bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving Notifiable Disease Case Reporting Through Electronic Information Exchange–Facilitated Decision Support: A Controlled Before-and-After Trial
Authors: Dixon Brian E. , Zhang Zuoyi , Arno Janet N. , Revere Debra , Joseph Gibson P. , Grannis Shaun J.
Published: April 2020

Objective

Outbreak detection and disease control may be improved by simplified, semi-automated reporting of notifiable diseases to public health authorities. The objective of this study was to determine the effect of an electronic, prepopulated notifiable disease report form on case reporting rates by ambulatory care clinics to public health authorities.

Methods

We conducted a 2-year (2012-2014) controlled before-and-after trial of a health information exchange (HIE) intervention in Indiana designed to prepopulate notifiable disease reporting forms to providers. We analyzed data collected from electronic prepopulated reports and “usual care” (paper, fax) reports submitted to a local health department for 7 conditions by using a difference-in-differences model. Primary outcomes were changes in reporting rates, completeness, and timeliness between intervention and control clinics.

Results

Provider reporting rates for chlamydia and gonorrhea in intervention clinics increased significantly from 56.9% and 55.6%, respectively, during the baseline period (2012) to 66.4% and 58.3%, respectively, during the intervention period (2013-2014); they decreased from 28.8% and 27.5%, respectively, to 21.7% and 20.6%, respectively, in control clinics ( P < .001). Completeness improved from baseline to intervention for 4 of 15 fields in reports from intervention clinics ( P < .001), although mean completeness improved for 11 fields in both intervention and control clinics. Timeliness improved for both intervention and control clinics; however, reports from control clinics were timelier (mean, 7.9 days) than reports from intervention clinics (mean, 9.7 days).

Conclusions

Electronic, prepopulated case reporting forms integrated into providers’ workflow, enabled by an HIE network, can be effective in increasing notifiable disease reporting rates and completeness of information. However, it was difficult to assess the effect of using the forms for diseases with low prevalence (eg, salmonellosis, histoplasmosis).
Acute hematogenous osteomyelitis in pediatric patients: epidemiology and risk factors of a poor outcome
Authors: Popescu Bogdan , Tevanov Iulia , Carp Madalina , Ulici Alexandru
Published: April 2020

Objective

Acute hematogenous osteomyelitis (AHO) has declining incidence in developed countries. AHO can cause rapid destruction of bone that can lead to functional impairment or even death if misdiagnosed and not treated urgently. In this study, we aimed to identify the main factors that may lead to a poor outcome and to establish a profile of patients with AHO who might have a negative outcome.

Methods

We conducted a retrospective single-center study including 94 patients with AHO, over a 10-year interval. Complete medical history including age at diagnosis, sex, socioeconomic status, symptoms, entry portal, pathogenic agent, location of infection, radiological features, treatment, and outcome were recorded.

Results

Male predominance was observed, with boys from rural areas more prone to a poor outcome. This is likely because they are more exposed to trauma and do not have proper access to emergency medical care. Staphylococcus aureus was the most common etiologic agent, with 84 patients testing positive. Disease evolution was toward chronicity in patients diagnosed late. The most frequent complications were sepsis and pathological fractures.

Conclusions

In our study, patients with negative outcomes were characterized by young age, repeated negative cultures, delayed surgery, rural residence, and male sex.
Thyroid cancer surgery – in what direction are we going? A mini-review
Authors: Kaliszewski Krzysztof , Wojtczak Beata , Sutkowski Krzysztof , Rudnicki Jerzy
Published: April 2020

The prevalence of thyroid cancer, especially in women, is increasing dramatically. Therefore, patients often undergo thyroidectomy upon diagnosis. However, the cosmetic outcome after surgery is of particular concern for many patients. Thus, minimally invasive procedures for treating thyroid disease have been established in recent decades. Total endoscopic and robotic procedures have been slowly and successively introduced while meeting all oncological criteria. Our analysis of the advantages and disadvantages of scarless surgical procedures suggests that the cosmetic aspects of these surgeries will continue to become more important. This review assesses the recent findings regarding the roles of endoscopic and robotic procedures in thyroid cancer surgery.
The sustainability of a quality improvement initiative
Authors: Belostotsky Veronica , Laing Catherine , White Deborah E.
Published: April 2020

Functional decline in seniors admitted to hospital is due in part to lack of mobilization. Many Quality Improvement (QI) initiatives targeting mobilization of the elderly population in acute care exist; however, their long-term effectiveness is not well-documented. Mobilization of Vulnerable Elders (MOVE) was a grant-funded initiative that started in Ontario and spread to Alberta. The primary objective of this project was to ascertain the sustainability of the MOVE project 1 year post implementation at two hospital sites in Alberta, Canada. Qualitative and quantitative cross-sectional data were gathered from multidisciplinary healthcare professionals. Our findings suggest MOVE was not well-sustained one year post implementation. Examination of specific survey questions provided an indication of strengths and weaknesses of the MOVE QI. Sustainable and cost-effective QI targeted at this elderly patient demographic could alleviate some of the demand on the healthcare system. Modifications to improve the sustainability of MOVE are summarized.
Public health physician perspectives on developing and deploying clinical practice guidelines during the 2009 H1N1 pandemic
Authors: Bandara Thilina , Musto Richard , Kancir Jesse , Neudorf Cordell
Published: April 2020

