bluuebunny/crossref_metadata_2025 huggingface dataset:
Non-conveyance of older adult patients and association with subsequent clinical and adverse events after initial assessment by ambulance clinicians: A cohort analysis
Authors: Lederman Jakob , Lindström Veronica , Elmqvist Carina , Löfvenmark Caroline , Ljunggren Gunnar , Djärv Therese
Published: August 2020

Background: Older adults (age ≥65 years) represent a significant proportion of all patients who are not transported to hospital after assessment by ambulance clinicians (non-conveyed patients). This study aimed to fill the knowledge gap in the understanding of the prevalence of older adult non-conveyed patients and investigate their characteristics and risk factors for subsequent and adverse events with those of younger non-conveyed patients comparatively.Methods: This population-based retrospective cohort study included all adult non-conveyed patients who availed the ambulance service of Region Stockholm, Sweden in 2015; they were age-stratified into two groups: 18–64 and ≥65 years. Inter-group differences in short-term outcomes (i.e. emergency department visits, hospitalisations, and mortality within 7 days following non-conveyance) were assessed using multivariate regression analyses.Results: Older adult patients comprised 48% of the 17,809 non-conveyed patients. Dispatch priority levels were generally lower among older non-conveyed patients than among younger patients. Non-conveyance among older patients occurred more often during daytime, and they were more frequently assessed by ambulance clinicians with nonspecific presenting symptoms. Approximately one in five older adults was hospitalised within 7 days following non-conveyance. Patients presenting with infectious symptoms had the highest mortality risk following non-conveyance. Oxygen saturation level <95% or systolic blood pressure >160 mmHg had significantly higher associations with hospitalisation within 7 days following non-conveyance in older adult patients.Conclusions: Older adult patients have an increased risk for adverse events following non-conveyance. In combination with a complex symptom presentation which proves difficult for dispatch operators and ambulance clinicians to identify, this risk raises questions on the patient safety of older adult non-conveyed patients.
Successes and Challenges of Implementing a Lung Cancer Screening Program in Federally Qualified Health Centers: A Qualitative Analysis Using the Consolidated Framework for Implementation Research
Authors: Allen Caitlin G. , Cotter Megan M. , Smith Robert A. , Watson Lesley
Published: August 2020

Background: The American Cancer Society (ACS) partnered with two federally qualified health centers (FQHCs) and American College of Radiology designated lung cancer screening facilities on a two-year pilot project to implement lung cancer screening. The project aimed to develop a referral program and care coordination practices to move patients through the screening continuum and identify critical facilitators and barriers to implementation. Methods: Evaluators conducted key informant interviews (N=46) with navigators, clinical staff, administrators from both sites, and ACS staff during annual site visits in 2017 and 2018 to capture data on implementation barriers and facilitators. Three evaluators conducted a thematic analysis using the Consolidated Framework for Implementation Research (CFIR) and assessed factors associated with effective implementation and improved screening outcomes.Results: One study site established a sustainable lung screening program, while the other encountered numerous implementation barriers which they failed to overcome. CFIR constructs highlighted critical barriers and factors associated with success and improved outcomes. Intervention Characteristics: Time spent with patients and disruption to normal workflows were challenges to implementation at both sites. Outer Setting: Both sites struggled with building patient trust and worked to gain trust by providing clear, consistent information about the screening process. One site was located in a state with Medicaid expansion that reimbursed screening but the other was not. Inner Setting: Engaged, supportive leaders who provided clear, consistent communication about implementation helped improve staff capacity, which was critical to building a successful program. Individual Characteristics: Knowledgeable, confident champions and intervention leaders were able to train, guide, and motivate staff throughout the intervention, whereas the absence of supportive leadership failed to produce staff champions and intervention leaders. Process: A slow, stepwise approach to implementation at one site allowed project champions to pilot-test the referral and reimbursement processes and resolve issues before scaling-up.Discussion: This pilot project provides insight into critical resources and steps for successful program implementation in underserved FQHC settings. Future efforts could build upon these findings by considering self-assessment and monitoring tools that incorporate CFIR constructs to help identify and address possible facilitators and barriers to implementation of LDCT.
Cell Banking of HEK293T Cell Line for Clinical-Grade Lentiviral Particles Manufacturing
Authors: Perpiña Unai , Herranz Cristina , Martin-Ibañez Raquel , Boronat Anna , Chiappe Felipe , Monforte Verónica , Orpella-Arecet Gemma , González Ester , Olive Myriam , Castella Maria , Suñe Guillermo , Urbano Alvaro , Delgado Julio , Juan Manel , Canals Josep M.
Published: August 2020

