bluuebunny/crossref_metadata_2025 huggingface dataset:
Comprehensive Geriatric Assessment in the Emergency Department for Identifying Elderly Individuals at Risk of Hip Fracture
Authors: Lin Pei-Ying , Huang Hsien-Hao , Yen David Hung-Tsang
Published: January 2021

Background Hip fracture (HF) is a major challenge for healthcare systems in terms of increased costs and lengths of stay, and it has been estimated that by 2050, half of the projected 6.26 million global HFs will occur in Asia. Owing to the high morbidity and mortality associated with HF in elderly individuals, it is crucial to recognize at-risk elderly patients in the ED so that special precautions and preventive measures can be taken. While comprehensive geriatric assessment (CGA) has been shown to improve outcomes and prevent secondary fractures in elderly individuals with HF in outpatient settings, there is a lack of data to support the use of CGA in the emergency department (ED) to identify elderly Asian patients who are at risk of HF. Aim To identify the characteristics of elderly Asian patients in the ED who have an increased risk of HF via CGA. Methods A case-control study was conducted in the ED at Taipei Veterans General Hospital, a medical center located in Taipei, Taiwan, from October 2018 to December 2019. Patients ≥75 years old with and without HF were compared using data obtained from CGAs conducted by trained nurses. Results A total of 85 HF patients (cases) and 680 non-HF patients were enrolled, among whom 85 non-HF control individuals (controls) were selected by simple random sampling. HF occurred more frequently in women and in patients with depressive symptoms. An association between decreased handgrip strength and HF risk, especially in men, was also identified (P < 0.001). The variables independently associated with the presence of HF in the multivariate analysis were female sex (odds ratio (OR) = 2.937; 95% CI = 1.519-5.677) and decreased handgrip strength (OR = 3.739; 95% CI = 1.641-8.519). Conclusions By performing CGAs in the ED, we found that female sex and decreased handgrip strength were associated with HF risk. Therefore, we propose that targeted assessment of handgrip strength in female patients aged ≥75 years in the ED may identify those at greatest risk of HF, resulting in improved emergency care for geriatric patients.
Making Mistakes Saves the Single World of the Extended Wigner’s Friend Experiment
Authors: Łukaszyk Szymon
Published: January 2021

The Extended Wigner’s Friend thought experiment comprising a quantum system containing an agent who draws conclusions, upon observing the outcome of a measurement of a qubit prepared in two non-orthogonal versions by another agent led its authors to conclude that quantum theory cannot consistently describe the use of itself. It has also been proposed that this thought experiment is equivalent to coherent entangled state (Bell type) experiments. It is argued in this paper that the assumption of the freedom of choice of the first Wigner’s friend invalidates such equivalency. It is also argued that the assumption of locality (physical space) introduces superfluous identity of indiscernibles metric axiom, which is invalid in quantum domain and generally disproven by the Ugly duckling mathematical theorem.
Developing a Diagnostic Decision Support Tool With Machine Learning Classification Algorithms to Improve Breast Cancer Screening: A Cross-Sectional Study on Iranian Women
Authors: Mousavi Seyed Amirreza , Noorchenarboo Mohammad , Moheimani Hamed
Published: January 2021

Background: Improper patient navigation and follow-up measures hamper breast cancer screening programs. To augment existing programs, we aimed to develop a decision support system for early breast cancer detection, by training and validating machine learning classification algorithms on routinely available patient data.Methods: Data were collected prospectively from eligible consenting women who visited a single university affiliated center in Tehran, Iran, during a two-year period. We selected 17 features from patient demographics, history, clinical examination and screening imaging. Breast cancer diagnosis was assessed one year after initial data collection. Positive outcomes where confirmed with tissue biopsy. Six supervised machine learning classification algorithms (including two artificial neural networks) were trained on 743 cases. Odds ratios were calculated using logistic regression.Results: 34% of participants were diagnosed with breast cancer. Highest adjusted odds ratios (95%CI) belonged to ultrasound: 24.8 (12.4,52.0) and mammography: 21.7 (8.8,58.5). When evaluated on all patients, random forest model possessed the highest AUC (95%CI) of 0.98 (0.97,0.99). The results of 10-fold stratified cross-validation supported model stability. Based on the mean of ten validation iterations, random forest provided the highest accuracy (93.3%) sensitivity (91.9%) and NPV (96.2%). K-nearest-neighbors model provided the highest specificity (95.9%) and PPV (91.9%).Conclusions: Machine learning models trained on basic demographics, history, clinical examination and breast screening imaging can predict breast cancer accurately. Such decision support tools when added to existing programs can boost the effectiveness of screening measures. Implementation ultimately depends on future works which will focus on external validation, interface development and cost-effectiveness analysis.
Performance Comparison of Public Hospitals between 2014 and 2018 in Different Regions of Guangdong Province, China, Following 2017 Medical Service Price Reforms
Authors: Weng Kaiyuan , Xia Feng , Wang Yibao
Published: January 2021