During the H1N1 outbreak of 2009, local public health units engaged in consultations with various levels of government to develop clinical practice guidelines. These guidelines provide specific clinical considerations around prevention, management, and treatment associated with the particular pathogen involved and are used by frontline healthcare professionals across many healthcare settings. In this article, we report on the lessons learned by Medical Officers of Health from across Canada on the guideline development and deployment processes and provide suggestions to improve guidelines development and deployment during future pandemic situations.
An intelligent optimization control method for the electrode current of submerged arc furnaces based on case reasoning
Authors: He Jianjun , Wang Chang , Zhu Qi , Shen Ling , Jing Mande , Gui Weihua
Published: April 2020

Due to the nonlinearity, strong coupling, and time-varying characteristics of three-phase electrode lift system of submerged arc furnace, the existing manual operation has the problems of electrode control hysteresis, poor balance of three-phase electrode current, and blindness of electrode current target setting. An intelligent optimization control method for the electrode current of submerged arc furnace based on case reasoning is proposed in this article, which is used to realize the automatic control of the electrode control system of the submerged arc furnace. First, the optimization model of electrode current setting value of the submerged arc furnace is established by the case-based reasoning method, and the corresponding electrode current value is calculated to maximize the yield in the safe power range of the furnace. Next, a three-phase electrode current decoupling controller is designed based on fuzzy rules. Finally, an intelligent optimization control system of three-phase electrode current of submerged arc furnace is designed and its superiority is verified by comparison with the proportional–integral–derivative controller. The designed control system has been applied to the smelting production of submerged arc furnace in a domestic smelter. The simulation and industrial operation results show that the system realizes automatic balance adjustment of electrode current of submerged arc furnace under normal working conditions, which greatly reduces the labor intensity of the operator, increases the smelting yield, reduces the unit energy consumption, and brings significant economic and social benefits to the enterprise.
The departed militant: A portrait of joy, violence and political evil
Authors: Austin Jonathan Luke
Published: April 2020

This is an essay about the personhood of militant violence, the phenomenological underpinnings of political evil and the friendship between two men. It begins by recounting the author’s street-side meeting with several Islamist militants in Tripoli, Lebanon, one of whom later described his preparations to become a ‘martyr’ in Syria. The essay takes my conversations with this man and his friends as a means of exploring the becoming of violent militancy as a fundamentally creative and essentially joyful series of encounters that lead to the emergence of extreme violence. To do so, I read the narrative account at the centre of the essay through the concept of social and political ‘fracturing’, which is described as the process through which individuals or groups are able to transcend traditional limits on knowledge, action and belief. This discussion of social and political fracturing is then brought into conversation with the question of what constitutes social or political evil in order to demonstrate that debates over what produces violent militant mobilization have generally missed the crucial relevance of a set of small, intimate and embodied rituals that suffuse evil, violence and war-fighting more generally with a fundamentally positive (yet eventually destructive) phenomenology.
Financial Globalization and Economic Growth in South Asia
Authors: Bhanumurthy N. R. , Kumawat Lokendra
Published: April 2020

The article examines relationship between financial globalization and economic growth in South Asian countries namely Bhutan, Bangladesh, India, Maldives, Nepal, Pakistan and Sri Lanka. Following the framework of Bekaert et al. (2005) and with the help of Panel VAR and Panel causality (in GMM framework) models the study concludes that the causation from financial globalization to growth in the region appears to be weak. There appears reverse causation running from growth to financial globalization. We found that domestic macroeconomic policies such as fiscal prudence act as pull factors for foreign capital. The article has some interesting results at individual country level.

JEL: C33, F21, F36, F65
Understanding Stress-Strain Behavioral Change in Fabrics for Compression Bandaging
Authors: Ruznan Wan Syazehan , Laing Raechel M. , Lowe Bronwyn J. , Wilson Cheryl A. , Jowett Timothy J.
Published: April 2020

Bandages are common in many health-related treatments, including management of edema of the lower limb where they may remain in place for several days. The behavior of 2 bandage fabrics was investigated after exposure for up to 5 days to a multiaxial extension laboratory setup on a tensile tester in compression mode. The fabrics were extended 20% and remained under that machine setting. Stress-relaxation over time was determined by analyzing the rate of change over 24 hours and over 5 days. Most change, a rapid drop in force, occurred during the first 15 minutes; thereafter, for the next 12-hour period, a slower rate of decrease was observed. Both fabrics continued to relax gradually during the next 12 hours and continued to do so for up to 5 days. Little further change was evident during the last 12 hours or so. This phenomenon suggests that rewrapping may be appropriate (albeit not practical) after 12 hours of compression therapy to optimize the compression given to the lower leg. Relaxation behavior of these 2 fabrics can be explained using the generalized Maxwell-Wiechert model.
Xiao-Ai-Ping Injection Enhances Effect of Paclitaxel to Suppress Breast Cancer Proliferation and Metastasis via Activating Transcription Factor 3
Authors: Chen Junjun , Zhang Xiangqi , Xiao Xiao , Ding Yawei , Zhang Wei , Shi Meizhi , Yang Jiao , Liu Ying , Han Yonglong
Published: April 2020

