bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical characteristics and survival of Chinese patients diagnosed with pulmonary arterial hypertension who carry BMPR2 or EIF2KAK4 variants
Authors: Zeng Qixian , Yang Hang , Liu Bingyang , Ma Yanyun , Liu Zhihong , Chen Qianlong , Li Wenke , Luo Qin , Zhao Zhihui , Zhou Zhou , Xiong Changming
Published: May 2020

Background

Variants in the gene encoding bone morphogenetic protein receptor type II (BMPR2) are the most common genetic cause of pulmonary arterial hypertension (PAH), whereas biallelic variants in the eukaryotic translation initiation factor 2 alpha kinase 4 gene (EIF2AK4) are described in pulmonary veno-occlusive disease/pulmonary capillary haemangiomatosis (PVOD/PCH). Racial background may influence the clinical characteristics of patients diagnosed with PAH or PVOD/PCH. Here, we compared the clinical characteristics and survival between patients with BMPR2 variants or EIF2AK4 variants in a Chinese population.

Methods

Heterozygous variants in BMPR2 and homozygous or compound heterozygous biallelic EIF2AK4 variants predicted to be deleterious were identified as potentially causal. Clinical and radiological data were collected and analysed. The primary outcomes were death or lung transplantation. Hazard ratios (HRs) for death or transplantation associated with the presence of BMPR2 or biallelic EIF2AK4 variants were calculated using Cox proportional hazards models to analyse patient survival.

Results

Two hundred thirty-two patients with PAH were enrolled for genetic testing, and PAH patients with associated conditions were excluded from the study. Forty-five patients with BMPR2 variants and 11 patients with biallelic EIF2AK4 variants were recruited. PAH patients with BMPR2 or biallelic EIF2AK4 variants presented symptoms at the ages of 25.57 ± 10.17 years and 31.6 ± 9.38 years, respectively. The whole group of patients showed female dominance either with BMPR2 variants or biallelic EIF2AK4 variants. Specific radiological abnormalities are more prominent in EIF2AK4 variant carriers but can also be found in some patients with BMPR2 variants. Biallelic EIF2AK4 variant carriers had worse survival than BMPR2 variant carriers (p < 0.0001).

Conclusions

Clinical pictures of PAH patients with BMPR2 and biallelic EIF2AK4 variants in the Chinese population differ from other populations by a younger age at diagnosis and demonstrate female dominance in the whole patient group. High-resolution chest CT can help assist in differentiating PAH with PVOD/PCH. BMPR2 variants and biallelic EIF2AK4 variants are associated with adverse outcomes, but the survival of patients with biallelic EIF2AK4 variants is dismal.
Evaluation of time courses of agreement between minutely obtained transcutaneous blood gas data and the gold standard arterial data from spontaneously breathing Asian adults, and various subgroup analyses
Authors: Umeda Akira , Ishizaka Masahiro , Tasaki Masamichi , Yamane Tateki , Watanabe Taiji , Inoue Yasushi , Mochizuki Taichi , Okada Yasumasa , Kesler Sarah
Published: May 2020

Background

Usual clinical practice for arterial blood gas analysis (BGA) in conscious patients involves a one-time arterial puncture to be performed after a resting period of 20–30 min. The aim of this study was to evaluate the use of transcutaneous BGA for estimating this gold standard arterial BGA.

Methods

Spontaneously breathing Asian adults (healthy volunteers and respiratory patients) were enrolled (n = 295). Transcutaneous PO2(PtcO2) and PCO2(PtcCO2) were monitored using a transcutaneous monitor (TCM4, Radiometer Medical AsP, Denmark) with sensors placed on the chest, forearm, earlobe or forehead. Transcutaneous BGA at 1-min intervals was compared with arterial BGA at 30 min. Reasonable steps to find severe hypercapnia with PaCO2 > 50 mmHg were evaluated.

Results

Sensors on the chest and forearm were equally preferred and used because of small biases (n = 272). The average PCO2bias was close to 0 mmHg at 4 min, and was almost constant (4–5 mmHg) with PtcCO2being higher than PaCO2at ≥8 min. The limit of agreement for PCO2narrowed over time: ± 13.6 mmHg at 4 min, ± 7.5 mmHg at 12–13 min, and ± 6.3 mmHg at 30 min. The limit of agreement for PO2also narrowed over time (± 23.1 mmHg at 30 min). Subgroup analyses showed that the PaCO2and PaO2levels, gender, and younger age significantly affected the biases. All hypercapnia subjects with PaCO2 > 50 mmHg (n = 13) showed PtcCO2 ≥ 50 mmHg for until 12 min.

Conclusions

Although PtcCO2is useful, it cannot completely replace PaCO2because PCO2occasionally showed large bias. On the other hand, the prediction of PaO2using PtcO2was unrealistic in Asian adults. PtcCO2 ≥ 50 mmHg for until 12 min can be used as a screening tool for severe hypercapnia with PaCO2 > 50 mmHg.
Predictive factors for early hypothyroidism following the radioactive iodine therapy in Graves’ disease patients
Authors: Hu Rui-Ting , Liu De-Shan , Li Bin
Published: May 2020

Background

Radioactive iodine (RAI) therapy is an important treatment option for Graves’ disease (GD), the main side effect of RAI treatment is hypothyroidism, and the factors resulting in hypothyroidism are still controversial. The purpose of this retrospective study was to clarify the possible risk factors of early hypothyroidism after RAI therapy in Graves’ disease.

