bluuebunny/crossref_metadata_2025 huggingface dataset:
Workplace Discrimination Experiences of Americans With Alcohol Use Disorders and Americans With Drug Use Disorders: A Comparative Analysis
Authors: Leslie Mykal , Osborn Cynthia J. , Rumrill Phillip , McMahon Brian
Published: November 2020

The purpose of this study was to investigate the patterns in allegations of workplace discrimination by individuals with alcohol use disorders (AUDs) relative to those with other drug use disorders (DUD). The goal of the research was to describe the uniqueness of workplace discrimination, both actual and perceived, that has occurred against individuals with AUD when compared to those with DUD through analysis of the U.S. Equal Employment Opportunity Commission (EEOC) Integrated Mission System (IMS) database. An ex post facto, causal comparative quantitative design was used to examine Americans with Disabilities Act Amendments Act (ADAAA) Title I complaints received by the EEOC from individuals with AUD ( n = 2,123) from 2009 through 2016 in comparison to ADAAA Title I complaints received from individuals with DUD ( n = 1,472) over the same time period. Results revealed statistically significant differences in the patterns of issues alleged by the two groups. The AUD charging parties (individuals who filed the complaints) were, on average, significantly older and involved fewer African Americans than did the DUD comparison group. Individuals with AUD were significantly less likely than the DUD group to achieve merit closures when investigations were completed. This means that the DUD group’s investigations were more often closed as favorable to the charging party. Implications for rehabilitation practice and further research are discussed.
Revisiting the Long Memory in Global Stock Market Returns: An Empirical Analysis
Authors: Mishra Ashok Kumar , Mishra Sibanjan
Published: November 2020

We present a multifarious view on the presence of long memory across 33 countries, subsampled as developed, emerging and frontier economies for the period 2000–2018. We employ the classical rescaled range test, and two semi-parametric tests proposed by Geweke Porter-Hudak (1983) and the frequency domain test proposed by Robinson (1995) to decipher the presence of long memory. The results confirm that while there exists no long-range dependence for developed countries, the return series in the emerging and the frontier countries display long memory characteristics. The rationale for such result emerges from market quality parameters such as size, liquidity, trading and settlement mechanism or sound regulatory framework. These results are of importance for the global investor community for asset allocation, risk management and portfolio diversification purposes.
COVID-19: Opportunities for interdisciplinary research to improve care for older people in Sweden
Authors: Baxter Rebecca , Jemberie Wossenseged Birhane , Li Xia , Naseer Mahwish , Pauelsen Mascha , Shebehe Jacques , Viklund Emilia W.E. , Xia Xin , Zulka Linn Elena , Badache Andreea
Published: November 2020

The emergence of COVID-19 has changed the world as we know it, arguably none more so than for older people. In Sweden, the majority of COVID-19-related fatalities have been among people aged ⩾70 years, many of whom were receiving health and social care services. The pandemic has illuminated aspects within the care continuum requiring evaluative research, such as decision-making processes, the structure and organisation of care, and interventions within the complex public-health system. This short communication highlights several key areas for future interdisciplinary and multi-sectorial collaboration to improve health and social care services in Sweden. It also underlines that a valid, reliable and experiential evidence base is the sine qua non for evaluative research and effective public-health systems.
Accounting for Culture in Policy Transfer: A Blueprint for Research and Practice
Authors: Bertram Daniel
Published: November 2020

In recent years, the burgeoning literature on transnational dissemination of policies has moved beyond orthodox models to incorporate the institutional context by means of social-constructivist approaches. This article engages in a critical review of the status quo by arguing for the importance of an overlooked key variable in policy transfer research: culture. Particularly, it is contended that culture plays an under-acknowledged role in co-shaping transfer dynamics both as a dependent and as an independent variable and consequently deserves a more thorough embedment in mainstream research. To this end, operational recommendations for how future studies can measure, incorporate, and isolate cultural factors are offered and a feasible research agenda is proposed.
Persistent Air Bubble Sequestered at the Silicone Oil–Silicone Intraocular Lens Interface as a Cause of Reversible Visual Distortion
Authors: Agranat Joshua S. , Eliott Dean
Published: November 2020

Purpose:

To report a novel cause of post-operative reversible visual distortion due to a persistent air bubble sequestered at the intraocular lens (IOL)–silicone oil interface.

Methods:

Two cases of persistent, sequestered air at the IOL-silicone oil interface were identified and reviewed. Relevant clinical information, images and surgical videos were analyzed and described.

Results:

Resolution of the visual distortion was achieved in both cases after silicone oil removal.

