bluuebunny/crossref_metadata_2025 huggingface dataset:
Translation, cross-cultural adaptation and validation of the English Lequesne Algofunctional index in to Bengali
Authors: Mahmood Tarek , Choudhury Minhaj Rahim , Islam Md Nazrul , Haq Syed Atiqul , Shahin Md Abu , Ali Syed Mohammad Monowar , Ahmed Shamim , Shazzad Md. Nahiduzzamane , Hasan A. T. M. Tanveer , Azad Mohammad Abul Kalam , Rasker Johannes Jacobus
Published: October 2020

Background

This study was focused on translation and cultural adaptation of the English Lequesne Algofunctional index (LAI) into Bengali for patients with primary knee osteoarthritis (OA) and testing reliability and validity of the Bengali version of the LAI.

Methods

This study was carried out in the Department of Rheumatology, BSM Medical University, Dhaka, Bangladesh. Using the forward–backward method the English LAI was translated into Bengali including cultural adaptation. For pretesting, A sample of 40 patients with primary knee osteoarthritis were screened using the Bengali version of LAI. Following the pretest, 130 consecutive patients with symptomatic knee OA completed the interviewer administered Bengali LAI, the validated Bengali version of SF-36, Visual Analogue Scale for Pain, Distance Walked and Activities of Daily Living. For the retest 60 randomly selected patients from the cohort were administered the Bengali LAI 7 days later. An item by item analysis was performed. Internal consistency was assessed by Cronbach’s alpha, test–retest reliability by intraclass correlation coefficient (ICC) and Kappa coefficient, construct validity was measured using the Spearman rank correlation coefficient.

Results

It took 3.25 ± 0.71 min to complete the Bengali LAI and the mean score was 9.23 ± 4.58. For the Bengali LAI Cronbach’s alpha score was 0.88, test–retest reliability assessed by ICC was 0.97. For construct validity, excellent convergent validity was achieved (ρ = 0.93) but the divergent validity was moderate (ρ = 0.43).

Conclusions

The Bengali LAI showed excellent convergent validity, internal consistency and test–retest reliability, only the divergent validity was moderate. So, the Bengali LAI can be applied as a HRQoL assessment tool for primary knee OA patients.
Male papillomavirus infection and genotyping in the Qingyuan area
Authors: Yin Wei-Guo , Yang Meng , Peng Lei , Liu Yan-Mei , Cheng Bin , Xuan Shu-Xia , Chen Chen , Tan Feng-Jun
Published: October 2020

Background

This study aims to screen the male human papillomavirus (HPV) infection status and genotyping in Qingcheng District, Qingyuan City, Guangdong Province, China to provide a reference basis for formulating prevention strategies for HPV infection.

Methods

The present study collected urethral epithelium or scraped penile epidermis from high-risk male patients in Qingyuan People's Hospital during the last five years, extracted DNA fragments using the boiling method, and detected 23 types of HPV genotypes by PCR-reverse blot hybridization.

Results

The positive detection rate was 54.31% of 1044 males with high risk of HPV (567/1044). Among these males, the positive detection rate of HPV was the highest in patients initially diagnosed with warts, and the rate was 66.47%. Five main HPV types are identified as follows: HPV6 18.87% (197/1044), HPV11 10.25% (107/1044), HPV52 8.81% (92/1044), HPV16 6.90% (72/1044), and HPV51 5.08% (53/1044). Among these HPV-infected patients, single infection mainly by low-risk HPV6 and HPV11 accounted for 56.61% (321/567); high- and low-risk combined HPV co-infections accounted for 29.10% (165/567). The HPV infected patients was mainly between 21 and 40 years old, and the HPV infection rate was higher with increased age.

Conclusions

The HPV infection rate in the Qingyuan area is higher than in other areas and the main infection is single infection. Furthermore, HPV52, HPV16, and HPV51 are the main high-risk infection types, while HPV6 and HPV11 are the main low-risk infection types.
Attitudes, beliefs, and practices among Swiss chiropractors regarding medication prescribing for musculoskeletal conditions: a national Q-methodology study
Authors: Emary Peter C. , Oremus Mark , Houweling Taco A. W. , Wangler Martin , Akhtar-Danesh Noori
Published: October 2020

Background

Swiss chiropractors have been licensed since 1995 to prescribe from a limited formulary of medications for treating musculoskeletal (MSK) conditions. In January 2018, this formulary was expanded to include additional muscle relaxant, analgesic, and anti-inflammatory medications. Internationally, controversy remains over whether or not medication prescribing should be pursued within the chiropractic profession.

Objective

The purpose of this study was to assess Swiss chiropractors’ attitudes, beliefs, and practices regarding their existing medication prescription privileges. This information will provide new insights on the topic and help inform research and policy discussions about expanding chiropractic prescription rights in other jurisdictions.

Methods

A 13-item questionnaire and Q-methodology approach were used to conduct the assessment. Recruitment was conducted by e-mail between December 2019 and February 2020, and all members of the Swiss Chiropractic Association were eligible to participate. Data were analyzed using by-person factor analysis and descriptive statistics.

