bluuebunny/crossref_metadata_2025 huggingface dataset:
Establishing Thresholds for Minimal Clinically Important Differences for the Peripheral Artery Disease Questionnaire
Authors: Peri-Okonny Poghni A. , Wang Jingyan , Gosch Kensey L. , Patel Manesh R. , Shishehbor Mehdi H. , Safley David L. , Abbott J. Dawn , Aronow Herbert D. , Mena-Hurtado Carlos , Jelani Qurat-Ul-Ain , Tang Yuanyuan , Bunte Matthew , Labrosciano Clementine , Beltrame John F. , Spertus John A. , Smolderen Kim G.
Published: May 2021

Background:

Understanding minimum clinically important differences (MCID) in patient-reported outcomes is essential in interpreting the magnitude of changes in these measures. No MCID from patients’ perspectives has ever been published for peripheral artery disease–specific health status assessment tools. The Peripheral Artery Questionnaire (PAQ) is a commonly used, validated peripheral artery disease–specific health status instrument for which we sought to prospectively establish its MCID from patients’ perspectives.

Methods and Results:

Patients presenting to vascular clinics with new or worsened claudication in the US cohort of the PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry who completed baseline and follow-up PAQ assessments along with the Global Assessment of Functioning scale were included. Mean change in PAQ summary scores from 3- to 6-month follow-up was calculated according to Global Assessment of Functioning category. MCID was defined as the mean difference in scores between those with small improvement or deterioration and those with no change. Multivariable linear regression was used to provide an MCID estimate after adjusting for patients’ 3-month PAQ score. Of the 483 patients who completed the Global Assessment of Functioning score at 6 months and who had available 3- and 6-month PAQ assessments, the mean age was 69 years, 42% were female, and 71% were White. The MCIDs for PAQ summary scale improvement and worsening were 8.7 (2.9–14.5) and −11.0 (−18.6 to −3.3), respectively. After multivariable adjustment, these were 8.9 (3.0–14.8) and −11.2 (−18.2 to −4.2), respectively. There was no significant interaction between treatment (invasive versus noninvasive) and Global Assessment of Functioning response (
P
=0.75).

Conclusions:

In patients with new or worsened claudication, a 10-point change in PAQ summary score represents an MCID. This estimate needs external validation and may inform the interpretation of PAQ scores when used as outcomes in clinical trials or in routine clinical care.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01419080.
Optimal Medical Management of Asymptomatic Carotid Stenosis
Authors: Hackam Daniel G.
Published: May 2021

Asymptomatic carotid stenosis (ACS) due to atherosclerosis is a risk factor for ipsilateral ischemic cerebrovascular events and cognitive impairment. The prognosis of ACS has improved over the past 4 decades due largely to improvements in medical management. Most patients with ACS can be managed without revascularization, but some patients with vulnerable plaque should be considered for revascularization. Regardless of the decision to refer for revascularization, all patients with ACS should receive intensive medical management. This includes lifestyle modification (Mediterranean diet, exercise, and smoking cessation) and pharmacological therapy (antiplatelets, lipid-lowering agents, blood pressure reduction, and glycemic control). Patients with ACS often have atherosclerosis in other critical locations, and thus optimal medical therapy is likely to reduce events outside the carotid arteries. The nature of optimal medical therapy is described.
Amylin Dyshomeostasis Hypothesis: Small Vessel–Type Ischemic Stroke in the Setting of Type-2 Diabetes
Authors: Despa Florin , Goldstein Larry B.
Published: May 2021

Recent histological analyses of human brains show that small vessel–type injuries in the setting of type-2 diabetes colocalize with deposits of amylin, an amyloid-forming hormone secreted by the pancreas. Amylin inclusions are also identified in circulating red blood cells in people with type-2 diabetes and stroke or cardiovascular disease. In laboratory models of type-2 diabetes, accumulation of aggregated amylin in blood and the cerebral microvasculature induces brain microhemorrhages and reduces cerebral blood flow leading to white matter ischemia and neurological deficits. At the cellular level, aggregated amylin causes cell membrane lipid peroxidation injury, downregulation of tight junction proteins, and activation of proinflammatory signaling pathways which, in turn, induces macrophage activation and macrophage infiltration in vascular areas positive for amylin deposition. We review each step of this cascade based on experimental and clinical evidence and propose the hypothesis that systemic amylin dyshomeostasis may underlie the disparity between glycemic control and stroke risk and may be a therapeutic target to reduce the risk of small vessel ischemic stroke in patients with type-2 diabetes.
A seasonal dynamics and population status of the steno-endemic karst fairy shrimp Chirocephalus croaticus (Steuer, 1899) (Branchiopoda, Anostraca) from Slovenia
Authors: Jugovic Jure , Jeklar Martina
Published: May 2021