Conclusions:

Silicone oil adhesion to the posterior surface of silicone IOLs is a known cause of visual degradation. The IOL-silicone oil interface can sequester air that persists and causes visual distortion until the oil is removed. We report the first cases, to our knowledge, of reversible visual distortion due to sequestered air at the IOL-silicone oil interface.
Pathogen-reduced PRP blocks T-cell activation, induces Treg cells, and promotes TGF-β expression by cDCs and monocytes in mice
Authors: Tran Johnson Q. , Muench Marcus O. , Jackman Rachael P.
Published: November 2020

Alloimmunization against platelet-rich plasma (PRP) transfusions can lead to complications such as platelet refractoriness or rejection of subsequent transfusions and transplants. In mice, pathogen reduction treatment of PRP with UVB light and riboflavin (UV+R) prevents alloimmunization and appears to induce partial antigen-specific tolerance to subsequent transfusions. Herein, the in vivo responses of antigen-presenting cells and T cells to transfusion with UV+R-treated allogeneic PRP were evaluated to understand the cellular immune responses leading to antigen-specific tolerance. Mice that received UV+R-treated PRP had significantly increased transforming growth factor β (TGF-β) expression by CD11b+ CD4+ CD11cHi conventional dendritic cells (cDCs) and CD11bHi monocytes (P < .05). While robust T-cell responses to transfusions with untreated allogeneic PRP were observed (P < .05), these were blocked by UV+R treatment. Mice given UV+R-treated PRP followed by untreated PRP showed an early significant (P < .01) enrichment in regulatory T (Treg) cells and associated TGF-β production as well as diminished effector T-cell responses. Adoptive transfer of T-cell–enriched splenocytes from mice given UV+R-treated PRP into naive recipients led to a small but significant reduction of CD8+ T-cell responses to subsequent allogeneic transfusion. These data demonstrate that pathogen reduction with UV+R induces a tolerogenic profile by way of CD11b+ CD4+ cDCs, monocytes, and induction of Treg cells, blocking T-cell activation and reducing secondary T-cell responses to untreated platelets in vivo.
Recipient and renal allograft survival following living related-donor transplantation: a single center experience
Authors: Sharafeldeen Mohamed , Elgebaly Omar , Abou Youssif Tamer , Fahmy Ahmed , Elsaqa Mohamed , Abdelsalam Mohamed Said
Published: November 2020

Background

Despite improvements in surgical techniques of renal transplantation, still surgical complications remain a big challenge that might affect the post-transplant recipient and graft outcome. The aim of the current study was to retrospectively assess the surgical complications following living related kidney transplants in our center from 1990 to 2012 and determine their impact on long term recipient and graft survival.

Methods

We conducted a retrospective study of all live related-donor kidney transplants performed at our tertiary referral center between June 1990 and December 2012. Data regarding recipient demographics, details of surgical techniques, any reported complications and cumulative recipient and graft survival was analyzed.

Results

One hundred and four patients were included in the study whom we had access to their complete hospital records and they didn’t miss follow up. There were 41 surgical complications reported in 37 recipients, prevalence of 35.5%. Vascular and urologic complications were reported in 17(16.3%) and 11 (10.5%) recipients respectively. Lymphocele was post-operatively diagnosed in nine (8.7%) recipients. Recipient survival at 1 year and 5-year were 100% and 97% respectively. Graft survival at 1 year and at 5 years were 96% and 85.5% respectively. Surgical complications mentioned, other than renal artery thrombosis, had no statistically significant impact on the graft and recipient survival.

Conclusion

Although surgical complications post-transplantation are not rare, the resulting morbidity can be minimized by prompt management of complications. In general, the existence of surgical complications did not impact recipient or graft survival.
Impact of weight on stone-free rate during percutaneous nephrolithotomy
Authors: Abdrabuh Abdrabuh M.
Published: November 2020

Background

To assess Impact of weight on stone-free rate during percutaneous nephrolithotomy.

Methods

Hundred and twenty-three PNL procedures were done between January 2016 and July 2017. The patients were divided into four groups according to the World Health Organization (WHO) classification of body mass index (BMI): < 25 ((group 1, average)), 25–29.9 (group 2, overweight), 30–39.9 (group 3, obese), and ≥ 40 kg/m2 (group 4, morbidly obese). All groups were compared as regarding preoperative variables, intra-operative procedure and postoperative results.

Results

The non-obese groups were younger in age than obese and morbid obese groups (P = 0.005). The difference in BMI was statistically significant between non-obese and obese groups (P = 0.0001). Most of females gender were obese and morbid obese (P = 0.0001) and most of the obese patients had left-sided renal stone (P = 0.001). Most of overweight and obese groups had radiopaque stones (P = 0.02). There were no statistically significant differences between all groups as regarding co-morbidity, stone size, stone locations, and hydronephrosis grade. Operative time (P = 0.034), length of hospital stay (P value = 0.014) and fluoroscopy time (P = 0.0001) were statistically significant differences between all groups. Number of accesses, access site, postoperative hemoglobin drop, post- operative complications, fate of residual stones and stone-free rate were not statistically significant differences between all groups. BMI was correlated with mean fluoroscopy time and mean hospitalization duration in our study as the time of hospitalization and time of x-ray exposure increase with obesity.

Conclusion

PNL is a safe and effective procedure for obese patients. BMI do not predict clearance post PNL.
Hepatitis C virus infection in EU/EEA and United Kingdom prisons: opportunities and challenges for action
Authors: Nakitanda Aya Olivia , Montanari Linda , Tavoschi Lara , Mozalevskis Antons , Duffell Erika
Published: November 2020

Background

Hepatitis C virus (HCV) transmission in the European Union, European Economic Area and United Kingdom is driven by injecting drug use (IDU), which contributes to the high burden of chronic infection among people in prisons. This study aimed to describe the context, epidemiology and response targeting HCV in prisons across the region.

