bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Related Factors of Brittle Hip Fracture in Postmenopausal Women with Osteoporosis
Authors: Zhuang Hua‐feng , Wang Pei‐wen , Li Yi‐zhong , Lin Jin‐kuang , Yao Xue‐dong , Xu Hao
Published: January 2020

Objective

To investigate the effects of age, body mass index (BMI), bone mineral density (BMD), and levels of serum 25‐hydroxyvitamin D (25OHD) on hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis.

Methods

A total of 252 postmenopausal women patients, whose bone density had reached the threshold of osteoporosis and age ≥50 years (50–98 years), collected from the Second Affiliated Hospital of Fujian Medical University from January 2015 to December 2018, were performed by retrospective analysis. According to whether or not they had a hip fracture, including femoral neck fracture or intertrochanteric fracture, the patients were divided into two groups, including 117 cases (50–84 years old) in the non‐hip fracture group and 135 cases (57–98 years old) in the hip fracture group. BMD was measured by Hologic Discovery A DXA bone mineral densitometer. Levels of serum 25OHD were detected by ROCHE detection instrument. Comparisons of age, BMI, bone density of femoral neck, and levels of serum 25OHD between the two groups were performed by using the Student's t‐test. Furthermore, the statistically significant factors were analyzed by multiple regression analysis to investigate the independent risk factors of hip fracture.

Results

The group without hip fracture: 117 cases; average age: 67.4 ± 8.5 years; BMI: 22.3 ± 3.2 kg/m2; bone density of femoral neck: (0.504 ± 0.067) g/cm2; T‐value of femoral neck: −3.1 ± 0.6; levels of serum 25OHD: (24.9 ± 8.5) ng/mL. The group with brittle hip fracture: 135 cases; average age: 80.7 ± 7.6 years; BMI: 20.3 ± 3.5 kg/m2; bone density of femoral neck: (0.426 ± 0.077) g/cm2; T‐value of femoral neck: −3.8 ± 0.7; levels of serum 25OHD: (15.9 ± 8.9) ng/mL. Age, BMI, bone density of femoral neck, and 25OHD level of the group without hip fracture were markedly lower than hip fracture group (P < 0.05). The results of logistic regression analysis suggested that age, bone density of femoral neck, and levels of serum 25OHD were independent risk factors for fragile hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis.

Conclusion

Higher age, lower levels of bone density and 25OHD are the main risk factors of hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis.
A large testudinid with African affinities in the post‐Messinian (lower Pliocene) record of south‐eastern Spain
Authors: Pérez‐García Adán , Vlachos Evangelos , Murelaga Xabier
Published: January 2020

Herein, we describe Alatochelon myrteum gen. et sp. nov., a large tortoise from the post‐Messinian (lower Pliocene) of the area of Puerto de la Cadena (Region of Murcia), Spain. The new taxon cannot be attributed to Titanochelon, which represented the only lineage of large tortoises previously recognized in the Neogene record of Europe. Alatochelon myrteum shows African affinities, especially with the extant African spurred tortoise Centrochelys sulcata. Although close phylogenetic relationships have previously been recognized among some tortoises of both continents, the dispersal of this lineage had always been proposed as having occurred in only one direction: from Europe to Africa. The dispersal of the lineage including the new Spanish form and Centrochelys sulcata from Africa to Europe is proposed here. This proposal is compatible with those previously recognized for some lineages of mammals also found in Puerto de la Cadena, identified as African lineages that probably reached Europe during the Messinian Salinity Crisis event. An African origin is also proposed for the lineage of Titanochelon. Therefore, the two lineages of large derived testudinids (i.e. Geochelona) recognized in the European record experienced diachronic dispersal events from Africa to Europe: that to which Alatochelon belongs probably during the Messinian and the other much earlier, at the beginning of the Miocene or before.
Quality of life in Korean tuberculosis patients: A longitudinal study
Authors: Park Sujung , George Maureen , Choi Ja Yun
Published: January 2020

Objective

The purpose of this study was to examine health‐related quality of life (HRQoL) in Korean tuberculosis (TB) patients and to identify factors associated with HRQoL.

Design

A longitudinal study design was employed with a six‐month tracking period.

Sample

Fifty patients were enrolled from a single TB clinic.

Measurements

Data on physical and mental HRQoL domains, physical symptoms, self‐esteem, stigma, treatment adherence and social support were collected on the day of TB diagnosis, and then again at 2‐ and 6‐months’ post‐TB diagnosis.

Results

Mental HRQoL scores did not change over time (p = .500) although changes in the physical HRQoL significantly improved over 6 months (p < .001); these changes were small and not considered clinically meaningful. Worse physical symptoms (p < .001) but better treatment adherence (p = .006) were associated with lower physical HRQoL. Similarly, worse physical symptoms but better self‐esteem (p < .001) and social support (p = .015) were associated with higher mental HRQoL.