Chemotherapy is an effective treatment for invasive breast cancer. Paradoxically, many recently published findings showed that the first-line chemotherapeutic agent paclitaxel (PTX) showed pro-metastatic effects in the progress of treating breast cancer. Xiao-Ai-Ping (XAP) injection, composed of a traditional herbal medicine, Marsdenia tenacissimae extract, is known to exert antitumor effects on various cancers. However, there are few experimental studies on breast cancer. The underlying mechanism of the antitumor effect of XAP combined with chemotherapy agents has not been fully understood. In the present study, we sought to find the antitumor effects of XAP combined with PTX in vitro and in vivo. The data demonstrated that the combination of XAP with PTX resulted in remarkable enhancement of the pro-apoptotic, migration-inhibiting, and anti-invasive effects of PTX in vitro. Significantly, further study showed the overexpression of ATF3 in PTX-treated cell, while XAP counteracted the change of ATF3 induced by PTX. Moreover, it showed that combination treatment could promote the inhibition of tumor growth in MDA-MB-231 cell xenograft mouse model. Compared with PTX treatment, the downregulation of ATF3 indicated that ATF3 played a pivotal role in the combination of XAP with PTX to exert a synergistic effect. Overall, it is expected that PTX combined with XAP may serve as an effective agent for antitumor treatment, and dampening ATF3 maybe a potential strategy to improve the efficacy of PTX.
Femme Fatales: Girl Gangsters and Violent Street Culture in Cape Town
Authors: Dziewanski Dariusz
Published: April 2020

This article examines the ways that 21 girl gangsters perform violent street culture in Cape Town, South Africa. It examines their participation in the city’s township gangs, with a particular focus on female involvement in gang-related acts of aggression and violence. Research looks to move beyond portrayals of girl gangsters in Cape Town as either victims or accessories. It shows how they leverage street cultural performances in reaction to intersectional oppression, and in an attempt to empower themselves. Young women in this study joined gangs and took part in violence for many of the same reasons that men do—protection, income, status, and so on—as well as due to threats of sexual violence faced specifically by females. But street cultural participation for females in Cape Town also often perpetuates cycles of violent victimization, incarceration, and substance abuse that keep girl gangsters trapped in a life on the streets. In this way, females in this study broke from the binary view of girl gangsterism as either totally liberating or totally injurious, embodying both simultaneously.
Nitrogen-Containing Compounds From Mangrove-Derived Fungus Aspergillus sp. 87
Authors: Luo Guangyuan , Lang Jiajia , She Zhigang , Yan Sujun , Tian Guobao , Li Jing , Liu Lan
Published: April 2020

Nine nitrogen-containing compounds including 1 new alkaloid, aspergilamide A (1), and 8 known alkaloids and dipeptides, pseurotin A (2), fumigaclavine C (3), isochaetominine (4), cyclo(L-Pro-L-tyr) (5), cyclo- trans-4-OH-(L)-Pro-(L)-Phe (6), brevianamide F (7), and spirotryprostatins A and B (8 and 9), were obtained from the mangrove-derived fungus Aspergillus sp. 87. Their structures were identified by extensive spectroscopic analyses. All compounds did not show significant antibacterial activities.
Toward mitigating pressure injuries: Detecting patient orientation from vertical bed reaction forces
Authors: Wong Gordon , Gabison Sharon , Dolatabadi Elham , Evans Gary , Kajaks Tara , Holliday Pamela , Alshaer Hisham , Fernie Geoff , Dutta Tilak
Published: April 2020

Introduction

Prolonged bed rest without repositioning can lead to pressure injuries. However, it can be challenging for caregivers and patients to adhere to repositioning schedules. A device that alerts caregivers when a patient has remained in the same orientation for too long may reduce the incidence and/or severity of pressure injuries. This paper proposes a method to detect a person’s orientation in bed using data from load cells placed under the legs of a hospital grade bed.

Methods

Twenty able-bodied individuals were positioned into one of three orientations (supine, left side-lying, or right side-lying) either with no support, a pillow, or a wedge, and the head of the bed either raised or lowered. Breathing pattern characteristics extracted from force data were used to train two machine learning classification systems (Logistic Regression and Feed Forward Neural Network) and then evaluate for their ability to identify each participant’s orientation using a leave-one-participant-out cross-validation.

Results

The Feed Forward Neural Network yielded the highest orientation prediction accuracy at 94.2%.

Conclusions

The high accuracy of this non-invasive system’s ability to a participant’s position in bed shows potential for this algorithm to be useful in developing a pressure injury prevention tool.
Nurses’ Perception of the Bed Alarm System in Acute-Care Hospitals
Authors: Okumoto Ayaka , Miyata Chiharu , Yoneyama Satoko , Kinoshita Ayae
Published: April 2020

Introduction

In hospitals, the nurse uses the bed alarm system for patients’ safety, which may have some forms of physical restraints included, depending on the situation. However, the nurses’ perceptions of the bed alarm system with reference to restraints are yet to be clarified. Moreover, there were no reports that can shed light upon the factors that relate to nurses’ perceptions about the bed alarm system in Japan. The objective of this study is to investigate the nurses’ perception on whether the bed alarm can be considered as a form of physical restraint and to elucidate the factors that pertain to the nurses’ perceptions regarding the bed alarm.