BackgroundThis study analyzed performance of public hospitals and regional differences in performance following reform of medical service prices in Guangdong province, China. From three cities in four regions, we randomly selected a total of 12 traditional Chinese medicine hospitals and 12 general tertiary hospitals.MethodsSix questionnaires were completed by the hospitals, using 2014–2018 internal data. Principal components analysis was used to compare performances of the hospitals and regions following price reform. The extent to which medical service prices were adjusted varied considerable for different procedures in the same region and for the same category of procedures among regions. ResultsAfter reform, compensation for medical services in public hospitals reached the target of 80%, except in the Western region. However, annual growth of costs to patients was generally above 4%; the burden on patients was not alleviated by fee control. Reforms were more effective for comprehensive than Chinese traditional medicine hospitals. Performance scores of general hospitals in the Pearl River Delta, Eastern, Western, and Northern regions were 1.24, 1.16, -0.22, and -1.01, respectively. This is consistent with ranking by level of economic development of each region.ConclusionThe government should implement a regional medical service pricing mechanism. Additionally, comprehensive and traditional Chinese medicine hospitals should each have appropriate pricing policies. Future policies should focus on controlling costs incurred by patients.
A dynamic control strategy to produce riboflavin with lignocellulose hydrolysate in the thermophile Geobacillus thermoglucosidasius
Authors: Wang Junyang , Li Zilong , Wang Weishan , Pang Shen , Qi Fengxian , Yao Yongpeng , Yuan Fang , Wang Huizhuan , Xu Zhen , Pan Guohui , Chen Yihua , Fan Keqiang
Published: January 2021

The efficient utilization of both glucose and xylose, the two most abundant sugars in biomass hydrolysates, is one of the main objectives of biofermentation with lignocellulosic materials. The utilization of xylose is commonly inhibited by glucose, which is known as glucose catabolite repression (GCR). Here we report a GCR-based dynamic control (GCR-DC) strategy aiming at a better co-utilization of glucose and xylose, by decoupling the cell growth and biosynthesis of riboflavin as a product. Using the thermophilic strain Geobacillus thermoglucosidasius DSM2542 as a host, we constructed extra riboflavin biosynthetic pathways that were activated by xylose but not glucose. The engineered strains showed a two-stage fermentation process. In the first stage, glucose was preferentially used for cell growth and no production of riboflavin was observed, while in the second stage where glucose was nearly depleted, xylose was effectively utilized for riboflavin biosynthesis. Using the corn cob hydrolysate as a carbon source, the optimized riboflavin yields of strains DSM2542-DCall-MSS (full pathway dynamic control strategy) and DSM2542-DCrib (single module dynamic control strategy) were 5.26 and 2.26 folds higher than that of the control strain DSM2542 Rib-Gtg constitutively producing riboflavin, respectively. This GCR-DC strategy should also be applicable to the construction of cell factories that can efficiently use natural carbon sources with multiple sugar components for the production of high-value chemicals in future.
Clinical Significance of Serum-derived Exosomal PD-L1 in Patients with Resected Non-small Cell Lung Cancer
Authors: Shimada Yoshihisa , Matsubayashi Jun , Kudo Yujin , Maehara Sachio , Takeuchi Susumu , Hagiwara Masaru , Kakihana Masatoshi , Ohira Tatsuo , Nagao Toshitaka , Ikeda Norihiko
Published: January 2021

PD-L1 expression is the most useful predictive biomarker for immunotherapy efficacy on non-small cell lung cancer (NSCLC), and CD8 + tumor-infiltrating lymphocytes (CD8 + TILs) play an essential role in the clinical activity of immunotherapy. PD-L1 is found on the exosome's surface, and PD-L1 expressing exosomes can inhibit antitumor immune responses. This study aimed to analyze tumor PD-L1 expression, serum exosomal PD-L1, and CD8 + TILs to investigate anti-PD-1 response and clinicopathological outcomes in NSCLC. One hundred twenty patients with stage I-III NSCLC were enrolled, and serum samples collected during the initial surgery were pooled. The Human CD274/PD-L1 ELISA kit was used to quantify the exosomal PD-L1. Exosomal PD-L1 levels were significantly correlated with tumor PD-L1 levels (p < 0.001) and the number of CD8 + TILs (p = 0.001). Patients with serum exosomal PD-L1 ≥ 200 pg/mL tended to have a worse RFS than those with < 200 pg/mL in stage I patients (p = 0.056). Seventeen patients exhibited postoperative recurrences and received anti-PD-1 treatment, 75% of patients with ≥ 200 pg/mL demonstrated a significant response to PD-1 inhibitors. The measurement of serum exosomal PD-L1 as a quantitative factor with tumor PD-L1 status may help predict anti-PD-1 response and be used to assess clinical outcomes in patients with NSCLC.
A Panel of miRNAs as Prognostic Markers for African-American Patients with Triple Negative Breast Cancer
Authors: Turkistani Safaa , Sugita Bruna M , Fadda Paolo , Marchi Rafael , Afsari Ali , Naab Tammey , Apprey Victor , Copeland Robert L , Campbell Michael , Cavalli Luciane R , Kanaan Yasmine
Published: January 2021

