bluuebunny/crossref_metadata_2025 huggingface dataset:
Cause and predictors of neonatal mortality among neonates admitted to neonatal intensive care units of public hospitals in eastern Ethiopia: a facility-based prospective follow-up study
Authors: Desalew Assefa , Sintayehu Yitagesu , Teferi Nardos , Amare Firehiwot , Geda Bifitu , Worku Teshager , Abera Kebebush , Asefaw Abiyot
Published: April 2020

Background

The first month is the most crucial period for child survival. Neonatal mortality continues to remain high with little improvement over the years in Sub-Saharan Africa, including Ethiopia. This region shows the least progress in reducing neonatal mortality and continues to be a significant public health issue. In this study setting, the causes and predictors of neonatal death in the neonatal intensive care units are not well documented. Hence, this study aimed to determine the causes and predictors of neonatal mortality among infants admitted to neonatal intensive care units in eastern Ethiopia.

Methods

A facility-based in prospective follow-up study was conducted among neonates admitted to neonatal intensive care units of public hospitals of eastern Ethiopia from November 1 to December 30, 2018. Data were collected using a pre-tested structured questionnaire and a follow-up checklist. The main outcomes and causes of death were set by pediatricians and medical residents. EpiData 3.1 and Statistical Package for Social Sciences Version 25 software were used for data entry and analysis, respectively. Multivariable logistic regression was used to identify the predictors of facility-based neonatal mortality.

Results

The proportion of facility-based neonatal mortality was 20% (95% CI:16.7–23.8%). The causes of death were complications of preterm birth (28.58%), birth asphyxia (22.45%), neonatal infection (18.36%), meconium aspiration syndrome (9.18%), respiratory distress syndrome (7.14%), and congenital malformation (4.08%). Low birth weight, preterm births, length of stay of the neonatal intensive care unit, low 5 min APGAR score, hyperthermia, and initiation of feeding were predictors of neonatal death among infants admitted to the neonatal intensive care units of public hospitals in eastern Ethiopia.

Conclusions

The proportion of facility-based neonatal deaths was unacceptably high. The main causes of death were preventable and treatable. Hence, improving the timing and quality of antenatal care is essential for early detection, anticipating high-risk newborns, and timely interventions. Furthermore, early initiation of feeding and better referral linkage to tertiary health facilities could lead to a reduction in neonatal death in this setting.
Evaluation of dialysis centres: values and criteria of the stakeholders
Authors: Parra Eduardo , Arenas María Dolores , Fernandez-Reyes Luis María José , Blasco Forcén Angel , Alvarez-Ude Fernando , Aguarón Joven Juan , Altuzarra Casas Alfredo , Moreno-Jiménez José María
Published: April 2020

Background

Evaluation of renal replacement therapy with haemodialysis is essential for its improvement. Remarkably, outcomes vary across centres. In addition, the methods used have important epistemological limitations, such as ignoring significant features (e.g., quality of life) or no relevance given to the patient’s perspective in the indicator’s selection. The present study aimed to determine the opinions and preferences of stakeholders (patients, clinicians, and managers) and establish their relative importance, considering the complexity of their interactions, to facilitate a comprehensive evaluation of haemodialysis centres.

Methods

Successive working groups (WGs) were established using a multicriteria methodology. WG1 created a draft of criteria and sub-criteria, WG2 agreed, using a qualitative structured analysis with pre-established criteria, and WG3 was composed of three face-to-face subgroups (WG3-A, WG3-B, and WG3-C) that weighted them using two methodologies: weighted sum (WS) and analytic hierarchy process (AHP). Subsequently, they determined a preference for the WS or AHP results. Finally, via the Internet, WG4 weighted the criteria and sub-criteria by the method preferred by WG3, and WG5 analysed the results.

Results

WG1 and WG2 identified and agreed on the following evaluation criteria: evidence-based variables (EBVs), annual morbidity, annual mortality, patient-reported outcome measures (PROMs), and patient-reported experience measures (PREMs). The EBVs consisted of five sub-criteria: type of vascular access, dialysis dose, haemoglobin concentration, ratio of catheter bacteraemia, and bone mineral disease. The patients rated the PROMs with greater weight than the other stakeholders in both face-to-face WG3 (WS and AHP) and WG4 via the Internet. The type of vascular access was the most valued sub-criterion. A performance matrix of each criterion and sub-criterion is presented as a reference for assessing the results based on the preferences of the stakeholders.

Conclusions

The use of a multicriteria methodology allows the relative importance of the indicators to be determined, reflecting the values of the different stakeholders. In a performance matrix, the inclusion of values and intangible aspects in the evaluation could help in making clinical and organizational decisions.
Recombinant lipidated Zika virus envelope protein domain III elicits durable neutralizing antibody responses against Zika virus in mice
Authors: Chen Mei-Yu , Chai Kit Man , Chiang Chen-Yi , Wu Chiao-Chieh , Yu Guann-Yi , Liu Shih-Jen , Chen Hsin-Wei
Published: April 2020

Background

The emergence of Zika virus (ZV) in tropical and subtropical areas of the world has created an urgent need for vaccines against ZV. However, approved vaccines that prevent ZV infection are not available. To develop an effective vaccine against ZV infection, a lipidated form of ZV envelope protein domain III that possesses an intrinsic adjuvant property was rationally designed. Our goal was to examine the immunogenicity of recombinant lipidated ZV envelope protein domain III (rLZE3) and evaluate its potential as a vaccine candidate against ZV.