Methods

This study conducted a quantitative cross-sectional survey. We used bivariate logistic regression analyses to investigate the nurses’ perception and the factors affecting these perception. Ethical approval was obtained from the research ethics committee of the Kyoto University. Participants opted for answering the questionnaire voluntarily.

Results

The sample population comprised of 289 nurses from 10 acute-care hospitals. Out of these, 214 (74.0%) nurses considered the bed alarm system as a form of restraint, and 75 nurses (26.0%) did not. Furthermore, the nurses’ perception was relevant to the hospitals that they belonged to, their years of experience, and the content of education. It was especially interesting that the group of nurses with little experience had the consciousness of being considered the bed alarm as restraint compared with nurses with many years of experience.

Conclusion

The alarm systems are gradually being considered to be classified as a restraint. Hospitals should ensure providing an ethically sensitive climate and appropriate educational opportunities to help nurses build these perceptions for patient care. An ethically sensitive climate and appropriate educational opportunities would lead to an environment that nurtures nurses with the ability to recognize problems in daily care.
Development, Ecology and Climate Change: Resistance by the Peasantry
Authors: Busck Ole , Schmidt Johannes Dragsbaek
Published: April 2020

Critical theory like political ecology and peasant studies point to the insufficiency of adaptation strategies and call for more radical alternatives, such as the abandonment of development strategies based on fossil-fuelled industrialisation and urban-centred economic growth. They favour rural livelihood strategies based on sustainable natural resource management and organic/agro-ecological production, thus combining genuine development with resistance to the hegemony of that neoliberal-driven transformation of fundamental socio-economic structures in developing countries. This is associated with detrimental climatic and ecological consequences. This article offers a theoretical and conceptual framework for understanding the nexus of development, ecology and climate change, and explores significant patterns of community resistance evolving into promising strategies of reactions ‘from below’ against growth-driven development implicating ecocide. Such resistance opposes the regional and global obsession with excessive growth and poses new challenges to the international political system.
Enhanced identification of significant regulators of gene expression
Authors: Ehsani Rezvan , Drabløs Finn
Published: April 2020

Background

Diseases like cancer will lead to changes in gene expression, and it is relevant to identify key regulatory genes that can be linked directly to these changes. This can be done by computing a Regulatory Impact Factor (RIF) score for relevant regulators. However, this computation is based on estimating correlated patterns of gene expression, often Pearson correlation, and an assumption about a set of specific regulators, normally transcription factors. This study explores alternative measures of correlation, using the Fisher and Sobolev metrics, and an extended set of regulators, including epigenetic regulators and long non-coding RNAs (lncRNAs). Data on prostate cancer have been used to explore the effect of these modifications.

Results

A tool for computation of RIF scores with alternative correlation measures and extended sets of regulators was developed and tested on gene expression data for prostate cancer. The study showed that the Fisher and Sobolev metrics lead to improved identification of well-documented regulators of gene expression in prostate cancer, and the sets of identified key regulators showed improved overlap with previously defined gene sets of relevance to cancer. The extended set of regulators lead to identification of several interesting candidates for further studies, including lncRNAs. Several key processes were identified as important, including spindle assembly and the epithelial-mesenchymal transition (EMT).

Conclusions

The study has shown that using alternative metrics of correlation can improve the performance of tools based on correlation of gene expression in genomic data. The Fisher and Sobolev metrics should be considered also in other correlation-based applications.
A qualitative transcriptional signature to reclassify histological grade of ER-positive breast cancer patients
Authors: Li Jing , Jiang Wenbin , Liang Qirui , Liu Guanghao , Dai Yupeng , Zheng Hailong , Yang Jing , Cai Hao , Zheng Guo
Published: April 2020

Background

Histological grade (HG) is commonly adopted as a prognostic factor for ER-positive breast cancer patients. However, HG evaluation methods, such as the pathological Nottingham grading system, are highly subjective with only 50–85% inter-observer agreements. Specifically, the subjectivity in the pathological assignment of the intermediate grade (HG2) breast cancers, comprising of about half of breast cancer cases, results in uncertain disease outcomes prediction. Here, we developed a qualitative transcriptional signature, based on within-sample relative expression orderings (REOs) of gene pairs, to define HG1 and HG3 and reclassify pathologically-determined HG2 (denoted as pHG2) breast cancer patients.