Background: To investigate the global expression profile of miRNAs, their impact on cellular signaling pathways and their association with poor prognostic parameters in African-American (AA) patients with triple negative breast cancer (TNBC).Methods: Twenty-five samples of AA TNBC patients were profiled for global miRNA expression and stratified considering three clinical-pathological parameters: tumor size, lymph node (LN), and recurrence (REC) status. Differential miRNA expression analysis was performed for each parameter, and their discriminatory power was determined by Receiver Operating Characteristic (ROC) curve analysis. KMplotter was assessed to determine the association of the miRNAs with survival, and functional enrichment analysis to determine the main affected pathways and miRNA/mRNA target interactions.Results: A panel of eight, 23 and 27 miRNAs were associated with tumor size, LN, and REC status, respectively. Combined ROC analysis of two (miR-2117, and miR-378c), seven (let-7f-5p, miR-1255b-5p, miR-1268b, miR-200c-3p, miR-520d, miR-527, and miR-518a-5p), and three (miR-1200, miR-1249-3p, and miR-1271-3p) miRNAs showed a robust discriminatory power based on tumor size (AUC=0.917), LN (AUC=0.945) and REC (AUC=0.981) status, respectively. Enrichment pathway analysis revealed their involvement in proteoglycans and glycan, and cancer-associated pathways. Eight miRNAs with deregulated expressions in patients with large tumor size, positive LN metastasis and recurrence were significantly associated with lower survival rates. Conclusions: Altogether, our data indicate that miRNA deregulated expression is a relevant biological factor that can be associated with the poor prognosis in TNBC of AA patients, by conferring to their TNBC cells aggressive phenotypes that are reflected in the clinical characteristics evaluated in this study.
Artificial Neural Network coupled Condition Monitoring for advanced Fault Diagnosis of Engine
Authors: Mohanty Suvendu , Paul Swarup , Hazra Soudip
Published: January 2021

This paper reflects on the use of the Artificial Neural Network ( ANN) approach to diagnose and interpret engine failure behaviour. The current research focuses on the analysis of quantitative wear trend patterns through Condition Tracking (CM) and soft computational approaches. Oil analysis has been carried out to observe the engine failure trend. An ANN model using a Nonlinear Autoregressive with Exogenous Input (NARX) architecture has been employed to predict quantitative outputs such as Wear Particle Concentration (WPC), Wear Severity Index (WSI), Severity Index (SI) and Percentage of Large Particle (PLP) in connection with input functions of Engine Running Hours, RPM and oil temperature. Correlation function and error similarity are statistically evaluated to represent the model's robustness and effectively chart the loss input-output sequence. The subsequent ANN model demonstrates the capabilities for advance diagnosis and better prediction of engine performance.
Silent Type Ii Truncus Arteriosus Diagnosed at the Age of 18-years in a Ugandan Male  
Authors: SEREKE SENAI Goitom , Isse Hamdi Mohamed , Jaffar Tamale , Bongomin Felix
Published: January 2021

Background: Persistent truncus arteriosus (TA) is a rare congenital heart condition with reported incidence of 1.2% among all congenital heart malformations. Majority of patients with TA die early in childhood due to complications such as heart failure. Case presentation: An 18-year-old adult with unsuspected congenital heart disease since birth, not detected in childhood. Six months prior to his presentation, he complained of easy fatigability and paroxysmal nocturnal dyspnea. Chest radiography demonstrated normal heart size and electrocardiogram showed biventricular hypertrophy. Echocardiograph showed truncus arteriosus type II with large outlet ventricular septal defect. The patient was put on medical therapy including bed rest, fluid restriction and then surgical correction was done. The patient’s symptom improved after the surgical correction.Conclusion: TA is a rare, serious congenital heart defect that can be detected in prenatal period by routine ultrasound screening. It is also very rare for TA to be silent and reach adulthood without clinical manifestation and a diagnosis.
Altitude and SARS-CoV-2 Infection in the First Pandemic Wave in Spain: An Ecological Study
Authors: Castilla Jesus , Fresán Ujué , Trobajo-Sanmartín Camino , Guevara Marcela
Published: January 2021

BackgroundAfter the first pandemic wave, a nationwide seroepidemiological survey assessed the seroprevalence of SARS-CoV-2 antibodies in the population of Spain and found notable differences among provinces whose causes remain unclear. The present study aimed to examine the influence of environmental factors on SARS-CoV-2 infection. MethodsThis ecological study analyzed the association between environmental and demographic factors and SARS-CoV-2 infection by province. Environmental temperature and humidity were obtained from the Spanish Meteorological Agency and province extension, and latitude and altitude above sea level of their capital cities from the Geographical Institute. The seroprevalence SARS-CoV-2 antibodies by province was obtained from a nationwide representative survey performed in June 2020, after the first pandemic wave in Spain. Linear regression was used in the analysis.ResultsThe seroprevalence of SARS-CoV-2 antibodies of the 50 provinces ranged from 0.2% to 13.6%. Altitude explained nearly half of differences in seroprevalence (determination coefficient [R2]=0.46, p<0.0001). Seroprevalence in people residing in provinces above the median altitude (215 meters) was threefold higher (6.5% vs 2.1%, p<0.0001). In the multivariate linear regression, the addition of population density significantly improved the predictive value of the altitude (R2=0.55, p<0.0001). Every 100 meters of altitude increase and 100 inhabitants/km2 of increase in population density, the seroprevalence increased by 0.84 and 0.63 percentage points, respectively.ConclusionsEnvironmental conditions related to higher altitude in winter-spring, as lower temperature and absolute humidity, may be relevant to SARS-CoV-2 transmission. Places with such adverse conditions may require additional efforts for pandemic control.
Statistics of Seismicity to Investigate the Campi Flegrei Caldera Unrest
Authors: Tramelli Anna , Godano Cataldo , Ricciolino Patrizia , Giudicepietro Flora , Caliro Stefano , Orazi Massimo , De Martino Prospero , Chiodini Giovanni
Published: January 2021