Conclusions

It is important that nurses caring for TB patients understand the physical and mental impact of TB and its treatment.
Root‐lesion nematodes of potato: Current status of diagnostics, pathogenicity and management
Authors: Orlando Valeria , Grove Ivan G. , Edwards Simon G. , Prior Thomas , Roberts David , Neilson Roy , Back Matthew
Published: January 2020

Root‐lesion nematodes of the genus Pratylenchus are migratory endoparasites with worldwide economic impact on several important crops including potato, where certain species like P. penetrans, P. neglectus, and P. scribneri reduce the yield and quality of potato tubers. Morphological identification of Pratylenchus spp. is challenging, and recent advancements in molecular techniques provide robust and rapid diagnostics to differentiate species without the need of specialist skills. However, the fact that molecular diagnostics are not available for all Pratylenchus species means that there are limitations in worldwide application. In general, root‐lesion nematodes are difficult to manage once introduced into agricultural land and damage can be related to pathogenicity and population densities. In addition, root‐lesion nematodes interact with fungi such as Verticillium dahliae, resulting in disease complexes that enhance the damage inflicted on the potato crop. Management interventions are often focused on limiting nematode reproduction before planting crops and include the application of nematicides, and cultural practices such as crop rotation, cover crops, biofumigation, and biological control. Understanding the limitations of the available crop protection strategies is important and there are many gaps for further study. This review discusses the status of the diagnosis, distribution, pathogenicity, and management of the main species of root‐lesion nematodes, reported to infect potatoes worldwide, and highlights areas for potential future research.
The interaction of tectonics, climate and eustasy in controlling dolomitization: A case study of Cenomanian–Turonian, shallow marine carbonates of the Iberian Basin
Authors: Newport Richard , Segura Manuel , Redfern Jonathan , Hollis Cathy
Published: January 2020

abstract

During the Cretaceous, high global sea‐level and low latitudinal temperature variations led to the growth of epeiric carbonate platforms. Platform‐scale dolomitization of these platforms is not common, reflecting the low Mg/Ca ratio of seawater and a humid climate. This study describes the processes governing pervasive dolomitization of a land‐attached carbonate platform within the Iberian Basin. Dolomite is planar to sub‐planar with a geochemical signature consistent with dolomitization from penesaline seawater. Dolomitization was most pervasive during a 1 Myr period in the middle Cenomanian, by repeated reflux of seawater from brine pools formed on the top of a southward‐prograding carbonate platform. Tilting and structural reorganization in the Upper Cenomanian led to a reversal in polarity of the platform, and dolomitization was restarted by the northward reflux of seawater. Rising relative sea‐level and oceanic acidification led to back‐stepping of the platform such that the supply of dolomitizing fluids was cut off. In the Lower Turonian, pervasively dolomitized rudist rudstone facies in the south of the study area indicate that dolomitization restarted, either penecontemporaneously or later, from highly evaporated Campanian–Maastrichtian seawater. A systematic increase in dolomite crystal size up‐section ties broadly, but not entirely, to stratigraphy. It is possible that these textural differences reflect changes in fluid chemistry, limestone permeability or precursor rock texture. However, the lack of stratigraphic conformance, and the preservation of the earliest‐formed dolomite only in the oldest sediments, could indicate a progressive recrystallization of early‐formed dolomite through repeated reflux of brines. As such, the succession appears to preserve a fossilized record of dolomite recrystallization through time during the Cenomanian–Turonian. The results of this study therefore provide a record of the progressive dolomitization of a carbonate platform and demonstrate the important interplay of climate and basin‐scale tectonics on dolomite distribution and crystallinity.
4‐month moxifloxacin containing regimens in the treatment of patients with sputum‐positive pulmonary tuberculosis in South India – a randomised clinical trial
Authors: Velayutham Banurekha , Jawahar Mohideen Shaheed , Nair Dina , Navaneethapandian Pooranagangadevi , Ponnuraja Chinnaiyan , Chandrasekaran Kandasamy , Narayan Sivaramakrishnan Gomathi , Makesh Kumar Marimuthu , Paul Kumaran Paramasivam , Ramesh Kumar Santhanakrishnan , Baskaran Dhanaraj , Bella Devaleenal Daniel , Sirasanambati Devarajulu Reddy , Vasantha Mahalingam , Palaniyandi Paramasivam , Ramachandran Geetha , Uma Devi Kadayam Ranganathan , Elizabeth Hannah Luke , Sekar Gomathi , Radhakrishnan Ammayappan , Kalaiselvi Dharuman , Dhanalakshmi Angamuthu , Thiruvalluvan Elangovan , Raja Sakthivel Murugesan , Mahilmaran Ayyamperumal , Sridhar Rathinam , Jayabal Lavanya , Rathinam Prabhakaran , Angamuthu Prabhakar , Soorappa Ponnusamy Kumaresan , Venkatesan Perumal , Natrajan Mohan , Prasad Tripathy Srikanth , Swaminathan Soumya
Published: January 2020

Background

Shortening tuberculosis (TB) treatment duration is a research priority. We tested the efficacy and safety of 3‐ and 4‐month regimens containing moxifloxacin in a randomised clinical trial in pulmonary TB (PTB) patients in South India.

Methods

New, sputum‐positive, adult, HIV‐negative, non‐diabetic PTB patients were randomised to 3‐ or 4‐month moxifloxacin regimens [moxifloxacin (M), isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E)] or to a control regimen (2H3R3Z3E3/4R3H3) [C]. The 4 test regimens were 3R7H7Z7E7M7 [M3], 2R7H7Z7E7M7/2R7H7M7 [M4], 2R7H7Z7E7M7/2R3H3M3 [M4‐I] or 2R7H7Z7E7M7/2R3H3E3M3 [M4‐IE]. Treatment was directly observed. Clinical and bacteriological assessments were done monthly during treatment and for 24 months post‐treatment. The primary end point was TB recurrence post‐treatment.