Results

In total, 187 Swiss chiropractors participated in this study (65.4% response rate). Respondents reported prescribing analgesics, anti-inflammatories, and muscle relaxants to a median of 5, 5, and 0% of patients, respectively. Forty-two percent of respondents expressed interest in further expanding the range of current medications available to Swiss chiropractors for treating MSK conditions. Only 15% expressed interest in expanding this range to include medications for treating non-MSK conditions. In the Q-methodology analysis, four salient viewpoints/groups regarding medication prescribing emerged:prescribers,non-prescribers,collaborators, andintegrators. All exceptnon-prescribersthought medication prescription privileges were advantageous for the chiropractic profession in Switzerland. There was also strong consensus among all four groups that medication prescribing should not replace manual therapy in chiropractic practice.

Conclusion

This was the first national survey on attitudes toward prescribing medications among Swiss chiropractors since the year 2000, and the first using Q-methodology. With this approach, four unique groups of chiropractic prescribers were identified. Even with diversity among clinicians, the findings of this study showed general support for, along with conservative use of, prescribing privileges within the Swiss chiropractic profession. Studies in jurisdictions outside of Switzerland are needed to assess whether chiropractors are interested in expanding their scopes of practice to include similar prescribing privileges.
Determining Trendelenburg test validity and reliability using 3-dimensional motion analysis and muscle dynamometry
Authors: McCarney Luke , Andrews Alexander , Henry Phoebe , Fazalbhoy Azharuddin , Selva Raj Isaac , Lythgo Noel , Kendall Julie C
Published: October 2020

Background

The hip abductor muscle group stabilises the pelvis during gait to prevent excessive pelvic drop. Hip abductor weakness has been linked to musculoskeletal conditions such as chronic low-back pain. As such, it is important that practitioners can correctly diagnose hip abductor weakness in a clinical setting. Although the Trendelenburg test is commonly used by practitioners, the validity of this test to assess hip abductor weakness in the absence of musculoskeletal injury remains questionable. The aim of this study was to determine the validity of the Trendelenburg test, as observed by a practitioner, to assess frontal plane pelvic motion and hip abductor strength in a population without intra-articular hip disorders.

Methods

This study was performed between June 14th and October 16th 2019. Eighteen participants were recruited for this study. Peak normalised isometric and isokinetic hip abductor torque were measured bilaterally (n = 36) using the Biodex System 4 isokinetic dynamometer. Each participant performed the Trendelenburg test bilaterally (n = 36) while a graduate year chiropractic practitioner assessed for a “positive” or “negative” sign. The test was simultaneously recorded using Vicon 3-Dimensional motion capture to measure frontal plane pelvic motion and elevation. Correlation analyses were performed between the measures of peak hip abductor torque and pelvic motion to determine if any relationship existed. Agreement between the practitioner and 3-Dimensional analysis was calculated using the kappa (κ) statistic.

Results

Weak, non-significant correlations were found between hip abductor strength and pelvic motion before outlier removal. Significant (p < 0.05) yet weak correlations were found after outlier removal, except for isometric hip abductor strength. Weak agreement was found between the chiropractic practitioner and 3-Dimesnional analysis for the Trendelenburg test assessment (κ = 0.22–0.25).

Conclusions

This study found no significant relationship between normalised peak isometric and isokinetic hip abductor torque and frontal plane pelvic motion during the Trendelenburg test in a healthy young adult population. There was also poor agreement between the practitioner and pelvic motion assessments. Caution should be used when using this test, in the absence of intra-articular hip pathology, to assesses hip abductor weakness. Before any definitive conclusion can be made, studies with a larger sample size should be performed.
The incidence of geriatric trauma is increasing and comparison of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients
Authors: Jiang Libing , Zheng Zhongjun , Zhang Mao
Published: October 2020

Purpose

The study aimed to examine the changing incidence of geriatric trauma and evaluate the predictive ability of different scoring tools for in-hospital mortality in geriatric trauma patients.

Methods

Annual reports released by the National Trauma Database (NTDB) in the USA from 2005 to 2015 and the Trauma Register DGU® in Germany from 1994 to 2012 were analyzed to examine the changing incidence of geriatric trauma. Secondary analysis of a single-center cohort study conducted among 311 severely injured geriatric trauma patients in a level I trauma center in Switzerland was completed. According to the in-hospital survival status, patients were divided into the survival and non-survival group. The differences of the ISS (injury severity score), NISS (new injury severity score), TRISS (Trauma and Injury Severity Score), APACHE II (Acute Physiology and Chronic Health Evaluation II), and SPAS II (simplified acute physiology score II) between two groups were evaluated. Then, the areas under the receiver-operating characteristic curve (AUC-ROC) of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients were calculated.

Results

The analysis of the NTDB showed that the increase in the number of geriatric trauma ranged from 18 to 30% between 2005 and 2015. The analysis of the DGU® showed that the mean age of trauma patients rose from 39.11 in 1993 to 51.10 in 2013, and the proportion of patients aged ≥ 60 years rose from 16.5 to 37.5%. The findings from the secondary analysis showed that 164 (52.73%) patients died in the hospital. The ISS, NISS, APACHE II, and SAPS II in the death group were significantly higher than those in the survival group, and the TRISS in the death group was significantly lower than those in the survival group. The AUCs of the ISS, NISS, TRISS, APACHE II, and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients were 0.807, 0.850, 0.828, 0.715, and 0.725, respectively.