Background: Cell banks have been widely used to preserve cell properties as well as to record and control cell line access in research. However, the generation of cell banks involved in the manufacturing of Advanced therapy medicinal products such as cell or gene therapy products must comply with the current Good Manufacturing Practice regulation. Similarly, the quality of those cell lines used as starting materials in viral-vector manufacturing processes must be also evaluated.Methods: Three batches of both Master Cell Bank and Working Cell Bank of the HEK293T cell line were manufactured under the current Good Manufacturing Practices regulation. Quality control test were performed according to the product specifications. The process validation includes previous qualification of the manufacturing personnel by performing simulation tests as well as the continuous measure of environmental parameters during manufacturing such as air particles and microorganism. Cell number and viability of cryopreserved cells were periodically measured in order to define the stability of these cellular products.Results: All batches of Master Cell Bank and Working Cell Bank fulfilled the acceptance criteria of their specifications showing the robustness and homogeneity of the processes. In addition, both Master and Working cell bank maintain the defined viability and cell number 37 months after cryopreservation. Conclusions: Manufacturing cell banks under Good Manufacturing Practices regulation for its use as raw material or final cellular product is feasible. HEK293T cell banks have been used to manufacture clinical-grade lentiviral particles for Chimeric Antigen Receptor T-cell based clinical trials.
Pretreatments for Enhancing Sewage Sludge Reduction and Reuse in Lipid Production
Authors: Chen Jiaxin , Li Ji , Zhang Xiaolei , Wu Zhaoyang
Published: August 2020

Background: Converting wastewater sludge for lipid is considered as one of the best strategies of sludge management. The current problem of lipid production from sludge is the low yield due to the low availability of easily uptaken materials in sludge. Pretreatments are efficient methods to improve sludge bioavailability. Results: In this study, it was observed that the soluable chemical oxygen demand (SCOD) had significantly increased after different pretreatment.The SCOD in the supernatant was increased from 32.64±5.19 to 180±13 mg/L, 924±17 mg/L, 1030±6 mg/L and 3708±22 mg/L after acidic, alkaline, microwave irradiation and ultrasonication pretreatment, respectively. Pretreatments have also increased the release in total nitrogen (TN) and total phosphorus (TP) from solids. The sludge after different pretreatments were used as medium for lipid production, thighest lipid content (36.67% g/g) was obtained in the fermentation with ultrasonication pretreatment sludge, and the sludge reduction was 63.10%.Conclusion: It was found that ultrasonication pretreatment was the most efficient way to increase the sludge biodegradability (SCOD), to release TN and TP from solid phase to liquid phase. Pretreated sludge for lipid production achieved significant improvement lipid yield and sludge reduction. Lipids produced from pretreated sludge was transesterified to biodiesel and the analysis showed that the biodiesel had similar composition as commercial biodiesel. The study reveals that pretreatment on sludge is a promising method for enhancing biological sludge management efficiency.
Exploring the Association between Changes in Dialysis Reimbursement Policies and Care Outcomes of Peritoneal Dialysis
Authors: Chang Ray-E , Lin Shih-Pi , Yang Feng-Jung , Myrtle Robert C.
Published: August 2020

Background: Except for renal transplantation, peritoneal dialysis (PD) is considered to be relatively cost-effective option for end-stage renal disease (ESRD) patients. Less than 7% of ESRD patients receiving PD in Taiwan, and the promising benefits of PD treatment influenced health policy makers to seek ways to encourage PD utilization. The purpose of this study is to evaluate the effect of their policy initiatives.Methods: An observational longitudinal study using a before-and-after analysis was conducted. The propensity score matching technique was employed to match PD patients before and after the introduction of Taiwan’s efforts to encourage PD utilization in ESRD patients, and the change in PD technical failure was analyzed. HD patients were also matched as the control group to assess the impact of Taiwan’s PD utilization encouraging policies on mortality in PD patients. The competing risk regression approach for survival analysis was adopted in our study.Results: The results showed that while the PD encouraging policies had increased the PD utilization, the increase in PD utilization was accompanied by an increase in technique failure and an increase in mortality.Conclusions: The adoption of new treatments which may benefit patients and incentives to change physician practice behaviors require more disciplined and carefully managed implementation efforts. Care providers need to be equipped by adequate training and sufficient manpower as part of the policy package.
High obliquity, high angular momentum Earth as Moon’s origin revisited by Advanced Kinematic Model of Earth-Moon System
Authors: Sharma Bijay K
Published: August 2020

Matija Cuk et.al (2016) have proposed a new model for the birth and tidal evolution of our natural satellite Moon, born from lunar accretion of impact generated terrestrial debris in the equatorial plane of high obliquity, high angular momentum Earth. This paper examines their findings critically in the light of Advanced Kinematic Model (AKM) which includes Earth’s obliquity(ɸ), Moon’s orbital plane inclination (α), Moon’s obliquity (β) and lunar’s orbit eccentricity (e). It is shown that AKM’s valid range of application is from 45RE to 60.33RE. The evolution of α, β, e is in correspondence with the simulation results of Matija Cuk et.al (2016) but evolution of Earth’s obliquity has a break at 45RE. According to AKM, earlier than 45RE Earth should achieve 0° obliquity in order to achieve the modern value of eco-friendly 23.44° obliquity. Cuk et al (2016) silent on this point. AKM stands vindicated because using protocol exchange algorithm http://doi.org/10.1038/protex.2019.017, AKM has successfully given precise theoretical formalism of Observed LOD curve for the last 1.2 Gy time span opening the way for early warning and forecasting methods for Earth-quake and sudden Volcanic eruptions. This paper gives us an algorithm to determine the short term and long term changes in Earth’s obliquity which is related to Weather and Climate Extremes. Hence this paper gives us the mathematical tool for predicting the Earth’s climate extreme.
A multi-year retrospective quantitative implementation evaluation of Safer Opioid Prescribing, an opioid prescribing continuing education program for Canadian healthcare providers
Authors: Sud Abhimanyu , Doukas Kathleen , Hodgson Katherine , Hsu Justin , Miatello Amber , Moineddin Rahim , Paton Morag
Published: August 2020