Results

Of 1371 patients, randomised, modified intention‐to‐treat (ITT) analysis was done in 1329 and per‐protocol (PP) analysis in 1223 patients. Regimen M3 was terminated due to high TB recurrence rates. ‘Favourable’ response at end of treatment was 96–100% in the moxifloxacin regimens and 93% in the control  regimen. Among these, the TB recurrence occurred in 4.1% in the M4 regimen and in 4.5% in the control regimen and demonstrated equivalence within a 5% margin (95% CI −3.68, 4.55). Similar findings were observed in modified ITT analysis. The TB recurrence rates in the M4‐I and M4‐IE regimens did not show equivalence with the control regimen. Sixteen (1.4%) of 1087 patients in the moxifloxacin regimens required treatment modification.

Conclusion

The 4‐month daily moxifloxacin regimen [M4] was found to be equivalent and as safe as the 6‐month thrice‐weekly control regimen.
A Context-Specific Design of an Electrosurgical Unit and Monopolar Handheld to Enhance Global Access to Surgical Care: A Design Approach Based on Contextual Factors
Authors: Oosting R. M. , Ouweltjes K. , Hoeboer M. D. B. , Hesselink L. , Madete J. K. , Diehl J. C. , Groen R. S. , Wauben L. S.G. L. , Dankelman J.
Published: January 2020

To comply with the large global need for surgery, surgical equipment that fits the challenging environment in low- and middle-income countries (LMICs) should be designed. The aim of this study is to present a context-specific design of an electrosurgical unit (ESU) and a monopolar handheld to improve global access to surgery. This paper presents both a detailed description of electrosurgery in clinical practice in LMICs and the design of an ESU generator and monopolar handheld for this specific setting. Extensive fieldwork (by means of surveys, interviews, observations, and collection of maintenance records) was done by authors RO, KO, and LH. Feedback from users working in Kenya on the first demonstrator designs was obtained, after which the designs were adapted into conceptual prototypes. These were further evaluated by surveying respondents who attended the annual meeting of the College of Surgeons of East, Central, and Southern Africa (COSECSA) in Kigali, Rwanda in December 2018. Conceptual prototypes were developed for (a) an affordable ESU that is compact and battery powered and (b) a robust reusable monopolar handheld that can be cleaned in the autoclave and by chemicals (e.g., glutaraldehyde solution). The conceptual prototypes were positively received by the 51 respondents of the survey. The findings from the field work and the feedback from users during the design phase have led to a clear understanding of the specific needs and potential solutions. The presented conceptual prototypes need to be further developed into functional prototypes, which could be implemented in Kenya and other settings for further evaluation.
Mesoscale Effects of Composition and Calendering in Lithium-Ion Battery Composite Electrodes
Authors: Trembacki Bradley L. , Noble David R. , Ferraro Mark E. , Roberts Scott A.
Published: January 2020

Macrohomogeneous battery models are widely used to predict battery performance, necessarily relying on effective electrode properties, such as specific surface area, tortuosity, and electrical conductivity. While these properties are typically estimated using ideal effective medium theories, in practice they exhibit highly non-ideal behaviors arising from their complex mesostructures. In this paper, we computationally reconstruct electrodes from X-ray computed tomography of 16 nickel–manganese–cobalt-oxide electrodes, manufactured using various material recipes and calendering pressures. Due to imaging limitations, a synthetic conductive binder domain (CBD) consisting of binder and conductive carbon is added to the reconstructions using a binder bridge algorithm. Reconstructed particle surface areas are significantly smaller than standard approximations predicted, as the majority of the particle surface area is covered by CBD, affecting electrochemical reaction availability. Finite element effective property simulations are performed on 320 large electrode subdomains to analyze trends and heterogeneity across the electrodes. Significant anisotropy of up to 27% in tortuosity and 47% in effective conductivity is observed. Electrical conductivity increases up to 7.5× with particle lithiation. We compare the results to traditional Bruggeman approximations and offer improved alternatives for use in cell-scale modeling, with Bruggeman exponents ranging from 1.62 to 1.72 rather than the theoretical value of 1.5. We also conclude that the CBD phase alone, rather than the entire solid phase, should be used to estimate effective electronic conductivity. This study provides insight into mesoscale transport phenomena and results in improved effective property approximations founded on realistic, image-based morphologies.
An array pairing method for localizing distributed sources by acoustic beamforming
Authors: Arcondoulis Elias J. G. , Liu Yu , Xu Pengwei , Chen Nanshu
Published: January 2020

An acoustic beamforming concept is presented that alleviates some misrepresentation caused by deconvolution algorithms that can oversimplify distributed sources as a series of point sources. In the Array Pairing Method (APM) an initial array beamforms the acoustic source, then an iterative randomized array is calculated whereby the square-rooted product of the beamformer output possesses a minimum product of Maximum Sidelobe Level (MSL) and Main Lobe Width (MLW). A single and distributed source simulation and a single and dual speaker experiment using the APM reveal significant improvements in MSL and MLW and resolution in the distributed source region.
Phosphate Transporter PstSCAB of Campylobacter jejuni Is a Critical Determinant of Lactate-Dependent Growth and Colonization in Chickens
Authors: Sinha Ritam , LeVeque Rhiannon M. , Bowlin Marvin Q. , Gray Michael J. , DiRita Victor J.
Published: January 2020