Conclusion

The total number of geriatric trauma is increasing as the population ages. The accuracy of ISS, NISS and TRISS was higher than the APACHE II and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients.
Artificial intelligence and machine learning in orthopedic surgery: a systematic review protocol
Authors: Maffulli Nicola , Rodriguez Hugo C. , Stone Ian W. , Nam Andrew , Song Albert , Gupta Manu , Alvarado Rebecca , Ramon David , Gupta Ashim
Published: October 2020

Background

Artificial intelligence (AI) and machine learning (ML) are interwoven into our everyday lives and have grown enormously in some major fields in medicine including cardiology and radiology. While these specialties have quickly embraced AI and ML, orthopedic surgery has been slower to do so. Fortunately, there has been a recent surge in new research emphasizing the need for a systematic review. The primary objective of this systematic review will be to provide an update on the advances of AI and ML in the field of orthopedic surgery. The secondary objectives will be to evaluate the applications of AI and ML in providing a clinical diagnosis and predicting post-operative outcomes and complications in orthopedic surgery.

Methods

A systematic search will be conducted in PubMed, ScienceDirect, and Google Scholar databases for articles written in English, Italian, French, Spanish, and Portuguese language articles published up to September 2020. References will be screened and assessed for eligibility by at least two independent reviewers as per PRISMA guidelines. Studies must apply to orthopedic interventions and acute and chronic orthopedic musculoskeletal injuries to be considered eligible. Studies will be excluded if they are animal studies and do not relate to orthopedic interventions or if no clinical data were produced. Gold standard processes and practices to obtain a clinical diagnosis and predict post-operative outcomes shall be compared with and without the use of ML algorithms. Any case reports and other primary studies assessing the prediction rate of post-operative outcomes or the ability to identify a diagnosis in orthopedic surgery will be included. Systematic reviews or literature reviews will be examined to identify further studies for inclusion, and the results of meta-analyses will not be included in the analysis.

Discussion

Our findings will evaluate the advances of AI and ML in the field of orthopedic surgery. We expect to find a large quantity of uncontrolled studies and a smaller subset of articles describing actual applications and outcomes for clinical care. Cohort studies and large randomized control trial will likely be needed.

Trial registration

The protocol will be registered on PROSPERO international prospective register of systematic reviews prior to commencement.
The adult phenotype of Schaaf-Yang syndrome
Authors: Marbach Felix , Elgizouli Magdeldin , Rech Megan , Beygo Jasmin , Erger Florian , Velmans Clara , Stumpel Constance T. R. M. , Stegmann Alexander P. A. , Beck-Wödl Stefanie , Gillessen-Kaesbach Gabriele , Horsthemke Bernhard , Schaaf Christian P. , Kuechler Alma
Published: October 2020

Background

MAGEL2-associated Schaaf-Yang syndrome (SHFYNG, OMIM #615547, ORPHA: 398069), which was identified in 2013, is a rare disorder caused by truncating variants of the paternal copy of MAGEL2, which is localized in the imprinted region on 15q11.2q13. The phenotype of SHFYNG in childhood partially overlaps with that of the well-established Prader–Willi syndrome (PWS, OMIM #176270). While larger numbers of younger individuals with SHFYNG have been recently published, the phenotype in adulthood is not well established. We recruited 7 adult individuals (aged 18 to 36) with molecularly confirmed SHFYNG and collected data regarding the clinical profile including eating habits, sleep, behavior, personal autonomy, psychiatric abnormalities and other medical conditions, as well as information about the respective phenotypes in childhood.

Results

Within our small cohort, we identified a range of common features, such as disturbed sleep, hypoactivity, social withdrawal and anxiety, but also noted considerable differences at the level of personal autonomy and skills. Behavioral problems were frequent, and a majority of individuals displayed weight gain and food-seeking behavior, along with mild intellectual disability or borderline intellectual function. Classical symptoms of SHFYNG in childhood were reported for most individuals.

Conclusion

Our findings indicate a high variability of the functional abilities and social participation of adults with SHFYNG. A high prevalence of obesity within our cohort was notable, and uncontrollable food intake was a major concern for some caregivers. The phenotypes of PWS and SHFYNG in adulthood might be more difficult to discern than the phenotypes in childhood. Molecular genetic testing for SHFYNG should therefore be considered in adults with the suspected diagnosis of PWS, if testing for PWS has been negative.
Sex differences in survival after out-of-hospital cardiac arrest: a meta-analysis
Authors: Lei Hao , Hu Jiahui , Liu Leiling , Xu Danyan
Published: October 2020

Background

Out-of-hospital cardiac arrest (OHCA) is a leading cause of sudden cardiac death worldwide. Researchers have found significant pathophysiological differences between females and males and clinically significant sex differences related to medical services. However, conflicting results exist and there is no uniform agreement regarding sex differences in survival and prognosis after OHCA. Therefore, we investigated the relationship between the prognosis of OHCA and sex factors.

Methods

We comprehensively searched the PubMed, Embase, and Cochrane databases and obtained a total of 1042 articles, from which 33 studies were selected for inclusion. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a random-effects model.

