bluuebunny/crossref_metadata_2025 huggingface dataset:
HIV-1-Syphilis Co-infection Associated with High Viral Load in Female Sex Workers in the Democratic Republic of the Congo
Authors: Musema Godefroid M.A. , Mapatano Ali M. , Tshala Desire K. , Kayembe Patrick K.
Published: July 2020

Background:

Sexually transmitted infections (STI) and HIV co-infection are common in countries where resources are limited constituting a leading public health issue. The negative impact of HIV transmission and acquisition are known. The aim of this study was to determine whether HIV-l-syphilis co-infection is associated with high HIV-l viral load (VL) in female sex workers (FSWs) in the Democratic Republic of the Congo (DRC).

Methods:

Sera from 411 FSWs tested HIV+ in a national DRC HIV/STI Integrated Biological and Behavioral Surveillance Survey (IBBS) conducted between December 2012 and January 2013. HIV and syphilis testing were performed according to validated DRC national testing algorithms used by the National AIDS Control Program (PNLS). VL was measured according to Abbot m2000sp and m2000rt protocols. HIV-l-syphilis co-infection proportion was determined and multivariate analyses were used to identify factors associated with higher VL in HIV-l-syphilis co-infected FSWs.

Results:

Of 411 HIV-infected FSWs, 19.2% (95% CI: 15.4 – 23.0) were co-infected with syphilis. The mean HIV-l VL in HIV-l-positive FSWs co-infected with syphilis [2.9 log10 HIV RNA/mL (95% CI: 2.49 – 3.29)] was higher compared with those not co-infected with syphilis [2.2 log10 HIV RNA/mL (95% CI: l.97 – 2.46)]. Multivariate analysis showed that syphilis co-infection was associated with high HIV-l VL (aOR [95% CI] = 1.90 [1.03, 3.52]) but HIV-1 VL was not influenced by age, education level, duration in sex profession, abnormal fluid, and genital sore.

Conclusion and Implications for Translation:

HIV-l Syphilis co-infection was associated with higher HIV-l VL. Preventing FSWs from getting STIs and screening HIV-infected individuals for STIs and providing them with appropriate treatment could impact the transmission of HIV from FSWs to their clients.
Archeological Test Excavations in Areas to be Affected by a Proposed French Drain West of the Granary, Mission San Jose State Site (41BX3), Bexar County, Texas
Authors: Clark  , Prewitt
Published: July 2020

Limited archeological test excavations were conducted along the west wall of the granary at Mission San Jose State Historic Site (41BX3) in Bexar County, Texas, during July and August, 1979. The investigations were designed to provide information regarding the presence or absence of significant archeological materials in areas to be affected by the construction of a proposed French drain intended to relieve moisture-related structural problems along the west wall of the granary. six 0.5 by 1 meter test pits were excavated; 1,303 artifacts and 1,809 bone and shell fragments were recovered. Seven features were documented; these included a wall and a flagstone floor remnant, 4 pits and a lime filled trench. The wall and floor may represent the remains of a Spanish Colonial blacksmith shop while the pits probably originated during the late 19th Century. The artifacts are primarily trash resulting from nearly 240 years of activity at the mission complex although some items may be relatable to the smithy. Two alternatives for the proposed construction are suggested: 1) abandon plans for a French drain and develop an alternate non-disruptive method for relying moisture problems; or, 2) continue plans for constructing a French drain but precede the modifications with an intensive program of archeological excavations in a broad area along the west wall of the granary.
The George C. Davis Site, Cherokee County, Texas: Spring 1980 Archeological Investigations
Authors: Fields  , Thurmond
Published: July 2020

The results of archeological investigations in portions of the George C. Davis Site are presented in this report prepared by Ross Fields and J. Peter Thurmond . Stringent contract requirements and the provisions of Texas Antiquities Permit No. 237 dictate that this report be brief and descriptive in nature. Requirements such as inclusion of a detailed site investigation history and environmental data were excluded and extensive excavations were stressed in preference to detailed analyses and comparisons. Field investigations were limited by contract to 20 working days and the analysis/write-up to 10 working days. The governing research design was prepared by the Texas Antiquities Committee staff to reflect agreements between the Committee and the Texas Forest Service. Significant findings include the general delineation of extensive, and in places intensive, Archaic and Late Prehistoric occupations. Of primary importance is the lack of an identifiable Alto Focus occupation within the northern portion of the Davis Site. This suggests that the small left bank tributary to Bowles Creek existed during Alto Focus times and served as a natural boundary for the village area during that period of site usage. There are hints that significant variations in the selection and use of lithic resources through time are identifiable. It is indeed ! unfortunate that time limitations precluded pursuit of this line of investigation. Ross and Pete have successfully accomplished a most challenging task under less than ideal conditions. They and their field crew are commended for their outstanding work at the Davis Site.
Archeological Investigations at the Laredo Cemetery Site (41WB22), Webb County, Texas
Authors: McReynolds  , Herrington  , Rodgers
Published: July 2020