Methods

We reviewed 312 GD patients treated with RAI between January 2017 to December 2018, collected the potential risk factors, and analyzed the relationship between these variables and early hypothyroidism.

Results

After 6 months’ follow-up, 218 (69.87%) patients were evaluated as early hypothyroid. Male gender, shorter duration of disease, smaller thyroid weight, lower 2-h radioactive iodine uptake (RAIU), 6-h RAIU, 24-h RAIU and 6/24-h uptake ratio, lower administered dosages were significantly associated with early hypothyroidism. Logistics regression analysis showed that male gender, smaller thyroid weight and lower 6-h RAIU were associated with early hypothyroidism. Multi-factors combined ROC curve analysis suggested that the predictive power of male gender, smaller thyroid weight and lower 6-h RAIU for early hypothyroidism was 0.711.

Conclusions

Our results show that RAI is an effective therapy for GD and most of the cured patients became to hypothyroid within 6 months. Male gender, smaller thyroid weight and lower 6-h RAIU are the main risk factors for early hypothyroidism.
Does fasting during Ramadan increase the risk of the development of sialadenitis?
Authors: Joachim Michael V. , Ghantous Yasmine , Zaaroura Suleiman , Alkeesh Kutaiba , Zoabi Tameem , Abu el-Na’aj Imad
Published: May 2020

Background

Ramadan is a month within the Islamic lunar calendar when Muslims are required to fast (abstain from food and drink) during the daytime (from sunrise to sunset) for the entire month. Due to the established connection between fasting and dehydration and acute sialadenitis, the aim of this study is to determine if there is a higher frequency of sialadenitis among the Muslim population during Ramadan than during other months of the year.

Methods

We conducted a retrospective study using the medical records of 120 Muslim patients admitted to the emergency room (ER) and diagnosed with acute sialadenitis over a 5-year period at the Baruch Padeh Medical Center, Poriya, and St. Vincent de Paul (French) Hospital, Nazareth, both located in Israel. The study group were Muslim patients, with the aforementioned diagnosis, admitted during Ramadan, while the control group included patients diagnosed with sialadenitis during the rest of the year. We analyzed overall admission frequency as well as descriptive and diagnostic data, including age, sex, gland involved and several blood test results.

Results

During the month of Ramadan, the admission of Muslims with a diagnosis of acute sialadenitis was more than double that during the other months of the year – a difference that was found to be statistically significant (p = 0.001). Additionally, we found that Ramadan sialadenitis patients had significantly higher leukocyte numbers at admission (p = 0.0085) and, importantly, a significantly higher level of dehydration (blood urea nitrogen (BUN)/creatinine ratio) than non-Ramadan sialadenitis patients (p = 0.0001).

Conclusion

There is evidence that fasting in Ramadan may increase the risk for the development of acute sialadenitis. Our results suggest that this may be the result of dehydration.
Scholarly productivity of faculty in primary care roles related to tenure versus non-tenure tracks
Authors: Braxton Michaela M. , Infante Linares Jhojana L. , Tumin Dmitry , Campbell Kendall M.
Published: May 2020

Background

Increasing the number of primary care physicians is critical to overcoming the shortage of healthcare providers. Primary care physicians are increasingly called upon to address not only medical concerns but also behavioral health needs and social determinants of health which requires ongoing research and innovation. This paper evaluated scholarly productivity of faculty in tenure versus non-tenure tracks in primary care roles, defined as family medicine, internal medicine, internal medicine/pediatrics and pediatrics.

Methods

The study included physician faculty in the clinical departments of Brody School of Medicine serving between the 2014–2015 and 2018–2019 academic years. Department, track, and rank at the beginning of each academic year (e.g., 2014–2015) were correlated with having any publications in the following calendar year (e.g., 2015), as determined from a search of the Scopus database.

Results

A total of 1620 observations and 542 unique faculty were included in the analysis. As of 2018–2019, 19% percent of primary care faculty were either tenured or on tenure track, as compared to 41% of faculty in other departments (p < 0.001). Primary care departments were also disproportionately staffed by junior faculty (60% as compared to 48% in other departments; p = 0.087). The proportion of faculty with any publications was significantly higher for faculty on the tenure track compared to those not on the tenure track (34% vs. 14%, p < 0.001).

Conclusions

Academic productivity was lower among non-tenure-track physician faculty, as measured by publication in peer-reviewed journals. This was exacerbated among faculty in primary care departments, who were also more likely to hold non-tenure-track appointments. The loss of tenure-track positions disproportionately impacts scholarly activity in primary care and may be limiting progress in care-oriented research. Findings suggest that providing non-tenure faculty the time and resources to be involved in research, in addition to their clinical work, as well as access to research collaborators and mentors can promote scholarly activity among this group.
“How can I do more?” Cultural awareness training for hospital-based healthcare providers working with high Aboriginal caseload
Authors: Kerrigan Vicki , Lewis Nicole , Cass Alan , Hefler Marita , Ralph Anna P.
Published: May 2020

Background

Aboriginal cultural awareness training aims to build a culturally responsive workforce, however research has found the training has limited impact on the health professional’s ability to provide culturally safe care. This study examined cultural awareness training feedback from healthcare professionals working with high Aboriginal patient caseloads in the Top End of the Northern Territory of Australia. The aim of the research was to assess the perception of training and the potential for expansion to better meet workforce needs.