Methods

We retrieved and collated HCV-related data from the World Health Organization’s Health in Prisons European Database and the European Centre for Disease Prevention and Control’s hepatitis C prevalence database. Prisons population data were obtained from the Council of Europe Annual Penal Statistics on prison populations (SPACE I).

Results

There were 12 to 93,266 people in prisons, with rates of 31·5 to 234·9 per 100,000 population. Median age was between 31 and 40 years, with up to 72% foreign nationals. Average detention time ranged from one to 31 months. Ministries of Health had sole authority over prisons health, budget administration and funding in 27, 31 and 8% of 26 reporting countries, respectively. Seroprevalence of HCV antibodies ranged from 2·3% to 82·6% while viraemic infections ranged from 5·7% to 82%, where reported. Up to 25·8 and 44% reported current and ever IDU, respectively. Eight countries routinely offered HCV screening on an opt-out basis. Needle and syringe programmes were available in three countries. Among the nine countries with data, the annual number of those who had completed HCV treatment ranged between one and 1215 people in prisons.

Conclusions

HCV burden in prisons remains high, amidst suboptimal levels of interventions. Systematic monitoring at both local and regional levels is warranted, to advance progress towards the elimination of HCV in the region.
Medical crowdfunding in a healthcare system with universal coverage: an exploratory study
Authors: Lublóy Ágnes
Published: November 2020

Background

In recent years, crowdfunding for medical expenses has gained popularity, especially in countries without universal health coverage. Nevertheless, universal coverage does not imply covering all medical costs for everyone. In countries with universal coverage unmet health care needs typically emerge due to financial reasons: the inability to pay the patient co-payments, and additional and experimental therapies not financed by the health insurance fund. This study aims at mapping unmet health care needs manifested in medical crowdfunding campaigns in a country with universal health coverage.

Methods

In this exploratory study we assess unmet health care needs in Germany by investigating 380 medical crowdfunding campaigns launched onLeetchi.com. We combine manual data extraction with text mining tools to identify the most common conditions, diseases and disorders which prompted individuals to launch medical crowdfunding campaigns in Germany. We also assess the type and size of health-related expenses that individuals aim to finance from donations.

Results

We find that several conditions frequently listed in crowdfunding campaigns overlap with the most disabling conditions: cancer, mental disorders, musculoskeletal disorders, and neurological disorders. Nevertheless, there is no strong association between the disease burden and the condition which prompted individuals to ask for donations. Although oral health, lipoedema, and genetic disorders and rare diseases are not listed among leading causes of disability worldwide, these conditions frequently prompted individuals to turn to crowdfunding. Unmet needs are the highest for various therapies not financed by the health insurance fund; additional, complementary, and animal-assisted therapies are high on the wish list. Numerous people sought funds to cover the cost of scientifically poorly supported or unsupported therapies. In line with the social drift hypothesis, disability and bad health status being associated with poor socioeconomic status, affected individuals frequently collected donations for their living expenses.

Conclusions

In universal healthcare systems, medical crowdfunding is a viable option to finance alternative, complementary, experimental and scientifically poorly supported therapies not financed by the health insurance fund. Further analysis of the most common diseases and disorders listed in crowdfunding campaigns might provide guidance for national health insurance funds in extending their list of funded medical interventions. The fact of numerous individuals launching crowdfunding campaigns with the same diseases and disorders signals high unmet needs for available but not yet financed treatment. One prominent example of such treatment is liposuction for patients suffering from lipoedema; these treatments were frequently listed in crowdfunding campaigns and might soon be available for patients at the expense of statutory health insurance in Germany.
Rare pulmonary barotrauma after explosive decompression: a case report
Authors: Tlapák Jakub , Oniščenko Boris , Došel Petr , Požár Pavel , Chmátal Petr , Hájek Michal
Published: November 2020

Background

Pneumothorax as a consequence of pulmonary barotrauma during explosive decompression military crew training in a hypobaric chamber is an extremely rare and sparsely diagnosed complication. Extensive bilateral tissue damage is even more unexpected.

Case presentation

A 26-year-old active duty Air Force pilot was performing an explosive decompression simulation from 8000 ft. (2438.4 m) to 25,000 ft. (7620 m) in a 1.5 s interval. The training was interrupted due to the pilot’s apparent health complications. After transfer to the emergency department, a CT scan showed bilateral lung barotrauma with emphysema.

Conclusions

The case report shows extensive emphysema and pneumothorax after a rapid decompression done for training purposes. It is a possible but rare complication. The cause remains unclear, with suspicion of a predisposed lung disease.
Estimating the effect of optimizing anticancer drug vials on medical costs in Japan based on the data from a cancer hospital
Authors: Matsuo Koichi , Nomura Hisanaga , Uchiyama Masanobu , Miyazaki Motoyasu , Imakyure Osamu
Published: November 2020

Background

The substantial increase in the use of expensive anticancer drugs has been accompanied by an increase in the amount of disposing residual liquid from drug preparations. Many Western countries, including the United States, have implemented drug vial optimization (DVO) to prevent the waste of anticancer drugs and have reported the reductions in the total drug costs. This study was designed to estimate the expected reduction in spending on anticancer drugs by Japanese cancer hospitals when DVO was implemented instead of individual preparations and to test the effectiveness of this approach.