The knowledge of the dynamic of the Campi Flegrei calderic system is a primary goal to mitigate the volcanic risk in one of the most densely populated volcanic areas in the world. From 50s to 80s Campi Flegrei suffered three bradyseismic crises with a total uplift of almost 4.3 m. After a period of subsidence of 20 years, the uplift started again in 2005 accompanied by a low increment in the seismicity rate. In 2012 an increment in the seismic energy release and a variation in the gas composition of the fumaroles of Solfatara (in the central area of the 1 caldera) were recorded. Since then, a slow and progressive increase in phenomena continued until today. We analyze the seismic catalogue of Campi Flegrei from 2000 to 2020 collected by INGV-Osservato-rio Vesuviano to look for any variation in the seismic parameters and compare them with geochemical monitored ones. A remarkable correlation between independent variables as earthquake cumulative number, CO/CO 2 values and vertical ground deformation reveals a likely common origin. The interpretation of the seismological, geochemical and geodetical observable brings back to the injection of magmatic fluids into the hydrothermal system or its pressurization.
Hierarchical Drug Release Designed Au @PDA-PEG-MTX NPs for Targeted Delivery to Breast Cancer with Combined Photothermal-chemotherapy
Authors: Li Wen , Cao Zhiwen , Yu Liuchunyang , Huang Qingcai , Zhu Dongjie , Lu Cheng , Lu Aiping , Liu Yuanyan
Published: January 2021

Breast cancer (BC) is the frequently diagnosed cancer and one of the deadliest causes of cancer-related death with a severe survival rate. Methotrexate (MTX) is an anti-tumor drug used in the treatment of BC. The poor dispersion in water and toxic side effects limit its clinical application. Gold nanoparticles (AuNPs), due to their specific structures and unique biological and physiochemical properties, have emerged as attractive candidates as vehicles for tumor targeting, bio-imaging and therapy. An innovative nano drug-loading system (Au @PDA-PEG-MTX NPs) was prepared for targeted treatment of BC. Au @PDA-PEG-MTX NPs under near infra-red region (NIR) irradiation showed effective photothermal therapy against MDA-MB-231 human BC cells growth in vitro by inducing apoptosis through triggering reactive oxygen species (ROS) overproduction and generating excessive heat. In vivo studies revealed that Au @PDA-PEG-MTX NPs under NIR irradiation showed deep penetration and cancer-targeted fluorescence imaging application and strong photothermal therapy against BC xenograft growth in vivo by induction of apoptosis. Analysis of histopathology, cellular uptake, cytotoxicity assay, apoptosis experiment indicated that Au @PDA-PEG-MTX NPs had a good therapeutic effect with high biocompatibility and less side effect. This Au NPs drug-loading system achieved specific BC targeting ability by surface decoration of MTX, NIR laser irradiation for fluorescence imaging and combined photothermal-chemotherapy as well as pH- and NIR- triggered hierarchical drug release.
Differentiation of Parkinson’s disease and Parkinsonism predominant multiple system atrophy in early disease stages by means of objective measurement in Susceptibility Weighted Imaging
Authors: Ren Qingguo , Wang Yihua , Nan Xiaomin , Zhang Jianyuan , Meng Xiangshui , Zhao Cuiping
Published: January 2021

Background

We have established radiological protocol and made morphological measurement of the lentiform nucleus (LN) and the signal intensity which we used to discriminate parkinsonism predominant multiple system atrophy (MSA-P) from Parkinson’s disease (PD). But we don’t know whether it works especially in early stage of MSA-P. This case-control study aimed to investigate whether the new measurement of the morphological and intensity changes in susceptibility weighted imaging (SWI) of the LN could discriminate MSA-P from PD in their early stage and controls.
Methods

We retrospectively enrolled patients with MSA-P, PD, and sex- and age-matched controls between January 2015 and July 2020 at the Movement Disorder Center who underwent brain MR scanning with SWI sequence. Two specialists at the center reviewed the medical records and made the final diagnosis, and two experienced neuroradiologists performed MRI image analysis based on a defined radiological protocol to conduct the region of interest (ROI) based morphological measurements of the LN and the signal intensity.
Results

A total of 17 patients with MSA-P, 17 patients with PD within 2 years of the disease duration and 17 controls were enrolled in this study. We found that patients with MSA-P had significant decreased size in the short line (SL, cSL), and the ratio of the SL and the long line (SLLr, cSLLr) compared with the patients with PD and with the controls (P < 0.05). Combining these four indexes, this finding had a sensitivity of 58.8% and a specificity of 100% to distinguish MSA-P from PD.
Conclusions