Archeological involvement in the exhumation of relatively recent historic cemeteries is a new development in Texas. Traditionally, archeologists have directed their attention toward the burial practices of aboriginal peoples and have shied away from any dealings with the excavations of late nineteenth and early twentieth century cemeteries. This trend has continued despite an ever-increasing awareness of and concern with changing modes of historic and recent tombstone embellishment on the part of archeologists, cultural anthropologists and historians. In practice, tombstones have been studied sporadically but the tasks of relocation and reinterment of the physical human remains have been left to undertakers and professional cemetery movers. The present report authored by Mary Jane McReynolds describes the results of limited archeological investigations at the Laredo Cemetery Site (4lWB22j in the City of Laredo, Texas. The investigations resulted from an emergency situation in which a forgotten cemetery was rediscovered in the midst of a construction project. The need for rapid action precluded the development of a thorough problem-oriented research design and consequently led to the adoption of a severely limited scope of investigations. Despite ! these problems, Ms. McReynolds has presented significant new data for archeologists in terms of coffin styles, coffin decorations, and artifacts associated with various interments. While the report is not intended to be exhaustive, it does recount some of the problems encountered in this type of investigation and provides general suggestions for directing future research in historic cemetery sites.
Survey, Testing and Assessment of Cultural Resources in Portions of Willacy County Drainage District No. 1, Willacy County, Texas
Authors: Mercado-Allinger
Published: July 2020

Two archeological projects were undertaken in the fall of 1982 by Prewitt and Associates, Inc. Both projects were authorized by the Willacy County Drainage District No. 1.

The first investigation was an archeological survey to locate, record and assess previously unknown cultural resources which potentially could be affected by proposed drainage ditch development (Main Floodway Channel) in the central county area. Field inspections of this proposed alignment detected 24 archeological sites. Fourteen of these recorded sites are classified as isolated finds which are presumed to be prehistoric . The remaining ten resources are classified as sites, six containing prehistoric materials and four attributed to the recent (post-1900) historic past. Five of the prehistoric sites, 41WY84, 41WY86 , 41WY89, 41WY90 and 41WY91, were assessed initially as having high information yield potential, and testing was considered warranted prior to the construction of the Main Floodway Channel to more fully assess the potential eligibility of these sites for nomination to the National Register of Historic Places.

This recommendation for testing prompted the second project which involved test excavations at site 41WY84. Site 41WY84 was selected from the five prehistoric sites for testing to better assess the nature and condition of these resources. It is concluded from the data recovered that site 41WY84 contains thinly dispersed cultural materials in a highly disturbed context and therefore does not warrant nomination to the National Register of Historic Places. On the basis of these testing results, archeological clearance for the proposed Willacy County Drainage District No. 1 Main Floodway Channel is recommended.
Contratos inteligentes y evaluación de la solvencia en el crédito inmobiliario
Authors: Bárcena Suárez Nicolás
Published: July 2020

La preocupación del legislador europeo por reducir el riesgo de impago en el mercado de crédito inmobiliario ha reforzado los sistemas de evaluación de solvencia de los estados europeos. El mecanismo más habitual empleado por la banca para medir los riesgos de un contrato de préstamo o crédito es el denominado credit score. La irrupción de la tecnología blockchain y los denominados smart contracts arrojan un nuevo escenario para el ámbito del credit score pero también algunas dudas debido a la ausencia de regulación concreta.
An Outbreak of Acute Respiratory Infection at a Training Base in Beijing, China Due to Human Adenovirus Type B55
Authors: Lu Guilan , Peng Xiaomin , Li Renqing , Liu Yimeng , Wu Zhanguo , Wang Xifeng , Zhang Daitao , Zhao Jiachen , Sun Ying , Zhang Li , Yang Peng , Wang Quanyi
Published: July 2020

Background: Twelve students experienced symptoms of acute respiratory infection (ARI) at a training base in Beijing from August 26 to August 30, 2015. We investigated the cause of this ARI outbreak. Methods: In partnership with the local center for disease control, we collected a total of twelve pharyngeal swab specimens as well as demographic information for the affected patients. We used multiplex real-time PCR to screen for sixteen common respiratory viruses in these samples. To isolate HAdV, we inoculated Hep-2 cells with the human adenovirus (HAdV)-positive samples and then carried out sequencing and phylogenetic analysis of the hexon, fiber, and penton genes of the isolated adenoviruses. In addition, we analyzed the entire genome of one strain isolated from the index case to identify single-nucleotide substitutions. Results: We identified ten HAdV-positive students using multiplex real-time PCR. None of the students were co-infected with other viruses. We successfully isolated seven HAdV strains from the pharyngeal swab specimens. The coding sequences of the hexon, fiber, and penton genes of these seven HAdV strains were identical, suggesting that they represented seven strains from a single virus clone. One HAdV isolate obtained from the index case, BJDX-01-2015, was selected for whole genome analysis. From this isolate, we obtained a 34,774-nucleotide sequence. The genome of BJDX-01-2015 clustered with HAdV-B55 in phylogenetic analyses and had 99.97% identity with human adenovirus 55 isolate HAdV-B/CHN/BJ01/2011/55 (GenBank accession no. JX491639). Conclusions: We identified HAdV-B55 as the strain associated with the August 2015 ARI outbreak at a training base in Beijing. This was the first reported outbreak in Beijing due to HAdV-B55. Continuous surveillance of respiratory adenoviruses is urgently needed to understand the epidemiological and evolutionary features of HAdV-B55, and an epidemiological modeling approach may provide further insights into this emerging public health threat. Furthermore, the clinical laboratory data from this outbreak provides important reference for the clinical diagnosis and may ultimately aid in informing the development of strategies to control and prevent respiratory tract infections caused by HAdV-B55.
Relationship between Internet addiction and sleep disturbance in high school students: a cross-sectional study
Authors: Tokiya Mikiko , Itani Osamu , Otsuka Yuichiro , Kaneita Yoshitaka
Published: July 2020