Results

The meta-analysis included 1,268,664 patients. Compared with males, females were older (69.7 years vs. 65.4 years, p < 0.05) and more frequently suffered OHCA without witnesses (58.39% vs 62.70%, p < 0.05). Females were less likely to receive in-hospital interventions than males. There was no significant difference between females and males in the survival from OHCA to hospital admission (OR 0.99, 95% CI 0.89–1.1). However, females had lower chances for survival from hospital admission to discharge (OR 0.59, 95% CI 0.48–0.73), overall survival to hospital discharge (OR 0.73, 95% CI 0.62–0.86), and favorable neurological outcomes (OR 0.62, 95% CI 0.47–0.83) compared with males.

Conclusions

Our results indicate that the overall discharge survival rate of females is lower than that of males, and females face a poor prognosis of the nervous system. This is likely related to the pathophysiological characteristics of females, more conservative treatment measures compared with males, and different post-resuscitation care. However, these findings should be interpreted with caution due to the presence of several confounding factors.
β-Glucosidase genes differentially expressed during composting
Authors: Zhang Xinyue , Ma Bo , Liu Jiawen , Chen Xiehui , Li Shanshan , Su Erlie , Gao Liyuan , Li Hongtao
Published: October 2020

Background

Cellulose degradation by cellulase is brought about by complex communities of interacting microorganisms, which significantly contribute to the cycling of carbon on a global scale. β-Glucosidase (BGL) is the rate-limiting enzyme in the cellulose degradation process. Thus, analyzing the expression of genes involved in cellulose degradation and regulation of BGL gene expression during composting will improve the understanding of the cellulose degradation mechanism. Based on our previous research, we hypothesized that BGL-producing microbial communities differentially regulate the expression of glucose-tolerant BGL and non-glucose-tolerant BGL to adapt to the changes in cellulose degradation conditions.

Results

To confirm this hypothesis, the structure and function of functional microbial communities involved in cellulose degradation were investigated by metatranscriptomics and a DNA library search of the GH1 family of BGLs involved in natural and inoculated composting. Under normal conditions, the group of non-glucose-tolerant BGL genes exhibited higher sensitivity to regulation than the glucose-tolerant BGL genes, which was suppressed during the composting process. Compared with the expression of endoglucanase and exoglucanase, the functional microbial communities exhibited a different transcriptional regulation of BGL genes during the cooling phase of natural composting. BGL-producing microbial communities upregulated the expression of glucose-tolerant BGL under carbon catabolite repression due to the increased glucose concentration, whereas the expression of non-glucose-tolerant BGL was suppressed.

Conclusion

Our results support the hypothesis that the functional microbial communities use multiple strategies of varying effectiveness to regulate the expression of BGL genes to facilitate adaptation to environmental changes.
Effect of Porphyromonas gingivalis infection on gut dysbiosis and resultant arthritis exacerbation in mouse model
Authors: Hamamoto Yuta , Ouhara Kazuhisa , Munenaga Syuichi , Shoji Mikio , Ozawa Tatsuhiko , Hisatsune Jyunzo , Kado Isamu , Kajiya Mikihito , Matsuda Shinji , Kawai Toshihisa , Mizuno Noriyoshi , Fujita Tsuyoshi , Hirata Shintaro , Tanimoto Kotaro , Nakayama Koji , Kishi Hiroyuki , Sugiyama Eiji , Kurihara Hidemi
Published: October 2020

Background

Porphyromonas gingivalis (Pg) infection causes periodontal disease and exacerbates rheumatoid arthritis (RA). It is reported that inoculation of periodontopathogenic bacteria (i.e., Pg) can alter gut microbiota composition in the animal models. Gut microbiota dysbiosis in human has shown strong associations with systemic diseases, including RA, diabetes mellitus, and inflammatory bowel disease. Therefore, this study investigated dysbiosis-mediated arthritis by Pg oral inoculation in an experimental arthritis model mouse.

Methods

Pg inoculation in the oral cavity twice a week for 6 weeks was performed to induce periodontitis in SKG mice. Concomitantly, a single intraperitoneal (i.p.) injection of laminarin (LA) was administered to induce experimental arthritis (Pg-LA mouse). Citrullinated protein (CP) and IL-6 levels in serum as well as periodontal, intestinal, and joint tissues were measured by ELISA. Gut microbiota composition was determined by pyrosequencing the 16 s ribosomal RNA genes after DNA purification of mouse feces. Fecal microbiota transplantation (FMT) was performed by transferring Pg-LA-derived feces to normal SKG mice. The effects of Pg peptidylarginine deiminase (PgPAD) on the level of citrullinated proteins and arthritis progression were determined using a PgPAD knockout mutant.

Results

Periodontal alveolar bone loss and IL-6 in gingival tissue were induced by Pg oral infection, as well as severe joint destruction, increased arthritis scores (AS), and both IL-6 and CP productions in serum, joint, and intestinal tissues. Distribution of Deferribacteres and S24-7 was decreased, while CP was significantly increased in gingiva, joint, and intestinal tissues of Pg-inoculated experimental arthritis mice compared to experimental arthritis mice without Pg inoculation. Further, FMT from Pg-inoculated experimental arthritis mice reproduced donor gut microbiota and resulted in severe joint destruction with increased IL-6 and CP production in joint and intestinal tissues. The average AS of FMT from Pg-inoculated experimental arthritis was much higher than that of donor mouse. However, inoculation of the PgPAD knockout mutant inhibited the elevation of arthritis scores and ACPA level in serum and reduced CP amount in gingival, joint, and intestinal tissues compared to Pg wild-type inoculation.