Methods

Recombinant ZV envelope protein domain III (rZE3) and rLZE3 were prepared with an Escherichia coli-based system. Dendritic cell surface marker expression and cytokine production upon stimulation were analyzed to evaluate the function of rLZE3. Neutralizing antibody capacities were evaluated using focus reduction neutralization tests after immunization. To investigate the protective immunity in immunized mice, serum samples collected from immunized mice were adoptively transferred into AG129 mice, and then viremia levels and survival times were examined after ZV challenge.

Results

rLZE3 alone but not rZE3 alone efficiently activated dendritic cells in vitro and was taken up by dendritic cells in vivo. Immunization of C57BL/6 mice with rLZE3 alone (without exogenous adjuvant) could induce ZV-specific neutralizing antibody responses. Furthermore, serum samples obtained from rLZE3-immunized mice provided protection as indicated by a reduction in viremia levels and prolongation of survival times after ZV challenge.

Conclusion

These results indicate that rLZE3 is an excellent vaccine candidate and has great potential that should be evaluated in further preclinical studies.
The abnormal lipid profile in obesity and coronary heart disease (CHD) in Pakistani subjects
Authors: Shabana  , Shahid Saleem Ullah , Sarwar Sumbal
Published: April 2020

Background

Obesity has become global epidemic in the last three decades, whereas Coronary Heart Disease (CHD) still remains the most important cause of mortality in the world. The study was aimed at determining the pattern of lipid profile for the obese and CHD population in Pakistan. As obesity is a strong predisposing risk factor for CHD, we aimed to analyze the lipid parameters in both conditions and compare them with the healthy controls of the same ethnicity.

Methods

Blood samples were collected from one thousand individuals (500 with CHD, 250 with obesity, 250 healthy controls). The lipid profile (total Cholesterol, triglycerides, HDL-C, LDL-C and VLDL) was measured using commercially available kits. The pattern of dyslipidemia was then studied by comparing the results in both groups with controls as well as population cutoffs. The quantitative variables were checked for normality and log transformation was done for variables where appropriate. Analysis of variance and logistic regression were done to check the association of lipid parameters with obesity and CHD.

Results

The obese and CHD groups showed a dyslipidemic profile than the healthy controls. CHD group had a higher proportion of CHD in any of the first degree blood relatives (36.0% vs. 1.8%), a similar trend was observed in the obese group, where 63.9% cases had positive family history. Among cases, 50.7% had combined lipid abnormalities, i.e., the values of TC, LDL-C, TG and HDL-C, all were deranged. Whereas 49.52% had TC more than normal cut off (> 200 mg/dl), 51.6% had LDL-C > 100 mg/dl. Similarly, 80.4% of patients had TG levels more than upper normal range (> 150 mg/dl) and 64% had HDL values in moderate CHD risk group (< 50 mg/dl). The results show that Pakistani cases are hyperlipidemic for lipid traits except for HDL which is lowered. Patients with comorbidities also had lipid profiles deviated from the normal range.

Conclusion

The study provides information regarding the aberration of lipid profile in the metabolic disorders that can increase the predisposition to complications.
A prospective, single-centre, single-arm, open label study of the long term use of a gonadotropin releasing hormone agonist (Triptorelin SR, 11.25 mg) in combination with Tibolone add-back therapy in the management of chronic cyclical pelvic pain
Authors: Alshehre Sallwa M. , Duffy Sheila , Jones Georgina , Ledger William L. , Metwally Mostafa
Published: April 2020

Background

Chronic cyclic pelvic pain (CCPP) affects women’s quality of life and pituitary downregulation is often used for symptomatic relief. However, prolonged suppression of ovarian function is associated with menopausal side effects and can lead to osteoporosis. Currently, the use of gonadotropin releasing hormone agonists (GnRHa) for treatment of CCPP is usually restricted to 6–9 months, limiting their efficacy. There is limited information regarding safety and efficacy with longer-term use. The aim of this study is to examine the safety and efficacy of long-term (24 months) pituitary down-regulation with the GnRHa (Triptorelin SR) with add-back therapy (ABT) using Tibolone for symptom relief in women with CCPP.

Methods

A single-arm, prospective clinical trial at a Tertiary University Teaching Hospital of 27 patients receiving Triptorelin SR (11.25 mg) and Tibolone (2.5 mg). Outcomes measures were the safety of treatment assessed by clinical examination, haematological markers, liver and renal function tests and bone mineral density (BMD) at 12, 18 and 24 months as well as at 6 months post-treatment. Pain and health-related quality of life (HR-QoL) assessed using the endometriosis health profile (EHP-30) and chronic pain grade (CPG) questionnaires.

Results

There was no evidence for any significant harmful effects on any of the measured haematological, renal or liver function tests. Although results regarding the effect on BMD are not conclusive there is an increased risk of development of osteopaenia after 12 months of treatment. Pain and HRQoL assessments showed significant improvement during medication, but with deterioration after treatment cessation.