Background: The increase in the number of Internet users has increased Internet dependence worldwide. In adolescents, this dependence may interfere with sleep, which is important for the development of psychophysiological capabilities. However, few large-scale surveys have described the relationship between Internet addiction (IA) and sleep disturbance using standardized questionnaires. We conducted a survey in one prefecture in Japan to determine the relationship between sleep disturbance and IA in adolescents based on the categories of the Young Diagnostic Questionnaire (YDQ). Methods: In 2016, high school students (N=10,405, age range: 15–16 years) in all 54 daytime high schools in the selected prefecture were surveyed using a self-administered questionnaire. Participants with scores > 5.5 points on the Japanese version of the Pittsburgh Sleep Quality Index were defined as having a sleep disturbance. IA was evaluated using the YDQ: Participants with five to eight YDQ items present were classified as having IA; those with three or four items present were classified as “at risk of IA”; and those with two or less YDQ items were classified as “non-IA”. Multiple logistic regression analysis was performed with sleep disturbance as the dependent variable, IA as the explanatory variable, and adjustments for eight other variables. Results: High YDQ scores were associated with a high prevalence of sleep disturbance in boys and girls . These findings persisted after controlling for other factors in the multiple regression model. Conclusions: Among Japanese adolescents, there was a significant independent relationship between IA and sleep disturbance. Keywords:
Conversion of sugar beet residues into lipids by Lipomyces starkeyi for biodiesel production
Authors: Martani Francesca , Maestroni Letizia , Torchio Mattia , Ami Diletta , Natalello Antonino , Lotti Marina , Porro Danilo , Branduardi Paola
Published: July 2020

Background: Lipids from oleaginous yeasts emerged as a sustainable alternative to vegetable oils and animal fat to produce biodiesel, the biodegradable and environmentally friendly counterpart of petro-diesel fuel. To develop economically viable microbial processes, the use of residual feedstocks as growth and production substrates is required.Results: In this work we investigated sugar beet pulp (SBP) and molasses, the main residues of sugar beet processing, as sustainable substrates for the growth and lipid accumulation by the oleaginous yeast Lipomyces starkeyi. We observed that in hydrolysed SBP the yeast cultures reached a limited biomass, cellular lipid content, lipid production and yield (2.5 g/L, 19.2 %, 0.5 g/L and 0.08 g/g, respectively). To increase the initial sugar availability, cells were grown in SBP blended with molasses. Under batch cultivation, the cellular lipid content was more than doubled (47.2 %) in the presence of 6 % molasses. Under pulsed-feeding cultivation, final biomass, cellular lipid content, lipid production and lipid yield were further improved, reaching respectively 20.5 g/L, 49.2 %, 9.7 g/L and 0.178 g/g. Finally, we observed that SBP can be used instead of ammonium sulphate to fulfil yeasts nitrogen requirement in molasses-based media for microbial oil production. Conclusions: This study demonstrates for the first time that SBP and molasses can be blended to create a feedstock for the sustainable production of lipids by L. starkeyi. The data obtained pave the way to further improve lipid production by designing a fed-batch process in bioreactor.
Using three statistical methods to analyze the association between exposure to 9 compounds and obesity in children and adolescents: National Health and Nutrition Examination Survey 2005-2010
Authors: Wu Bangsheng , Jiang Yi , Jin Xiaoqing , He Li
Published: July 2020

Background : Various risk factors influence obesity differently, and environmental endocrine disruption may increase the occurrence of obesity. However, most of the previous studies have considered only a unitary exposure or a set of similar exposures instead of mixed exposures, which entail complicated interactions. We utilized three statistical models to evaluate the correlations between mixed chemicals to analyze the association between 9 different chemical exposures and obesity in children and adolescents. Methods: We fitted the generalized linear regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) to analyze the association between the mixed exposures and obesity in the participants aged 6-19 in the National Health and Nutrition Examination Survey (NHANES) 2005–2010. Results: In the multivariable logistic regression model, 2,5-dichlorophenol (2,5-DCP) ( OR ( 95% CI ) : 1.25 (1.11, 1.40) ), monoethyl phthalate (MEP) ( OR ( 95% CI ) : 1.28 (1.04, 1.58) ), and mono-isobutyl phthalate (MiBP) ( OR ( 95% CI ) : 1.42 (1.07, 1.89) ) were found to be positively associated with obesity, while methylparaben (MeP) ( OR ( 95% CI ) : 0.80 (0.68, 0.94) ) was negatively associated with obesity. In the multivariable linear regression, MEP w as found to be positively associated with the body mass index (BMI) z-score ( β (95% CI ) : 0.12 (0.02, 0.21) ). In the WQS regression model, the WQS index had a significant association ( OR ( 95% CI ) : 1.48 (1.16, 1.89) ) with the outcome in the obesity model, in which 2,5-DCP (weighted 0.41), bisphenol A (BPA) (weighted 0.17) and MEP (weighted 0.14) all had relatively high weights. In the BKMR model, despite no statistically significant difference in the overall association between the chemical mixtures and the outcome (obesity or BMI z-score), there was nonetheless an increasing trend. 2,5-DCP and MEP were found to be positively associated with the outcome (obesity or BMI z-score), while fixing other chemicals at their median concentrations. Conclusion: Comparing the three statistical models, we found that 2,5-DCP and MEP may play an important role in obesity. Considering the advantages and disadvantages of the three statistical models, our study confirms the necessity to combine different statistical models on obesity when dealing with mixed exposures.
Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis
Authors: Gravesteijn Benjamin , Schluep Marc , Disli Maksud , Garkhail Prakriti , Miranda Dinis Dos Reis , Stolker Robert-Jan , Endeman Henrik , Hoeks Sanne Elisabeth
Published: July 2020