We investigated the presence and ecology of Chirocephalus croaticus (Steuer, 1899) during three successive seasons (spring and autumn 2018, spring 2019) at Lake Petelinje (SW Slovenia). Although the presence (duration, abundance) of this fairy shrimp strongly differs among different seasons and both years, we showed that in a season with favourable conditions (spring 2018) its abundance increases rapidly at the end of the season as the shrimps persist in small pools until the water dries out. The species may appear again during the autumn, however, its abundance and persistence seem to be much lower and shorter than during the spring, respectively. Nevertheless, persistence and abundance may also differ strongly among the two successive spring seasons (less shrimps found during the shorter season of 2019 than in 2018). Larvae appear first, and are most abundant at the beginning of the season, and are followed by adult males (protandry) and females, which become most abundant at the end of the season. Also, larvae seem to be more abundant on exposed bottom (gravel path), while adults are much more abundant in the shelter of a submerged meadow. Ovigerous females had 9-37 cysts (fertilized eggs) in their brood pouch, and the position of differently developed eggs changed during the season; the presence of females without eggs during mid- and at the end of season indicates the production of thin-shelled summer, and thick-shelled winter cysts, respectively. In contrast with the water decrease that is in strongly negative association with the abundance of the fairy shrimps (lake size — abundance: , ), no other environmental parameters were highly associated () with species abundance. Although the local population (one of only two currently known) seems to be in good condition, appropriate conservation action should be taken to prevent the decrease of this population in the future.
Questions and Dilemmas Raised during a Pandemic in Laboratory Animal Settings
Authors: Galligioni V.
Published: May 2021

The COVID-19 pandemic has put lot of pressure on management of laboratory animals. With the risk of human infection and the lockdown, specific measures had to be arranged. Unfortunately, these often included depopulation of animal facility. Wild-type and genetically modified rodents had to be culled and breeding had to be reduced, to be able to provide standard care all the time. Being animal care staff essential workers, they were coming to check animals also instead of researchers, who were not able to access the facility. Undergoing experiments had to be stopped to avoid animal welfare issues in a time when personnel wouldn’t be available as usual. At the same time, new in vivo studies for COVID-19 projects had to be evaluated by the Ethics Committee, raising many questions: how do you objectively review the study and assess harms on animals when only few scientific information is available and we don’t even know what is the best model for the disease? Has it been right to stop all other research areas in favour of COVID-19 related research? The pandemic has shown many weakness points in how animals are used, how projects are reviewed and funded, and how staff care for animals, so, perhaps, we will be better prepared for the next pandemic.
Holy community of life and property amongst the poor:
Authors: Capper Brian J.
Published: May 2021

This article explores the origins of the earliest Jerusalem believers’ communal lifestyle (Acts 1:13-14; 2:42-47; 4:32-5:11; cf. 6.1-6). Jesus’ example and authority sanctioned community of life and property. Wealthy supporters made benefactions (Luke 8:1-3) to his travelling party’s shared purse. Jesus’ group financed from their common purse support for the poor, common meals and other needs (John 6.5-7; 12:4-6; 13:29). Ideals of holiness and complete consecration dominated ancient Judaea more than Galilee. Highly dedicated service to God in common life amongst the poor had originated as a Judaean response, amongst the Essenes, to the harshness of agrarian subsistence economy. The verb nosphizomai, used of Ananias’ crime in Acts 5:2-3, means ‘embezzle, misappropriate’; Peter’s reference to Ananias’ sale of property (5:4) may reflect the Hebrew verb makar in its root sense ‘hand over’. Ananias’ property-surrender, which was only provisional, reflected both the Essene novitiate (1QS 6.13-23, cf. Josephus, Jewish War 2.8.7 §§137-142) and the nascent Church’s associations with Jerusalem Essenism.
From free choice to God’s choice: Augustine’s exegesis of Romans 9
Authors: Roach David
Published: May 2021

In the mid-390s, Augustine shifted his interpretation of Romans 9 from one highlighting the priority of man’s free will in salvation to one highlighting the priority of God’s sovereign choice in election. The change first appeared in To Simplician – On Various Questions and remained a consistent part of his theology for the rest of his life. Carol Harrison’s study Rethinking Augustine’s Early Theology: An Argument for Continuity rightly emphasizes scriptural exegesis as a driving force behind Augustine’s theology but downplays this important theological shift.
Evangelicalism and Patristic Christianity: 1517 to the present
Authors: Stewart Kenneth J.
Published: May 2021

In the last twenty years, persons departing from Evangelicalism have regularly alleged this movement’s systematic neglect of early Christianity as a primary warrant for their re-affiliation to other branches of the Christian family. The complaint has become so widespread that it has now come to be embraced as self-evidently accurate; no burden of proof has been laid on those pressing the charge. Yet a historical survey of five centuries discloses that to whatever extent early Christianity has been neglected in the recent past, this neglect has characterized liberal as well as evangelical Protestantism. In the more distant evangelical Protestant past, the period 1500-1900 was characterized by a much deeper familiarity with the Early Church and a much freer appropriation of its teaching and practices. The current upswing of interest in the Early Church provides Evangelicalism with an opportunity to reassert its earlier interest in and creative use of Patristic resources.
Amyraldus redivivus: a review article
Authors: Macleod Donald
Published: May 2021

This article explores recent Amyraldian commentary on post-Dort Calvinism, including the charge that it preaches only a limited love and paralyses evangelism. As part of the response to this latter claim it reflects on the actual content of biblical evangelism, and on Calvinist commitment to universal mission and the free offer of the gospel. Analysis is offered of the Amyraldian appeal to a dual understanding of the divine will and to its use of the distinction between natural and moral inability. The concluding section briefly traces the impact of Amyraldianism on modern Scottish Presbyterianism.
The freedom of God in mercy and judgment:
Authors: Shellrude Glen
Published: May 2021