Methods

Audit and qualitative thematic analysis of cultural awareness training evaluation forms completed by course participants between March and October 2018. Course participants ranked seven teaching domains using five-point Likert scales (maximum summary score 35 points) and provided free-text feedback. Data were analysed using the Framework Method and assessed against Kirkpatrick’s training evaluation model. Cultural safety and decolonising philosophies shaped the approach.

Results

621 participants attended 27 ACAP sessions during the study period. Evaluation forms were completed by 596 (96%). The mean overall assessment score provided was 34/35 points (standard deviation 1.0, range 31-35) indicating high levels of participant satisfaction. Analysis of 683 free text comments found participants wanted more cultural education, designed and delivered by local people, which provides an opportunity to consciously explore both Aboriginal and non-Aboriginal cultures (including self-reflection). Regarding the expansion of cultural education, four major areas requiring specific attention were identified: communication, kinship, history and professional relevance. A strength of this training was the authentic personal stories shared by local Aboriginal cultural educators, reflecting community experiences and attitudes. Criticism of the current model included that too much information was delivered in one day.

Conclusions

Healthcare providers found cultural awareness training to be an invaluable entry point. Cultural education which elevates the Aboriginal health user’s experience and provides health professionals with an opportunity for critical self-reflection and practical solutions for common cross-cultural clinical encounters may improve the delivery of culturally safe care. We conclude that revised models of cultural education should be developed, tested and evaluated. This requires institutional support, and recognition that cultural education can contribute to addressing systemic racism.
Re-designing a rapid response system: effect on staff experiences and perceptions of rapid response team calls
Authors: Chalwin Richard , Giles Lynne , Salter Amy , Kapitola Karoline , Karnon Jonathan
Published: May 2020

Background

Rapid Response Team (RRT) calls are clinical crises. Clinical and time pressures can hinder effective liaison between staff who call the RRT (‘users’) and those responding as part of the RRT (‘members’). Non-technical skills (NTS) training has been shown to improve communication and cooperation but requires time and financial resources that may not be available in acute care hospitals. Rapid Response System (RRS) re-design, aiming to promote use of NTS, may provide an alternative approach to improving interactions within RRTs and between members and users.

Methods

Re-design of an existing mature RRS was undertaken in a tertiary, metropolitan hospital incorporating the addition of: 1) regular RRT meetings 2) RRT role badges and 3) a structured member-to-user patient care responsibility “hand-off” process. To compare experiences and perceptions of calls, users and members were surveyed pre and post re-design.

Results

Post re-design there were improvements in members’ understanding of RRT roles (P = 0.03) and responsibilities (P < 0.01), and recollection of introducing themselves to users (P = 0.02). For users, after the re-design, there were improvements in identification of the RRT leader (P < 0.01), and in the development of clinical plans for patients remaining on the ward at the end of an RRT call (P < 0.01). However, post-re-design, fewer users agreed that the structured hand-off was useful or that they should be involved in the process. Both members and users reported fewer experiences of conflict at RRT calls post-re-design (both P < 0.01).

Conclusion

The RRS re-design yielded improvements in interactions between members in RRTs and between RRT members and users. However, some unintended consequences arose, particularly around user satisfaction with the structured hand-off. These findings suggest that refinement and improvement of the RRS is possible, but should be an ongoing iterative effort, ideally supported by staff training.

Trial registration

NCT01551160. Registered: 12th March 2012.
Development and validation of the LoVI: the Laws on Violence against women and girls Index
Authors: Yount Kathryn M. , Lewis Patricia C. , Clark Cari Jo , Heise Lori , Naved Ruchira T. , Maxwell Lauren
Published: May 2020

Background

Violence against women and girls (VAWG) is a human-rights violation with adverse long-term and inter-generational consequences. Redefining VAWG as legally unacceptable is one strategy for social change. The co-occurrence of national laws against VAWG is understudied, and tools to monitor the national legal environment are lacking. We developed the Laws on Violence against Women and Girls Index (LoVI) to measure global progress to develop comprehensive national legislation against child marriage, sexual harassment, domestic violence, and marital rape.

Methods

Using data from 2016 and 2018 for 189 countries from the World Bank Women, Business, and the Law database, we used factor analysis to assess the dimensionality of the LoVI. We examined the distribution of the LoVI across countries and regions, and the relationship of national rankings on the LoVI with those for other indicators from the United Nations, Demographic and Health Surveys, and World Factbook.

Results

A single LoVI factor showed good model fit in the factor analysis. National LoVI rankings were positively associated with gender equality in human development and economic rights-related rankings and negatively associated with rates of justifying wife beating and of lifetime and prior-year physical and/or sexual IPV. The LoVI was not associated with national indicators for human development and income inequality.

Conclusion

The LoVI is a concise, coherent, validated index to monitor the progress of nations on adopting comprehensive legislation to advance 2030 Sustainable Development Goal 5, to eliminate VAWG.
Pulmonary and systemic responses to aerosolized lysate of Staphylococcus aureus and Escherichia coli in calves
Authors: Bassel Laura L. , Co Carmon , Macdonald Alaina , Sly Laurel , McCandless Erin E. , Hewson Joanne , Tiwari Raksha , Sharif Shayan , Siracusa Laura , Clark Mary Ellen , Caswell Jeff L.
Published: May 2020

Background

Constitutive and inducible defenses protect the respiratory tract from bacterial infection. The objective of this study was to characterize the response to an aerosolized lysate of killed bacteria, as a basis for studying the regulation and in vivo effects of these inducible innate immune responses.