Background: In hospital cardiac arrest (IHCA) is a major adverse event with a high mortality rate if not treated appropriately. Extracorporeal cardiopulmonary resuscitation (ECPR), as adjunct to conventional cardiopulmonary resuscitation (CCPR) is a promising technique for IHCA treatment. Evidence pertaining to neurological outcomes after ECPR is still scarce. Methods: We performed a comprehensive systematic search of all studies up to December 20th 2019. Our primary outcome was neurological outcome after ECPR at any moment after hospital discharge, defined by the Cerebral Performance Category (CPC) score. A score of 1 or 2 was defined as favourable outcome. Our secondary outcome was post-discharge mortality. A fixed-effects meta-analysis was performed. Results: Our search yielded 1215 results, of which 19 studies were included in this systematic review. The average survival rate was 30% (95% CI: 28-33%, I2=0%, p=0.24). In the surviving patients, the pooled percentage of favourable neurological outcome was 84% (95% CI: 80-88%, I2=24%, p=0.90). Conclusion: CPR as treatment for in-hospital cardiac arrest is associated with a large proportion of patients with good neurological outcome. The large proportion of favourable outcome could potentially be explained by the selection of patients for treatment using ECPR. Moreover, survival is higher than described in the conventional CPR literature. As indications for ECPR might extend to older or more fragile patient populations in the future, research should focus on increasing survival, while maintaining optimal neurological outcome.
Breastfeeding support at an Australian Breastfeeding Association drop-in service: a descriptive survey
Authors: Burns Elaine , Duursma Louise , Triandafilidis Zoi
Published: July 2020

Background In Australia, during the early establishment phase of breastfeeding, women can access telephone peer support counselling provided by the Australian Breastfeeding Association (ABA) however options for face-to-face peer support are limited. The known factors which improve ongoing and exclusive breastfeeding include face-to-face support, peer and/or professional support, and trained personnel. This study aimed to examine women’s experiences of accessing one breastfeeding drop-in peer support service provided by trained peer support volunteer counsellors from the ABA. Methods Women who accessed the service were invited to participate in an anonymous online survey which collected both quantitative and qualitative data. Participants were asked about their experiences of breastfeeding support, as well as their experiences of the drop-in service. In total, 53 women completed the online survey, and subsequent analysis generated descriptive statistics and qualitative themes. Findings Responses to the survey revealed that women attended the drop-in service with infants ranging in age from less than 1 week through to 12 months of age. Most women reported attending with infants aged 0-8 weeks of age 72%. The predominant presenting problems identified were sore/damaged nipples, difficulties with infant latching to the breast, or concerns about using nipple shields. Analysis of the open text qualitative responses revealed one overarching theme ‘Support to continue breastfeeding’ and four subthemes: ‘feeling listened to and not judged’; ‘emotional support and confidence building’; ‘the importance of face-to-face, practical support'; and ‘the need for ongoing, free access’. Discussion In this study many women were seeking support for ongoing breastfeeding difficulties. Health professionals who had limited breastfeeding knowledge and skills were identified as most unhelpful in providing support with ongoing breastfeeding difficulties. Women valued having access to trained peer counsellors, who had the capacity to provide non-judgemental, face-to-face support; who could sit through a feed; in a space that was ‘safe’; and who could enhance a woman’s confidence with breastfeeding over the course of her full breastfeeding journey. Conclusion Women described the importance of access to a reactive style of drop-in service, in response to need, which was dedicated to breastfeeding support and which was available locally.
Defining pain and interference recovery trajectories after acute non-catastrophic musculoskeletal trauma through Growth Mixture Modeling
Authors: Lee Joshua , Walton David M. , Tremblay Paul , May Curtis , Millard Wanda , Elliott James M. , MacDermid Joy C.
Published: July 2020

Background

Recovery trajectories support early identification of delayed recovery and can inform personalized management or phenotyping of risk profiles in patients. The objective of this study was to investigate the trajectories in pain severity and functional interference following non-catastrophic musculoskeletal (MSK) trauma in an international, mixed injury sample.

Methods

A prospective longitudinal cohort of n= 241 was formed from patients identified within 4 weeks of trauma, from attendance at emergency or urgent care centres located in London, ON, Canada, or Chicago, IL, USA. Pain interference was measured via the Brief Pain Inventory (London cohort) or the Neck Disability Index (Chicago cohort). Pain severity was captured in both cohorts using the numeric pain rating scale. Growth mixture modeling and RM ANOVA approaches identified distinct trajectories of recovery within pain interference and pain severity data.