Romans 9:6-26 is commonly interpreted to mean that Jewish unbelief and Gentile responsiveness to the Gospel was something ordained or predestined by God. This article identifies elements in the whole context of 9 – 11 which call this approach in question. It then proposes that Paul’s intent is to rebut the claim that God was under obligation to ensure that Israel recognize the time of fulfillment. Paul argues that God: 1. is free to define his people on the basis of who responds to his gracious initiative; 2. is free to respond to Israel’s unbelief with a judgment of hardening rather than turning up the heat of irresistible grace; 3. is free to use the occasion of a hardened Israel for a broader proclamation of the Gospel; 4. is free to show mercy to Gentiles, to those who were not understood as the primary recipients of God’s covenant promises. The overarching point is that when the present situation is viewed from this perspective, God’s Word has clearly not failed. The objectives of the article are 1. to challenge the traditional Calvinist reading of the text; 2. to propose an alternative which is not eisegetical but is supported by a reconstruction of the issue to which Paul was responding and the context of his whole argument in Romans 9 – 11.
Is Jeremiah 33:14-26 a ‘centre’ to the Bible? A test case in inter-canonical hermeneutics
Authors: Ortlund Dane
Published: May 2021

The article draws attention to a neglected passage in the current recovery of biblical-theological sensitivity to the Bible: Jeremiah 33:14-26. Drawing out six intercanonical themes that cluster here as God promises at the conclusion to the Book of Consolation to restore his people, the article suggests that this text forms a unique whole-Bible intersection. The article begins with an introduction clarifying what is (and what is not) being argued before moving on to point out the neglect of Jeremiah 33 in biblical theology. The heart of the article reflects on the six intercanonical themes that emerge. Two objections are handled before the article draws to a close.
Molecular and morphological evidences of Sabulina nerimanae sp. nov. (Caryophyllaceae)

Authors: KOÇ MURAT , HAMZAOĞLU ERGİN , AKSOY AHMET
Published: May 2021

Strange samples of Sabulina found in the ISTO herbarium were recollected  and then compared with herbarium material of related species. It was determined that the most similar species was Sabulina gracilis. Both were compared with molecular and morphological methods. As a result, it was decided that the interesting specimens represented a new species. The new species,  Sabulina nerimanae Koç & Hamzaoğlu, is described and illustrated here and information on , distribution, habitat, micromorphological seed characters, threatened categories, and phylogenetic relationships between closely related species are given.
New names in Pittosporum, extant and fossil (Pittosporaceae)
Authors: DOWELD ALEXANDER B.
Published: May 2021

The nomenclature of some homonyms of Pittosporum is resolved. Fossil Pittosporum elegans (Ettingshausen) W.R.B. Oliver, being an illegitimate later homonym of extant Pittosporum elegans Raoul, is re-named R. ettingshausenii nom. nov. Pittosporum pulchrum Gagnepain (extant) is replaced by a new name P. gagnepainii nom. nov., because of the earlier homonym, Pittosporum pulchrum Saporta (fossil). Pittosporum pulchrum Gagnepain and Pittosporum pulchrum Saporta are both lectotypified for the first time. Fossil Pittosporum beringianum is excluded from Pittosporum on the basis of differences in leaf morphology and segregated in the distinct fossil-genus Xenopanax gen. nov.
An extreme-preserving long-term gridded daily precipitation data set for the conterminous United States
Authors: Pierce David W. , Su Lu , Cayan Daniel R. , Risser Mark D. , Livneh Ben , Lettenmaier Dennis P.
Published: May 2021

Extreme daily precipitation contributes to flooding that can cause significant economic damages, and so is important to properly capture in gridded meteorological data sets. This work examines precipitation extremes, the mean precipitation on wet days, and fraction of wet days in two widely used gridded data sets over the conterminous U.S. (CONUS). Compared to the underlying station observations, the gridded data show a 27% reduction in annual 1-day maximum precipitation, 25% increase in wet day fraction, 1.5 to 2.5 day increase in mean wet spell length, 30% low bias in 20-year return values of daily precipitation, and 25% decrease in mean precipitation on wet days. It is shown these changes arise primarily from the time-adjustment applied to put the precipitation gauge observations into a uniform time frame, with the gridding process playing a lesser role. A new daily precipitation data set is developed that omits the time-adjustment (as well as extending the gridded data by 7 years) and is shown to perform significantly better in reproducing extreme precipitation metrics. When the new data set is used to force a land surface model, annually averaged 1-day maximum runoff increases 38% compared to the original data, annual mean runoff increases 17%, evapotranspiration drops 2.3%, and fewer wet days leads to a 3.3% increase in estimated solar insolation. These changes are large enough to affect portrayals of flood risk and water balance components important for ecological and climate-change applications across the CONUS.
Experimental High-Resolution Winter Seasonal Climate Reforecasts for Florida
Authors: Bhardwaj Amit , Misra Vasubandhu , Kirtman Ben , Asefa Tirusew , Maran Carolina , Morris Kevin , Carter Ed , Martinez Christopher , Roberts Daniel
Published: May 2021

We present here the analysis of 20 years of high-resolution experimental winter seasonal CLImate reForecasts for Florida (CLIFF). These winter seasonal reforecasts were dynamically downscaled by a regional atmospheric model at 10km grid spacing from a global model run at T62 spectral resolution (~210km grid spacing at the equator) forced with sea surface temperatures (SST) obtained from one of the global models in the North American Multimodel Ensemble (NMME). CLIFF was designed in consultation with water managers (in utilities and public water supply) in Florida targeting its five water management districts, including two smaller watersheds of two specific stakeholders in central Florida that manage public water supply. This enterprise was undertaken in an attempt to meet the climate forecast needs of water management in Florida.