Methods

We investigated the doses of drugs used and quantity specifications for individually prepared vials for patients who received anticancer drug treatment in December 2017 at the Outpatient Treatment Center of the National Cancer Center Hospital East. Based on these findings, we calculated the total quantity of each drug used on a given day, and the minimum cost for preparation of the number of specified combinations corresponding to the total cost (DVO preparation). Based on the differences in these two costs, we estimated the economic impact of implementing DVO.

Results

While the cost for anticancer drugs for the 1-month study period was US$3,305,595 (US$1 = \110) for individual preparations, the estimated cost for DVO preparations was US$3,092,955, equivalent to a reduction of US$212,640.

Conclusions

Based on these study results, implementation of DVO-based preparation of injectable anticancer drugs in Japan in 2017 would have resulted in saving approximately US$460 million. This calculation revealed the need for the Japanese government to modify the methods employed to calculate drug costs in the insurance system and develop policies for the proper and optimal use of medical resources.
Non-utilization of health facility delivery and its correlates among childbearing women: a cross-sectional analysis of the 2018 Guinea demographic and health survey data
Authors: Ahinkorah Bright Opoku
Published: November 2020

Background

Many childbearing women in sub-Saharan African countries like Guinea still face challenges accessing and utilizing health facility delivery services and opt to deliver at home. This study examined the non-utilization of health facility delivery and its associated factors among childbearing women in Guinea.

Methods

Data from the 2018 Guinea Demographic and Health Survey was used in this study. Data of 5406 childbearing women were analysed using STATA version 14.2 by employing a multilevel logistic regression approach. The results were presented using adjusted odds ratios (aOR) at 95% confidence interval (CI).

Results

More than three-quarters (47.6%) of childbearing women in Guinea did not deliver at health facilities. Women who had no formal education (aOR = 1.52, 95% CI = 1.09–2.12), those whose partners had no formal education (aOR = 1.25, 95% CI =1.01–1.56), those whose pregnancies were unintended (aOR = 1.40, 95% CI =1.13–1.74) and those who were Muslims (aOR = 2.87, 95% CI =1.17–7.08) were more likely to deliver at home. Furthermore, women with parity four or more (aOR = 1.78, 95% CI =1.34–2.37), those who listened to radio less than once a week (aOR = 5.05, 95% CI =1.83–13.89), those who never watched television (aOR = 1.46, 95% CI =1.12–1.91), those with poorest wealth quintile (aOR = 4.29, 95% CI =2.79–6.60), women in female-headed households (aOR = 1.38, 95% CI =1.08–1.78) and rural dwellers (aOR = 3.86, 95% CI =2.66–5.60) were more likely to deliver at home.

Conclusion

This study has identified low socio-economic status, inadequate exposure to media, having an unplanned pregnancy and religious disparities as key predictors of home delivery among childbearing women in Guinea. The findings call for the need to enhance advocacy and educational strategies like focus group discussions, peer teaching, mentor-mentee programmes at both national and community levels for women to encourage health facility delivery. There is also the need to improve maternal healthcare services utilization policies to promote access to health facility delivery by reducing costs and making health facilities available in communities.
Identification of an immune gene signature for predicting the prognosis of patients with uterine corpus endometrial carcinoma
Authors: Zhou Cankun , Li Chaomei , Yan Fangli , Zheng Yuhua
Published: November 2020

Background

Uterine corpus endometrial carcinoma (UCEC) is a frequent gynecological malignancy with a poor prognosis particularly at an advanced stage. Herein, this study aims to construct prognostic markers of UCEC based on immune-related genes to predict the prognosis of UCEC.

Methods

We analyzed expression data of 575 UCEC patients from The Cancer Genome Atlas database and immune genes from the ImmPort database, which were used for generation and validation of the signature. We constructed a transcription factor regulatory network based on Cistrome databases, and also performed functional enrichment and pathway analyses for the differentially expressed immune genes. Moreover, the prognostic value of 410 immune genes was determined using the Cox regression analysis. We then constructed and verified a prognostic signature. Finally, we performed immune infiltration analysis using TIMER-generating immune cell content.

Results

The immune cell microenvironment as well as the PI3K-Akt, and MARK signaling pathways were involved in UCEC development. The established prognostic signature revealed a ten-gene prognostic signature, comprising of PDIA3, LTA, PSMC4, TNF, SBDS, HDGF, HTR3E, NR3C1, PGR, and CBLC. This signature showed a strong prognostic ability in both the training and testing sets and thus can be used as an independent tool to predict the prognosis of UCEC. In addition, levels of B cells and neutrophils were significantly correlated with the patient’s risk score, while the expression of ten genes was associated with immune cell infiltrates.

Conclusions

In summary, the ten-gene prognostic signature may guide the selection of the immunotherapy for UCEC.
New insights into malaria vector bionomics in Lao PDR: a nationwide entomology survey
Authors: Marcombe Sébastien , Maithaviphet Santi , Bobichon Julie , Phommavan Nothasin , Nambanya Simone , Corbel Vincent , Brey Paul T.
Published: November 2020

Background

In Laos, the malaria burden remains high despite a significant reduction of cases during the last decade. In the context of the disease elimination by 2030, a nationwide entomological survey was conducted to better understand the distribution, abundance and behaviour of major malaria vectors (Anopheles spp.) in the country.