Conclusion

Long- term Triptorelin plus Tibolone add-back therapy in women suffering from CCPP does not appear to be associated with significant serious adverse events apart from the possibility of deterioration in the BMD that needs to be monitored. This mode of therapy appears to be effective in pain relief and in improving quality of life over a 24-month period.

Trial registration

Clinical trials database NCT00735852.
Effects of advanced age upon astrocyte-specific responses to acute traumatic brain injury in mice
Authors: Early Alexandria N. , Gorman Amy A. , Van Eldik Linda J. , Bachstetter Adam D. , Morganti Josh M.
Published: April 2020

Background

Older-age individuals are at the highest risk for disability from a traumatic brain injury (TBI). Astrocytes are the most numerous glia in the brain, necessary for brain function, yet there is little known about unique responses of astrocytes in the aged-brain following TBI.

Methods

Our approach examined astrocytes in young adult, 4-month-old, versus aged, 18-month-old mice, at 1, 3, and 7 days post-TBI. We selected these time points to span the critical period in the transition from acute injury to presumably irreversible tissue damage and disability. Two approaches were used to define the astrocyte contribution to TBI by age interaction: (1) tissue histology and morphological phenotyping, and (2) transcriptomics on enriched astrocytes from the injured brain.

Results

Aging was found to have a profound effect on the TBI-induced loss of astrocyte function needed for maintaining water transport and edema—namely, aquaporin-4. The aged brain also demonstrated a progressive exacerbation of astrogliosis as a function of time after injury. Moreover, clasmatodendrosis, an underrecognized astrogliopathy, was found to be significantly increased in the aged brain, but not in the young brain. As a function of TBI, we observed a transitory refraction in the number of these astrocytes, which rebounded by 7 days post-injury in the aged brain. Transcriptomic data demonstrated disproportionate changes in genes attributed to reactive astrocytes, inflammatory response, complement pathway, and synaptic support in aged mice following TBI compared to young mice. Additionally, our data highlight that TBI did not evoke a clear alignment with the previously defined “A1/A2” dichotomy of reactive astrogliosis.

Conclusions

Overall, our findings point toward a progressive phenotype of aged astrocytes following TBI that we hypothesize to be maladaptive, shedding new insights into potentially modifiable astrocyte-specific mechanisms that may underlie increased fragility of the aged brain to trauma.
Reverse-genetics studies of lncRNAs—what we have learnt and paths forward
Authors: Gao Fan , Cai Ye , Kapranov Philipp , Xu Dongyang
Published: April 2020

Long non-coding RNAs (lncRNAs) represent a major fraction of the transcriptome in multicellular organisms. Although a handful of well-studied lncRNAs are broadly recognized as biologically meaningful, the fraction of such transcripts out of the entire collection of lncRNAs remains a subject of vigorous debate. Here we review the evidence for and against biological functionalities of lncRNAs and attempt to arrive at potential modes of lncRNA functionality that would reconcile the contradictory conclusions. Finally, we discuss different strategies of phenotypic analyses that could be used to investigate such modes of lncRNA functionality.
Principal component analysis of adipocytokines and insulin associate with risk factors of cardiovascular diseases
Authors: Yarizadeh Habib , Setayesh Leila , Askarpoor Moein , Pooyan Sara , Sajjadi Seyedeh Forough , Badrooj Negin , Roberts Caroline , Mirzaei Khadijeh
Published: April 2020

Objectives

Obesity plays an important role in the development of chronic diseases like cardiovascular diseases and diabetes. The possible underlying mechanism for this connection is that adipose tissue secretes an array of chemical messenger adipokines proinflammatory cytokines (tumor necrosis factor-alpha, interleukin-6, and interleukin-1-beta). This study aimed to investigate the linkage between adipocytokines and insulin with the cardiovascular disease risk, with particular reference to the adipokines galectin-3, plasminogen activator inhibitor-1, and interleukin-1-beta, C-reactive protein, and monocyte chemoattractant protein.

Result

Two patterns were identified. The first pattern was galectin-3, plasminogen activator inhibitor-1 and interleukin-1-beta and the second one was C-reactive protein, insulin and monocyte chemoattractant protein-1. The second pattern was strongly associated with the higher scores for resting metabolic rate, diastolic blood pressure, homeostasis model insulin resistance index, lipid profile (except low density lipoprotein, total cholesterol), and body composition parameters (except fat free mass index and waist hip ratio), while negatively associated with age and high density lipoprotein level (all p < 0.05). The first pattern was, however, significantly associated with body fat mass, obesity degree percentage, waist circumference, fat mass index, and waist hip ratio (p < 0.05 for all).

This is a retrospective study. Ethics approval (IR.TUMS.VCR.REC.1395.1597).
Virtual reality as a non-pharmacologic analgesic for fasciotomy wound infections in acute compartment syndrome: a case report
Authors: Esumi Ryo , Yokochi Ayumu , Shimaoka Motomu , Kawamoto Eiji
Published: April 2020

Background

Fasciotomy is a life-saving procedure to treat acute compartment syndrome, a surgical emergency. As fasciotomy dramatically improves wound pain, it should be performed as soon as possible. Moreover, delays in the use of fasciotomy can increase the rate of wound infections. Once the fasciotomy wound is infected, pain control is achieved via the long-term use of opioids or anti-inflammatory analgesics. However, the administration of high doses of opioids may cause complications, such as respiratory depression, over-sedation, and constipation. Therefore, treatment methods other than narcotic administration should be established to better manage the pain caused by fasciotomy wound infections.