CLIFF has 30 ensemble members per season generated by changes to the physics and the lateral boundary conditions of the regional atmospheric model. Both deterministic and probabilistic skill measures of the seasonal precipitation at the zero-month lead for November-December-January (NDJ) and one-month lead for December-January-February (DJF) show that CLIFF has higher seasonal prediction skill than persistence. The results of the seasonal prediction skill of land surface temperature are more sobering than precipitation, although, in many instances, it is still better than the persistence skill.
Awake prone positioning for hypoxaemic respiratory failure: past, COVID-19 and perspectives
Authors: Touchon François , Trigui Youssef , Prud'homme Eloi , Lefebvre Laurent , Giraud Alais , Dols Anne-Marie , Martinez Stéphanie , Bernardi Marie , Begne Camille , Granier Pascal , Chanez Pascal , Forel Jean-Marie , Papazian Laurent , Elharrar Xavier
Published: May 2021

Prone positioning reduces mortality in the management of intubated patients with moderate-to-severe acute respiratory distress syndrome. It allows improvement in oxygenation by improving ventilation/perfusion ratio mismatching.

Because of its positive physiological effects, prone positioning has also been tested in non-intubated, spontaneously breathing patients, or “awake” prone positioning. This review provides an update on awake prone positioning for hypoxaemic respiratory failure, in both coronavirus disease 2019 (COVID-19) and non-COVID-19 patients. In non-COVID-19 acute respiratory failure, studies are limited to a few small nonrandomised studies and involved patients with different diseases. However, results have been appealing with regard to oxygenation improvement, especially when combined with noninvasive ventilation or high-flow nasal cannula.

The recent COVID-19 pandemic has led to a major increase in hospitalisations for acute respiratory failure. Awake prone positioning has been used with the aim to prevent intensive care unit admission and mechanical ventilation. Prone positioning in conscious, non-intubated COVID-19 patients is used in emergency departments, medical wards and intensive care units.

Several trials reported an improvement in oxygenation and respiratory rate during prone positioning, but impacts on clinical outcomes, particularly on intubation rates and survival, remain unclear. Tolerance of prolonged prone positioning is an issue. Larger controlled, randomised studies are underway to provide results concerning clinical benefit and define optimised prone positioning regimens.
Decline of semen quality over the last 30 years in Uruguay
Authors: Rosa-Villagrán Lucía , Barrera Natalibeth , Montes José , Riso Carlos , Sapiro Rossana
Published: May 2021

Background

Over the last years, there has been an increasing concern about a global decline in men’s fertility. Specifically, some evidence indicates that sperm quality has decreased over the last years. However, reports showing the changes in sperm quality with time are inconsistent. Part of the contradictions between studies is attributed to geographical differences. Surprisingly, few studies include data from South American countries, creating a bias in the conclusions. This study aims to determine how sperm quality has evolved over the past 30 years in Uruguay. For this purpose, 317 medical records from allegedly healthy sperm donor candidates, aged between 18 and 36 years old, who voluntarily requested to be considered as sperm donors between 1988 and 2019, were analyzed. The studied variables were the following sperm parameters: semen volume, sperm cell concentration, total sperm number, progressive motility, vitality, and sperm morphology. A correlative statistical analysis was performed between seminal parameter values and the year data were collected.

Results

We found a statistically significant decrease in sperm concentration and normal sperm morphology during the studied period. There was no decrease in vitality, seminal volume, and total progressive motility. Semen parameters were not associated with tobacco, drugs, or alcohol consumption.

Conclusions

We conclude that the sperm quality of donor candidates in Uruguay decreased during this period. Further studies should be carried out to verify the occurrence of this phenomenon in the general population and find its possible causes.
Mitogenomic diversity and phylogeny analysis of yak (Bos grunniens)
Authors: Wang Xingdong , Pei Jie , Bao Pengjia , Cao Mengli , Guo Shaoke , Song Rende , Song Weiru , Liang Chunnian , Yan Ping , Guo Xian
Published: May 2021

Background and aim

Mitochondrial genome has aseries of characteristics such as simple structure, no recombination, maternalinheritance, stable structure, fast evolution rate, and high copy number. Moreover, it is easy to be sequenced,contains high-resolution phylogenetic information, and exists in a wide rangeof taxa. Therefore, it is widely used in the study of biological phylogeny. Atpresent, phylogenetic studies focus mainly on D-loop region, cytochrome b gene,and protein-coding sequence. Phylogenetic studies using the mitochondrialcomplete sequence are rarely reported in yak. Therefore, the present studyaimed to construct phylogenetic tree using yak mitochondrial complete sequenceand compare the subsequent results with previous findings obtained usingpartial sequences.

