 2021

Background

The Coronavirus disease 2019 (COVID-19) pandemic has extraordinarily impacted global healthcare. Neuro-oncological surgery units have peculiar features that make them highly relevant in the strategic reaction to the pandemic. In this Chinese Society of Neuro-Oncology (CSNO) initiated survey, we appraise the changes implemented in neuro-oncological surgery hospitals across different Asian countries and provide expert recommendations for responses at different stages of the pandemic.

Methods

We performed a 42-question survey of the early experience of neuro-oncological surgery practice in hospitals across different Asian countries on April 1, 2020, with responses closed on April 18, 2020.

Results

144 hospitals completed the questionnaire. Most were in WHO post-peak phase of the pandemic and reported a median reduction in neuro-oncological surgery volume of 25–50%. Most (67.4%) resumed elective surgery in only COVID-19 negative patients;11.1% performed only emergency cases irrespective of COVID-19 status;2.1% suspended all surgical activity. Ninety-one (63.2%) relocated personnel from neurosurgery to other departments. Fifty-two (36.1%) hospitals suspended post-operative adjuvant therapy and 94 (65.2%) instituted different measures to administer post-operative adjuvant therapy. Majority (59.0%) of the hospitals suspended research activity. Most (70%) respondents anticipate that current neurosurgery restrictions will continue to remain for > 1 month.

Conclusions

Majority of the respondents to our survey reported reduced neuro-oncological surgery activity, policy modification, personnel reallocation, and curtailment of educational/research activities in response to the COVID-19 pandemic. The persistent widespread interruption of surgical neuro-oncology in even post-peak phases of the pandemic raises serious concerns about the long-term impact of the pandemic on neuro-oncological patients and highlights the essence of timely measures for pandemic preparedness, patient triage, and workforce protection.
Ultrastructural and molecular analysis of the origin and differentiation of cells mediating brittle star skeletal regeneration
Authors: Piovani Laura , Czarkwiani Anna , Ferrario Cinzia , Sugni Michela , Oliveri Paola
Published: January 2021

Background

Regeneration is the ability to re-grow body parts or tissues after trauma, and it is widespread across metazoans. Cells involved in regeneration can arise from a pool of undifferentiated proliferative cells or be recruited from pre-existing differentiated tissues. Both mechanisms have been described in different phyla; however, the cellular and molecular mechanisms employed by different animals to restore lost tissues as well as the source of cells involved in regeneration remain largely unknown. Echinoderms are a clade of deuterostome invertebrates that show striking larval and adult regenerative abilities in all extant classes. Here, we use the brittle star Amphiura filiformis to investigate the origin and differentiation of cells involved in skeletal regeneration using a combination of microscopy techniques and molecular markers.

Results

Our ultrastructural analyses at different regenerative stages identify a population of morphologically undifferentiated cells which appear in close contact with the proliferating epithelium of the regenerating aboral coelomic cavity. These cells express skeletogenic marker genes, such as the transcription factor alx1 and the differentiation genes c-lectin and msp130L, and display a gradient of morphological differentiation from the aboral coelomic cavity towards the epidermis. Cells closer to the epidermis, which are in contact with developing spicules, have the morphology of mature skeletal cells (sclerocytes), and express several skeletogenic transcription factors and differentiation genes. Moreover, as regeneration progresses, sclerocytes show a different combinatorial expression of genes in various skeletal elements.