Results

From the gene pairs with significantly stable REOs in pathologically-determined HG1 (denoted as pHG1) samples and reversely stable REOs in pathologically-determined HG3 (denoted as pHG3) samples, concordantly identified from seven datasets, we extracted a signature which could determine the HG state of samples through evaluating whether the within-sample REOs match with the patterns of the pHG1 REOs or pHG3 REOs. A sample was classified into the HG3 group if at least a half of the REOs of the 10 gene pairs signature within this sample voted for HG3; otherwise, HG1. Using four datasets including samples of early stage (I–II) ER-positive breast cancer patients who accepted surgery only, we validated that this signature was able to reclassify pHG2 patients into HG1 and HG3 groups with significantly different survival time. For the original pHG1 and pHG3 patients, the signature could also more accurately and objectively stratify them into distinct prognostic groups. And the up-regulated and down down-regulated genes in HG1 compared with HG3 involved in cell proliferation and extracellular signal transduction pathways respectively. By comparing with existing signatures, 10-GPS was with prognostic significance and was more aligned with survival of patients especially for pHG2 samples.

Conclusions

The transcriptional qualitative signature can provide an objective assessment of HG states of ER-positive breast cancer patients, especially for reclassifying patients with pHG2, to assist decision making on clinical therapy.
Growth response of greenhouse-produced muskmelon and tomato to sub-surface drip irrigation and soil aeration management factors
Authors: Li Yuan , Niu Wenquan , Cao Xiaoshu , Zhang Mingzhi , Wang Jingwei , Zhang Zhenxing
Published: April 2020

Background

Hypoxia causes injury and yield loss. Soil aeration has been reported to accelerate the growth of plants and increase crop yield. The aim of this study was to examine growth response of greenhouse-produced muskmelon to 3 levels of sub-surface drip irrigation (I), 3 different installation depths of drip laterals in the soil (D), and 4 levels of supplemental soil aeration frequency (A). A fractional factorial experiment was designed to examine these treatment effects on marketable fresh fruit yield, leaf area index during 3 growth stages, and dry matter partitioning at harvest. In addition, we studied the response of fruit yield and dry matter of tomato to 2 levels of burial depths of subsurface tubing in combination with 3 frequency levels of soil aeration.

Results

Results showed that soil aeration can positively influence the yield, leaf area index, dry matter and irrigation use efficiency of the muskmelon (p < 0.05). The fruit yield of muskmelon and tomato were increased by 21.5 and 30.8% respectively with 1-d and 2-d aeration intervals compared with the no aeration treatment.

Conclusions

The results suggest that soil aeration can positively impact the plant root zone environment and more benefits can be obtained with aeration for both muskmelon and tomato plants.
Association between the ratio of serum n-3 to n-6 polyunsaturated fatty acids and acute coronary syndrome in non-obese patients with coronary risk factor: a multicenter cross-sectional study
Authors: Nishizaki Yuji , Shimada Kazunori , Tani Shigemasa , Ogawa Takayuki , Ando Jiro , Takahashi Masao , Yamamoto Masato , Shinozaki Tomohiro , Miyazaki Tetsuro , Miyauchi Katsumi , Nagao Ken , Hirayama Atsushi , Yoshimura Michihiro , Komuro Issei , Nagai Ryozo , Daida Hiroyuki
Published: April 2020

Background

Previous studies have reported that being overweight, obese, or underweight is a risk factor for ischemic cardiovascular disease (CVD); however, CVD also occurs in subjects with ideal body mass index (BMI). Recently, the balance of n-3/n-6 polyunsaturated fatty acids (PUFAs) has received attention as a risk marker for CVD but, so far, no study has been conducted that investigates the association between BMI and the balance of n-3/n-6 PUFAs for CVD risk.

Methods

We evaluated the association between n-3/n-6 PUFA ratio and acute coronary syndrome (ACS) in three BMI-based groups (< 25: low BMI, 25–27.5: moderate BMI, and ≥ 27.5: high BMI) that included 1666 patients who visited the cardiovascular medicine departments of five hospitals located in urban areas in Japan.

Results

The prevalence of ACS events was 9.2, 7.3, and 10.3% in the low, moderate, and high BMI groups, respectively. We analyzed the relationship between ACS events and several factors, including docosahexaenoic acid/arachidonic acid (DHA/AA) ratio by multivariate logistic analyses. In the low BMI group, a history of smoking (odds ratio [OR]: 2.47, 95% confidence interval [CI]: 1.40–4.35) and low DHA/AA ratio (OR: 0.30, 95% CI: 0.12–0.74) strongly predicted ACS. These associations were also present in the moderate BMI group but the magnitude of the association was much weaker (ORs are 1.47 [95% CI: 0.54–4.01] for smoking and 0.63 [95% CI: 0.13–3.10] for DHA/AA). In the high BMI group, the association of DHA/AA (OR: 1.98, 95% CI: 0.48–8.24) was reversed and only high HbA1c (OR: 1.46, 95% CI: 1.03–2.08) strongly predicted ACS. The interaction test for OR estimates (two degrees of freedom) showed moderate evidence for reverse DHA/AA ratio–ACS associations among the BMI groups (P = 0.091).

Conclusions

DHA/AA ratio may be a useful marker for risk stratification of ACS, especially in non-obese patients.
Prevalence estimation by joint use of big data and health survey: a demonstration study using electronic health records in New York city
Authors: Kim Ryung S. , Shankar Viswanathan
Published: April 2020

Background

Electronic Health Records (EHR) has been increasingly used as a tool to monitor population health. However, subject-level errors in the records can yield biased estimates of health indicators. There is an urgent need for methods to estimate the prevalence of health indicators using large and real-time EHR while correcting the potential bias.