Campylobacter jejuni
causes millions of human gastrointestinal infections annually, with poultry a major source of infection. Due to the emergence of multidrug resistance in
C. jejuni
, there is need to identify alternative ways to control this pathogen. Genes encoding the high-affinity phosphate transporter PstSCAB are highly expressed by
C. jejuni
in chickens and humans. In this study, we address the role of PstSCAB on chicken colonization and other
C. jejuni
phenotypes. PstSCAB is required for colonization in chicken, metabolism and survival under different stress responses, and during growth on lactate, a potential growth substrate in chickens. Our study highlights that PstSCAB may be an effective target to develop mechanisms for controlling bacterial burden in both chicken and human.
Porphyrin Production and Regulation in Cutaneous Propionibacteria
Authors: Barnard Emma , Johnson Tremylla , Ngo Tracy , Arora Uma , Leuterio Gunilla , McDowell Andrew , Li Huiying
Published: January 2020

Porphyrins are a group of metabolites essential to the biosynthesis of heme, cobalamin, and chlorophyll in living organisms. Bacterial porphyrins can be proinflammatory, with high levels linked to human inflammatory diseases, including the common skin condition acne vulgaris. Propionibacteria are among the most abundant skin bacteria. Variations in propionibacteria composition on the skin may lead to different porphyrin levels and inflammatory potentials. This study characterized porphyrin production in all lineages of
Propionibacterium acnes
, the most dominant skin
Propionibacterium
, and other resident skin propionibacteria, including
P. granulosum
,
P. avidum
, and
P. humerusii
. We revealed that
P. acnes
type I strains produced significantly more porphyrins than did type II and III strains and other
Propionibacterium
species. The findings from this study shed light on the proinflammatory potential of the skin microbiome and can be used to guide the development of effective acne treatments by modulating the skin microbiome and its metabolic activities.
Dual and Triple Epithelial Coculture Model Systems with Donor-Derived Microbiota and THP-1 Macrophages To Mimic Host-Microbe Interactions in the Human Sinonasal Cavities
Authors: De Rudder Charlotte , Calatayud Arroyo Marta , Lebeer Sarah , Van de Wiele Tom
Published: January 2020

Despite the relevance of the resident microbiota in sinonasal health and disease and the need for cross talk between immune and epithelial cells in the upper respiratory tract, these parameters have not been combined in a single
in vitro
model system. We have developed a coculture system of differentiated respiratory epithelium and natural nasal microbiota and incorporated an immune component. As indicated by absence of cytotoxicity and stable cytokine profiles and epithelial integrity, nasal microbiota from human origin appeared to be well tolerated by host cells, while microbial community composition remained representative for that of the human (sino)nasal cavity. Importantly, the introduction of macrophage-like cells enabled us to obtain a differential readout from the epithelial cells dependent on the donor microbial background to which the cells were exposed. We conclude that both model systems offer the means to investigate host-microbe interactions in the upper respiratory tract in a more representative way.
Effects of consultant residence out-of-hours on acute paediatric admissions
Authors: Scott-Jupp Robert , Carter Emily , Brown Nick
Published: January 2020

Acute paediatric units require round-the-clock skilled resident medical cover. Fully trained doctors remaining resident on-site at night and weekends may improve care at these times, but costs are higher. In compensation, more senior doctors may be less likely to admit children.

Methods

In a unit providing 24-hour, 7-day acute services, out-of-hours resident cover has been divided between level 2/3 trainees and consultants. Between 2007 and 2017, night and weekend day shifts were identified as resident consultant or non-resident consultant. Admission numbers (duration of stay of ≥4 hours) were obtained from hospital activity databases. Analyses were undertaken on total admissions and stratified by time of day and duration of stay of >12 or < 12 hours. Incidence rate ratios (IRRs) were derived using negative binomial regression .

Results

For all out-of-hours and short-stay patients, children were significantly more likely to be admitted when there was no resident consultant: IRRs 1.07 (95% CI 1.04 to 1.09) and 1.09 (95% CI 1.02 to 1.18), respectively. There was no difference between rates stratified into long stay at night or weekend days: IRRs 1.01 (95% CI 0.96 to 1.07) and 1.03 (95% CI 0.99 to 1.18) respectively .

Conclusion

A resident consultant presence was associated with reduced total, night-time and short-stay admissions.
Supraglottic laryngeal sarcoidosis masquerading as supraglottitis
Authors: Leedman Samuel Robert , Hendriks Thomas , Leahy Travis William , Hall David
Published: January 2020

Sarcoidosis is a rare multisystem disorder of unknown aetiology characterised by non-caseating granulomas in involved organs; it is a diagnosis of exclusion. Laryngeal involvement affects only 0.5%–5% of those with sarcoidosis. It is an uncommon but important cause of supraglottic inflammation and oedema and should be considered in the differential diagnosis in patients with supraglottitis. This case describes a 30-year-old man who presented with stridor and shortness of breath. Flexible nasendoscopic examination revealed a grossly oedematous, pale pink, diffusely hypertrophied epiglottis. Surgical biopsy revealed non-caseating granulomatous inflammation. In the context of exclusion of hepatitis, anti-neutrophil cytoplasmic antibody (ANCA) positivity, malignancy and mycobacterial infection, the diagnosis of supraglottic laryngeal sarcoid was made. He is being treated with azathioprine immunosuppression with symptomatic improvement.
Delayed diagnosis of T3 supplementation in a bodybuilder presenting with tachycardia and features of sepsis
Authors: Warner Bronwen E , Woodrow Charles J , Pal Aparna
Published: January 2020