Results

Bacterial lysate consisting of heat-killed and sonicatedStaphylococcus aureusandEscherichia coliwas aerosolized to 6 calves and systemic and pulmonary innate immune and inflammatory responses were measured in the first 24 h relative to baseline. Evaluated parameters included clinical parameters (body temperature and heart and respiratory rates), blood acute phase proteins and leukocyte counts, and leukocytes and proteins in bronchoalveolar lavage fluid. Mild clinical signs with increased heart rates and rectal temperatures developed following administration of the lysate, with resolution by 24 h. Serum haptoglobin and plasma fibrinogen concentrations were elevated at 24 h relative to baseline. Bronchoalveolar lavage fluid (BALF) had increased cellularity and increased proportion of neutrophils, as well as higher concentrations of interleukin (IL)-8, IL-10 and total protein at 24 h relative to baseline. Mass spectrometry identified 965 unique proteins in BALF: 19 proteins were increased and 26 proteins were decreased relative to baseline. The upregulated proteins included those involved in innate immunity including activation of complement, neutrophils and platelets. At postmortem examination, calves receiving higher doses of lysate had areas of lobular consolidation and interlobular edema. Histologically, neutrophils were present within bronchioles and to a lesser extent within alveoli. Calves receiving highest doses of lysate had patchy areas of neutrophils, hemorrhage and hyaline membranes within alveoli.

Conclusions

Aerosolization of bacterial lysate stimulated an innate immune response in lungs and airways, with alveolar damage observed at higher doses. Such a stimulus could be of value for investigating the effects of inducible innate immune responses on occurrence of disease, or for evaluating how stress, drugs or genetics affect these dynamic responses of the respiratory tract.
Identification and validation of m6A RNA methylation regulators with clinical prognostic value in Papillary thyroid cancer
Authors: Wang Xinyi , Fu Xiaorui , Zhang Junjia , Xiong Chengfeng , Zhang Shuyong , Lv Yunxia
Published: May 2020

Background

Papillary thyroid cancer (PTC) is a type of malignant tumor with excellent prognosis, accounting for more than 80% of thyroid cancer. Recently, numerous studies illustrated the importance of N6-methyladenosine (m6A) RNA modification to tumorigenesis, but it has never been reported in PTC.

Methods

We downloaded data from The Cancer Genome Atlas (TCGA) and analyzed RNA expression, single nucleotide polymorphisms (SNPs) and copy number variations (CNVs) of 19 m6A RNA methylation regulators in PTC. Then we used nonnegative matrix factorization (NMF) to cluster patients into two m6A subtypes and compared them in overall survival (OS) and disease-free survival (DFS). The Weighted correlation network analysis (WGCNA) and univariate Cox proportional hazard model (CoxPH) were used to select genes for the construction of a m6A-related signature. The accuracy and prognostic value of this signature were validated by using receiver operating characteristic (ROC) curves, K-M (Kaplan–Meier) survival analysis, univariant and multivariant analyses.

Results

CNVs and differential expression of m6A regulators were observed in PTC patients. Especially IGF2BP2 (Insulin-like growth factor 2 mRNA binding protein 2), which was most significantly overexpressed in tumor tissue. We chose 4 genes in the m6A-related module from WGCNA: IGF2BP2, STT3A, MTHFD1 and GSTM4, and used them to construct a m6A-related signature. The prognostic value of this signature was validated, and risk scores provided by the signature was the independent prognostic factor for PTC. A nomogram was also provided for clinical usage.

Conclusions

We performed a comprehensive evaluation of the m6A RNA modification landscape of PTC and explored its underlying mechanisms. Our m6A-related signature was of great significance in predicting the DFS of patients with PTC. And IGF2BP2 was a gene worthy for further analysis as its strong correlation with DFS and clinical phenotypes of PTC.
Identification of a conserved var gene in different Plasmodium falciparum strains
Authors: Dimonte Sandra , Bruske Ellen I. , Enderes Corinna , Otto Thomas D. , Turner Louise , Kremsner Peter , Frank Matthias
Published: May 2020

Background

The multicopy var gene family of Plasmodium falciparum is of crucial importance for pathogenesis and antigenic variation. So far only var2csa, the var gene responsible for placental malaria, was found to be highly conserved among all P. falciparum strains. Here, a new conserved 3D7 var gene (PF3D7_0617400) is identified in several field isolates.

Methods

DNA sequencing, transcriptional analysis, Cluster of Differentiation (CD) 36-receptor binding, indirect immunofluorescence with PF3D7_0617400-antibodies and quantification of surface reactivity against semi-immune sera were used to characterize an NF54 clone and a Gabonese field isolate clone (MOA C3) transcribing the gene. A population of 714 whole genome sequenced parasites was analysed to characterize the conservation of the locus in African and Asian isolates. The genetic diversity of two var2csa fragments was compared with the genetic diversity of 57 microsatellites fragments in field isolates.