Virtual reality has recently been introduced in analgesic therapy as a replacement, or complement, to conventional pharmacological treatments. Its use has been extensively studied in the pain management of patients with burns. An increasing number of painful conditions are being successfully treated with virtual reality. Here, we report a case of acute compartment syndrome complicated by fasciotomy wound infection.

Case presentation

A 40-year-old Japanese man suffering from acute compartment syndrome of his leg due to a car accident trauma was treated with a fasciotomy to decompress intra-compartmental pressure and restore tissue perfusion, and admitted to an intensive care unit. Unfortunately, as the open fasciotomy wound was complicated by infection, he complained of hyperalgesia and severe pain during wound debridement. He was therefore given acetaminophen and high-dose intravenous patient-controlled analgesic fentanyl (35 μg/kg per day) to reduce the pain. Despite these efforts, the pain was poorly controlled and opioid-induced side effects such as respiratory depression were observed. An immersive virtual reality analgesic therapy aimed at distraction and relaxation was used and effectively alleviated the pain. Three sessions of virtual reality analgesic therapy over 2 days produced sustainable analgesic effects, which led to a 25–75% dose reduction in fentanyl administration and the concomitant alleviation of respiratory depression.

Conclusions

This case suggests the feasibility of virtual reality analgesic therapy for pain management of fasciotomy wound complications in acute compartment syndromes. Virtual reality represents a treatment option that would reduce analgesic consumption and eliminate opioid-induced respiratory depression to treat fasciotomy wound infection.
KnowTox: pipeline and case study for confident prediction of potential toxic effects of compounds in early phases of development
Authors: Morger Andrea , Mathea Miriam , Achenbach Janosch H. , Wolf Antje , Buesen Roland , Schleifer Klaus-Juergen , Landsiedel Robert , Volkamer Andrea
Published: April 2020

Risk assessment of newly synthesised chemicals is a prerequisite for regulatory approval. In this context, in silico methods have great potential to reduce time, cost, and ultimately animal testing as they make use of the ever-growing amount of available toxicity data. Here, KnowTox is presented, a novel pipeline that combines three different in silico toxicology approaches to allow for confident prediction of potentially toxic effects of query compounds, i.e. machine learning models for 88 endpoints, alerts for 919 toxic substructures, and computational support for read-across. It is mainly based on the ToxCast dataset, containing after preprocessing a sparse matrix of 7912 compounds tested against 985 endpoints. When applying machine learning models, applicability and reliability of predictions for new chemicals are of utmost importance. Therefore, first, the conformal prediction technique was deployed, comprising an additional calibration step and per definition creating internally valid predictors at a given significance level. Second, to further improve validity and information efficiency, two adaptations are suggested, exemplified at the androgen receptor antagonism endpoint. An absolute increase in validity of 23% on the in-house dataset of 534 compounds could be achieved by introducing KNNRegressor normalisation. This increase in validity comes at the cost of efficiency, which could again be improved by 20% for the initial ToxCast model by balancing the dataset during model training. Finally, the value of the developed pipeline for risk assessment is discussed using two in-house triazole molecules. Compared to a single toxicity prediction method, complementing the outputs of different approaches can have a higher impact on guiding toxicity testing and de-selecting most likely harmful development-candidate compounds early in the development process.
Possible effects of potential lahars from Cotopaxi volcano on housing market prices
Authors: Echegaray-Aveiga Richard Caleb , Rodríguez-Espinosa Fabian , Toulkeridis Theofilos , Echegaray-Aveiga Richard Damian
Published: April 2020

The recent awakening of the Cotopaxi volcano in Ecuador set the conditions to estimate and verify the possible effects of potential lahars on residential housing unit prices. About 300,000 people live in the Los Chillos valley, which is the northern natural drainage of Cotopaxi’s lahars; therefore, the effects on house values can be significant. We have used housing information from 2016 of 240 properties to settle a hedonic price model within and outside of the lahar’s area. The regression model has a significant R2 value of about 0.723. The variable that determined the effects of potential lahar on the hedonic model demonstrates that the value of a residence house unit will increase its price by 41.99 USD for each meter away from the lahar path. Our study suggests that environmental disamenities generated by natural hazards will have a negative effect on residential house unit prices and we infer that consumers would be willing to pay a higher price in order to avoid such potential disamenities.
Retraction Note: Levin’s type boundary behaviors for functions harmonic and admitting certain lower bounds
Authors: Li Zhiqiang , Vetro Mohamed
Published: April 2020

The Editors-in-Chief have retracted this article [1] because it significantly overlaps with a previously published article by Pang et al. [2]. The article also shows evidence of authorship manipulation. The identity of the corresponding author could not be verified; the University of Ioannina have confirmed that Mohamed Vetro has not been affiliated with their institution. The authors have not responded to correspondence regarding this retraction.
Adaptive changes in physiological and perceptual responses during 10-day heat acclimation training using a water-perfused suit
Authors: Ko Yelin , Seol Seon-Hong , Kang Juho , Lee Joo-Young
Published: April 2020

Background

While active heat acclimation strategies have been robustly explored, not many studies highlighted passive heat acclimation strategies. Particularly, little evidence demonstrated advantages of utilizing a water-perfused suit as a passive heating strategy. This study aimed to explore heat adaptive changes in physiological and perceptual responses during 10-day heat acclimation training using a water-perfused suit.