A 25-year-old man presented generally unwell to the emergency department. Initial assessment identified systemic inflammatory response syndrome markers with an insect bite as a potential source of infection and he was treated for presumed sepsis. Tachycardia persisted and baseline thyroid function testing showed undetectable free thyroxine and thyroid-stimulating hormone (TSH), prompting further endocrine investigation. Triiodothyronine (T3) was markedly raised with normal TSH receptor antibodies, and the patient later confessed to supplementary testosterone and T3 use as part of bodybuilding activities. Following counselling, thyroid function normalised and the patient returned to his usual health. This case describes the diagnostic work up in a case of persistent tachycardia caused by T3 supplementation, demonstrating the potential for endocrine supplementation by bodybuilders which may be poorly understood and recognised by clinicians. T3 supplementation should be considered and a thorough drug history obtained in bodybuilders presenting with symptoms of thyrotoxicosis and deranged thyroid function tests.
Neurological recovery after surgical intervention of a complete spinal cord injury secondary to a chronic untreated odontoid neck fracture: a lesson in patient prognostication
Authors: Dumlao Patricio III Espinoza , Grozman Samuel
Published: January 2020

Odontoid fractures are injuries that can either be benign or devastatingly progress to quadriplegia and significant morbidity and mortality. Management is not clear cut for patients who already present late and with severe neurological deficits. We present a case of a type 2 odontoid fracture with associated complete spinal cord injury (American Spinal Injury Association A) initially untreated for 3 months but was subsequently managed with posterior decompression, instrumentation and occipitocervical fusion. The patient fully recovered all deficits and is independent of activities of daily living.
Effects of improved complementary feeding and improved water, sanitation and hygiene on early child development among HIV-exposed children: substudy of a cluster randomised trial in rural Zimbabwe
Authors: Chandna Jaya , Ntozini Robert , Evans Ceri , Kandawasvika Gwendoline , Chasekwa Bernard , Majo Florence D , Mutasa Kuda , Tavengwa Naume V , Mutasa Batsirai , NN Mbuya Mduduzi , Moulton Lawrence H , Humphrey Jean H , Prendergast Andrew J , Gladstone Melissa
Published: January 2020

Introduction

HIV-exposed uninfected children may be at risk of poor neurodevelopment. We aimed to test the impact of improved infant and young child feeding (IYCF) and improved water, sanitation and hygiene (WASH) on early child development (ECD) outcomes.

Methods

Sanitation Hygiene Infant Nutrition Efficacy was a cluster randomised 2×2 factorial trial in rural Zimbabwe ClinicalTrials.govNCT01824940). Pregnant women were eligible if they lived in study clusters allocated to standard-of-care (SOC; 52 clusters); IYCF (20 g small-quantity lipid-based nutrient supplement/day from 6 to 18 months, complementary feeding counselling; 53 clusters); WASH (pit latrine, 2 hand-washing stations, liquid soap, chlorine, play space, hygiene counselling; 53 clusters) or IYCF +WASH (53 clusters). Participants and fieldworkers were not blinded. ECD was assessed at 24 months using the Malawi Developmental Assessment Tool (MDAT; assessing motor, cognitive, language and social skills); MacArthur Bates Communication Development Inventories (assessing vocabulary and grammar); A-not-B test (assessing object permanence) and a self-control task. Intention-to-treat analyses were stratified by maternal HIV status.

Results

Compared with SOC, children randomised to combined IYCF +WASH had higher total MDAT scores (mean difference +4.6; 95% CI 1.9 to 7.2) and MacArthur Bates vocabulary scores (+8.5 words; 95% CI 3.7 to 13.3), but there was no evidence of effects from IYCF or WASH alone. There was no evidence that that any intervention impacted object permanence or self-control.

Conclusions

Combining IYCF and WASH interventions significantly improved motor, language and cognitive development in HIV-exposed children.

Trial registration number

NCT01824940.
Perceptions of healthcare professionals about the adoption and use of EHR in Gulf Cooperation Council countries: a systematic review
Authors: Alanazi Bander , Butler-Henderson Kerryn , Alanazi Mohammed
Published: January 2020

Introduction

Electronic health records (EHRs) can improve the quality and safety of care. However, the adoption and use of the EHR is influenced by several factors, including users’ perception.

Objectives

To undertake a systematic review of the literature to understand healthcare professionals’ perceptions about the adoption and use of EHRs in Gulf Cooperation Council (GCC) countries in order to influence the implementation strategies, training programme and policy development in the GCC region.

Method

A systematic literature search was undertaken on seven online databases to identify articles published between January 2006 and December 2017 examining healthcare professionals’ perception towards the adoption and use of EHR in the Gulf context.

Results

The fourteen articles included in this review identified both positive and negative perceptions of the role of EHR in healthcare. The positive perceptions included EHR benefits, such as improvements to work efficiency, quality of care, communication and access to patient data. Conversely, the negative perceptions were associated with challenges or risks of adopting an EHR, such as disruption of provider–patient communication, privacy and security concerns and high initial costs. The perceptions were influenced by personal factors (eg, age, occupation and computer literacy) and system factors (perceived usefulness and perceived ease of use).