As compared to PD and control subjects, the MSA-P patients are characterized by narrowing morphology of the posterior region of LN. The quantitative morphological change is a possible potential marker to differentiate MSA-P from PD in the early stage.
Long-Term Impact of Baseline Serum Uric Acid Levels On Living Kidney Donors: A Retrospective Study
Authors: Tanaka Kosuke , Yamanaga Shigeyoshi , Hidaka Yuji , Nishida Sho , Kinoshita Kohei , Kaba Akari , Ishizuka Toshinori , Hamanoue Satoshi , Okumura Kenji , Kawabata Chiaki , Toyoda Mariko , Miyata Akira , Kashima Masayuki , Yokomizo Hiroshi
Published: January 2021

Background: Preoperative characteristics of living kidney donors are commonly considered during donor selection and postoperative follow-up. However, the impact of preoperative uric acid (UA) levels is poorly documented. The aim of this study was to evaluate the association between preoperative serum UA levels and post-donation long-term events and renal function.Methods: This was a single-center retrospective analysis of 183 living kidney donors. The donors were divided into high (≥5.5 mg/dl) and low (<5.5 mg/dl) UA groups. We analyzed the relationship between preoperative UA levels and postoperative estimated glomerular filtration rate (eGFR), as well as adverse events (cardiovascular events and additional prescriptions for hypertension, gout, dyslipidemia, and diabetes mellitus), over 5 years after donation. Results: In total, 44 donors experienced 52 adverse events over 5 years. The incidence of adverse events within 5 years was significantly higher in the high UA group than in the low UA group (50% vs. 24%, p = 0.003); this was true even after the exclusion of hyperuricemia-related events (p = 0.047). UA emerged as an independent risk factor for adverse events (p = 0.012). Donors with higher UA levels had lower eGFRs after donation, whereas body mass index, hemoglobin A1c, blood pressure, and low-density lipoprotein cholesterol did not have any impact on the eGFR.Conclusions: The findings suggest that preoperative UA levels should be considered during donor selection and postoperative follow-up.
Improving Access to Health and Gender-based Violence Services for Female Entertainment Workers in Cambodia: Findings From the Mobile Link Randomized Controlled Trial
Authors: Brody Carinne , Chhoun Pheak , Tuot Sovannary , Fehrenbacher Anne E. , Moran Alexander , Swendeman Dallas , Yi Siyan
Published: January 2021

Background: Female entertainment workers (FEWs) in Cambodia experience a greater prevalence of human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), psychological distress, substance use, and gender-based violence (GBV) than the general population. Reaching FEWs with health education and linking them to services has been difficult because of their hidden and stigmatized status. This study evaluates the Mobile Link intervention, aiming to improve FEWs’ health by connecting them to existing HIV, sexual and reproductive health, and GBV services using short message services and voice messages.Methods: This randomized controlled trial was conducted between March 2018 and June 2019. We employed a stratified random sampling method to select participants from five study sites. Initially, we randomly selected 600 participants from a list of 4000 FEWs by age group and study site and randomized them to intervention or standard care control arms. The primary outcome measures included self-reported HIV and STI testing, condom use, and contraceptive use. We also measured secondary outcomes, including contact with outreach workers, escorted referral services use, forced drinking, and GBV experiences. Intervention effects were modeled using repeated measures, multilevel mixed-effects logistic regression.Results: We included 218 FEWs in intervention and 170 FEWs in control arms in the per-protocol analyses after removing dropouts. Evidence of positive intervention effects was detected for the following secondary outcomes: contacting an outreach worker (group by time 2 AOR 3.29, 95% CI 1.28–8.47), receiving an escorted referral (group by time 2 AOR 2.86, 95% CI 1.09–7.52; group by time 3 AOR 8.15, 95% CI 1.65–40.25), and never being forced to drink at work (group by time 3 AOR 3.95, 95% CI 1.62–9.60). No significant differences between intervention and control groups over time were observed for any primary outcomes in the fully adjusted models.Conclusions: The Mobile Link intervention effectively connected FEWs with outreach workers and escorted referrals. Reductions in forced drinking at work were also significantly more extensive in the intervention group than the control group. Longer-term messaging may increase access to services and impact FEWs’ health outcomes in the future.Trial registration: Clinical trials.gov, NCT03117842 . Registered 31 March 2017, https://clinicaltrials.gov/ct2/show/NCT03117842?term=NCT03117842&rank=1
Protocol for the Implementation Mechanisms of Stepping Up (I.M. Stepping Up) Study, a Longitudinal Natural Experiment Examining Implementation Mechanisms to Improve Mental Health and Substance Use Services for Justice-involved Individuals in 950 Stepping Up and Comparison Counties Across the U.S.
Authors: Johnson Jennifer E. , Viglione Jill , Ramezani Niloofar , Cuellar Alison , Hailemariam Maji , Rosen Rochelle , Breno Alex , Taxman Faye
Published: January 2021