Results

For pain interference, the 3 trajectories were labeled accordingly: Class 1 = Rapid recovery (lowest intercept, full or near full recovery by 3 months, 32.0% of the sample); Class 2 = Delayed recovery (higher intercept, recovery by 12 months, 26.7% of the sample); Class 3 = Minimal or no recovery (higher intercept, persistently high interference scores at 12 months, 41.3% of the sample). For pain severity, the 2 trajectories were labeled: Class 1 = Rapid recovery (lower intercept, recovery by 3 months, 81.3% of the sample); and Class 2 = Minimal or no recovery (higher intercept, flat curve, 18.7% of the sample). The “Minimal or No Recovery” trajectory could be predicted by female sex and axial (vs. peripheral) region of trauma with 74.3% accuracy across the 3 classes for the % Interference outcome. For the Pain Severity outcome, only region (axial trauma, 81.3% accuracy) predicted the “Minimal or No Recovery” trajectory.

Conclusions

These results suggest that 3 meaningful recovery trajectories can be identified in an international, mixed-injury sample when pain interference is the outcome, and 2 recovery trajectories emerge when pain severity is the outcome. Females in the sample or people who suffered axial injuries (head, neck, or low back) were more likely to be classed in poor outcome trajectories.
Personal values in adolescence and their associations with metabolic biomarkers in adulthood: a population-based study in Japan
Authors: Sasaki Natsu , Watanabe Kazuhiro , Kawakami Norito
Published: July 2020

Background : Personal values, which are formed in early life, can have an impact on the health outcome later in life. Objective: The aim of this study is to investigate the relationship between personal values in adolescence and bio-indicators related to metabolic syndrome (MetS) in adulthood. Participant and Methods : The longitudinal data was used from the Japanese Study on Stratification, Health, Income, and Neighborhood (J-SHINE) in 2012 and 2017. Personal values in adolescence were retrospectively obtained in 2017 from a self-reporting questionnaire, composed of value priorities and commitment to the values. Venous samples were collected in 2012 for low and high-density lipoprotein (LDL, HDL) cholesterol and hemoglobin A1c (HbA1c). Body mass index (BMI), waist circumference and systolic and diastolic blood pressure (SBP, DBP) were also measured. The associations of each variable were examined by partial correlation analysis. In addition, multiple linear regression analysis was conducted to examine overall associations between personal values and the sum of standardized scores (Z-score) of the biomarkers as a proxy of MetS. Furthermore, cluster analysis was conducted to identify groups of the participants who have some specific values and to examine their associations with the Z-score. Results : The total population (n=668) included 261 men and 407 women. Among men, the personal value priority of “Having influence on society” was associated with high HDL cholesterol (partial r=0.13, p=0.032) and “Cherishing familiar people” with low waist circumference (r=-0.129, p=0.049), low SBP, and high DBP (r=-0.135, p=0.039; r=0.134, p=0.041). In women, “Not bothering others” was associated with high SBP and low DBP (r=0.125, p=0.015; r=-0.123, p=0.017). "Economically succeeding" were associated with worse outcome (β=0.162, p=0.042). In the cluster analysis, both in men and women, the cluster which had highest openness to change value; “Having and keeping a belief”, “Exploring what you were interested in” and “Actively challenging” with the highest commitment showed worst proxy outcomes although there were no significant differences. Conclusions : Although some significant associations were found between personal values in adolescence and MetS-related markers in adulthood, overall associations were not strong. Culturally prevailing values were likely to be associated with a good outcome of metabolic health.
Spatial-temporal analysis of Tuberculosis in Chongqing, China 2011-2018
Authors: Yu Ya , Wu Bo , Wu Chengguo , Wang Qingya , Hu Daiyu , Chen Wei
Published: July 2020

Background: China is a country with a high burden of pulmonary tuberculosis (PTB). Chongqing is in the southwest of China, where the notification rate of PTB ranks tenth in China. This study analyzed the temporal and spatial distribution characteristics of PTB in Chongqing in order to improve TB control measures.

Methods: A spatial-temporal analysis has been performed based on the data of PTB from 2011 to 2018, which was extracted from the National Surveillance System. The effect of TB control was measured by variation trend of pathogenic positive PTB notification rate and total TB notification rate. Time series, spatial autonomic correlation and spatial-temporal scanning methods were used to identify the temporal trends and spatial patterns at county level.

Results: A total of 188,528 cases were included in this study. A downward trend was observed in PTB between 2011 and 2018 in Chongqing. The peak of PTB notification occurred in late winter and early spring annually. By calculating the value of Global Moran's I and Local Getis’s Gi*, we found that PTB was spatially clustered and some significant hot spots were detected in the southeast and northeast of Chongqing. One most likely cluster and three secondary clusters were identified by Kulldorff’s scan spatial-temporal Statistic.