Conclusion

Positive perceptions of EHRs by the healthcare professionals could facilitate the adoption of this technology in the Gulf region, particularly when barriers are addressed early. Negative perceptions may inform change management strategies during adoption and implementation. The perceptions should be further evaluated from a technology acceptance perspective.
Application of a Common Data Model (CDM) to rank the paediatric user and prescription prevalence of 15 different drug classes in South Korea, Hong Kong, Taiwan, Japan and Australia: an observational, descriptive study
Authors: Brauer Ruth , Wong Ian Chi Kei , Man Kenneth KC , Pratt Nicole L , Park Rae Woong , Cho Soo-Yeon , Li Yu-Chuan (Jack) , Iqbal Usman , Nguyen Phung-Anh Alex , Schuemie Martijn
Published: January 2020

Objective

To measure the paediatric user and prescription prevalence in inpatient and ambulatory settings in South Korea, Hong Kong, Taiwan, Japan and Australia by age and gender. A further objective was to list the most commonly used drugs per drug class, per country.

Design and setting

Hospital inpatient and insurance paediatric healthcare data from the following databases were used to conduct this descriptive drug utilisation study: (i) the South Korean Ajou University School of Medicine database; (ii) the Hong Kong Clinical Data Analysis and Reporting System; (iii) the Japan Medical Data Center; (iv) Taiwan’s National Health Insurance Research Database and (v) the Australian Pharmaceutical Benefits Scheme. Country-specific data were transformed into the Observational Medical Outcomes Partnership Common Data Model.

Patients

Children (≤18 years) with at least 1 day of observation in any of the respective databases from January 2009 until December 2013 were included.

Main outcome measures

For each drug class, we assessed the per-protocol overall user and prescription prevalence rates (per 1000 persons) per country and setting.

Results

Our study population comprised 1 574 524 children (52.9% male). The highest proportion of dispensings was recorded in the youngest age category (<2 years) for inpatients (45.1%) with a relatively high user prevalence of analgesics and antibiotics. Adrenergics, antihistamines, mucolytics and corticosteroids were used in 10%–15% of patients. For ambulatory patients, the highest proportion of dispensings was recorded in the middle age category (2–11 years, 67.1%) with antibiotics the most dispensed drug overall.

Conclusions

Country-specific paediatric drug utilisation patterns were described, ranked and compared between four East Asian countries and Australia. The widespread use of mucolytics in East Asia warrants further investigation.
Civil society stakeholders’ participation in national health reporting on sex/gender issues: a study protocol for an intersectionality-informed and sex/gender-sensitive approach to focus group research
Authors: Pöge Kathleen , Strasser Sarah Mirabella , Saß Anke-Christine , Rommel Alexander
Published: January 2020

Introduction

Health reporting is one of the foundations on which public health interventions and policies as well as prevention measures are developed. However, it faces the challenge of adequately reflecting social and sex/gender-related heterogeneity. The German Federal Ministry of Education and Research-funded joint project, AdvanceGender, aims to develop guidelines for sex/gender-sensitive and intersectional approach to population-based studies and health reporting. In its subproject, AdvanceHealthReport, four focus groups will be conducted to provide essential information on possible ways of participation of civil society stakeholders and on communication of health information for the further development of the guidelines (research period: from January 2019 to March 2020).

Methods and analysis

The civil society stakeholders provide valuable information which health topics are relevant in regard to specific populations and how health information should be communicated in a non-stigmatising way. The groups will also discuss how civil society stakeholders should participate in health reporting. The starting point for intersections will be sex/gender. The intersection of sex/gender and migration and sex/gender and sexual orientation is particularly taken into account. The focus groups will be recorded, transcribed, anonymised and then analysed according to the qualitative content analysis.

Results

The results will show the pathways as well as benefits and possible limitations of civil society stakeholder involvement in national health reporting and will contribute in developing guidelines for sex/gender-sensitive and intersectional health reporting.

Ethics and Dissemination

The results of the focus groups will be published in scientific journals and presented at various national and international conferences. Furthermore, the findings will be incorporated into guidelines for research and health reporting. The study was approved by the Ethics Commission of Brandenburg Medical School Theodor Fontane (AZ: E-01–20180529).
Protocol for a systematic review of reporting standards of anaesthetic interventions in randomised controlled trials
Authors: Elliott Lucy , Coulman Karen , Blencowe Natalie S , Qureshi Mahim , Watson Sethina , Mouton Ronelle , Hinchliffe Robert J
Published: January 2020

Introduction

There is significant variation in how anaesthesia is defined and reported in clinical research. This lack of standardisation complicates the interpretation of published evidence and planning of future clinical trials. This systematic review will assess the reporting of anaesthesia as an intervention in randomised controlled trials (RCT) against the Consolidated Standards of Reporting Trials for Non-Pharmacological Treatments (CONSORT-NPT) framework.

Methods and analysis

Online archives of the top six journals ranked by impact factor for anaesthesia and the top three general medicine and general surgery journals will be systematically hand searched over a 42-month time period to identify RCTs describing the use of anaesthetic interventions for any invasive procedure. All modes of anaesthesia and anaesthesia techniques will be included. All study data, including the type of anaesthetic intervention described, will be extracted in keeping with the CONSORT-NPT checklist. Descriptive statistics will be used to summarise general study details including types/modes of anaesthetic interventions, and reporting standards of the trials.