Results

PFGA01_060022400 was identified in a Gabonese parasite isolate (MOA) from a chronic infection and found to be 99% identical with PF3D7_0617400 of the 3D7 genome strain. Transcriptional analysis and immunofluorescence showed expression of the gene in an NF54 and a MOA clone but CD36 binding assays and surface reactivity to semi-immune sera differed markedly in the two clones. Long-read Pacific bioscience whole genome sequencing showed that PFGA01_060022400 is located in the internal cluster of chromosome 6. The full length PFGA01_060022400 was detected in 36 of 714 P. falciparum isolates and 500 bp fragments were identified in more than 100 isolates. var2csa was in parts highly conserved (He = 0) but in other parts as variable (He = 0.86) as the 57 microsatellites markers (He = 0.8).

Conclusions

Individual var gene sequences exhibit conservation in the global parasite population suggesting that purifying selection may limit overall genetic diversity of some var genes. Notably, field and laboratory isolates expressing the same var gene exhibit markedly different phenotypes.
Radiotherapy dose distribution prediction for breast cancer using deformable image registration
Authors: Bai Xue , Wang Binbing , Wang Shengye , Wu Zhangwen , Gou Chengjun , Hou Qing
Published: May 2020

Background

Radiotherapy treatment planning dose prediction can be used to ensure plan quality and guide automatic plan. One of the dose prediction methods is incorporating historical treatment planning data into algorithms to estimate the dose–volume histogram (DVH) of organ for new patients. Although DVH is used extensively in treatment plan quality and radiotherapy prognosis evaluation, three-dimensional dose distribution can describe the radiation effects more explicitly. The purpose of this retrospective study was to predict the dose distribution of breast cancer radiotherapy by means of deformable registration into atlas images with historical treatment planning data that were considered to achieve expert level. The atlas cohort comprised 20 patients with left-sided breast cancer, previously treated by volumetric-modulated arc radiotherapy. The registration-based prediction technique was applied to 20 patients outside the atlas cohort. This study evaluated and compared three different approaches: registration to the most similar image from a dataset of individual atlas images (SIM), registration to all images from a database of individual atlas images with the average method (WEI_A), and the weighted method (WEI_F). The dose prediction performance of each strategy was quantified using nine metrics, including the region of interest dose error, 80% and 100% prescription area dice similarity coefficients (DSCs), and γ metrics. A Friedman test and a nonparametric exact Wilcoxon signed rank test were performed to compare the differences among groups. The clinical doses of all cases served as the gold standard.

Results

The WEI_F method could achieve superior dose prediction results to those of WEI_A. WEI_F outperformed SIM in the organ-at-risk mean absolute difference (MAD). When using the WEI_F method, the MAD values for the ipsilateral lung, heart, and whole lung were 197.9 ± 42.9, 166 ± 55.1, 122.3 ± 25.5, and 55.3 ± 42.2 cGy, respectively. Moreover, SIM exhibited superior prediction in the DSC and γ metrics. When using the SIM method, the means of the 80% and 100% prescription area DSCs, 33γ metric, and 55γ metric were 0.85 ± 0.05, 0.84 ± 0.05, 0.64 ± 0.13, and 0.84 ± 0.10, respectively. The plan target volume and spinal cord MAD when using SIM and WEI were 235.6 ± 158.4 cGy versus 227.4 ± 144.0 cGy ($$p > 0.05$$p>0.05) and 61.4 ± 44.9 cGy versus 55.3 ± 42.2 cGy ($$p > 0.05$$p>0.05), respectively.

Conclusions

A predicted dose distribution that approximated the clinical plan could be generated using the methods presented in this study.
Nano-copper enhanced flexible device for simultaneous measurement of human respiratory and electro-cardiac activities
Authors: Wang Li , Zhang Feng , Lu Kechao , Abdulaziz Mohammed , Li Chao , Zhang Chongyu , Chen Jun , Li Yunlun
Published: May 2020

Background

Dysfunction of human respiratory and electro-cardiac activities could affect the ability of the heart to pump blood and the lungs to inhale oxygen. Thus, a device could simultaneously measure electro-cardiac signal and respiratory pressure could provide vital signs for predicting early warning of cardio-pulmonary function-related chronic diseases such as cardiovascular disease, and respiratory system disease.

Results

In this study, a flexible device integrated with piezo-resistive sensing element and voltage-sensing element was developed to simultaneously measure human respiration and electro-cardiac signal (including respiratory pressure, respiration frequency, and respiration rhythm; electro-cardio frequency, electro-cardio amplitude, and electro-cardio rhythm). When applied to the measurement of respiratory pressure, the piezo-resistive performance of the device was enhanced by nano-copper modification, which detection limitation of pressure can reduce to 100 Pa and the sensitivity of pressure can achieve to 0.053 ± 0.00079 kPa−1. In addition, the signal-to-noise ratio during bio-electrical measurement was increased to 10.7 ± 1.4, five times better than that of the non-modified device.

Conclusion

This paper presents a flexible device for the simultaneous detection of human respiration and cardiac electrical activity. To avoid interference between the two signals, the layout of the electrode and the strain sensor was optimized by FEA simulation analysis. To improve the piezo-resistive sensitivity and bio-electric capturing capability of the device, a feather-shaped nano-copper was modified onto the surface of carbon fiber. The operation simplicity, compact size, and portability of the device open up new possibilities for multi-parameter monitoring.
Gender inequality in the health workforce in the midst of achieving universal health coverage in Mexico
Authors: Montañez-Hernández Julio César , Alcalde-Rabanal Jacqueline Elizabeth , Nigenda-López Gustavo Humberto , Aristizábal-Hoyos Gladis Patricia , Dini Lorena
Published: May 2020

Background

The third Sustainable Development Goal aims to ensure healthy lives and to promote well-being for all at all ages. The health system plays a key role in achieving these goals and must have sufficient human resources in order to provide care to the population according to their needs and expectations.