Methods

Nineteen young males were divided into three experimental groups: exercise condition (N = 6, HAEXE, 1-h exercise at 6 km h−1 followed by 1-h rest in a sitting position), exercise and passive heating condition (N = 6, HAEXE+SUIT, 1-h exercise at 6 km h−1 followed 1-h passive heating in a sitting position), and passive heating condition (N = 7, HASUIT, 2-h passive heating in a sitting position). All heating programs were conducted for 10 consecutive days in a climatic chamber maintained at 33 °C with 60% relative humidity. The passive heating was conducted using a newly developed water-perfused suit with 44 °C water.

Results

Greater whole-body sweat rate and alleviated perceptual strain were found in HASUIT and HAEXE+SUIT after 5 and/or 10 days (P < 0.05) but not in the exercise-only condition (HAEXE). Lower rectal temperature and heart rate were found in all conditions after the training (P < 0.05). Heat adaptive changes appeared earlier in HASUIT except for sweat responses.

Conclusions

For heat acclimation in hot humid environments, passive and post-exercise heat acclimation training using the suit (water inflow temperature 44 °C) were more effective than the mild exercise (1-h walking at 6 km h−1). This form of passive heating (HASUIT) may be an especially effective strategy for the elderly and the disabled who are not able to exercise in hot environments.
Different fundus imaging modalities and technical factors in AI screening for diabetic retinopathy: a review
Authors: Lim Gilbert , Bellemo Valentina , Xie Yuchen , Lee Xin Q. , Yip Michelle Y. T. , Ting Daniel S. W.
Published: April 2020

Background

Effective screening is a desirable method for the early detection and successful treatment for diabetic retinopathy, and fundus photography is currently the dominant medium for retinal imaging due to its convenience and accessibility. Manual screening using fundus photographs has however involved considerable costs for patients, clinicians and national health systems, which has limited its application particularly in less-developed countries. The advent of artificial intelligence, and in particular deep learning techniques, has however raised the possibility of widespread automated screening.

Main text

In this review, we first briefly survey major published advances in retinal analysis using artificial intelligence. We take care to separately describe standard multiple-field fundus photography, and the newer modalities of ultra-wide field photography and smartphone-based photography. Finally, we consider several machine learning concepts that have been particularly relevant to the domain and illustrate their usage with extant works.

Conclusions

In the ophthalmology field, it was demonstrated that deep learning tools for diabetic retinopathy show clinically acceptable diagnostic performance when using colour retinal fundus images. Artificial intelligence models are among the most promising solutions to tackle the burden of diabetic retinopathy management in a comprehensive manner. However, future research is crucial to assess the potential clinical deployment, evaluate the cost-effectiveness of different DL systems in clinical practice and improve clinical acceptance.
Low-cost FDM 3D-printed modular electrospray/electrospinning setup for biomedical applications
Authors: Huang Jing , Koutsos Vasileios , Radacsi Norbert
Published: April 2020

Here, we report on the inexpensive fabrication of an electrospray/electrospinning setup by fused deposition modelling (FDM) 3D printing and provide the files and parameters needed to print this versatile device. Both electrospray and electrospinning technologies are widely used for pharmaceutical, healthcare and bioengineering applications. The setup was designed to be modular, thus its parts can be exchanged easily. The design provides a safe setup, ensuring that the users are not exposed to the high voltage parts of the setup. PLA, PVA, and a thermoplastic elastomer filament were used for the 3D printing. The filament cost was $100 USD and the rig was printed in 6 days. An Ultimaker 3 FDM 3D printer was used with dual print heads, and the PVA was used as a water-soluble support structure. The end part of the setup had several gas channels, allowing a uniform gas flowing against the direction of the nanoparticles/nanofibers, enhancing the drying process by enhancing the evaporation rate. The setup was tested in both electrospray and electrospinning modes successfully. Both the .sldprt and .stl files are provided for free download.
The case for gender considerate tobacco control policies in Albania
Authors: Guliani Harminder , Çule Monika
Published: April 2020

Background

Tobacco use is a serious health concern in Albania. While the prevalence of tobacco smoking has traditionally been higher for men, the increasing prevalence of smoking for women is becoming a concern. The 2007 Tobacco Control policy mandated smoke-free indoor spaces, banned various forms of tobacco advertising, required written health warnings on packaging and levied excise taxes on cigarette sales. Since smoking behavior varies among different demographic groups, each group’s response to a uniform policy will differ, blunting the effectiveness of these efforts as a result. This study examines various socioeconomic, demographic and behavioral factors affecting both the likelihood and frequency of smoking in Albanian households in order to provide insights on targeting various populations more effectively.