Methods

Mosquito collections were implemented in ten villages from ten provinces during the rainy and dry seasons of 2014 and 2015 by using human landing catch (HLC) and cow bait collection (CBC) methods. After morphological identification in the field, molecular identification of the sibling species of Anopheles mosquitoes from the Funestus, Leucosphyrus, and Maculatus groups were determined using PCR specific alleles. A screening of Plasmodium falciparum and Plasmodium vivax infections in the vectors was carried out by quantitative PCR assays.

Results

A total of 14,146 adult mosquitoes representing 25 different Anopheles species were collected and morphologically identified. Molecular identification revealed the presence of 12 sibling species within the main primary vector groups, including Anopheles maculatus, Anopheles rampae, Anopheles sawadwongporni, Anopheles pseudowillmori, Anopheles dravidicus, Anopheles minimus, Anopheles aconitus, Anopheles pampanai, Anopheles harrisoni, Anopheles dirus, Anopheles baimaii, Anopheles nemophilous. Anopheles maculatus and An. minimus were predominant during both the dry and rainy seasons, but showed highly zoophilic preferences (Zoophilic index of 98% and 95%, respectively). Overall, 22% of the total malaria vectors were collected between 10:00 PM and 5:00 AM indoors when people are sleeping. Twenty-seven percent of primary and secondary vectors were collected outdoors before 10:00 PM or after 5:00 AM, times when people are usually awake and outdoors. Only two specimens were positive for P. falciparum, one An. aconitus from Phongsaly and one An. minimus from Vientiane Province

Conclusions

The results indicate that people living in rural areas in Laos are constantly exposed to malaria vectors throughout the year and specifically outdoors. The use of LLINs/IRS remains important but innovative tools and new strategies are needed to address locally, the early and outdoor malaria transmission. Lack of expertise in general entomological methods may further exacerbate the situation.
Emerging agents and regimens for multiple myeloma
Authors: Yang Yang , Li Yi , Gu Huiyao , Dong Mengmeng , Cai Zhen
Published: November 2020

The outcomes of multiple myeloma (MM) have been improved significantly with the therapies incorporating proteasome inhibitors (PI), immunomodulatory drugs, monoclonal antibodies (MoAb) and stem cell transplantation. However, relapsed and refractory MM (RRMM) remains a major challenge. Novel agents and regimens are under active clinical development. These include new PIs such as ixazomib, marizomib, and oprozomib; new MoAbs such as isatuximab and MOR202; novel epigenetic agent ricolinostat and novel cytokines such as siltuximab. Recently, the first XPO-1 inhibitor, selinexor, was approved for RRMM. BCMA-targeted BiTE, antibody–drug conjugates and CAR-T cells have the potential to revolutionize the therapy for RRMM. In this review, we summarized the latest clinical development of these novel agents and regimens.
Combination of SB431542, Chir9901, and Bpv as a novel supplement in the culture of umbilical cord blood hematopoietic stem cells
Authors: Zarrabi Morteza , Afzal Elaheh , Asghari Mohammad Hassan , Ebrahimi Marzieh
Published: November 2020

Background

Small molecule compounds have been well recognized for their promising power in the generation, expansion, and maintenance of embryonic or adult stem cells. The aim of this study was to identify a novel combination of small molecules in order to optimize the ex vivo expansion of umbilical cord blood-derived CD34+ cells.

Methods

Considering the most important signaling pathways involved in the self-renewal of hematopoietic stem cells, CB-CD34+ cells were expanded with cytokines in the presence of seven small molecules including SB, PD, Chir, Bpv, Pur, Pμ, and NAM. The eliminativism approach was used to find the best combination of selected small molecules for effective ex vivo expansion of CD34+ cell. In each step, proliferation, self-renewal, and clonogenic potential of the expanded cells as well as expression of some hematopoietic stem cell-related genes were studied. Finally, the engraftment potential of expanded cells was also examined by the mouse intra-uterine transplantation model.

Results

Our data shows that the simultaneous use of SB431542 (TGF-β inhibitor), Chir9901 (GSK3 inhibitor), and Bpv (PTEN inhibitor) resulted in a 50-fold increase in the number of CD34+CD38− cells. This was further reflected in approximately 3 times the increase in the clonogenic potential of the small molecule cocktail-expanded cells. These cells, also, showed a 1.5-fold higher engraftment potential in the peripheral blood of the NMRI model of in utero transplantation. These results are in total conformity with the upregulation of HOXB4, GATA2, and CD34 marker gene as well as the CXCR4 homing gene.