Conclusion

Pg oral infection affected gut microbiota dysbiosis and joint destruction via increased CP generation.
DNMT1-mediated methylation inhibits microRNA-214-3p and promotes hair follicle stem cell differentiate into adipogenic lineages
Authors: Jin Fangcao , Li Min , Li Xuyang , Zheng Yunpeng , Zhang Kun , Liu Xiaojun , Cai Bingjie , Yin Guangwen
Published: October 2020

Background

Dysfunction of the DNA methylation was associated with stem cell reprogramming. Moreover, DNA methyltransferase 1 (DNMT1) deficiency was involved in the differentiation of hair follicle stem cell (HFSc), but the molecular mechanisms remain unknown.

Methods

HFSc from human scalp tissues were isolated and cultured. The oil red O staining was used to observe the adipogenesis. The interaction relationship between microRNA (miR)-214-3p and mitogen-activated protein kinase 1 (MAPK1) was accessed by dual-luciferase reporter gene assay. The methylation level of miR-214-3p promoter was detected by methylation-specific PCR and the enrichment of DNMT1 in miR-214-3p promoter by chromatin immunoprecipitation assay. A mouse model of trauma was established to observe the skin regeneration at 0, 6, and 14 days.

Results

Expression of DNMT1 and MAPK1 was increased in the HFSc, while the expression of miR-214-3p was reduced. Moreover, DNMT1 inhibited the expression of miR-214-3p by promoting the promoter methylation of miR-214-3p. Overexpression of DNMT1 could reduce the expression of miR-214-3p, but increase the expression of MAPK1 and the extent of extracellular signal regulated kinase (ERK)1/2 phosphorylation, leading to enhanced adipogenic differentiation. Importantly, DNMT1 promoted skin regeneration in vivo. Conversely, overexpression of miR-214-3p could reverse the effects of DNMT1 on adipogenesis of HFSc.

Conclusion

DNMT1 promotes adipogenesis of HFSc by mediating miR-214-3p/MAPK1/p-ERK1/2 axis. This study may provide novel biomarkers for the potential application in stem cell therapy.
Patient–ventilator asynchrony in acute brain-injured patients: a prospective observational study
Authors: Luo Xu-Ying , He Xuan , Zhou Yi-Min , Wang Yu-Mei , Chen Jing-Ran , Chen Guang-Qiang , Li Hong-Liang , Yang Yan-Lin , Zhang Linlin , Zhou Jian-Xin
Published: October 2020

Background

Patient–ventilator asynchrony is common in mechanically ventilated patients and may be related to adverse outcomes. Few studies have reported the occurrence of asynchrony in brain-injured patients. We aimed to investigate the prevalence, type and severity of patient–ventilator asynchrony in mechanically ventilated patients with brain injury.

Methods

This prospective observational study enrolled acute brain-injured patients undergoing mechanical ventilation. Esophageal pressure monitoring was established after enrollment. Flow, airway pressure, and esophageal pressure–time waveforms were recorded for a 15-min interval, four times daily for 3 days, for visually detecting asynchrony by offline analysis. At the end of each dataset recording, the respiratory drive was determined by the airway occlusion maneuver. The asynchrony index was calculated to represent the severity. The relationship between the prevalence and the severity of asynchrony with ventilatory modes and settings, respiratory drive, and analgesia and sedation were determined. Association of severe patient–ventilator asynchrony, which was defined as an asynchrony index  ≥ 10%, with clinical outcomes was analyzed.

Results

In 100 enrolled patients, a total of 1076 15-min waveform datasets covering 330,292 breaths were collected, in which 70,156 (38%) asynchronous breaths were detected. Asynchrony occurred in 96% of patients with the median (interquartile range) asynchrony index of 12.4% (4.3%–26.4%). The most prevalent type was ineffective triggering. No significant difference was found in either prevalence or asynchrony index among different classifications of brain injury (p > 0.05). The prevalence of asynchrony was significantly lower during pressure control/assist ventilation than during other ventilatory modes (p < 0.05). Compared to the datasets without asynchrony, the airway occlusion pressure was significantly lower in datasets with ineffective triggering (p < 0.001). The asynchrony index was significantly higher during the combined use of opioids and sedatives (p < 0.001). Significantly longer duration of ventilation and hospital length of stay after the inclusion were found in patients with severe ineffective triggering (p < 0.05).

Conclusions

Patient–ventilator asynchrony is common in brain-injured patients. The most prevalent type is ineffective triggering and its severity is likely related to a long duration of ventilation and hospital stay. Prevalence and severity of asynchrony are associated with ventilatory modes, respiratory drive and analgesia/sedation strategy, suggesting treatment adjustment in this particular population.