Background. The criminal justice system is the largest provider of mental health services in the U.S. Many jurisdictions are interested in reducing the use of the justice system for mental health problems. The national Stepping Up Initiative works with counties to reduce the number of individuals with mental illness in jails and to improve access to mental health services in the community. The Implementation Mechanisms of Stepping Up (I.M. Stepping Up) Study leverages a large natural experiment created by comparing Stepping Up counties to matched comparison counties over time to examine implementation mechanisms and outcomes. Methods. The study will survey 475 Stepping Up counties and 475 matched comparison counties at three waves: baseline, 18 months, and 36 months. Surveys will be sent to up to four respondents per county including administrators of jail, probation, community mental health services, and community substance use treatment services (3,800 total respondents). Implementation target mechanisms include: (1) use of and capacity for performance monitoring; (2) use and functioning of interagency teams; (3) common goals and mission across agencies; and (4) system integration (i.e., building an integrated system of care rather than adding one program or training). We will examine whether Stepping Up counties show a faster rate of improvement in hypothesized target mechanisms between Wave 1 and subsequent assessments (i.e., Waves 2 and 3) than do comparison counties (primary). We will also examine whether Stepping Up counties show a faster increases in implementation outcomes (number of justice-involved clients receiving behavioral health services, number of behavioral health evidence-based practices and policies [EBPPs] available to justice-involved individuals, and resources for behavioral health EBPP for justice-involved individuals). We will evaluate whether engagement of hypothesized mechanisms explains differences in implementation outcomes. Finally, we will characterize implementation processes and critical incidents using survey responses and qualitative interviews. Discussion. There are few rigorous, prospective studies examining implementation mechanisms and their relationship with behavioral health implementation outcomes in justice and associated community behavioral health settings. There is also limited understanding of implementation mechanisms that occur across systems with multiple goals. This study will elucidate target mechanisms in multi-goal, multi-agency systems.
Amphiphilic branched polymeric nitroxides for efficient magnetic resonance imaging of multiple-object in vivo
Authors: Wang Xiaoming , Guo Shiwei , Li Zhiqian , Luo Qiang , Dai Yan , Zhang Hu , Gong Qiyong , Luo Kui
Published: January 2021

Background: In order to solve the potential toxicity of metal-based Magnetic resonance imaging (MRI) contrast agents (CAs), a concept of non-metallic MRI CAs has emerged. Currently, paramagnetic nitroxides (such as (2, 2, 5, 5-tetramethylpyrrolidine-1-oxyl, PROXYL), (2, 2, 6, 6-tetramethylpiperidine-1-oxide, TEMPO), etc.) are being extensively studied because their good stability and imaging mechanism are similar to metal based contrast agents (such as Gd3+ chelate-based clinical CAs). However, nitroxides lower relaxivity and metabolizes rapidly in vivo are still challenge. Previous researches have proven that the construction of macromolecular nitroxides contrast agents (mORCAs) is a promising solution through the macromolecularization of nitroxides (ie, large molecules carry nitroxides). Macromolecular effects not only improve the stability of nitroxides by limiting their exposure to reductive substances in the body, but also improve the overall 1H water relaxation by increasing the concentration of nitroxides and slowing the molecular rotation speed. Results: Branched pDHPMA-mPEG-Ppa-PROXYL with high molecular weight (MW=160 kDa) and nitroxides content (0.059 mmol/g), it can form a nanoscale (~ 28 nm) self-assembled aggregate in a water environment and hydrophobic PROXYL can be protected by the hydrophilic outer layer to obtain the strong reduction resistance in vivo. Compared with the small molecular 3-Carboxy-PROXYL (3-CP), Branched pDHPMA-mPEG-Ppa-PROXYL displays there prominent performance: 1) its longitudinal relaxivity (0.50 mM-1 s-1) is about three times that of the 3-CP (0.17 mM-1 s-1); 2) the blood retention time of nitroxides is increased significantly from a few minutes of 3-CP to 6 h; 3) it could provide long-term and significant enhancement in MR imaging of the tumor, liver, kidney and cardiovascular system (heart and aortaventralis), and this is the first report on nitroxides-based MRI CAs for imaging the cardiovascular system. Conclusions: As a safe and efficient candidate metal-free magnetic resonance contrast agent, Branched pDHPMA-mPEG-Ppa-PROXYL is expected to be used not only in tumor, liver and kidney imaging, but also in cardiovascular system imaging, which expands the application scope of this kind of CAs.
Poor Implant Retention Rate in Patients Treated with Beta-Lactam Antibiotics for Initial Intravenous Empirical Therapy in Acute Periprosthetic Knee Joint Infection
Authors: Tsukada Sachiyuki , Wakui Motohiro , Miyao Masunao , Nishino Masahiro , Tasaki Atsushi
Published: January 2021

Background: Beta-lactam antibiotics are frequently selected as initial intravenous empirical therapy in acute periprosthetic joint infection (PJI), but show poor drug migration to the knee joint.Methods: We retrospectively assessed 23 patients undergoing irrigation and debridement surgery for acute PJI after primary TKA. First, we compared the success rate of implant retention between patients receiving beta-lactam antibiotics as initial intravenous empirical therapy and those receiving antibiotics other than beta-lactams. Second, multivariate logistic regression analysis was used to control for confounding factors and to distinguish independent risk factors for the failure of implant retention.Results: Twelve patients received beta-lactam antibiotics as initial intravenous therapy (67% received cefazolin) and 11 patients received antibiotics other than beta-lactams (82% received linezolid). Patients receiving beta-lactam antibiotics had significantly lower implant retention rate than those receiving other antibiotics (5 of 12 patients [42%] versus 10 of 11 patients [91%], respectively, p = 0.027). Logistic regression analysis showed that use of beta-lactam antibiotics as initial intravenous empirical therapy was a significant independent risk factor predicting implant failure.Conclusion: The rate of implant retention was lower in patients administered beta-lactam antibiotics as initial intravenous empirical treatment.
Projection-Mapping-Based Object Pointing Using a High-Frame-Rate Camera-Projector System
Authors: Kumar Deepak , Raut Sushil , Shimasaki Kohei , Senoo Taku , Ishii Idaku
Published: January 2021