Conclusion

Taken together, our findings introduce a novel combination of small molecules to improve the yield of existing protocols used in the expansion of hematopoietic stem cells.
Why did EFSA not reduce its ADI for aspartame or recommend its use should no longer be permitted?
Authors: Millstone Erik Paul , Dawson Elisabeth
Published: November 2020

On behalf of the European Food Safety Authority (EFSA), Kass and Lodi recently published a letter purporting to ‘refute’ our July 2019 analysis of EFSA’s December 2013 assessment of the risks of aspartame. We had previously claimed inter alia that the EFSA panel had evaluated studies that had indicated that aspartame might be harmful far more sceptically than those that had not indicated harm. We reported that EFSA had deemed every one of 73 studies suggesting harm to have been unreliable. Kass and Lodi provided a tabulation with figures that differed from ours in every detail. This commentary shows that, while Kass and Lodi provided a response to our analysis, they have not come close to refuting it. Our analysis provided detailed characterisations of each of the studies and how the panel interpreted them, but Kass and Lodi provide no corresponding information at all. Kass and Lodi claim that EFSA deemed 21 of 35 studies that had indicated possible harm to have been reliable. But if that is so, we now ask: why did the EFSA panel not recommend that aspartame should be banned, or at least tightly restricted?
Incidence and risk factors of postdural puncture headache: prospective cohort study design
Authors: Weji Bedilu Girma , Obsa Mohammed Suleiman , Melese Kidest Getu , Azeze Gedion Asnake
Published: November 2020

Background

Postdural puncture headache is one of the complications following spinal anesthesia and accidental dural puncture. Several modifiable risk factors contribute to the development of headache after lumbar puncture, which includes needle size, needle design, direction of the bevel, and number of lumbar puncture attempts. This study aimed to assess the incidence and risk of postdural puncture headache.

Methods

This prospective cohort study design was conducted using a consecutive sampling method. Regular supervision and follow-up were performed. Data were entered into Epi info version 7 software and transported to SPSS version 20 for analysis. The odds ratio and 95% confidence interval were computed. The findings of the study were reported using tables, figures, and narrations. Variables that were found to be candidates (p value < 0.25) on binary logistic regression entered into a multiple logistic regression analysis to identify independent predictors of postdural puncture headache.

Results

One hundred fifty eligible study participants were included in our study, of which 28.7% had developed postdural puncture headache. This study found that needle size, number of cerebrospinal fluid drops, and multiple attempts were significant independent predictors of postdural puncture headache (p < 0.05). In addition, twenty-five needles were identified as the strongest preoperative independent predictor of postdural puncture headache (AOR = 4.150, CI = 1.433–12.021)

Conclusions

A recent study revealed that a small spinal needle was much better than a large cutting spinal needle regarding the frequency of postdural puncture headache. In addition, frequent attempts during lumbar puncture and increased cerebrospinal fluid leakage were associated with the events. In view of this, we recommend the use of a small spinal needle to avoid more leakage of cerebrospinal fluid and multiple attempts at spinal anesthesia and lumbar puncture.
The carbapenem resistance gene blaOXA-23 is disseminated by a conjugative plasmid containing the novel transposon Tn6681 in Acinetobacter johnsonii M19
Authors: Zong Gongli , Zhong Chuanqing , Fu Jiafang , Zhang Yu , Zhang Peipei , Zhang Wenchi , Xu Yan , Cao Guangxiang , Zhang Rongzhen
Published: November 2020

Background

Carbapenem resistant Acinetobacter species have caused great difficulties in clinical therapy in the worldwide. Here we describe an Acinetobacter johnsonii M19 with a novel blaOXA-23 containing transposon Tn6681 on the conjugative plasmid pFM-M19 and the ability to transferand carbapenem resistance.

Methods

A. johnsonii M19 was isolated under selection with 8 mg/L meropenem from hospital sewage, and the minimum inhibitory concentrations (MICs) for the representative carbapenems imipenem, meropenem and ertapenem were determined. The genome of A. johnsonii M19 was sequenced by PacBio RS II and Illumina HiSeq 4000 platforms. A homologous model of OXA-23 was generated, and molecular docking models with imipenem, meropenem and ertapenem were constructed by Discovery Studio 2.0. Type IV secretion system and conjugation elements were identified by the Pathosystems Resource Integration Center (PATRIC) server and the oriTfinder. Mating experiments were performed to evaluate transfer of OXA-23 to Escherichia coli 25DN.

Results

MICs of A. johnsonii M19 for imipenem, meropenem and ertapenem were 128 mg/L, 48 mg/L and 24 mg/L, respectively. Genome sequencing identified plasmid pFM-M19, which harbours the carbapenem resistance gene blaOXA-23 within the novel transposon Tn6681. Molecular docking analysis indicated that the elongated hydrophobic tunnel of OXA-23 provides a hydrophobic environment and that Lys-216, Thr-217, Met-221 and Arg-259 were the conserved amino acids bound to imipenem, meropenem and ertapenem. Furthermore, pFM-M19 could transfer blaOXA-23 to E. coli 25DN by conjugation, resulting in carbapenem-resistant transconjugants.

Conclusions

Our investigation showed that A. johnsonii M19 is a source and disseminator of blaOXA-23 and carbapenem resistance. The ability to transfer blaOXA-23 to other species by the conjugative plasmid pFM-M19 raises the risk of spread of carbapenem resistance.