Methods

The study utilizes data from Albanian 2008–09 and 2017–18 Demographic and Health Surveys consisting of adults aged 15–49 years. The outcome variable includes respondents’ current tobacco smoking behaviour and its frequency. The exposure variables include respondents’ sociodemographic and lifestyle characteristics. We use a two-level random intercept model with the two-stage residual inclusion estimation method to determine the association between outcome and exposure variables. By including a time variable, we capture the change in smoking behavior during the 2009–2018 period. We also extend the analysis by assessing the differential influence of gender on the likelihood of smoking, both by income quintiles and education.

Results

The results suggest that the likelihood of smoking decreased by 23% in 2017–18 compared to 2008–09, after controlling for various socioeconomic and demographic factors. Tobacco smoking is also found to be linked to alcohol consumption, with binge drinkers 59% more likely to smoke tobacco compared to moderate drinkers. We also found significant inter-quintile and inter-educational differences in smoking practices within each gender category. While the likelihood of tobacco smoking decreases with increasing wealth and educational attainment among men, the opposite (for wealth) or more involved (for educational attainment) patterns are true among women.

Conclusions

To further enhance the effectiveness of the current Tobacco Control policy, the Government of Albania should target various demographic groups (such as poor males, rich and educated females) in a differentiated fashion.
Proximal fibular resection improves knee biomechanics and enhances tibial stress fracture healing in patients with osteoarthritis with varus deformity: a prospective, randomized control analysis
Authors: Shah Vikram Indrajit , Upadhyay Sachin , Shah Kalpesh , Sheth Ashish , Kshatriya Amish , Patil Jayesh
Published: April 2020

Background

The present study aimed to evaluate the functional outcome of single-stage total knee arthroplasty using long-stem tibial component with proximal fibular resection (PFR) for patients with knee osteoarthritis with varus deformity associated with tibial stress fracture.

Method

A cohort of 62 patients with a mean age 71.63 ± 7.40 years who met the criteria were randomized to a study group and a control group. Patients in the study group underwent single-stage total knee arthroplasty using long-stem tibial component with PFR. The control group received conventional treatment. All patients were followed at 1, 3, 6 and 12 month(s) after surgery. Standard anteroposterior and lateral weight bearing knee X-rays were analyzed. Western Ontario and Mc-master Universities Osteoarthritis Index score (WOMAC) and the visual analog scale (VAS) score were used to assess the functional outcome. The level of significance was set atp < 0.05 levels.

Results

One patient in the study group was lost to follow-up, leaving 61 patients for final assessment. The WOMAC total score and mean VAS score were significantly better in study group than in control group at final follow-up (p < 0.05). All fractures were successfully united in a mean time of 12.26 ± 1.20 weeks in study group. A total of 16 patients in control group had delayed union, five had established nonunion and required further interventions. No complications relating to surgery was detected.

Conclusion

Total knee arthroplasty with PFR for knee arthritis with varus deformity associated with tibial stress fractures restores limb alignment, improves biomechanics, enhances fracture healing and provides excellent functional outcome.
Zinc Levels and Birth Weight in Pregnant Women with Gestational Diabetes Mellitus: A Matched Cohort Study in China
Authors: Luo Jiajun , Wu Weiwei , Zhang Ping , Chen Xi , Feng Yongliang , Ma Ning , Yang Hailan , Wang Ying , Li Mei , Xie Bingjie , Guo Pengge , Liew Zeyan , Deziel Nicole C , Vasiliou Vasilis , Shi Xiaoming , Wang Suping , Zhang Yawei
Published: April 2020

Background

Zinc (Zn) has been suggested to impact fetal growth. However, the effect may be complicated by gestational diabetes mellitus (GDM) due to its impact on fetal growth and placental transport. This study aims to investigate whether GDM modifies the association between Zn levels and birth weight.

Method

A cohort matched by GDM was established in Taiyuan, China, between 2012 and 2016, including 752 women with GDM and 744 women without. Dietary Zn intake was assessed during pregnancy. Maternal blood (MB) and cord blood (CB) Zn levels were measured at birth. Birth weight was standardized as the z score and categorized as high (HBW, >4000 g) and low (LBW, <2500 g) groups. Multivariate linear regression and multinomial logistic regression were used to examine the association between Zn levels and birth weight in offspring born to women with or without GDM.

Results

88.8% (N = 1328) of the population had inadequate Zn intake during pregnancy. In women with GDM, MB Zn level was inversely associated with birth weight (β = –.17; 95% confidence interval (CI), –0.34 to –0.01), while CB Zn level was positively associated with birth weight (β = .38; 95% CI, 0.06-0.70); suggestive associations were observed between MB Zn level and LBW (odds ratio 2.01; 95% CI, 0.95-4.24) and between CB Zn level and HBW (odds ratio 2.37; 95% CI, 1.08-5.21).