Results

Complete mitochondrial sequences of five yakpopulations from Qinghai and Xinjiang were obtained. The mitotype diversity ofthe five populations was Xueduo yak (0.992 ± 0.015), Pamir yak (0.990 ± 0.014),Yushu yak (0.963 ± 0.033), Qilian yak (0.948 ± 0.036), and Huanhu yak (0.905 ±0.048), which showed a higher mitotype diversity compared with other breeds fromthe previous reports, including Jiulong yak, Maiwa yak, Zhongdian yak, andTianzhu yak. A total of 78 mitotypes were obtained from 111 individuals. Amongthese, Yushu yak, Huanhu yak, Xueduo yak, and Qilian yak all shared mitotypes,but the Pamir yak did not share mitotypes with these four populations.Phylogenetic analysis showed that yak populations were separable into threedistinct branches. The analysis identified a new phylogenetic branch containingboth wild and domestic yaks. The 155 mitotypes found in 206 individuals weredivided into 3 haplogroups by mitotype clustering. Thehaplogroup was not associated with the geographical distribution of yaks. Theyaks in the same population or the same ecological environment were distributedin different haplogroups. Among the threehaplogroups, haplogroup A and haplogroup B showed a star-shaped distribution ofmitotypes. The central mitotypes were widely distributed and had a highfrequency.

Conclusions

Thegenetic diversity of yaks in Qinghai was high. Both domestic and wild yaks clusteredinto three branches.
Outcomes and limitations of endoscopic ultrasound-guided hepaticogastrostomy in malignant biliary obstruction
Authors: Jagielski Mateusz , Zieliński Michał , Piątkowski Jacek , Jackowski Marek
Published: May 2021

Background

Transpapillary biliary drainage in ERCP is an established method for symptomatic treatment of patients with unresectable malignant biliary obstruction. Percutaneous transhepatic biliary drainage frequently remains the treatment of choice when the transpapillary approach proves ineffective. Recently, EUS-guided extra-anatomical anastomoses of bile ducts to the gastrointestinal tract have been reported as an alternative to percutaneous biliary drainage. To assess the usefulness of extra-anatomical intrahepatic biliary duct anastomoses to the gastrointestinal tract as endotherapy for unresectable malignant biliary obstruction and to determine factors affecting the efficacy of treatment.

Methods

A prospective analysis of the treatment results of all patients with unresectable biliary obstruction treated with EUS-guided hepaticogastrostomy at our institution in the years 2016–2019.

Results

Transmural intrahepatic biliary drainage (EUS-guided hepaticogastrostomy) was performed due to the ineffectiveness of ERCP in 53 patients (38 males, 15 females; mean age 74.66 [56–89] years) with unresectable biliary obstruction. Technical success of EUS-guided hepaticogastrostomy was achieved in 52/53 (98.11%) patients. Complications of endoscopic treatment were observed in 10/53 (18.87%) patients. Clinical success of EUS-guided hepaticogastrostomy was achieved in 46/53 (86.79%) patients. Bismuth type II–IV cholangiocarcinoma, hepatic metastases, ascites, suppurative cholangitis, and high blood bilirubin levels exceeding 30 mg/dL were independent factors for increased complications and inefficacy of EUS-guided hepaticogastrostomy.

Conclusions

In the event of transpapillary biliary drainage proving ineffective, extra-anatomical anastomoses of intrahepatic bile ducts to the gastrointestinal tract provide an effective method for the treatment of patients with malignant biliary obstruction.
The Socioecological Model as a framework for exploring factors influencing childhood immunization uptake in Lagos state, Nigeria
Authors: Olaniyan Abisola , Isiguzo Chinwoke , Hawk Mary
Published: May 2021

Background

Nigeria is one of the ten countries globally that account for 62% of under- and unvaccinated children worldwide. Despite several governmental and non-governmental agencies’ interventions, Nigeria has yet to achieve significant gains in childhood immunization coverage. This study identifies intrapersonal, interpersonal, organizational, community, and policy-level factors that influence childhood immunization uptake from various stakeholders’ perspectives using the Socioecological Model (SEM).

Methods

Using the Socioecological Model as a guiding framework, we conducted ten focus group sessions with mothers/caregivers and community leaders residing in Lagos state and nine semi-structured interviews with healthcare workers who provide routine immunization services in Lagos state primary healthcare facilities. We performed a qualitative analysis of focus groups and semi-structured interviews using deductive coding methods.

Results

The study sample included 44 mothers/caregivers and 24 community leaders residing in Lagos State, Nigeria, and 19 healthcare workers (routine immunization focal persons) working in the primary healthcare setting in Lagos state. Study participants discussed factors at each level of the SEM that influence childhood immunization uptake, including intrapersonal (caregivers’ immunization knowledge, caregivers’ welfare and love of child/ren), interpersonal (role of individual relationships and social networks), organizational (geographical and financial access to health facilities, health facilities attributes, staff coverage, and healthcare worker attributes), community (community outreaches and community resources), and policy-level (free immunization services and provision of child immunization cards). Several factors were intertwined, such as healthcare workers’ education of caregivers on immunization and caregivers’ knowledge of vaccination.