Graphic abstract

The carbapenem resistance gene blaOXA-23 is disseminated by a conjugative plasmid containing the novel transposon Tn6681 in Acinetobacter johnsonii M19.
Carriership of two copies of C9orf72 hexanucleotide repeat intermediate-length alleles is a risk factor for ALS in the Finnish population
Authors: Kaivola Karri , Salmi Samuli J. , Jansson Lilja , Launes Jyrki , Hokkanen Laura , Niemi Anna-Kaisa , Majamaa Kari , Lahti Jari , Eriksson Johan G. , Strandberg Timo , Laaksovirta Hannu , Tienari Pentti J.
Published: November 2020

The hexanucleotide repeat expansion in intron 1 of the C9orf72 gene causes amyotrophic lateral sclerosis (ALS) and frontotemporal dementia. In addition to the effects of the pathogenic expansion, a role of intermediate-length alleles has been suggested in ALS, corticobasal degeneration and Parkinson’s disease. Due to the rarity of intermediate-length alleles with over 20 repeats and the geographical variability in their frequency, large studies that account for population stratification are needed to elucidate their effects. To this aim, we used repeat-primed PCR and confirmatory PCR assays to determine the C9orf72 repeat allele lengths in 705 ALS patients and 3958 controls from Finland. After exclusion of expansion carriers (25.5% of the ALS patients and 0.2% of the controls), we compared the frequency of intermediate-length allele carriers of 525 ALS cases and 3950 controls using several intermediate-length allele thresholds (7–45, 17–45, 21–45, 24–45 and 24–30). The carriership of an intermediate-length allele did not associate with ALS (Fisher’s test, all p ≥ 0.15) nor was there any association with survival (p ≥ 0.33), when we divided our control group into three age groups (18–65, 66–84 and 85–105 years). Carriership of two intermediate-length alleles was associated with ALS, when the longer allele was ≥ 17 repeats (p = 0.002, OR 5.32 95% CI 2.02–14.05) or ≥ 21 repeats (p = 0.00016, OR 15.21 95% CI 3.79–61.0). Our results show that intermediate-length alleles are a risk factor of ALS when present in both alleles, whereas carrying just one intermediate-length allele was not associated with ALS or survival.
Future dynamic sea level change in the western subtropical North Pacific associated with ocean heat uptake and heat redistribution by ocean circulation under global warming
Authors: Suzuki Tatsuo , Tatebe Hiroaki
Published: November 2020

In the present study, the relative importance of ocean heat uptake and heat redistribution on future sea level changes in the western North Pacific has been reconciled based on a set of climate model experiments in which anomalous surface fluxes of wind stress, heat, and freshwater in a warmed climate are separately given to those fluxes in a pre-industrial control simulation. Our findings suggest that the basin-wide ocean heat uptake and resultant heat accumulation by the climatological-mean advection are required to explain the future dynamic sea level (DSL) rise in the western subtropical North Pacific caused by the thermal expansion of subtropical mode water (STMW). At the same time, it has been recognized that the localized heat uptake in association with the wintertime mixed-layer formation around the Kuroshio Extension can be solely attributed to the future STMW change. The thermally induced component is a dominant contribution to the future DSL rise in the western subtropical North Pacific compared to the contributions of wind-induced and halosteric components, which, especially the former, have been reported as a dominant factor resulting from a linear response of the ocean to the northward shift and strengthening of the mid-latitude westerly over the North Pacific in a warmed climate.
Lessons learned from implementing the pilot Micronutrient Powder Initiative in four districts in Ghana
Authors: Kyei-Arthur Frank , Situma Ruth , Aballo Jevaise , Mahama Abraham B. , Selenje Lilian , Amoaful Esi , Adu-Afarwuah Seth
Published: November 2020

Background

Micronutrient deficiencies affect many children in low-income settings due primarily to over-reliance on complementary foods low in nutrients. Home-fortification (HF) could improve children’s diet quality in these settings. The Ghana Health Service, supported by UNICEF, integrated the pilot Micronutrient Powder Initiative (MPI) into Child Welfare Clinic (CWC) services in four districts (Tain, Tolon, Talensi, and Ho West), whereby micronutrient powder (MNP) is supplied for HF for children aged 6–23 months attending CWCs. This study’s main aim was to identify the facilitators, barriers and “lessons learned” after 2 years of program implementation.

Methods

This was a qualitative cross-sectional study. MNP distributed and children enrolled were obtained from program records. Primary data were collected from November to December 2019 and included, by district: interviews with senior program staff; key informant interviews and focus group discussion with caregivers in each of 6 sub-districts; and discussions workshop with frontline staff from at least 10 health facilities. Besides field notes, all interactions were audio-recorded and transcribed verbatim. Qualitative data were analyzed using NVivo10.

Results

The MPI remains on-going, with about 2.5 million MNP sachets distributed to nearly 30,000 children within 90 district-months. Caregivers generally accept the MNP; reported positive responses in children include: “increased appetite”, “less frequent illnesses, “increased energy/strength”, “increased weight”, and “walking independently relatively early”. Main facilitators are: generally regular MNP availability; increased patronage of CWC services; various contact points for supplying MNPs; fairly strong social mobilization strategy; good integration of MPI with CWC services; “one-on-one” counselling for caregivers reporting side effects; and tracing caregivers to address concerns and monitor adherence. Main barriers are: lack of counselling materials; caregivers’ suspicions towards the program; absence of refresher training for frontline workers; and perceived MNP side-effects. Key lessons learned are: incorporating MNPs into CWC services is feasible, acceptable, and could reduce child micronutrient deficiencies in program districts; and MPI’s success requires stronger community sensitization, equipping frontline workers to advise caregivers and manage side-effects, and consciously identifying and managing logistical challenges.