Conclusions

GDM may modify the associations between MB and CB Zn levels and birth weight in this population characterized by insufficient Zn intake. These findings suggest a previously unidentified path of adverse effects of GDM.
Science Without Conscience Is but the Ruin of the Soul: The Ethics of Big Data and Artificial Intelligence in Perioperative Medicine
Authors: Canales Cecilia , Lee Christine , Cannesson Maxime
Published: April 2020

Artificial intelligence–driven anesthesiology and perioperative care may just be around the corner. However, its promises of improved safety and patient outcomes can only become a reality if we take the time to examine its technical, ethical, and moral implications. The aim of perioperative medicine is to diagnose, treat, and prevent disease. As we introduce new interventions or devices, we must take care to do so with a conscience, keeping patient care as the main objective, and understanding that humanism is a core component of our practice. In our article, we outline key principles of artificial intelligence for the perioperative physician and explore limitations and ethical challenges in the field.
NF-κB signaling regulates the formation of proliferating Müller glia-derived progenitor cells in the avian retina
Authors: Palazzo Isabella , Deistler Kyle , Hoang Thanh V. , Blackshaw Seth , Fischer Andy J.
Published: April 2020

Retinal regeneration is robust in some cold-blooded vertebrates, but this process is ineffective in warm-blooded vertebrates. Understanding the mechanisms that suppress the reprogramming of Müller glia into neurogenic progenitors is key to harnessing the regenerative potential of the retina. Inflammation and reactive microglia are known to influence the formation of Müller glia-derived progenitor cells (MGPCs), but the mechanisms underlying this interaction are unknown. We used the chick model in vivo to investigate Nuclear Factor kappa B (NF-κB) signaling, a critical regulator of inflammation, during the reprogramming of Müller glia into proliferating progenitors. We find that components of the NF-κB pathway are dynamically regulated by Müller glia after neuronal damage or treatment with growth factors. Inhibition of NF-κB enhances, whereas activation suppresses the formation of proliferating MGPCs. Following microglia ablation, the effects of NF-κB-agonists on MGPC-formation are reversed, suggesting that signals provided by reactive microglia influence how NF-κB impacts Müller glia reprogramming. We propose that NF-κB is an important signaling “hub” that suppresses the reprogramming of Müller glia into proliferating MGPCs and this “hub” coordinates signals provided by reactive microglia.
Development of Photoswitchable Fluorescent Molecules Using Arylazopyrazole
Authors: Torii Kenji , Hori Yuichiro , Watabe Keiichiro , Kikuchi Kazuya
Published: April 2020

Photoswitchable fluorescent molecules (PSFMs) are important tools for fluorescence imaging of biomolecules. To date, PSFMs have been applied for pulse-chase experiments and super-resolution imaging. However, most have limitations in that their fluorophores have low photostability or require cytotoxic additives. Here, we have developed PSFMs using a photochromic compound, arylazopyrazole, to overcome these limitations. These molecules showed reversible changes in fluorescence intensity upon photoirradiation and high photostability in aqueous solutions.
An ancient evolutionary connection between Ribonuclease A and EndoU families
Authors: Mushegian Arcady , Sorokina Irina , Eroshkin Alexey , Dlakić Mensur
Published: April 2020

The ribonuclease A family of proteins is well studied from the biochemical and biophysical points of view, but its evolutionary origins are obscure, as no sequences homologous to this family have been reported outside of vertebrates. Recently, the spatial structure of the ribonuclease domain from a bacterial polymorphic toxin was shown to be closely similar to the structure of vertebrate ribonuclease A. The absence of sequence similarity between the two structures prompted a speculation of convergent evolution of bacterial and vertebrate ribonuclease A-like enzymes. We show that bacterial and homologous archaeal polymorphic toxin ribonucleases with a known or predicted ribonuclease A-like fold are distant homologs of the ribonucleases from the EndoU family, found in all domains of cellular life and in viruses. We also detected a homolog of vertebrate ribonucleases A in the transcriptome assembly of the sea urchin Mesocentrotus franciscanus. These observations argue for the common ancestry of prokaryotic ribonuclease A-like and ubiquitous EndoU-like ribonucleases, and suggest a better-grounded scenario for the origin of animal ribonucleases A, which could have emerged in the deuterostome lineage, either by an extensive modification of a copy of an EndoU gene, or, more likely, by a horizontal acquisition of a prokaryotic immunity-mediating ribonuclease gene.
Formation and Implementation of Projects Approach in Integrated Structures in the Field of Medical Industry and Health
Authors: Gercik Yuriy , Kokueva Z.
Published: April 2020

The article is devoted to the study of the urgent scientific problem of efficiency and project management in various economic and production systems, including the cluster structures of the medical industry and healthcare. The role of competence of the project team is noted, a model for the formation of competencies of team members is developed. The examples of presentations at the All-Russian conferences on specialized topics show the importance of determining the role of lean production in the project, the prospects for its development in the cluster structure. The methodological basis of the work was the theory of project management, cluster theory and analysis of the prospects of their development. The information base of the study was articles in peer-reviewed journals, Internet data with the presence of specific speeches on the profile of the work presented, study guides and public websites of enterprises and organizations. Based on the results of the study, recommendations are made about the possibility of applying the research results in other areas of activity, in particular, in the educational sphere. The authors developed a model for the formation of the competence of the project team, a structural diagram of the formation and implementation of the project cycle of the cluster system in the field of the medical industry and healthcare, and scientific conclusions were formulated based on the results of the study.
A brief overview of recently published nursing and health articles
Authors: Welyczko Nikki
Published: April 2020