Trial registration The study has been registered on 4 July 2017 in ClinicalTrials.gov (NCT03212482) (https://clinicaltrials.gov/ct2/show/NCT03212482).
Protocol for a systematic review and network meta-analysis of randomised controlled trials examining the effectiveness of early parenting interventions in preventing internalising problems in children and adolescents
Authors: Costantini Ilaria , Paul Elise , Caldwell Deborah M. , López-López José A. , Pearson Rebecca M.
Published: October 2020

Background

Internalising problems, such as depression and anxiety, are common and represent an important economical and societal burden. The effectiveness of parenting interventions in reducing the risk of internalising problems in children and adolescents has not yet been summarised. The aims of this review are to assess the effectiveness of parenting interventions in the primary, secondary and tertiary prevention of internalising problems in children and adolescents and to determine which intervention components and which intervention aspects are most effective for reducing the risk of internalising problems in children and adolescents.

Methods

Electronic searches in OVID SP versions of MEDLINE, EMBASE and PsycINFO; Cochrane Central Register of Controlled Trials; EBSCO version of ERIC andClinicalTrials.govhave been performed to identify randomised controlled trials or quasi-randomised controlled trials of parenting interventions. At least two independent researchers will assess studies for inclusion and extract data from each paper. The risk of bias assessment will be conducted independently by two reviewers using the Cochrane Collaboration’s Risk of Bias Assessment Tool. Statistical heterogeneity is anticipated given potential variation in participant characteristics, intervention type and mode of delivery, and outcome measures. Random effects models, assuming a common between-study variability, will be used to account for statistical heterogeneity. Results will be analysed using a network meta-analysis (NMA). If appropriate, we will also conduct a component-level NMA, where the ‘active ingredients’ of interventions are modelled using a network meta-regression approach.

Discussion

Preventing and reducing internalising problems could have major beneficial effects at the economic and societal level. Informing policy makers on the effectiveness of parenting interventions and on which intervention’s component is driving the effect is important for the development of treatment strategies.

Systematic review registration

International Prospective Register for Systematic Reviews (PROSPERO) numberCRD42020172251
Costs incurred by patients with drug-susceptible pulmonary tuberculosis in semi-urban and rural settings of Western India
Authors: Rupani Mihir P. , Cattamanchi Adithya , Shete Priya B. , Vollmer William M. , Basu Sanjib , Dave Jigna D.
Published: October 2020

Background

India reports the highest number of tuberculosis (TB) cases worldwide. Poverty has a dual impact as it increases the risk of TB and exposes the poor to economic hardship when they develop TB. Our objective was to estimate the costs incurred by patients with drug-susceptible TB in Bhavnagar (western India) using an adapted World Health Organization costing tool.

Methods

We conducted a descriptive cross-sectional study of adults, notified in the public sector and being treated for drug-susceptible pulmonary TB during January–June 2019, in six urban and three rural blocks of Bhavnagar region, Gujarat state, India. The direct and indirect TB-related costs, as well as patients’ coping strategies, were assessed for the overall care of TB till treatment completion. Catastrophic costs were defined as total costs > 20% of annual household income (excluding any amount received from cash transfer programs or borrowed). Median and interquartile range (IQR) was used to summarize patient costs. The median costs between any two groups were compared using the median test. The association between any two categorical variables was tested by the Pearson chi-squared test. All costs were described in US dollars (USD). During the study period, on average, one USD equalled 70 Indian Rupees.

Results

Of 458 patients included, 70% were male, 62% had no formal education, 71% lived in urban areas, and 96% completed TB treatment. The median (IQR) total costs were USD 8 (5–28), direct medical costs were USD 0 (0–0), direct non-medical costs were USD 3 (2–4) and indirect costs were USD 6 (3–13). Among direct non-medical costs, travel cost (median = USD 3, IQR: 2–4) to attend health facilities were the most prominent, whereas the indirect costs were mainly contributed by the patient’s loss of wages (median = USD 3, IQR: 0–6). Four percent of patients faced catastrophic costs, 11% borrowed money to cover costs and 7% lost their employment; the median working days lost to TB was 30 (IQR: 15–45). A majority (88%) of patients received a median USD 43 (IQR: 41–43) as part of a cash transfer program for TB patients.

Conclusions

Treatment completion was high and the costs incurred by TB patients were low in this setting. However, negative financial consequences occur even in low-cost settings. The role of universal cash transfer programs in such settings requires further study.
What are the effects of supporting early parenting by newborn behavioral observations (NBO)? A cluster randomised trial
Authors: Kristensen Ingeborg Hedegaard , Juul Svend , Kronborg Hanne
Published: October 2020

Background

Professional support to enhance the early parent-infant relationship in the first months after birth is recommended, but little is known about the effect of universal interventions. The objective was to investigate the effect of health visitors’ use of the Newborn Behavioral Observations system in new families.

Methods

A cluster-randomised study was conducted in four Danish municipalities. Health visitors’ geographical districts constituted the units for randomisation (n = 17). In the intervention group, 1332 families received NBO from 3 weeks after birth; in the comparison group, 1234 received usual care. Self-administered questionnaires were collected at baseline one to two weeks after birth, and at follow-up three and nine months postpartum. The outcomes were change over time measured by The Karitane Parenting Confidence Scale (KPCS), The Major Depression Inventory (MDI), The Ages and Stages Questionnaire: social-emotional (ASQ:SE) and The Mother and Baby Interaction Scale (MABIC). Data were analysed with mixed-effects linear regression using the intention-to-treat approach.