Conclusions: This study identified seasonal patterns and spatial-temporal clusters of PTB cases in Chongqing. Priorities should be given to southeast and northeast of Chongqing for better TB control.
C-Reactive Protein and Lymphocyte are important indicators of severe coronavirus disease and poor prognosis in elderly patients
Authors: He Qinglin , Hu Xiafen , Xiang Xiaochen , Chen Siyang , Liu Wanxin , Liu Xiaoliu , Wang Qiang , Guo Kaiwen , Wu Qingming
Published: July 2020

Objective： To explore the value of C-reactive protein (CRP) and lymphocyte (L) in the assessment of disease severity and prognosis of elderly COVID-19 patients. Methods: A total of 194 positive COVID-19 patients were collected from Tianyou Hospital and Puren Hospital, affiliated hospital of Wuhan University of Science and Technology. Their demographic characteristics were analyzed. The dynamic changes of CRP and L in peripheral blood were retrospectively studied. Results: (1) There were significant statistical differences in CRP, L in clinical typing and clinical outcome in patients over 60 years old compared with those under 60 years old. Survival analysis showed that the risk of death was greater in patients over 60 than in those under 60.（2）In 125 patients over 60 years old, the hospitalized patients with severe or critical types had significantly higher CRP than those with moderate type (p<0.01). In the outcome of the elderly patients, the CRP of the patients with the outcomes of discharge, improvement, aggravation and death increased successively (p<0.01). According to the analysis of Logistic regression model, the increase of CRP constitutes a risk factor for death in elderly patients. (3) In the ROC curve analysis to distinguish the death outcome and non-death outcome of COVID-19 patients, the area under the curve (AUC) of CRP and L was 0.751 and 0.720 respectively. CRP and L had good diagnostic accuracy for the death outcome of patients. (4) Changes in CRP were correlated with changes in CT imaging and were consistent with changes in the course of the disease. Conclusions: (1) COVID-19 patients over 60 years old were clinically heavy at admission and had poor prognosis, especially elderly male patients. (2) CRP and L are important monitoring indicators of COVID-19 in elderly patients. Combined with CT examination and observation of their dynamic changes, CRP and L are of important clinical guiding value for the judgment of disease severity and the evaluation of prognosis.
Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: A retrospective cohort study
Authors: Sawaya Rasha , Wakil Cynthia , Wazir Adonis , Shayya Sami , Berbari Iskandar , Safa Rawan , Makki Maha , Hamade Mahdi , Tamim Hani
Published: July 2020

Background: Managing children with minor head trauma remains challenging for physicians who evaluate for the need for computed tomography (CT) imaging for clinically important traumatic brain injury (ciTBI) identification. The Pediatric Emergency Care Applied Research Network (PECARN) prediction rules were adopted in our pediatric emergency department (PED) in December 2013 to identify children at low risk for ciTBI. This study aimed to evaluate this implementation’s impact on CT rates and clinical outcomes. Methods: Retrospective cohort study on pediatric patients with head trauma presenting to the PED of the American University of Beirut Medical Center in Lebanon. Participants were divided into pre- (December 2012 to 2013) and post-PECARN (January 2014 to December 2016) groups. Patients were further divided into <2 and ≥2 years and stratified into groups of low, intermediate and high risk for ciTBI. Bivariate analysis was conducted to determine differences between both groups. Results: We included 1362 children of which 425 (31.2%) presented pre- and 937 (68.8%) presented post-PECARN rules implementation with 1090 (80.0%) of low, 214 (15.7%) of intermediate and 58 (4.3%) of high risk for ciTBI. CTs were ordered on 92 (21.6%) pre- versus 174 (18.6%) patients post-PECARN (p=0.18). Among patients <2 years, CT rates significantly decreased from 25.2% (34/135) to 16.5% (51/309) post-PECARN (p=0.03), and dropped in all risk groups but only significantly for low risk patients from 20.7% (24/116) to 11.4% (30/264) (p=0.02). There was no significant decrease in CT rates in patients ≥2 years (20% pre (58/290) vs 19.6% post (123/628), p=0.88). There was no increase in bounce back numbers, nor in admission rates or positive CT findings among bounce backs. Conclusions: PECARN rules implementation did not significantly change the overall CT scan rate but reduced the CT scan rate in patients aged <2 years at low risk of ciTBI. The implementation did not increase the number of missed ciTBI.
Deep learning vs. atlas-based models for fast auto-segmentation of the masticatory muscles on head and neck CT images
Authors: Chen Wen , Li Yimin , Dyer Brandon A , Feng Xue , Rao Shyam , Benedict Stanley H. , Chen Quan , Rong Yi
Published: July 2020