Nikki Welyczko, Associate Professor at the Faculty of Health and Life Sciences, De Montfort University, provides a brief overview of recently published nursing and health articles
Documenting specialist nursing practice: data need not be daunting
Authors: Russell-Roberts Paul
Published: April 2020

Specialist nurses can use quantitative data and validated assessment tools to make evidence-based decisions, improve patient outcomes and demonstrate value
Stoma support garments: a survey on patient information needs, product selection and equity of provision
Authors: Taylor Claire , Munro Julie , Goodman William , Beeken Rebecca , Dames Nicola , Oliphant Raymond , Watson Angus , Hubbard Gill
Published: April 2020

Many people with a stoma wear support garments, often a belt or underwear, to support the abdominal muscles, secure the stoma and conceal the appliance. There is some evidence that they reduce the risk of a parastomal hernia developing or getting worse. To investigate the experiences of UK adults living with a stoma regarding the use of support garments, a cross-sectional online survey was designed and distributed on social media and via a mailing list. The questionnaire was completed by 1528 people, 598 of whom answered a free-text question. These responses underwent thematic analysis. This article discusses the responses related to information provision, product selection and equity of provision, while separate articles discuss those related to the rationale for wearing stoma support garments. A third of respondents had not received any expert information on support garments and had to rely on their own research to make their selection. Of the 1004 who had received information, the main sources were stoma care nurses (73.4%), commercial suppliers (49.7%), peers (20.9%) and support groups (19.2%). Free-text comments indicated that respondents did not always feel they had been adequately counselled about support garments or shown the range available. Many respondents described restrictions being imposed on the number or range of products they could order. This study highlights the important role stoma care nursing specialists can play in assessment and review of support garments to ensure ostomates select the right product for their prescription.
Health inequalities and policy: the Marmot Review revisited
Authors: Harrison Penny
Published: April 2020

Penny Harrison, Senior Lecturer in Adult Nursing at De Montfort University, Leicester, discusses the impact of reports on health inequalities in the UK
Is it time to stop using desflurane?
Authors: Armstrong Fiona , Sebastian Joseph
Published: April 2020

Desflurane has a carbon equivalence 20 times greater than sevoflurane. This article discusses alternative anaesthetic techniques, including sevoflurane, xenon, total intravenous anaesthesia and regional techniques, and methods of reducing venting of gases, which might lower the environmental impact of anaesthesia.
Unusual presentations in patients with systemic lupus erythematosus: a result of disease activity or something else?
Authors: Rahman Anisur
Published: April 2020

Systemic lupus erythematosus can affect any organ or tissue, but skin manifestations, joint pain and fatigue are the most common symptoms. Two case reports in this issue describe patients with systemic lupus erythematosus who suffered severe internal organ manifestations.
Research roundup: April 2020
Authors: Odd Dawn , Willis Angela , Oakes Betheny
Published: April 2020

In this section, a range of brief synopses of recently published articles that may be of interest to health visitors is presented. The aim of this roundup is to provide an overview, rather than a detailed summary, of the research papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided.
Preventing bite injuries: Pet safety advice at home
Authors: Noakes Amy
Published: April 2020

In the UK there are approximately 9.9 million pet dogs. Amy Noakes looks at the importance for health visitors of discussing dog safety with families
A child health record audit of outcome comparisons for school screening referrals in Ireland
Authors: Pitt-Byrne Theresa , Roche Pauline
Published: April 2020

This study sought to make use of existing child health records to assess recent changes in school entry screening (hearing and vision) in Ireland. The study aims were to analyse screening protocol and staff changes; estimate newborn and school hearing screening yields; and summarise pre-school specialist referrals against later school screen outcomes. The findings included that specialist school public health nurses (PHNs) had lower hearing screen but similar vision screen referral rates compared to area public health nurses. Approximately 1% of school hearing screens had persistent otitis media, justifying audiology referral priority. Over a quarter of pre-school records audited showed a specialist referral, many with ‘speech-only delay’; this sub-group had average referral rates from later school (hearing) screening. This study found that by employing specialist school PHNs to manage school screening, audiology referrals were reduced. Additionally, pre-school speech delay without other relevant risk factors should not need automatic audiology referral.
That pesky nucleic acid molecule in a protein coat
Authors: Hanley Jane
Published: April 2020

In March it seemed not only surreal but impossible to comprehend that the coronavirus would ever venture near our shores – and yet here it is. Jane Hanley looks at the effects of the pandemic on the emotional wellbeing of parents and professionals alike
On the Existence of Hurwitz Polynomials with no Hadamard Factorization
Authors: Białas Stanisław , Góra Michał
Published: April 2020

A Hurwitz stable polynomial of degree $n\geq1$ has a Hadamard factorization if it is a Hadamard product (i.e., element-wise multiplication) of two Hurwitz stable polynomials of degree $n$. It is known that Hurwitz stable polynomials of degrees less than four have a Hadamard factorization. It is shown that, for arbitrary $n\geq4$, there exists a Hurwitz stable polynomial of degree $n$ which does not have a Hadamard factorization.