Conclusion

Further research is needed to evaluate the effectiveness of the MPI in reducing micronutrient deficiencies among 6–23-months-olds in Ghana.
Permanent or temporary settlement? A study on the short-term effects of residence status on refugees’ labour market participation
Authors: Jutvik Kristoffer , Robinson Darrel
Published: November 2020

Whether refugees in need of protection should be granted long- or short-term residence permits in the host country upon arrival is a long-standing debate in the migration policy and scholarly literature. Rights-based models of inclusion advocate for secure and long-term residency status arguing that this will provide the foundations for successful inclusion. Responsibilities-based models on the other hand claim that migrants should only be granted such status if certain criteria, such as full-time employment, have been met, again under the belief that such a system will facilitate inclusion into the host society. Using a sudden policy change as a natural experiment combined with detailed Swedish registry data, we examine the effect permanent residency on three measures of labour market inclusion in the short-term. Our findings are twofold. On the one hand, we find that temporary residents that are subject to a relatively less-inclusive situation have higher incomes and less unemployment. However, at the same time, they are less likely to spend time in education than are those with permanent residency.

First part title

Permanent or Temporary Settlement?

Second part title

A Study on the Short-Term Effects of Temporary and Permanent Residence Permits on Labour Market Participation
Optimal load frequency control through combined state and control gain estimation for noisy measurements
Authors: Pillai Anju G. , Samuel Elizabeth Rita , Unnikrishnan A.
Published: November 2020

Combined estimation of state and feed-back gain for optimal load frequency control is proposed. Load frequency control (LFC) addresses the problem of controlling system frequency in response to disturbance, and is one of main research areas in power system operation. A well acknowledged solution to this problem is feedback stabilization, where the Linear Quadratic Regulator (LQR) based controller computes the feedback gain K from the known system parameters and implements the control, assuming the availability of all the state variables. However, this approach restricts control to cases where the state variables are readily available and the system parameters are steady. Alternatively, by estimating the states continuously from available measurements of some of the states, it can accommodate dynamic changes in the system parameters. The paper proposes the technique of augmenting the state variables with controller gains. This introduces a non-linearity to the augmented system and thereby the estimation is performed using an Extended Kalman Filter. This results in producing controller gains that are capable of controlling the system in response to changes in load demand, system parameter variation and measurement noise.
Studies on mycosis of Metarhizium (Nomuraea) rileyi on Spodoptera frugiperda infesting maize in Andhra Pradesh, India
Authors: Visalakshi M. , Varma P. Kishore , Sekhar V. Chandra , Bharathalaxmi M. , Manisha B. L. , Upendhar S.
Published: November 2020

Background

Mycosis on the fall armyworm, Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae), infecting maize was observed in research farm of Regional Agricultural Research Station, Anakapalli from October 2019 to February 2020.

Main body

High relative humidity (94.87%), low temperature (24.11 °C), and high rainfall (376.1 mm) received during the month of September 2019 predisposed the larval instars for fungal infection and subsequent high relative humidity and low temperatures sustained the infection till February 2020. An entomopathogenic fungus (EPF) was isolated from the infected larval instars as per standard protocol on Sabouraud’s maltose yeast extract agar and characterized based on morphological and molecular analysis. The fungus was identified as Metarhizium (Nomuraea) rileyi based on ITS sequence homology and the strain was designated as AKP-Nr-1. The pathogenicity of M. rileyi AKP-Nr-1 on S. frugiperda was visualized, using a light and electron microscopy at the host-pathogen interface. Microscopic studies revealed that all the body parts of larval instars were completely overgrown by white mycelial threads of M. rileyi, except the head capsule, thoracic shield, setae, and crotchets. The cadavers of larval instars of S. frugiperda turned green on sporulation and mummified with progress in infection. In vitro pathogenicity tests revealed the potential of AKP-Nr-1 strain of M. rileyi in management of S. frugiperda.

Short conclusion

The results indicated the potential of M. rileyi AKP-Nr-1 as biocontrol agent for management of the fall armyworm. This AKP-Nr-1 strain of M. rileyi needs further evaluation under field conditions to evaluate its efficacy against S. frugiperda and its effects on other hosts.
Gastrointestinal presentation of COVID-19 in a pediatric heart transplant recipient
Authors: Helal Abdelmonem , Elmahrouk Ahmed F. , Jamjoom Ahmed A. , Al-Ata Jameel A.
Published: November 2020

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated coronavirus disease 2019 (COVID-19) most commonly causes a mild respiratory illness; however, there are wide ranges of presenting symptoms and disease severity. It has a mortality rate around 7%.

Case presentation

We present a case of a 9-year-old female patient with hypoplastic left heart syndrome status post heart transplantation at age of 7 days. She presented to our emergency room complaining of intermittent fever, chills, fatigue, poor appetite, and diarrhea.

A throat swab nucleic acid test was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Intravenous fluids therapy was used for correction of hydration status. To the best of our knowledge this is the first reported case of non-pulmonary presentation of coronavirus disease-2019 (COVID-19) in a pediatric heart transplant recipient, which was successfully managed conservatively.

Conclusions

Gastrointestinal manifestations can be the only presenting symptom in pediatric heart transplant recipients with COVID-19. Conservative treatment could be used successfully. Immunomodulatory medications that are used in heart transplant recipients may have protective value in SARS-CoV-2 infection.