Conclusions

The reciprocity of the findings across the Socioecological Model levels emphasizes the importance of developing multi-pronged interventions that operate at multiple levels of the SEM. Our results can inform the design of culturally appropriate and effective interventions to address Nigeria’s suboptimal immunization coverage.
Knowledge, attitude, and beliefs toward group behavior therapy programs among male adults attending smoking cessation clinics, cross-sectional analysis
Authors: Alduraywish Shatha A. , Alnofaie Meaad F. , Alrajhi Balqes F. , Balsharaf Fatima A. , Alblaihed Sarah S. , Alsowigh Alaa A. , Alotaibi Wafa S. , Aldakheel Fahad M.
Published: May 2021

Background

Group therapy assists individuals in learning many behavioral techniques for smoking cessation and providing each other with mutual support. Group behavior therapy is not routinely provided as a modality of tobacco cessation assistance in tobacco cessation clinics in Saudi Arabia despite it is effectiveness. Therefore, this study aimed to assess the knowledge, attitude, and beliefs toward group behavior therapy programs among male adults who attend smoking cessation clinics and to identify the associated factors.

Methods

A cross-sectional study was conducted with a targeted sample of 229 males aged 18 and above who were attending smoking cessation clinics. The participants were randomly selected. Data were collected using a paper-based questionnaire. One-way ANOVA and chi-square test were used for statistical analysis.

Results

Results showed a high percentage of the study participants were in the age group of 21–40 years. Most of them were consuming 10–20 cigarettes per day. Around 79% of the participants had previous attempted to quit smoking. This study demonstrated a deficit in knowledge about group behavior therapy. The mean score for attitude and beliefs was 5.3 out of 11. Multiple factors influenced their attitudes and beliefs, such as previous attempts to quit smoking (p-value < 0.05) and the number of cigarettes used per day (p-value = 0.03). The knowledge was found to be affected by the level of education (p-value = 0.04).

Conclusion

The study demonstrates a deficit in knowledge about group behavior therapy and it shows that the level of education was associated with the knowledge. Additionally, previous attempts to quit smoking and the number of cigarettes used per day, influenced the participants’ attitude and beliefs toward group behavioral therapy. Increase awareness about the role of group behavior therapy in smoking cessation is required before this method is implemented in the routine practice.
A systematic review of the incidence, risk factors and prognosis of acute exacerbation of systemic autoimmune disease-associated interstitial lung disease
Authors: Kamiya Hiroyuki , Panlaqui Ogee Mer
Published: May 2021

Introduction

Acute exacerbation (AE) is a devastating phenomenon and reported to be complicated with systemic autoimmune disease-associated interstitial lung disease (ILD). The aim of this study was to investigate the incidence and prognosis of AE of systemic autoimmune disease-ILD and clarify relevant clinical information predictive of these outcomes.

Method

This study was designed as a systematic review and meta-analysis. A primary study except for a case report, which reported the incidence and/or prognosis of AE of systemic autoimmune disease-ILD, was eligible for the review. Electronic databases such as Medline and EMBASE were searched from 2002 through 23 February 2020. Two reviewers independently selected eligible reports and extracted relevant data. Risk of bias of individual studies was assessed similarly. The incidence and prognosis of the disease were analysed qualitatively. Univariate results of risk and prognostic factors were combined if feasible.

Results

Out of a total of 2662 records, 24 studies were eligible. A total of 420 subjects with 45.7% of men developed AE of systemic autoimmune disease-ILD and the two major underlying systemic autoimmune diseases were rheumatoid arthritis (34.2%) and polymyositis/dermatomyositis (31.9%). The frequency ranged from 4.3 to 32.9% with the incident rate being 3.19 and 5.77 per 100 patient-years and all-cause mortality was between 30.0 and 58.3% at 90 days. Age at initial presentation was significantly associated with the development of AE of systemic autoimmune disease-ILD with an HR of 1.22 (95%CI 1.05–1.50) while a percentage of predicted diffusing capacity of the lung for carbon monoxide (%DLCO) was also significantly associated with the development of the disease with an HR of 0.95 (95%CI 0.90–1.00) and an OR of 0.97 (95%CI 0.95–0.99). Partial pressure of arterial oxygen/fraction of inspired oxygen ratio (PaO2/FiO2) at AE was significantly associated with all-cause mortality of AE of systemic autoimmune disease-ILD with an HR of 0.99 (95%CI 0.98–0.99).

Conclusion

AE of systemic autoimmune disease-ILD was not uncommon and demonstrated dismal prognosis. Age at initial presentation and %DLCO were deemed as risk factors while PaO2/FiO2 at AE was considered as a prognostic factor of the disease.

Registration CRD42019138941.
Investigate knowledge management technology implementation for supporting decision making in Ethiopian health sectors
Authors: Belay Mniyichel , Desta Amare , Smithson Steve , Meshesha Million
Published: May 2021

Introduction

Knowledge management technology is a key tool for facilitating and improving the quality of health care delivery in hospitals. However, the use and implementation of this technology is not an easy task. This study aims to investigate a knowledge management technology implementation and use in Ethiopian hospitals, with a particular reference to Jimma University Specialized Hospital.

Methodology

Information about challenges of knowledge management technology implementation was gathered using qualitative research methods, through conducting semi-structured interviews. Purposive sampling method was applied to select fifty-four participants from a well-defined population. Findings were first validated, according to published literature and research works, and then sorted into three main areas, such as current usage of KM technology to enhance and improve decision-making, factors affecting the implementation of KM technology

Results

This study revealed that the overall level of KM technology implementation in Jimma University Specialized hospital is still low.