The novel approach to physical security based on visible light communication (VLC) using an informative object-pointing and simultaneous recognition by high-framerate (HFR) vision systems is presented in this study. In the proposed approach, a convolutional neural network (CNN) based object detection method is used to detect the environmental objects that assist a spatiotemporal-modulated-pattern (SMP) based imperceptible projection mapping for pointing the desired objects. The distantly located HFR vision systems that operate at hundreds of frames per second (fps) can recognize and localize the pointed objects in real-time. The prototype of an artificial intelligence-enabled camera-projector (AiCP) system is used as a transmitter that detects the multiple objects in real-time at 30~fps and simultaneously projects the detection results by means of the encoded-480-Hz-SMP masks on to the objects. The multiple 480-fps HFR vision systems as receivers can recognize the pointed objects by decoding pixel-brightness variations in HFR sequences without any camera calibration or complex recognition methods. Several experiments were conducted to demonstrate our proposed method's usefulness using miniature and real-world objects under various conditions
Mentorship on malaria microscopy diagnostic service in Ethiopia: Baseline competency of microscopists and performance of health facilities
Authors: Gidey Bokretsion , Nega Desalegn , Abera Adugna , Abebe Abnet , Mekasha Sindew , Tasew Geremew , Haile Mebrahtom , Dillu Dereje , Mehari Degu , Assefa Ashenafi , Liknew Wondimeneh , G/tsadik Abeba , Mohammed Hussien , Woldie Ermias , Getachew Tsegaye , Ararso Desaelegn , Yenealem Dereje , Kebede Adisu , Etana Kebede , Kedida Gizachew , Solomon Hiwot , Tollera Getachew , Woyessa Adugna , Abate Ebba
Published: January 2021

Background: In Ethiopia, malaria cases are declining as a result of proven interventions and in 2017, the country launched a malaria elimination strategy in targeted settings. Accurate malaria diagnosis and prompt treatment are the key components of the strategy to prevent morbidity and stop the continuation of transmission. However, the quality of microscopic diagnosis in general is deteriorating as malaria burden declines. Therefore, this study was carried out to evaluate the competency of microscopists and the performance of health facilities on malaria microscopic diagnosis.Methods: A cross-sectional study was conducted from August 1st to September 30th, 2019 in nine regional states and one city administration. A standard checklist was used for on-site evaluation, archived patient slides were re-checked, and proficiency of microscopists was tested using WHO certified slides from the national slide bank at the Ethiopian Public Health Institute (EPHI). The strength of agreement, the sensitivity, the specificity, and the positive and negative predictive values were calculated.Results: In this study, 102 health facilities (84 health centers and 18 hospitals) were included; from which, 202 laboratory professionals participated. In slide re-checking, moderate agreement (Agreement: 76.0%; Kappa: 0.41) was observed between experts and microscopists on malaria detection in all health facilities. The sensitivity and specificity of routine slide reading and the re-checking results were 78.1% and 80.7%, respectively. Likewise, positive predictive value of 65.1% and negative predictive value of 88.8% were scored in the routine diagnosis. By panel testing, a substantial overall agreement (A: 91.8%; K: 0.79) was observed between microscopists and experts in detecting malaria parasites. The sensitivity and specificity in the detection of malaria parasites was 92.7% and 89.1%, respectively. Furthermore, in identifying species, a slight agreement (A: 57%; K: 0.18) was observed between microscopists and experts. Conclusion: The study found significant false positive and false negative results in routine microscopy on slide re-checking of Plasmodium parasites. Moreover, reduced grade in parasite species identification was reported on the panel tests. Therefore, implementing comprehensive malaria microscopy mentorship, in-service training, and supportive supervision are the key strategies to improve the overall performance of health facilities in malaria microscopy.
Effects of Sensory Distraction and Salience Priming on Emotion Identification in Autism: an fMRI Study
Authors: Patterson Genevieve , Cummings Kaitlin K. , Jung Jiwon , Okada Nana J. , Tottenham Nim , Bookheimer Susan Y. , Dapretto Mirella , Green Shulamite A.
Published: January 2021