Background: Impaired function of masticatory muscles will lead to trismus. Routine delineation of these muscles during planning may improve dose tracking and facilitate dose reduction resulting in decreased radiation-related trismus. This study aimed to compare a deep learning model with a commercial atlas-based model for fast auto-segmentation of the masticatory muscles on head and neck computed tomography (CT) images. Material and methods: Paired masseter (M), temporalis (T), medial and lateral pterygoid (MP, LP) muscles were manually segmented on 56 CT images. CT images were randomly divided into training (n=27) and validation (n=29) cohorts. Two methods were used for automatic delineation of masticatory muscles (MMs): Deep learning auto-segmentation (DLAS) and atlas-based auto-segmentation (ABAS). The automatic algorithms were evaluated using Dice similarity coefficient (DSC), recall, precision, Hausdorff distance (HD), HD95, and mean surface distance (MSD). A consolidated score was calculated by normalizing the metrics against interobserver variability and averaging over all patients. Differences in dose (∆Dose) to MMs for DLAS and ABAS segmentations were assessed. A paired t-test was used to compare the geometric and dosimetric difference between DLAS and ABAS methods.Results: DLAS outperformed ABAS in delineating all MMs (p < 0.05). The DLAS mean DSC for M, T, MP, and LP ranged from 0.83±0.03 to 0.89±0.02, the ABAS mean DSC ranged from 0.79±0.05 to 0.85±0.04. The mean value for recall, HD, HD95, MSD also improved with DLAS for auto-segmentation. Interobserver variation revealed the highest variability in DSC and MSD for both T and MP, and the highest scores were achieved for T by both automatic algorithms. With few exceptions, the mean ∆D98%, ∆D95%, ∆D50%, and ∆D2% for all structures were below 10% for DLAS and ABAS and had no detectable statistical difference (P >0.05). DLAS based contours had dose endpoints more closely matched with that of the manually segmented when compared with ABAS. Conclusions: DLAS auto-segmentation of masticatory muscles for the head and neck radiotherapy had improved segmentation accuracy compared with ABAS with no qualitative difference in dosimetric endpoints compared to manually segmented contours.
Sensitization to cat and dog components and prediction of symptoms in cat-sensitized children.
Authors: Smejda Katarzyna , Jerzyńska Joanna , Podlecka Daniela , Brzozowska Agnieszka
Published: July 2020

Background: Sensitization to cat and/or dog allergens during childhood represents a risk factor for the development of allergic diseases later in life.Material and Methods: The study investigated the association of patterns of sensitization to cat and dog allergen components with clinical symptoms of allergy to these furry animals among cat-sensitized children. It included 50 children aged 5-17 years who showed sensitization to cat in the skin prick test. They were considered to have cat allergy if they suffered from one or more allergy symptoms when being exposed to contact with a cat. The children were evaluated for the presence of bronchial asthma, atopic dermatitis and allergic rhinitis. Their mothers completed a questionnaire on pet exposure at home. Levels of serum IgE cat epitopes Fel d (1, 2, 4), as well as dog components Can f (1, 2, 3, 5) were measured in all the studied children.Results: Respiratory symptoms following exposure to the cat allergen were most common in children with Fel d 2 epitope (p = 0.041). After contact with a dog, respiratory symptoms were most common in children with Can f 1 epitope (p = 0.042), eczema in children with sensitization to both Can f 1 (p = 0.009) and Can f 2 (p = 0.002), whereas eye symptoms occurred mostly in children with Can f 3 (p = 0.039).Conclusions: Molecular diagnosis in patients with pet allergy may help clinicians to predict clinical symptoms and their severity.
Adjuvant Therapy by High-Speed Burr May Cause Intraoperative Bone Tumor Seeding: an animal study
Authors: Wang Pai-han , Wu Chia-Lun , Chen Chao-Ming , Wang Jir‐You , Wu Po-Kuei , Chen Wei-Ming
Published: July 2020

Background Bone tumors are often treated with intralesional curettage. High-speed burring, an adjuvant therapy, was performed to maximize the tumor cell killing; however, tumor recurrence might still occur, which may be caused by residual tumor or local tumor spread during surgery. Methods A porcine cadaver (femur) was utilized to determine whether the use of a high-speed burr causes bone cement spray. To mimic residual tumor after curettage, luminescent cement was smeared on two locations of the bone cavity, the wall and the bottom. The cavity in the femoral bone was then placed in the middle of a sheet of drawing paper featuring 10 cm, 20 cm, and 30 cm concentric circles. The luminescent cement was then burred totally with a high-speed burr. Results The intensity of the area in the wall in circle I was 72.6% ± 5.8%; within circle II, it was 22.1% ± 4.2%; and within circle III, it was 5.4% ± 1.5%. The intensity of the area within the bottom of the femoral bone within circle I was 66.5% ± 6.1%, within circle II was 28.1 ± 4.8%, and within circle III, it was 5.4% ± 1.4%. The amount of luminescent cement seeding decreased with distance, but there was no difference while burring at different locations of the bone cavity. Under the handpiece cover, a greater amount of cement spray was retained in circle I during burring of the cement in the bottom of the cavity and less was sprayed out in circle III. Conclusions High-speed burring may cause explosive bone cement spray, which could extend to 20 cm. The intensities of spray did not decrease, even when the handpiece cover was used. The wide range of bone cement spray caused by high-speed burr was inspected in this pilot study, which may lead to tumor seeding.
Predictors of Mental Health Problems in Formal and Informal Caregivers of Patients with Alzheimer's Disease
Authors: Sołtys Anna , Tyburski Ernest
Published: July 2020