Results

At baseline, no significant differences between the two groups were seen regarding maternal and infant factors. At follow-up three and nine months after birth, the change in maternal confidence and mood, infant’s socio-emotional behaviour, and early parent-infant relationship moved in a slightly more positive direction in the intervention group than in the comparison group, though not statistically significant. The only significant effect was that the intervention mothers reported higher level of knowledge about infant’s communication skills, response to cues, and how to sooth and establish a relation with the infant, compared to the comparison group.

Conclusions

We found no effect of the NBO system delivered in a universal context to all families in a community setting. The only significant difference between groups was a higher maternal degree of knowledge regarding early parenting in the intervention group.

Trial registration

ClinicalTrials.gov ID: NCT03070652. Registrated February 22, 2017.
Historical scarf and splice carpentry joints: state of the art
Authors: Karolak Anna , Jasieńko Jerzy , Raszczuk Krzysztof
Published: October 2020

This paper summarises the current state of knowledge related to scarf and splice carpentry joints in flexural elements, also providing some examples of tensile joints. Descriptions and characteristics of these types of joints found in historical buildings are presented. In addition, issues related to forming carpentry joints in historic and heritage structures are discussed. Next, analyses and studies of flexural elements as well as selected examples of tensile joints described in the literature are presented. It is worth noting that authors of vast majority of the publications cited draw attention to the need for further research in this area. They acknowledge that existing descriptions are incomplete and insufficient for bringing about precise understanding and correct description of the static behaviour of these joints. Knowledge about designing and assessing static behaviour of existing carpentry joints is an important issue and is necessary to properly design and strengthen existing joints in historical timber structures.
A prospective clinical trial of the effects produced by the extrusion arch in the treatment of anterior open bite
Authors: de Brito Vasconcelos Juliana , de Almeida-Pedrin Renata Rodrigues , Poleti Thais Maria Freire Fernandes , Oltramari Paula , de Castro Conti Ana Cláudia Ferreira , Bicheline Mirchel Henrique Bertola , Lindauer Steven J. , de Almeida Marcio Rodrigues
Published: October 2020

Aim

To evaluate the maxillary dentition effects of the extrusion arch for anterior open bite (AOB) correction in mixed dentition patients.

Materials and methods

Fourteen subjects with an initial mean age of 9.17 ± 1.03 years presenting with dentoalveolar AOB (mean − 1.28 ± 1.46 mm) and normal facial pattern (FMA = 25.76°) were treated with an extrusion arch. The mean treatment period was 7.79 ± 2.58 months. Lateral cephalograms and dental models were taken before (T0) and after the correction of AOB (T1). Data were analyzed using paired t test to evaluate differences between T0 and T1. For all tests, a significance level of P < .05 was used.

Results

All patients achieved positive overbite at T1, with a mean increase of 3.07 mm. The maxillary incisors extruded 1.94 mm. Retroclination of the maxillary incisors (− 6.15°) and an increase in the interincisal angle (5.57°) were observed. There was a significant decrease in the distance between the incisal edge of the maxillary incisors and the molars (− 2.21 mm). There was significant mesial tipping of the maxillary molar (− 11.49°). Significant reductions of overjet (− 1.65 mm), arch perimeter (− 3.02 mm), and arch length (− 2.23 mm) were noted. The transverse maxillary intermolar distance did not change significantly.

Conclusions

The use of a maxillary extrusion arch was effective in the treatment of AOB. Overbite increased due to incisor extrusion, as well as retroinclination and overjet reduction. However, side effects, such as mesial molar tipping and decreases in arch perimeter and length might occur.
Exploring the trends of educational virtual reality games: a systematic review of empirical studies
Authors: Oyelere Solomon Sunday , Bouali Nacir , Kaliisa Rogers , Obaido George , Yunusa Abdullahi Abubakar , Jimoh Ebunayo R.
Published: October 2020

Virtual Reality (VR) and educational games are emerging technologies mediating a rapid transformation in the educational world. However, few studies have systematically analyzed Educational Virtual Reality Games (EVRGs) and how they have been applied in educational settings. This study reviewed 31 articles published in high impact journals and educational conference proceedings to unravel thetechnological, pedagogical, and gaming characteristics of contemporaryEVRGs. The results show the predominance of Oculus Rift headsets and HTC Vive as the main technology used in EVRGs. Moreover, the analysis revealed that the pedagogical application of the majority of EVRGs was developed for all levels of education (e.g. tertiary, K-12, lifelong learning), with the specific target audience of each game based on the desired learning outcome. Furthermore, the application of EVRGs has primarily focused on out of class use, with healthcare education topics dominating the topics taught using EVRGs. Based on our findings, we highlight some key implications and suggestions to advance the field of EVRGs.
The usage of Mate Select, a web-based selection tool for pedigree dogs for promoting sustainable breeding
Authors: Janes Mateja , Lewis Thomas W. , Ilska Joanna J. , Woolliams John A.
Published: October 2020

Background

Inbreeding is a phenomenon that accumulates through the mating of relatives within closed populations, such as pedigree dog breeds, and results in reduced genetic variation within breeds, and may lead to poorer health and fertility from inbreeding depression. The impact of inbreeding is driven by the selection and mating of parents, but information on choices to reduce inbreeding is difficult to assess for individual breeders. Tools to inform dog breeders on the current state of the inbreeding and the relationships among possible parents are potentially useful for providing guidance towards choices that are more beneficial to the breed. However, their utility depends on their usage and this study examines the usage of Mate Select, a web-based tool offered by The Kennel Club, covering 222 breeds for a period of 7 years following its launch in 2011.