Methods

This paper explores the issues of unemployment, underemployment, and labor wastage in physicians and nurses in Mexico, all of which serve as barriers to achieving universal health coverage. We conducted a descriptive, observational, and longitudinal study to analyze the rates of employment, underemployment, unemployment, and labor wastage during the period 2005–2017 by gender. We used data from the National Occupation and Employment Survey. Calculating the average annual rates (AAR) for the period, we describe trends of the calculated rates. In addition, for 2017, we calculated health workforce densities for each of the 32 Mexican states and estimated the gaps with respect to the threshold of 4.45 health workers per 1000 inhabitants, as proposed in the Global Strategy on Human Resources for Health.

Results

The AAR of employed female physicians was lower than men, and the AARs of qualitative underemployment, unemployment, and labor wastage for female physicians are higher than those of men. Female nurses, however, had a higher AAR in employment than male nurses and a lower AAR of qualitative underemployment and unemployment rates. Both female physicians and nurses showed a higher AAR in labor wastage rates than men. The density of health workers per 1000 inhabitants employed in the health sector was 4.20, and the estimated deficit of workers needed to match the threshold proposed in the Global Strategy is 70 161 workers distributed among the 16 states that do not reach the threshold.

Conclusions

We provide evidence of the existence of gender gaps among physicians and nurses in the labor market with evident disadvantages for female physicians, particularly in labor wastage. In addition, our results suggest that the lack of physicians and nurses working in the health sector contributes to the inability to reach the health worker density threshold proposed by the Global Strategy.
Maternal nutritional status and child feeding practices: a retrospective study in Santal communities, Birbhum District, West Bengal, India
Authors: Stiller Caroline Katharina , Golembiewski Silvia Konstanze Ellen , Golembiewski Monika , Mondal Srikanta , Biesalski Hans Konrad , Scherbaum Veronika
Published: May 2020

Background

In West Bengal, according to the National Family Health Survey (NFHS-4) 2015-16, undernutrition and anemia are particularly common among scheduled tribe women and children. The purpose of this research is to assess the nutritional status of Adivasi mothers and child feeding patterns, relevant for clinical practice and the design of future preventive actions. These baseline characteristics were obtained in the scope of a feeding trial aimed at improving the hemoglobin concentration of the index child (6–39 months).

Methods

In February 2015, the baseline survey was conducted in 21 tribal villages. In total, 288 mothers and 307 children were recruited for their hemoglobin levels (HemoCue Hb201+), as well as anthropometric indices height/length, weight and MUAC. By questionnaire-based interview aspects on child feeding practices, childcare, family scheduling, and prenatal care were elucidated.

Results

The majority of mothers belong to the Santal tribe (93.8%). Nearly half of mothers suffered from underweight including severe forms (BMI < 18.5: 49.4%), and the majority of mothers were anemic (Hb < 12 g/dl: 86.2%). Similarly, undernutrition was highly prevalent among the index children. Ever breastfeeding was almost universal in the study area (99.6%), with all infants aged < 12 months at the time of the interview still being breastfed. The majority of children were breastfed within the first hour after birth (75.7%), still every third child (32.2%) was deprived of colostrum. Merely 32.9% of infants were exclusively breastfed for 6 months (180 days) according to the recommendations of the WHO/UNICEF. When relating to the proposed complementary feeding (CF) indicator then 89.6% of children have received CF (mainly family foods/biscuits/plain rice) during the first 6 to 8 months, and 46.8% of children aged 6 to 23 months fulfilled the minimum acceptable diet (2 to 3 meals per day and ≥ 4 food groups per day), corresponding to 58.1% among children aged 12 to 23 months versa 25% among infants aged 6 to 11 months.

Conclusion

The maternal nutritional status was poor and showed interrelations with the nutritional status of the index child. Inadequate feeding and caring practices were common. In particular the younger age group (< 12 months) was found at risk of being offered inadequate CF, which needs to be tackled by future programs.

Trial registration

The trial was retrospectively registered at the German Clinical Trials Register on the 1st July 2019 (DRKS00017388).
Analytical methods in strigolactone research
Authors: Halouzka Rostislav , Zeljković Sanja Ćavar , Klejdus Bořivoj , Tarkowski Petr
Published: May 2020

Strigolactones (SLs) are important plant hormones that are produced via the carotenoid biosynthetic pathway and occur at extremely low concentrations in various plant species. They regulate root development, play important roles in symbioses between higher plants and mycorrhizal fungi, and stimulate germination of plant–parasitic Orobanche and Striga species. Chemical analysis is central to research on the biochemistry of SLs and their roles in developmental biology and plant physiology. Here we summarize key issues relating to the identification and quantification of SLs isolated from plant tissues and exudates. The advantages and drawbacks of different protocols used for strigolactone analysis are discussed, and guidelines for selecting a procedure that will minimize losses during isolation and purification prior to final analysis are proposed. Hyphenated techniques suitable for SL analysis such as GC–MS and LC–MS/MS are also discussed, and newer ambient techniques such as HR-DART-MS and DESI-MS are highlighted as tools with considerable potential in SL research. A key advantage of these methods is that they require only simply sample preparation.
The influence of long-term shoulder loading on sagittal spino-pelvic morphology: a population-based retrospective study of Chinese farmers from radiology
Authors: Zhang Xuyang , Yang Wei , Zheng Zeyu , Wang Jiasheng , Huang Bao , Fan Shunwu , Wang Xianjun , Zhao Fengdong
Published: May 2020

Background

To investigate associations between long-term shoulder loading and sagittal spino-pelvic morphology in Chinese farmers from radiology evidences.