Methods

We demonstrate joint analyses of EHR and a smaller gold-standard health survey. We first adopted Mosteller’s method that pools two estimators, among which one is potentially biased. It only requires knowing the prevalence estimates from two data sources and their standard errors. Then, we adopted the method of Schenker et al., which uses multiple imputations of subject-level health outcomes that are missing for the subjects in EHR. This procedure requires information to link some subjects between two sources and modeling the mechanism of misclassification in EHR as well as modeling inclusion probabilities to both sources.

Results

In a simulation study, both estimators yielded negligible bias even when EHR was biased. They performed as well as health survey estimator when EHR bias was large and better than health survey estimator when EHR bias was moderate. It may be challenging to model the misclassification mechanism in real data for the subject-level imputation estimator. We illustrated the methods analyzing six health indicators from 2013 to 14 NYC HANES and the 2013 NYC Macroscope, and a study that linked some subjects in both data sources.

Conclusions

When a small gold-standard health survey exists, it can serve as a safeguard against potential bias in EHR through the joint analysis of the two sources.
A classification-based approach to low back pain in primary care – protocol for a benchmarking controlled trial
Authors: Simula A. S. , Malmivaara A. , Booth N. , Karppinen J.
Published: April 2020

Background

Guidelines recommend a biopsychosocial framework for low back pain (LBP) management and the avoidance of inappropriate imaging. In clinical practice, care strategies are often inconsistent with evidence and guidelines, even though LBP is the most common disabling health condition worldwide. Unhelpful beliefs, attitudes and inappropriate imaging are common. LBP is understood to be a complex biopsychosocial phenomenon with many known multidimensional risk factors (symptom- and lifestyle-related, psychological and social) for persistent or prolonged disability, which should be identified and addressed by treatment. The STarT Back Tool (SBT) was developed for early identification of individual risk factors of LBP to enable targeted care. Stratified care according SBT has been shown to improve the effectiveness of care in a primary care setting. A biopsychosocially-oriented patient education booklet, which includes imaging guidelines and information, is one possible way to increase patients’ understanding of LBP and to reduce inappropriate imaging. Premeditated pathways, education of professionals, written material, and electronic patient registry support in health care organizations could help implement evidence-based care.

Methods

We will use a Benchmarking Controlled Trial (BCT) design in our study. We will prospectively collect data from three health care regions before and after the implementation of a classification-based approach to LBP in primary care. The primary outcome will be change in PROMIS (Patient-Reported Outcomes Measurement Information System) (short form 20a) over 12-month follow-up.

Discussion

The implementation of a classification-based biopsychosocial approach can potentially improve the care of LBP patients, reduce inappropriate imaging without increasing health-care costs, and decrease indirect costs by reducing work disability. Using the BCT we will be able to evaluate the effectiveness of the improvement strategy for the entire care pathway.

Trial registration

ISRCTN,ISRCTN13273552, retrospectively registered 13/05/2019.
Endoscopic stent placement above the sphincter of Oddi for biliary strictures after living donor liver transplantation
Authors: Koizumi Mitsuhito , Kumagi Teru , Kuroda Taira , Imamura Yoshiki , Kanemitsu Kozue , Ogawa Kohei , Takada Yasutsugu , Hiasa Yoichi
Published: April 2020

Background

Endoscopic balloon dilation and/or plastic stent placement has been a standard method for treating biliary strictures complicated post living donor liver transplantation (LDLT). The strictures may be refractory to endoscopic treatment and require long-term stent placement. However, consensus on the optimal period of the stent indwelling and usefulness of the inside stent does not exist.

Methods

We evaluated the long-term efficacy of stent treatment in patients with biliary stricture post LDLT. In addition, we compared the stent patency between inside stent and conventional outside stent.

Results

A total of 98 ERC sessions (median 6: range 1–14) performed on 16 patients receiving endoscopic treatment for biliary strictures post LDLT with duct-to-duct biliary reconstruction were analyzed. Biliary strictures successfully treated in 14 patients (88%) included 7 patients (44%) showing improvement of biliary strictures with repeated endoscopic stent placement. Stent replacement was carried out every 6 to 12 months for the remainder 7 patients (44%). Biliary stents were placed in 87 sessions (77 inside sessions and 10 outside sessions). Stent migration occurred 13 times (16%) and none of the inside stent sessions and the outside stent sessions, respectively. Median patency of inside stent and outside stent were 222 days (range; 8–1736) and 99 days (range; 7–356), respectively. The stent occlusion was significantly less in inside stent than in outside stent (p < 0.001). Stone formation was observed in 14 (18%) of the inside stent and 3 (30%) of the outside stent. Biliary stones were small and successfully removed endoscopically.

Conclusions

The endoscopic treatment using inside stent was useful in the management of biliary strictures after LDLT.
Two cases of agenesis of the dorsal pancreas and a review of the literature
Authors: Mei Wentong , Cao Feng , Li Fei
Published: April 2020

Background

Agenesis of the dorsal pancreas (ADP) is a very rare disease with no specific symptoms, and the pathogenesis is not clear. Some patients will be accompanied by other diseases, such as pancreatic tumor or pancreatitis. But most cases are very atypical and difficult to distinguish. Some syndromes of pancreatic exocrine insufficiency are common in patients with ADP. Here, we report two cases of ADP and summarize the clinical features, diagnosis, and treatment of ADP.