Results

The average usage was 2830 searches/week in 2012 with a slight fall of 2.2% per year (P < 0.001) to 2480 searches/week in 2018. Of these, 4% originated from outside the UK, across all continents except Antarctica, with the majority coming from English speaking countries. Searches/week showed a cyclical pattern with two cycles of 26.0 and 50.1 weeks. Since Mate Select’s launch there has been a steady increase in searches from mobile devices, from 11% in 2012 to 43% in 2018. For the 197 breeds with at least 10 dams registered with the Kennel Club during the study period, there was a relationship between usage and registrations, with the average number of searches as a multiple of the number of dams increasing from 2 to 10 for breeds with up to 70 dams and declining towards 2 again for the largest breeds with approximately 20,000 registered dams. However, there remained substantial variation among breeds of similar size, and breeds for which EBVs had become available during the study period had a 2.46 fold greater frequency of searches per registered bitch (P < 0.001), but this was not linked directly to the publication of EBVs.

Conclusions

Mate Select has sustained and substantial usage, although there is also substantial variation in usage among breeds, which offers an opportunity to develop further guidance.
Half-graben inversion tectonics revealed by gravity modeling in the Mikawa Bay Region, Central Japan
Authors: Miyakawa Ayumu , Abe Tomoya , Sumita Tatsuya , Otsubo Makoto
Published: October 2020

The Mikawa Bay Region, central Japan, is characterized by many active faults recording Quaternary activities. It is, however, difficult to understand the overall tectonic character of the region due to a thick sedimentary cover. We report the first finding of Neogene basin inversion in southwest Japan by estimating the depth and structure of the basement surface in the Mikawa Bay Region by analyzing gravity data. Our gravity basement map and two-dimensional density-structure model automatically determined using the genetic algorithm revealed a half-graben bounded on the south by the north-dipping Utsumi Fault. The motion of the Utsumi Fault, which inverted from normal faulting during the Miocene to recent reverse faulting, indicated the inversion of the half-graben. The timing of the inversion of the fault motion, i.e., the reverse faulting of the Miocene normal fault, can be compared with an episode of basin inversion observed at the eastern margin of the Japan Sea, northeastern Japan. The Takahama Fault in the southwestern part of the Nishi–Mikawa Plain is considered to have formed as a result of the backthrust of the Utsumi Fault under inversion tectonics. If the Takahama Fault is indeed the backthrust fault of the Utsumi Fault, the root of the Takahama Fault may be deep such that the Takahama Fault is seismogenic and linked to the 1945 Mikawa earthquake.
Recurrent gastric cancer sustaining a partial response after the nivolumab discontinuation because of immune-related adverse events: a case report
Authors: Arigami Takaaki , Matsushita Daisuke , Okubo Keishi , Tanaka Takako , Sasaki Ken , Noda Masahiro , Kita Yoshiaki , Mori Shinichiro , Tsuruda Yusuke , Kurahara Hiroshi , Ohtsuka Takao
Published: October 2020

Background

The prognosis of patients with recurrent gastric cancer is poor despite chemotherapy being clinically recommended as the first therapeutic strategy. Recent clinical trials have established the clinical utility of nivolumab in the third-line treatment of such patients. Immune-related adverse events (irAE) have been focused as a promising predictor for tumor response to nivolumab. This report aims to present a long-term survivor of recurrent gastric cancer who was followed up without any treatments after the nivolumab discontinuation because of irAE.

Case presentation

A 65-year-old male with stage III gastric cancer (cT4aN1M0) underwent surgery after neoadjuvant chemotherapy. Owing to the final pathological stage IIIB (ypT4bN1M0), the patient received adjuvant chemotherapy. Nevertheless, during adjuvant chemotherapy 1-year post-surgery, computed tomography (CT) revealed lymph node swelling in station no. 9. Thus, upon diagnosis with lymph node recurrence, the patient was treated with two courses of capecitabine + oxaliplatin and three courses of ramucirumab + paclitaxel as the first- and second-line regimens, respectively. Based on these regimens, the patient had a progressive disease to chemotherapy. Consequently, we administered nivolumab as the third-line regimen. After four courses of nivolumab, CT revealed a significant shrinkage of the metastatic lymph node, with a 45.6% reduction. We confirmed a partial response during 11 courses of nivolumab. Since the occurrence of grade 4 diabetes mellitus after 12 courses of nivolumab, the patient was followed up without any treatment after the nivolumab discontinuation. Currently, the patient remains a partial response for 15 months, since the nivolumab discontinuation and is alive for 31 months after disease recurrence.

Conclusions

Acute irAE during nivolumab chemotherapy could be one of the crucial clinical factors to predict tumor suppression in patients with advanced gastric cancer.