Background: Caring for a person with Alzheimer's disease (AD) is associated with significant mental burden e.g., depression and anxiety, and difficulties with social, familial, and professional functioning. To date, few studies have examined variables which would allow for a comprehensive and detailed study of the relationship between personal resources and caregiver health status, with a majority of studies focusing on factors that contribute to increased caregiver's burden. Moreover, the available evidence fails to address differences in the functioning of formal and informal carers. Paying proper attention to the problems of nursing home staff can help identify important risk factors. Therefore, this study compared mental health problems in informal and formal caregivers and examined the relationship between mental resources and mental health problems in both groups of caregivers. Methods: This cross-sectional study examined 100 formal (n = 50) and informal (n = 50) caregivers of AD patients. Personal resources were measured with the Social Support Questionnaire (SSQ), the Generalized Self-Efficacy Scale (GSES), and the Sense of Coherence Questionnaire (SCQ), while mental health was assessed with the Depression Assessment Questionnaire (DAQ) and the General Health Questionnaire (GHQ). Multivariate stepwise regression was performed separately for both investigated groups. Results: There were no significant differences between informal and formal caregivers in terms of psychological variables, i.e., sense of coherence, social support, self-efficacy, or mental health problems. In contrast, there were different significant predictors of mental health problems in both groups. Comprehensibility (SCQ) was a significant predictor of mental health problems measured by DAQ and self-efficacy (GSES) was a significant predictor of mental health problems measured by GHQ in informal caregivers. For formal caregivers, emotional support (SSQ) and comprehensibility (SCQ) were significant predictors of mental health problems measured by DAQ, while tangible support (SSQ) and meaningfulness (SCQ) were significant predictors of mental health problems measured by GHQ. Conclusions: Personal resources are significant predictors of mental health outcomes in caregivers of AD patients. Preventive actions should therefore include assessment of factors affecting caregivers’ mental health in order to provide them with necessary care and create appropriate support groups.
Grooved pegboard test performance before and after cerebral-spinal fluid tap test in patients with normal pressure hydrocephalus
Authors: Liu Caiyan , Dong Liling , Mao Chenhui , Li Jie , Huang Xinying , Wei Junji , Hou Bo , Feng Feng , Cui Liying , Gao Jing
Published: July 2020

Background Motor impairment in patients with normal pressure hydrocephalus (NPH) can extend beyond gait and include deficits in upper extremity functions and psychomotor speed. Evaluation of upper extremity function will be helpful for NPH patients who are unable to ambulate (e.g., wheelchair-bound patients) and may not be able to comply with the gait evaluation. Our study aimed to explore the use of the grooved pegboard test to assess responsiveness to the cerebrospinal fluid (CSF) tap test in patients with NPH. Methods Seventy-five possible NPH patients were enrolled from 2012 to 2018. All patients underwent detailed neuropsychological and walking assessments, CSF tap tests, and brain magnetic resonance imaging. The grooved pegboard test results before and after the CSF tap test were compared and correlated with the other clinical assessments. In diffusion tensor imaging analysis, the fractional anisotropy (FA) and mean diffusivity (MD) values of periventricular white matter were measured by the region of interest method and were correlated with pegboard test performance. Results The grooved pegboard test scores significantly improved after the CSF tap test and correlated with patient walking ability, cognitive function, and functional scores (P < 0.01). The improvement ratios in the complex visual motor speed index (i.e., the grooved pegboard test performance combined with the Symbol-Digit Modalities Test performance) were significantly different between the CSF tap test responder and nonresponder groups. The grooved pegboard test times were significantly correlated with the FA values in right periventricular lesions (P=0.017). Conclusions The performance on the grooved pegboard test was related to lower extremity motor ability and cognitive function. It can be used as an alternative evaluation tool for patients who are unable to ambulate and may not be able to comply with the gait evaluation.
Serial Multiple Mediation of the Association Between Internet Gaming Disorder and Suicidal Ideation by Insomnia and Depression in Adolescents in Shanghai, China
Authors: Yu Yuelin , Yang Xue , Wang Suping , Wang Huwen , Chang Ruijie , Tsamlag Lhakpa , Zhang Shuxian , Xu Chen , Yu Xiaoyue , Cai Yong , Lau Joseph TF
Published: July 2020

Background: High prevalence and strong relationships among suicidal ideation, Internet gaming disorder (IGD), insomnia, and depression have been reported for adolescents worldwide, but the mechanism underlying these psychological problems remains unclear. This cross-sectional study explored the mediating effect of insomnia and depression on the association between IGD and suicidal ideation.Methods: Participants were 1,066 adolescents (median age= 13.0 years) with Internet games exposure in the previous 12 months from junior high schools in Shanghai, China. Questionnaire measures of suicidal ideation, IGD, insomnia, depressive symptoms, and background characteristics were obtained. Path analysis was conducted to test the multiple mediating roles of insomnia and depression.Results: Suicidal ideation, IGD, insomnia, and depression prevalence was 27.2%, 13.6%, 9.2%, and 17.0%, respectively. A serial multiple mediation model was generated. The mediation effect of insomnia and depression on the pathway from IGD to suicidal ideation was 45.5% (direct effect: standardized estimate [Std. estimate] = 0.186; total indirect effect: Std. estimate = 0.155). The association between IGD and depression was partially mediated by insomnia (direct effect: Std. estimate = 0.211; indirect effect: Std. estimate = 0.135). The proposed model fit the data well.Conclusions: Insomnia and depression may serially mediate the association between IGD and suicidal ideation. IGD was positively associated with insomnia, then with depression, which in turn positively contributed to suicidal ideation. We suggest greater monitoring of Internet use and prevention of insomnia and depression to mitigate the risk of suicidal ideation among Chinese adolescents.