Conclusions

We hypothesize that sclerocyte precursors originate from the epithelium of the proliferating aboral coelomic cavity. As these cells migrate towards the epidermis, they differentiate and start secreting spicules. Moreover, our study shows that molecular and cellular processes involved in skeletal regeneration resemble those used during skeletal development, hinting at a possible conservation of developmental programmes during adult regeneration. Finally, we highlight that many genes involved in echinoderm skeletogenesis also play a role in vertebrate skeleton formation, suggesting a possible common origin of the deuterostome endoskeleton pathway.
Plasma levels of a methadone constant rate infusion and their corresponding effects on thermal and mechanical nociceptive thresholds in dogs
Authors: Amon T. , Kästner S. B. R. , Kietzmann M. , Tünsmeyer J.
Published: January 2021

Background

The present study aimed to collect pharmacokinetic data of a methadone continuous rate infusion (CRI) and to investigate its effect on mechanical and thermal nociceptive thresholds. Seven, 47 to 54 months old beagle dogs, weighing 9.8 to 21.2 kg, were used in this experimental, randomized, blinded, placebo-controlled crossover study. Each dog was treated twice with either a methadone bolus of 0.2 mg kg− 1followed by a 0.1 mg kg− 1 h− 1methadone CRI (group M) or an equivalent volume of isotonic saline solution (group P) for 72 h. Mechanical and thermal thresholds, as well as vital parameters and sedation were measured during CRI and for further 24 h. Blood samples for methadone plasma concentrations were collected during this 96 h period.

Results

Percentage thermal excursion (%TE) increased significantly from baseline (BL) until 3 h after discontinuation of CRI in M. Within P and between treatment groups differences were not significant. Mechanical threshold (MT) increased in M until 2 h after CRI discontinuation. Bradycardia and hypothermia occurred in M during drug administration and dogs were mildly sedated for the first 47 h. Decreased food intake and regurgitation were observed in M in five and four dogs, respectively. For methadone a volume of distribution of 10.26 l kg− 1and a terminal half-life of 2.4 h were detected and a clearance of 51.44 ml kg− 1 min− 1was calculated. Effective methadone plasma concentrations for thermal and mechanical antinociception were above 17 ng ml− 1.

Conclusion

A methadone CRI of 0.1 mg kg− 1 h− 1for 3 days after a loading dose results in steady anti-nociceptive effects in an acute pain model in healthy dogs. Main side effects were related to gastrointestinal tract, hypothermia, bradycardia and sedation.
Quantifying individual variability in exposure risk to mosquito bites in the Cascades region, Burkina Faso
Authors: Guglielmo Federica , Sanou Antoine , Churcher Thomas , Ferguson Heather M. , Ranson Hilary , Sherrard-Smith Ellie
Published: January 2021

Background

The Cascades region, Burkina Faso, has a high malaria burden despite reported high insecticide-treated mosquito net (ITN) use. Human and vector activities outside the hours when indoor interventions offer direct protection from infectious bites potentially increase exposure risk to bites from malaria-transmittingAnophelesmosquitoes. This work investigated the degree of variation in human behaviour both between individuals and through time (season) to quantify how it impacts exposure to malaria vectors.

Methods

Patterns in human overnight activity (18:00–06:00) to quantify time spent using an ITN across 7 successive nights in two rural communities, Niakore (N = 24 participants) and Toma (71 participants), were observed in the dry and rainy seasons, between 2017 and 2018. Hourly human landingAnophelesmosquito catches were conducted in Niakore specifically, and Cascades region generally, between 2016 and 2017. Data were statistically combined to estimate seasonal variation in time spent outdoors andAnophelesbites received per person per night (bpppn).

Results

Substantial variability in exposure to outdoorAnophelesbites was detected within and between communities across seasons. In October, whenAnophelesdensities are highest, an individual’s risk ofAnophelesbites ranged from 2.2 to 52.2 bites per person per night (bpppn) within the same week with variable risk dependent on hours spent indoors. Comparably higher outdoor human activity was observed in April and July but, due to lowerAnophelesdensities estimated, bpppn were 0.2–4.7 and 0.5–32.0, respectively. Males and people aged over 21 years were predicted to receive more bites in both sentinel villages.

Conclusion

This work presents one of the first clear descriptions of the degree of heterogeneity in time spent outdoors between people and across the year. Appreciation of sociodemographic, cultural and entomological activities will help refine approaches to vector control.