Conclusion

Implementation and use of KM technology to improve the quality of hospital health services is needed. Thus, it suggested that hospital managers should make much more effort to develop a strategy and policy on the implementation and use of KM technology so that the hospital could improve the quality of healthcare services.
Reduction in pericyte coverage leads to blood–brain barrier dysfunction via endothelial transcytosis following chronic cerebral hypoperfusion
Authors: Sun Zhengyu , Gao Chenhao , Gao Dandan , Sun Ruihua , Li Wei , Wang Fengyu , Wang Yanliang , Cao Huixia , Zhou Guoyu , Zhang Jiewen , Shang Junkui
Published: May 2021

Background

Chronic cerebral hypoperfusion (CCH) is the leading cause of cerebral small vessel disease (CSVD). CCH is strongly associated with blood–brain barrier (BBB) dysfunction and white matter lesions (WMLs) in CSVD. However, the effects of CCH on BBB integrity and components and the cellular and molecular mechanisms underlying the effects of BBB dysfunction remain elusive. Whether maintaining BBB integrity can reverse CCH-induced brain damage has also not been explored.

Methods

In this study, we established a rat model of CSVD via permanent bilateral common carotid artery occlusion (2VO) to mimic the chronic hypoperfusive state of CSVD. The progression of BBB dysfunction and components of the BBB were assessed using immunostaining, Western blotting, transmission electron microscopy (TEM) and RNA sequencing. We also observed the protective role of imatinib, a tyrosine kinase inhibitor, on BBB integrity and neuroprotective function following CCH. The data were analyzed using one-way or two-way ANOVA.

Results

We noted transient yet severe breakdown of the BBB in the corpus callosum (CC) following CCH. The BBB was severely impaired as early as 1 day postoperation and most severely impaired 3 days postoperation. BBB breakdown preceded neuroinflammatory responses and the formation of WMLs. Moreover, pericyte loss was associated with BBB impairment, and the accumulation of serum protein was mediated by increased endothelial transcytosis in the CC. RNA sequencing also revealed increased transcytosis genes expression. BBB dysfunction led to brain damage through regulation of TGF-β/Smad2 signaling. Furthermore, imatinib treatment ameliorated serum protein leakage, oligodendrocyte progenitor cell (OPC) activation, endothelial transcytosis, microglial activation, and aberrant TGF-β/Smad2 signaling activation.

Conclusions

Our results indicate that reduced pericyte coverage leads to increased BBB permeability via endothelial transcytosis. Imatinib executes a protective role on the BBB integrity via inhibition of endothelial transcytosis. Maintenance of BBB integrity ameliorates brain damage through regulation of TGF-β/Smad2 signaling following CCH; therefore, reversal of BBB dysfunction may be a promising strategy for CSVD treatment.
An external validation of the Candiolo nomogram in a cohort of prostate cancer patients treated by external‐beam radiotherapy
Authors: Gabriele Domenico , Guarneri Alessia , Bartoncini Sara , Munoz Fernando , Tamponi Matteo , Russo Filippo , Stamatakos Georgios , Guiot Caterina , Regge Daniele , Ricardi Umberto
Published: May 2021

Background

the aim of this study is to perform an external validation for the Candiolo nomogram, a predictive algorithm of biochemical and clinical recurrences in prostate cancer patients treated by radical Radiotherapy, published in 2016 on the journal “Radiation Oncology”.

Methods

561 patients, treated by Radiotherapy with curative intent between 2003 and 2012, were classified according to the five risk-classes of the Candiolo nomogram and the three risk-classes of the D’Amico classification for comparison. Patients were treated with a mean prostatic dose of 77.7 Gy and a combined treatment with Androgen-Deprivation-Therapy in 76% of cases. The end-points of the study were biochemical-progression-free-survival (bPFS) and clinical-Progression-Free-Survival (cPFS). With a median follow-up of 50 months, 56 patients (10%) had a biochemical relapse, and 30 patients (5.4%) a clinical progression. The cases were divided according to D’Amico in low-risk 21%, intermediate 40%, high-risk 39%; according to Candiolo very-low-risk 24%, low 37%, intermediate 24%, high 10%, very-high-risk 5%. Statistically, the Kaplan-Meier survival curves were processed and compared using Log-Rank tests and Harrell-C concordance index.

Results

The 5-year bPFS for the Candiolo risk-classes range between 98 and 38%, and the 5-year cPFS between 98 and 50% for very-low and very-high-risk, respectively. The Candiolo nomogram is highly significant for the stratification of both bPFS and cPFS (P < 0.0001), as well as the D’Amico classification (P = 0.004 and P = 0.001, respectively). For the Candiolo nomogram, the C indexes for bPFS and cPFS are 75 and 80%, respectively, while for D’Amico classification they are 64 and 69%, respectively. The Candiolo nomogram can identify a greater number of patients with low and very-low-risk prostate cancer (61% versus 21% according to D’Amico) and it better picks out patients with high and very-high-risk of recurrence, equal to only 15% of the total cases but subject to 48% (27/56) of biochemical relapses and 63% (19/30) of clinical progressions.

Conclusions

the external validation of the Candiolo nomogram was overall successful with C indexes approximately 10% higher than the D’Amico control classification for bPFS and cPFS. Therefore, its clinical use is justified in prostate cancer patients before radical Radiotherapy.