Methods

We retrospectively analyzed 463 back pain patients who attended outpatient and inpatient departments of two hospitals from January 2016 to December 2018, and who had long, standing lateral X-rays according to inclusion and exclusion criteria. One hundred eighty-four of them were farmers with a long history of heavy shoulder loading for over 20 years in their young age, while others were office workers with no reported long-term shoulder loading history. The following parameters were measured by three researchers independently and then analyzed statistically: thoracic kyphosis (TK), lumbar lordosis (LL), thoracolumbar kyphosis (TLK), T9 sagittal offset (T9SO), T1 sagittal offset (T1SO), sacral slope (SS), pelvic incidence (PI), pelvic tilt (PT), C7 tilt (C7T), spino-pelvic angle (SSA), and sagittal vertical axis (SVA).

Results

The “Loading group” included 86 males and 98 females with average age 73.3 (SD 8.3) years, whereas the “Non-loading group” included 126 males and 153 females with average age 63.7 (SD 14.1) years. Age was significantly higher in the loading group (p < 0.001), but gender, height, weight, BMI, and BMD were not significantly different (p > 0.05). The following spino-pelvic parameters were significantly greater (p < 0.05) in the loading group: TK (mean 39.1° vs 32.8°), TLK (25.8° vs 10.1°), and T9SO (12.2° vs 10.1°). Other values were not significantly different between the two groups (p > 0.05).

Conclusion

Long-term shoulder loading in youth is a risk factor for pathological thoracic kyphosis especially in the lower thoracic spinal segments when farmers getting older.
Prevalence of human papillomavirus in sinonasal squamous cell carcinoma with and without association of inverted papilloma in Eastern China
Authors: Hu Chunyan , Quan Huatao , Yan Li , Sun Ji , Lan Lin , Wang Shengzi
Published: May 2020

Background

Information on HPV-associated sinonasal squamous cell carcinoma (SNSCC) is very limited in China. The aim of this study was to determine the prevalence of HPV in a large cohort of SNSCC patients in China.

Methods

Clinical records and formalin-fixed and paraffin-embedded tumor specimens from 30 SNSCC patients with associated inverted papilloma (IP-SNSCC) and 84 de novo SNSCC (DN-SNSCC) patients were retrieved between 2010 and 2017. HPV status was determined for each specimen using a combination of p16 immunohistochemistry and GP5+/6+ PCR.

Results

Immunohistochemistry for p16 was positive in two IP-SNSCC patients (2/30, 6.7%) and in 16 DN-SNSCC patients (16/84, 19.0%). HPV DNA was detected in six IP-SNSCC patients (6/30, 20%) and in three DN-SNSCC patients (3/84, 3.8%). Expression of p16 was not correlated with the presence of HPV DNA (p = 0.150). Among 18 p16-positive SNSCC patients, only three were HPV DNA-positive. Furthermore, only three of nine HPV DNA-positive tumors exhibited high p16 expression. In IP-SNSCC patients, only one of six HPV DNA-positive tumors exhibited high p16 expression. In DN-SNSCC patients, two of three HPV DNA-positive tumors exhibited high p16 expression. The positive rates for both HPV DNA and p16 in IP-SNSCC patients and DN-SNSCC patients were 3.3 and 2.4%, respectively.

Conclusions

Immunostaining for p16 is not a reliable surrogate marker of HPV status in SNSCC. The presence of HPV is rarely detected in DN-SNSCC patients in Eastern China. IP-SNSCC patients frequently lack of p16 overexpression despite the presence of high-risk HPV DNA.
Combining online and offline peer support groups in community mental health care settings: a qualitative study of service users’ experiences
Authors: Strand Monica , Eng Lillian Sofie , Gammon Deede
Published: May 2020

Background

Peer support for people with long-term mental health problems is central to recovery-oriented approaches in mental health care. Peer support has traditionally been conducted offline in face-to-face groups, while online groups on the Internet have increased rapidly. Offline and online peer support groups are shown to have differing strengths and weaknesses. However, little is known about how combining the two formats might be experienced by service users, which this paper aims to illuminate.

Methods

In this exploratory and descriptive study, a recovery-oriented Internet-based portal called ReConnect was used by service users in two mental health communities in Norway for 6–12 months. The portal included an online peer support group which also facilitated participation in local offline peer support groups. Both group formats were moderated by an employed service user consultant. Qualitative data about service users’ experiences were collected through focus groups and individual interviews and inductively analyzed thematically.