Case presentation

Case A is a 65-year-old Chinese woman who presented with abdominal pain accompanied by nausea, bloating and acid reflux. The enhanced abdominal CT scan found nothing meaningful except the absence of the body and tail of the pancreas. The diagnosis was considered as gastrointestinal dysfunction cause by exocrine pancreatic insufficiency and recovered after symptomatic treatment. Case B is a 61-year-old Chinese woman who presented with abdominal pain accompanied by fever, vomiting and bloating. The abdominal CT showed multiple stones in the gallbladder, and the body and tail of the patient’s pancreas were absent. She was diagnosed with cholelithiasis and recovered after laparoscopic cholecystectomy.

Conclusion

Agenesis of the dorsal pancreas (ADP) is a rare congenital disease with an unclear pathogenesis that presents multiple symptoms. It should be considered when the patients have non-specific, persistent and unexplained symptoms such as bloating or uncontrolled blood sugar. Imaging examination is helpful for diagnosis. And it does not require surgical intervention unless it accompanies other diseases, EPI need to be considered when the non-specific gastrointestinal symptoms appear.
Hepatocellular carcinoma occurs frequently and early after treatment in HCV genotype 3 infected persons treated with DAA regimens
Authors: Tayyab Ghias Un Nabi , Rasool Shafqat , Nasir Bilal , Rubi Ghazala , Abou-Samra Abdul-Badi , Butt Adeel A.
Published: April 2020

Background

There are conflicting data regarding the risk of hepatocellular carcinoma (HCC) after direct-acting antiviral agent (DAA) treatment. Risk of HCC in HCV genotype-3 infected persons after DAA therapy is not well known.

Methods

We prospectively studied HCV infected persons initiated on a DAA regimen between October 2014 and March 2017 at two centers in Pakistan. All persons were free of HCC at study initiation. HCC was confirmed based on characteristic CT scan findings. Patients were followed for 12 months after the completion of therapy.

Results

A total of 662 persons initiated treatment. Median age (IQR) was 50 (41, 57) years and 48.8% were male. At baseline, 49.4% were cirrhotic, 91% were genotype 3 and 91.9% attained SVR. Treatment regimens used were: Sofosbuvir (SOF)/ribavirin (RBV)/pegylated interferon (PEG-IFN), 25.2%; SOF/RBV, 62.4%; SOF/RBV/daclatasavir (DCV), 10.6%; SOF/DCV, 2.0%. Incident HCC was detected in 42 patients (12.8%) in the 12-month period after treatment completion and was exclusively observed in those with cirrhosis. In multivariable Cox regression analysis, SVR was associated with a reduction in HCC risk (HR, 95% CI: 0.35, 0.14,0.85). In Kaplan-Meier plots by treatment regimen, those treated with SOF/RBV, SOF/RBV/DCV, or SOF/DCV regimens had a shorter HCC-free survival compared with those treated with a SOF/RBV/PEG-IFN regimen.

Conclusion

In a predominantly genotype 3 cohort, incident HCC occurred frequently and early after treatment completion, and exclusively in those with pre-treatment cirrhosis. SVR reduced the risk of HCC. Treating HCV infected persons before development of cirrhosis may reduce risk of HCC.
Leucine-rich α2-glycoprotein-1 upregulation in plasma and kidney of patients with lupus nephritis
Authors: Yang Yi , Luo Ran , Cheng Yichun , Liu Tingting , Dai Wei , Li Yueqiang , Ge Shuwang , Xu Gang
Published: April 2020

Background

Increased leucine-rich α2-glycoprotein-1 (LRG1) has been observed in various inflammatory and autoimmune diseases. We aimed to explore the expression and role of LRG1 in lupus nephritis (LN).

Methods

Plasma LRG1 (pLRG1) was measured by enzyme-linked immunosorbent assay in 101 patients with renal biopsy-proven LN and 21 healthy controls (HC). Relationships between pLRG1 and clinical and pathological characteristics were analyzed. The expression of LRG1 in peripheral blood leukocytes and kidney was detected by flow cytometry, immunohistochemistry and immunofluorescence, respectively. Further cell experiments were focused on the role of LRG1.

Results

We found that LRG1 was expressed in plasma, some peripheral blood leukocytes, proximal tubule and several inflammatory cells. The levels of LRG1 in plasma, peripheral blood leukocytes and kidney were elevated in LN patients as compared to HC. Plasma expression levels of LRG1 correlated positively with renal function and renal disease activity, and reflect specific pathologic lesions in the kidneys of patients with LN. Interleukin-1β and interleukin-6, not tumor necrosis factor-α and interferon γ induced the LRG1 expression in human renal tubular epithelial cell line. Moreover, stimulation of recombinant human LRG1 could inhibit late apoptosis, promote proliferation and regulate expression of inflammatory factors and cytokines.