Trial registration Retrospectively registered.
Intraoperative 3D imaging in intraarticular tibial plateau fractures - Does it help to improve the patients’ outcomes?
Authors: Souleiman F. , Henkelmann R. , Theopold J. , Fakler J. , Spiegl U. , Hepp P.
Published: May 2021

Background

In tibial plateau fractures (TPF) the restoration of an anatomical joint surface as well as an exact subchondral screw position for postoperative stability is crucial for the outcome.

The aim of this study was to determine whether the additional use of an intraoperative 3D imaging intensifier (3D) might help to improve the outcome of complex TPF.

Methods

We performed a retrospective case-control study of a level 1 trauma center. Patients with AO/OTA 41 B3 and C-TPF operated on using a 3D imaging intensifier between November 2015 and December 2018 (3D group) were included. The outcomes of this patients were compared to patients operated without 3D imaging between January 2005 to December 2014 (2D group). The comparison of the groups was performed by matched pair analysis. The functional outcome of both groups was measured by KOOS and Lysholm Score after a follow-up period of at least 12 months. Operation time, infections and postoperative revisions were registered.

Results

In total, 18 patients were included in the 3D group (mean age: 51.0± 16.4 years; 12 females) and an equal number of matching partners from the 2D group (mean age: 50.3± 15.2 years; 11 females) were found (p=0.82; p=0.79). We found 9x B3, 2x C1, 1x C2, 6x C3 fractures according to AO/OTA for each group (p=1.00) with comparable ASA score (p=0.27). The mean operation time was 127.9± 45.9 min and 116.1± 45.7 min for the 3D and 2D group (p=0.28). The mean follow-up time was 20.9± 10.7 months for the 3D and 55.5± 34.7 months for the 2D group (p< 0.001). For the 3D group a mean Lysholm overall score of 67.4± 26.8 and KOOS overall score of 72.6± 23.5 could be assessed. In contrast, a mean Lysholm overall score of 62.0± 21.4 and KOOS overall score of 65.8± 21.6 could be measured in the 2D group (p=0.39; p=0.31). Thereby, functional outcome of the 3D group showed a significant higher KOOS Sport/Rec sub score of 54.7± 35.0 in comparison to the 2D group with 26.7± 31.6 (p= 0.01). Postoperative revisions had to be performed in 27.8% of cases in both groups (p=1.00). Due to the 3D imaging an intraoperative revision was performed in 33.3% (6/18).

Conclusion

In our study we could show that re-reduction of the fracture or implant re-positioning were performed in relevant numbers based on the 3D imaging. This was associated with a midterm clinical benefit in regard to better KOOS Sport/Rec scores.

Trial registration

AZ 488 /20-ek
Celiac disease in pediatric patients according to HLA genetic risk classes: a retrospective observational study
Authors: Tolone Carlo , Piccirillo Marisa , Dolce Pasquale , Alfiero Salvatore , Arenella Mattia , Sarnataro Marina , Iardino Patrizia , Pucciarelli Alessia , Strisciuglio Caterina
Published: May 2021

Background

Celiac disease (CD) is an autoimmune enteropathy in which HLA-DQ haplotypes define susceptibility. Our aim was to evaluate if belonging to a certain HLA-DQ class risk could be associated to the clinical, serological and histological presentation of CD.

Methods

We performed a retrospective observational monocentric study including all 300 patients diagnosed with CD, who underwent HLA typing. Clinical, serological and histological data was collected from clinical records and their association with HLA-DQ class risk was verified through statistical tests.

Results

In our sample mean age at onset was 6.7 ± 4.2 years, with a prevalence of females (n = 183; 61%), typical symptoms (n = 242; 80.6%) and anti-tTG IgA ≥ 100 U/mL (n = 194; 64.7%). Family history was present only in 19% (n = 57) of patients, and it was not significantly associated with any of the clinical and demographical data analyzed or the belonging to a certain HLA-DQ class risk. We found in the male population more frequently a coexistence of CD and atopic syndrome (males:n = 47; 40.2%; females:n = 50; 27.3%;p = 0.020).

Early age of onset, instead, was associated with typical symptoms (m = 6.4 ± 4;p = 0.045) and elevated liver enzymes (m = 5 ± 3.8;p < 0.001), while later age of onset was associated with presence of other autoimmune diseases (m = 8.2 ± 4;p = 0.01).

We observed statistically significant influences of HLA class risk on antibodies and liver enzymes levels: G1, G4 and G2 classes showed more frequently anti-tTG IgA ≥ 100 U/mL (n = 44; 80%,n = 16; 69.6%,n = 48; 67.6% respectively;p-value = 0.037), and in patients from G2 class we found enhanced liver enzymes (n = 28; 39.4%; p-value = 0.005). HLA class risk was still significantly associated with anti-tTG ≥ 100 (p = 0.044) and with hypertransaminasemia (p = 0.010) after a multiple logistic regression adjusted for the effect of gender, age at onset and family history.

Conclusions

We failed to prove an association between HLA-DQ genotypes and the clinical features in our CD pediatric patients. Although, our results suggest an effect of the DQB1–02 allele not only on the level of antibodies to tTG, but possibly also on liver involvement.