Results

A total of 14 female service users 22–67 years of age with various diagnoses participated in three focus groups and 10 individual interviews. Two main themes were identified: (1) balancing anonymity and openness, and (2) enabling connectedness. These themes are further illustrated with the subthemes: (i) dilemmas of anonymity and confidentiality, (ii) towards self-disclosure and openness, (iii) new friendships, and (iv) networks in the local community. Three of the subthemes mainly describe benefits, while challenges were more implicit and cut across the subthemes. Identified challenges were related to transitions from anonymity online to revealing one’s identity offline, confidentiality, and barriers related to participation in offline peer support groups.

Conclusions

This study suggests that online and offline peer support groups complement each other, and that combining them is mainly described as beneficial by service users. Identified benefits appeared to arise from service users’ options of one format or the other, or that they could combine formats in ways that suited their individual values and comfort zones. Moderation by a trained service user consultant appeared essential for both formats and can be used systematically to address identified challenges. Combining online and offline peer support groups is a promising concept for facilitating recovery-oriented care and warrants continued research.
Developmental regulation of canonical and small ORF translation from mRNAs
Authors: Patraquim Pedro , Mumtaz Muhammad Ali Shahzad , Pueyo José Ignacio , Aspden Julie Louise , Couso Juan-Pablo
Published: May 2020

Background

Ribosomal profiling has revealed the translation of thousands of sequences outside annotated protein-coding genes, including small open reading frames of less than 100 codons, and the translational regulation of many genes. Here we present an improved version of Poly-Ribo-Seq and apply it to Drosophila melanogaster embryos to extend the catalog of in vivo translated small ORFs, and to reveal the translational regulation of both small and canonical ORFs from mRNAs across embryogenesis.

Results

We obtain highly correlated samples across five embryonic stages, with nearly 500 million putative ribosomal footprints mapped to mRNAs, and compare them to existing Ribo-Seq and proteomic data. Our analysis reveals, for the first time in Drosophila, footprints mapping to codons in a phased pattern, the hallmark of productive translation. We propose a simple binomial probability metric to ascertain translation probability. Our results also reveal reproducible ribosomal binding apparently not resulting in productive translation. This non-productive ribosomal binding seems to be especially prevalent amongst upstream short ORFs located in the 5′ mRNA leaders, and amongst canonical ORFs during the activation of the zygotic translatome at the maternal-to zygotic transition.

Conclusions

We suggest that this non-productive ribosomal binding might be due to cis-regulatory ribosomal binding and to defective ribosomal scanning of ORFs outside periods of productive translation. Our results are compatible with the main function of upstream short ORFs being to buffer the translation of canonical canonical ORFs; and show that, in general, small ORFs in mRNAs display markers compatible with an evolutionary transitory state towards full coding function.
Cognitive behavioural therapy for insomnia in patients with rheumatoid arthritis: protocol for the randomised, single-blinded, parallel-group Sleep-RA trial
Authors: Latocha K. M. , Løppenthin K. B. , Østergaard M. , Jennum P. J. , Christensen R. , Hetland M. , Røgind H. , Lundbak T. , Midtgaard J. , Esbensen B. A.
Published: May 2020

Background

More than half of patients with rheumatoid arthritis complain of insomnia, which is predominantly treated with hypnotic drugs. However, cognitive behavioural therapy for insomnia is recommended as the first-line treatment in international guidelines on sleep. Patients with rheumatoid arthritis suffer from debilitating symptoms, such as fatigue and pain, which can also be linked to sleep disturbance. It remains to be determined whether cognitive behavioural therapy for insomnia can be effective in patients with rheumatoid arthritis. The aim of the Sleep-RA trial is to investigate the efficacy of cognitive behavioural therapy for insomnia on sleep and disease-related symptoms in patients with rheumatoid arthritis. The primary objective is to compare the effect of cognitive behavioural therapy for insomnia relative to usual care on changes in sleep efficiency from baseline to week 7 in patients with rheumatoid arthritis. The key secondary objectives are to compare the effect of cognitive behavioural therapy for insomnia relative to usual care on changes in sleep onset latency, wake after sleep onset, total sleep time, insomnia, sleep quality, fatigue, impact of rheumatoid arthritis and depressive symptoms from baseline to week 26 in patients with rheumatoid arthritis.

Methods

The Sleep-RA trial is a randomised controlled trial with a two-group parallel design. Sixty patients with rheumatoid arthritis, insomnia and low-to-moderate disease activity will be allocated 1:1 to treatment with cognitive behavioural therapy for insomnia or usual care. Patients in the intervention group will receive nurse-led, group-based cognitive behavioural therapy for insomnia once a week for 6 weeks. Outcome assessments will be carried out at baseline, after treatment (week 7) and at follow-up (week 26).

Discussion

Data on treatment of insomnia in patients with rheumatoid arthritis are sparse. The Sleep-RA trial is the first randomised controlled trial to investigate the efficacy of cognitive behavioural therapy for insomnia in patients with rheumatoid arthritis. Because symptoms of rheumatoid arthritis and insomnia have many similarities, we also find it relevant to investigate the secondary effects of cognitive behavioural therapy for insomnia on fatigue, impact of rheumatoid arthritis, depressive symptoms, pain, functional status, health-related quality of life and disease activity.

If we find cognitive behavioural therapy for insomnia to be effective in patients with rheumatoid arthritis this will add weight to the argument that evidence-based non-pharmacological treatment for insomnia in rheumatological outpatient clinics is eligible in accordance with the existing international guidelines on sleep.

Trial registration

ClinicalTrials.gov: NCT03766100. Registered on 30 November 2018.