Background: Social interaction often occurs in noisy environments with many extraneous sensory stimuli. This is especially relevant for youth with autism spectrum disorders (ASD) who commonly experience sensory over-responsivity (SOR) in addition to social impairment. However, the relationship between these symptoms is still poorly understood and thus rarely addressed in interventions. This study investigated the effect of auditory sensory distracters on neural processing of emotion identification in youth with ASD and the effects of increasing attention to social cues by priming participants with their own emotional faces.Methods: While undergoing functional magnetic resonance imaging (fMRI), 30 youth with ASD and 24 typically developing (TD) age-matched controls (ages 8-17 years) identified faces as happy or angry with and without simultaneously hearing aversive environmental noises. Halfway through the task, participants also viewed videos of their own emotional faces. The relationship between parent-rated auditory SOR and brain responses during the task was also examined.Results: Despite showing comparable behavioral performance on the task, ASD and TD youth demonstrated distinct patterns of neural activity. Compared to TD, ASD youth showed greater increases in amygdala, insula and primary sensory regions when identifying emotions with noises compared to no sounds. After viewing videos of their own emotion faces, ASD youth showed greater increases in medial prefrontal cortex activation compared to TD youth. Within ASD youth, lower SOR was associated with reduced increased activity in subcortical regions after the prime and greater increased activity in ventromedial prefrontal cortex after the prime, particularly in trials with noises. Conclusions: The results suggest that the sensory environment plays an important role in how ASD youth process social information. Additionally, we demonstrated that increasing attention to relevant social cues helps ASD youth engage frontal regions involved in higher-order social cognition, a mechanism that could be targeted in interventions. Importantly, the effect of the intervention may depend on individual differences in SOR, supporting the importance of pre-screening youth for sensory challenges prior to social interventions.
Retrospective evaluation of vector-borne pathogens in cats living in Germany (2012-2020)
Authors: Schäfer Ingo , Kohn Barbara , Volkmann Maria , Müller Elisabeth
Published: January 2021

Background: Blood-feeding arthropods can transmit parasitic, bacterial, or viral pathogens to domestic animals and wildlife. Vector-borne infections are gaining significance due to increasing travel and import of pets from abroad, as well as the changing climate in Europe. The main objective of this study was to assess the percentage of cats with positive test results for selected vector-borne pathogens in Germany and explore any possible association of such results with time spent abroad.Methods: This retrospective study included test results from cats for which a ‘Feline Travel Profile’ established by the laboratory LABOKLIN had been requested by veterinarians in Germany between April 2012 and March 2020. This above-mentioned diagnostic panel includes the direct detection of Hepatozoon spp. and Dirofilaria spp. via PCR as well as indirect detection assays (IFAT) for Ehrlichia spp. and Leishmania spp. The panel was expanded to include an IFAT for Rickettsia spp. from July 2015 onwards.Results: A total of 624 cats were tested using the “Feline Travel Profile”. Serum for indirect detection assays was available for all 624 cats, EDTA-samples for direct detection methods were available from 618 cats. Positive test results were as follows: Ehrlichia spp. IFAT 73 out of 624 (12%), Leishmania spp. IFAT 22 out of 624 (4%), Hepatozoon spp. PCR 53 out of 618 (9%), Dirofilaria spp. PCR 1 out of 618 cats (0.2%) and, Rickettsia spp. IFAT 52 out of 467 cats (11%) tested from July 2015 onwards. Three cats had positive test results for more than one pathogen before 2015. After testing for Rickettsia spp. was included in 2015, 19 cats had positive test results for more than one pathogen (Rickettsia spp. were involved in 14 out of these 19 cats).Conclusions: At least one pathogen could be detected in 175 out of 624 cats (28%) via indirect and/or direct detection methods. Four percent had positive test results for more than one pathogen. This data emphasizes the importance of considering the above-mentioned vector-borne infections as potential differential diagnoses in clinically symptomatic cats.
The landscape of chromatin accessibility in skeletal muscle during embryonic development in pigs
Authors: Yue Jingwei , Hou Xinhua , Liu Xin , Wang Ligang , Gao Hongmei , Zhao Fuping , Shi Lijun , Shi Liangyu , Yan Hua , Deng Tianyu , Gong Jianfei , Wang Lixian , ZHANG Longchao
Published: January 2021

Background: The development of skeletal muscle during the embryonic stage in pigs is precisely regulated by transcriptional mechanisms, which depends on chromatin accessibility. However, the landscape of chromatin accessibility in skeletal muscle during embryonic development in pigs has not been reported. To gain insight into the landscape of chromatin accessibility and the associated genome-wide transcriptome during embryonic muscle development, we performed ATAC-seq and RNA-seq on skeletal muscle of pig embryos at 45, 70 and 100 days post coitus (dpc).Results: In total, 21638, 35447 and 60181 unique regions (or peaks) were found across 45 dpc (LW45), 70 dpc (LW70) and 100 dpc (LW100) embryos, respectively. More than 91% of peaks were annotated within -1 kb to 100 bp of transcription start sites (TSSs). First, widespread increases in specific accessible chromatin regions (ACRs) from 45 to 100 dpc embryos suggested that the regulatory mechanisms became increasingly complicated during embryonic development. Second, the findings of integrated ATAC-seq and RNA-seq analyses showed that not only the numbers but also the peak intensities of ACRs could control the expression of associated genes. Finally, motif screening of stage-specific ACRs revealed some transcription factors that regulated muscle development-related genes, such as MyoD, Mef2c, and Mef2d. Motif screening of DPI of common peaks detected that a potential transcriptional repressor, namely CTCF, was identified among those genes that exhibited different change trends between the ATAC-seq and RNA-seq data.Conclusions: This work indicates that chromatin accessibility plays an important regulatory role in the embryonic muscle development of pigs and regulates the temporal and spatial expression patterns of key genes in muscle development by influencing the binding of transcription factors. Our results contribute to a better understanding of the regulatory dynamics of genes involved in pig embryonic skeletal muscle development.