Ethics and dissemination

No ethical approval is required. The results will be used to inform a funding application to formally standardise general, local, regional anaesthesia and sedation for use in clinical research. The systematic review will be disseminated via peer-reviewed manuscript and conferences.

PROSPERO registration number

CRD42019141670.
Peripheral neuropathy from paclitaxel: risk prediction by serum microRNAs
Authors: Noda-Narita Shoko , Shimomura Akihiko , Tanabe Yuko , Kawauchi Jumpei , Matsuzaki Juntaro , Takizawa Satoko , Aoki Yoshiaki , Shimizu Chikako , Tamura Kenji , Ochiya Takahiro
Published: January 2020

Objectives

MicroRNAs (miRNAs) have recently been reported as useful diagnostic markers in cancer; however, relationships of miRNAs with adverse events during chemotherapy have yet to be fully described. In this study, we examined the relationship between serum miRNA and the risk of peripheral neuropathy (PN), a common and persistent adverse event induced by paclitaxel, in patients with breast cancer.

Methods

A total of 84 serum samples from patients with breast cancer, who received paclitaxel as neoadjuvant or adjuvant chemotherapy, were obtained between January 2011 and September 2013 at National Cancer Center Hospital. Samples were divided, 2:1, into a training cohort and a test cohort, respectively; both cohorts included specimens from patients with severe PN (≥grade 2, PN group) and non-severe PN controls (non-PN group). The training cohort was used to identify miRNAs, and combinations thereof, that could predict PN, which then were validated in the test cohort.

Results

Eighty-four patients received paclitaxel: 38 and 46 patients in the PN and non-PN groups, respectively. We identified 15 discriminatory miRNAs with |fold change|>0.5, and 14 combinations of three miRNAs showed the ability to discriminate, with sensitivity, specificity and accuracy of >50%. The most discriminatory miRNA, with the highest |fold change|, was miR-451a, which regulates the expression of the drug-transporter protein P-glycoprotein, potentially promoting paclitaxel resistance.

Conclusion

MiR-451a could be a predictive marker for PN caused by paclitaxel-containing chemotherapy; however, further investigation of the underlying mechanism is required to determine the role of miR-451a.
Novel CCM2 missense variants abrogating the CCM1–CCM2 interaction cause cerebral cavernous malformations
Authors: Bergametti Françoise , Viot Geraldine , Verny Christophe , Brechard Marie Pierre , Denier Christian , Labauge Pierre , Petit Paul , Nouet Aurélien , Viallet François , Chaussenot Annabelle , Hervé Dominique , Tournier-Lasserve Elisabeth , Riant Florence
Published: January 2020

Background

Cerebral cavernous malformations (CCMs) are vascular malformations mostly located within the central nervous system. Most deleterious variants are loss of function mutations in one of the threeCCMgenes. These genes code for proteins that form a ternary cytosolic complex with CCM2 as a hub. Very fewCCM2missense variants have been shown to be deleterious by modifying the ternary CCM complex stability.

Objectives

To investigate the causality of novel missenseCCM2variants detected in patients with CCM.

Methods

The three CCM genes were screened in 984 patients referred forCCMmolecular screening. Interaction between CCM1 and CCM2 proteins was tested using co-immunoprecipitation experiments for theCCM2missense variants located in the phosphotyrosine binding (PTB) domain.

Results

11 distinctCCM2rare missense variants were found. Six variants predicted to be damaging were located in the PTB domain, four of them were novel. When co-transfected with CCM1 in HEK293T cells, a loss of interaction between CCM1 and CCM2 was observed for all six variants.

Conclusion

We showed, using co-immunoprecipitation experiments, that CCM2 missense variants located in the PTB domain were actually damaging by preventing the normal interaction between CCM1 and CCM2. These data are important for diagnosis and genetic counselling, which are challenging in patients harbouring such variants.
Reconsidering fetal pain
Authors: Derbyshire Stuart WG , Bockmann John C
Published: January 2020

Fetal pain has long been a contentious issue, in large part because fetal pain is often cited as a reason to restrict access to termination of pregnancy or abortion. We have divergent views regarding the morality of abortion, but have come together to address the evidence for fetal pain. Most reports on the possibility of fetal pain have focused on developmental neuroscience. Reports often suggest that the cortex and intact thalamocortical tracts are necessary for pain experience. Given that the cortex only becomes functional and the tracts only develop after 24 weeks, many reports rule out fetal pain until the final trimester. Here, more recent evidence calling into question the necessity of the cortex for pain and demonstrating functional thalamic connectivity into the subplate is used to argue that the neuroscience cannot definitively rule out fetal pain before 24 weeks. We consider the possibility that the mere experience of pain, without the capacity for self reflection, is morally significant. We believe that fetal pain does not have to be equivalent to a mature adult human experience to matter morally, and so fetal pain might be considered as part of a humane approach to abortion.
Transradial embolization of the left middle meningeal artery and accessory middle meningeal artery for treatment of subacute–chronic subdural hematoma
Authors: Rajah Gary B , Tso Michael K , Dossani Rimal , Vakharia Kunal , Siddiqui Adnan H
Published: January 2020