Conclusions

Plasma expression levels of LRG1 were associated with renal function, disease activity, and pathology in LN. It might also be involved in renal inflammation, proliferation and apoptosis of endothelial cells. LRG1 might be a potential prognosis novel predictor in LN patients.
Effectiveness of telemedicine for pregnant women with gestational diabetes mellitus: an updated meta-analysis of 32 randomized controlled trials with trial sequential analysis
Authors: Xie Weihua , Dai Pinyuan , Qin Yu , Wu Ming , Yang Bingquan , Yu Xiaojin
Published: April 2020

Background

Gestational diabetes mellitus (GDM) is now a global health problem. Poor blood glucose control during pregnancy may lead to maternal and neonatal/foetal complications. Recently, the development of information and communication technology has resulted in new technical support for the clinical care of GDM. Telemedicine is defined as health services and medical activities provided by healthcare professionals through remote communication technologies. This study aimed to update the systematic review of the effectiveness of telemedicine interventions on glycaemic control and pregnancy outcomes in pregnant women with GDM.

Methods

We searched the Web of Science, PubMed, Scopus, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Wan-fang Database, China Biology Medicine and VIP Database for randomized controlled trials (RCTs) related to the effectiveness of telemedicine interventions for GDM from database inception to July 31st, 2019. Languages were limited to English and Chinese. Literature screening, data extraction and assessment of the risk of bias were completed independently by two reviewers. Meta-analysis and trial sequential analysis were conducted in Stata 14.0 and TSA v0.9.5.10 beta, respectively.

Results

A total of 32 RCTs were identified, with a total of 5108 patients. The meta-analysis showed that telemedicine group had significant improvements in controlling glycated haemoglobin (HbA1c) [mean difference (MD) = − 0.70, P < 0.01], fasting blood glucose (FBG) (MD = -0.52, P < 0.01) and 2-h postprandial blood glucose (2hBG) (MD = -1.03, P = 0.01) compared to the corresponding parameters in the standard care group. In the telemedicine group, lower incidences of caesarean section [relative risk (RR) = 0.82, P = 0.02], neonatal hypoglycaemia (RR = 0.67, P < 0.01), premature rupture of membranes (RR = 0.61, P < 0.01), macrosomia (RR = 0.49, P < 0.01), pregnancy-induced hypertension or preeclampsia (RR = 0.48, P < 0.01), preterm birth (RR = 0.27, P < 0.01), neonatal asphyxia (RR = 0.17, P < 0.01), and polyhydramnios (RR = 0.16, P < 0.01) were found. The trial sequential analyses conclusively demonstrated that the meta-analytic results of the change in HbA1c, the change in 2hBG, the change in FBG, the incidence rates of caesarean section, pregnancy-induced hypertension or preeclampsia, premature rupture of membranes, premature birth, neonatal asphyxia, and polyhydramnios were stable.

Conclusions

Compared to standard care, telemedicine interventions can decrease the glycaemic levels of patients with GDM more effectively and reduce the risk of maternal and neonatal/foetal complications.
Influence of age on clinical presentation, diagnosis delay and outcome in pre-school children with acute appendicitis
Authors: Lounis Yasmine , Hugo Julie , Demarche Martine , Seghaye Marie-Christine
Published: April 2020

Background

Unusual clinical presentation of acute appendicitis in preschool children leads to misdiagnosis and complications.

We aimed to analyze the influence of age on clinical presentation, laboratory findings and complications in preschool children with acute appendicitis.

Methods

From January 2012 until December 2017, 29 children younger than 6 years of age (median 50 months) with acute appendicitis were enrolled in this retrospective study. Patients were grouped according to their age: group 1: < 48 months (n = 13); group 2: > 48 months (n = 16), their clinical data, laboratory results and complications were compared.

Results

In group 1, duration of nausea and vomiting was longer, alteration of general state was more frequent and pain in the right fossa iliaca less frequent than in group 2 (p = 0.026, p = 0.000 and p = 0.029, respectively). Heart rate was higher in group 1 than in group 2 (p = 0.012). Leucocyte and polynuclear neutrophil counts were lower in group 1 than in group 2 (p = 0.028 and = 0.004, respectively) but C-reactive protein levels were not different between groups. In the whole cohort however, C-reactive protein at admission value correlated negatively with age (p = 0.025).

Abdominal ultrasound allowed diagnosis in 19/29 patients (65.5%), without any difference between groups. Appendicular perforation was more frequent in group 1 than in group 2 (p = 0.003). Perforation was also related to longer hospital stay (p = 0.018). Peritonitis occurred in 21/29 (72%), post-operative ileus in 5/29 (17%) and sepsis in 4/29 (14%) patients without any difference between groups. In the whole cohort, hospital stay correlated negatively with age (p = 0.000). There was no mortality.

Conclusions

Among preschool children, those younger than 48 months present with longer duration of pre-admission symptoms indicating longer infection course than in older children. Altered general state and higher degree of tachycardia in the younger reflect higher systemic repercussions of the illness. Less specific abdominal pain and dissociation of the inflammatory markers with lower leucocyte- and neutrophil counts and higher C-reactive protein levels in the younger may contribute to further diagnosis delay and higher rate of perforation in these patients.