This 52-year-old man with no remarkable medical history, no anticoagulation use, and no history of trauma was noted to have a subacute–chronic left subdural hematoma during outpatient headache evaluation. No occult vascular lesion or cross-calvarial supply of the right middle meningeal artery (MMA) to the left side was identified on bilateral selective external carotid injections. Because the patient preferred non-surgical management, we performed a left MMA embolization with Onyx 18 (Medtronic), utilizing a Headway Duo microcatheter (MicroVention) via the transradial route. A 6 French Benchmark (Penumbra) was utilized for transradial support into the left external carotid. The patient was discharged home the same day. Repeat scans from 2 to 6 weeks revealed complete resolution of the subdural hematoma. The patient’s headaches resolved. Transradial MMA embolization for subacute–chronic subdural hematoma represents a minimally invasive treatment option for mass effect and hemorrhage-related symptoms. Tailored embolizations are necessary when >1 meningeal vessel supplies the subdural hematoma.
Habitat change at a multi-species goose breeding area on Southampton Island, Nunavut, Canada, 1979–2010
Authors: Abraham Kenneth F. , Sharp Christopher M. , Kotanen Peter M.
Published: January 2020

Foraging by hyperabundant Arctic-nesting geese has significant impacts on vegetation of Arctic and subarctic coastal lowlands, but long-term data sets documenting these changes are rare. We undertook intensive surveys of plant communities at East Bay and South Bay, Southampton Island, Nunavut, Canada, in July 2010. Lesser Snow Geese, Ross’s Geese, Cackling Geese, and Brant nest and rear young at these sites; the first three have experienced up to 10-fold increases since the 1970s. At East Bay, we found significant declines in graminoids over the 31-year span, as well as significant declines in lichen and willow cover, and significant increases in rock cover. Transect data indicated graminoids were present at only 15%–36% of points at East Bay, whereas at South Bay, graminoids were present at 28%–90% of points. Moss was more prominent in transects at South Bay than at East Bay (40%–85% vs. 19%–42%), but quadrat data indicated much more of the moss cover at South Bay apparently was dead than at East Bay. Puccinellia phryganodes (Trin.) Scribn. & Merr. exceeded 1% in only two transects. Our data demonstrate a striking decline of preferred forage species and increases in non-forage cover, consistent with the hypothesis that changes resulted from persistent long-term foraging by the four species of breeding geese between spring arrival and late summer departure.
The effect of anisotropy on the traffic flow behavior: Investigation of the correlation created by a single node on two-lane roads
Authors: Tahiri Zineb , Jetto Kamal , Bouadi Marouane , Benyoussef Abdelilah , Kenz Abdallah El
Published: January 2020

In this paper, we have tried to point out the features of the correlation between the lanes of a two-lane road, created by the entry of this facility. For this purpose, we have adopted a quasi-one-dimensional system composed of a diverging node connecting two roads and where no lanes’ changing is allowed. Our study has highlighted the strong effect of a node. We have found that if we create a disturbance in one lane, a spontaneous symmetry breaking occurs in the whole system. In fact, a self-anisotropy is produced at the node, to which the system responds via a self-organization mechanism. Those results have urged us to investigate the anisotropy as an extrinsic parameter. By privileging one lane over the other at the node, we have been able to confirm that the system can always get self-organized and that three phases can be established: the symmetric high density phase, the asymmetric low density phase and the asymmetric phase of transition low density/high density. Finally, we have found that the system is strongly correlated when it is in a symmetric phase, and is not when in an asymmetric phase. This finding brought us to the assumption that the cross-correlation of the observables of a quasi-one-dimensional system can be considered as an order parameter that defines the phases’ transitions.
A Comprehensive Review for Phytochemical, Pharmacological, and Biosynthesis Studies onGlycyrrhizaspp.
Authors: Wang Chengcheng , Chen Lihong , Xu Chaoqie , Shi Jingjing , Chen Shuyu , Tan Mengxia , Chen Jiali , Zou Lisi , Chen Cuihua , Liu Zixiu , Liu Xunhong
Published: January 2020

Licorice is extensively applied in food as well as herbal medicine across the world, possessing a substantial share in the global market. It has made great progress in chemical and pharmacological research in recent years. Currently, Glycyrrhiza uralensis Fisch., Glycyrrhiza inflata Bat., and Glycyrrhiza glabra L. were officially used as Gan-Cao according to the Chinese Pharmacopoeia. Accumulating evidence demonstrated three varieties of licorice have their own special compounds except for two quality markers set by Pharmacopoeia, providing great possibility for better understanding their characteristics, evaluating quality of each species and studying biosynthesis mechanisms of species–specific compounds. As a special “guide drug” in clinic, licorice plays an important role in Chinese herbal formulas. The interaction between licorice with other ingredients and their metabolism in vivo should also be taken into consideration. In addition, draft genome annotation, and success of the final step of glycyrrhizin biosynthesis have paved the way for biosynthesis of other active constituents in licorice, a promising beginning of solving source shortage. Accordingly, we comprehensively explored the nearly 400 chemical compounds found in the three varieties of licorice so far, systematically excavated various pharmacological activities, including metabolism via CYP450 system in vivo, and introduced the complete biosynthesis pathway of glycyrrhizin in licorice. The review will facilitate the further research toward this herbal medicine.