Background: Continuing health professions education is considered an important policy intervention for the opioid epidemic. Besides examining effectiveness or impact, it is important to also study health policy implementation to understand how an intervention was delivered within complex policy and practice environments. Implementation outcomes can be used to help interpret continuing health profession education effects and impacts, help answer questions of “how” and “why” programs work, and inform transferability.Methods: We conducted a retrospective quantitative implementation evaluation of the 2014–2017 cohort of Safer Opioid Prescribing, a Canadian continuing health professions education program consisting of three synchronous webinars and in-person workshop. To measure reach and dose, we examined participation and completion data. We used Ontario physician demographic data, including regulatory status with respect to narcotics to examine relevant trends. To measure fidelity and participant responsiveness, we analyzed participant-provided evaluations of bias, active learning and relevance to practice. We used descriptive statistics and measures of association for both continuous and categorical variables. We used logistic regression to determine predictors of workshop participation and analysis of covariance to examine variation in satisfaction across different-sized sessions.Results: Eighty four percent of participants were family physicians with representative reach to non-major urban physicians. Webinar completion rate was 86.2% with no differences in completion based on rurality, gender or status with the regulatory college. Participants who had regulatory involvement with respect to opioids were more likely to be male, have been in practice for longer and participate in the workshop. Participants reported no significant bias and highly rated both active learning and relevance to practice regardless of their cohort size.Conclusions: This evaluation demonstrates that Safer Opioid Prescribing was implemented as intended. Over a short period and without any external funding, the program reached more than 1% of the Ontario physician workforce. This suggests that Safer Opioid Prescribing is a good model for using virtual continuing health professions education to reach a critical mass of prescribers to drive population level opioid utilization changes. This study represents a methodological advance of adapting evaluation methods from health policy and complex interventions for continuing health professions education.
Routine blood parameters can detect early influenza virus infection in children
Authors: Zhu Ronghe , Wang Qiu , Chen Cuie , Zhang Xixi , Lu Chaosheng , Sun Yuanyuan
Published: August 2020

Purpose
We aimed to explore the value of Routine blood parameters, such as the lymphocyte (LYM) count, platelet (PLT) count, lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), LYM*PLT and mean platelet volume-to-platelet ratio (MPV/PLT), are widely used to predict the prognosis of infectious diseases, for predicting influenza virus infection in children.
Methods
We conducted a single-center, retrospective, observational study on fever with influenza-like symptom in pediatric outpatients in different age groups and evaluated the predictive value of various routine blood parameters within 48 hours of the onset of fever after influenza virus infection.
Results
The LYM count, PLT count, LMR and LYM*PLT were lower, and the NLR and MPV/PLT were higher in the infected children. The LYM count, LMR and LYM*PLT in the infected group were lower in the 1- to 6-year-old group, and the LMR and LYM*PLT in the infected group were lower in the > 6-year-old group. In the 1- to 6-year-old group, the cutoff value of the LMR for predicting influenza A virus infection was 3.75, the sensitivity was 81.87%, the specificity was 84.31%, and the AUC was 0.886; the cutoff value of the LMR for predicting influenza B virus infection was 3.71, the sensitivity was 73.58%, the specificity was 84.31%, and the AUC was 0.843. In the > 6-year-old group, the cutoff value of the LMR for predicting influenza A virus infection was 3.05, the sensitivity was 89.27%, the specificity was 89.61%, and the AUC was 0.949; the cutoff value of the LMR for predicting influenza B virus infection was 2.88, the sensitivity was 83.19%, the specificity was 92.21%, and the AUC was 0.924.
Conclusions
Routine blood tests are simple, inexpensive and easy to perform, and they are useful for predicting influenza virus infection in children. The LMR had the strongest predictive value for influenza virus infection in children older than 1 year, especially influenza A virus infection.
The impact of dexmedetomidine on tourniquet induced systemic effects in total knee arthroplasty under spinal anesthesia: a prospective randomized, double-blinded study.
Authors: Lee Cheol , Lee Cheolhyeong , So Cheolhwan , Choi Insung , Lee Jiheui , Lee Myeongjong , Ma Xiao , Hwang Ji Hyo
Published: August 2020

Background: Clinical studies on the impact of dexmedetomidine on tourniquet-induced systemic effects have been inconsistent. We investigated the impact of dexmedetomidine on tourniquet-induced systemic effects including pain outcomes in patients undergoing total knee arthroplasty under spinal anesthesia. Methods: Eighty patients were randomly assigned to either control (CON) or dexmedetomidine (DEX) group. DEX group received an intravenous loading dose of 0.5 µg/ kg DEX over 10 minutes, followed by a continuous infusion of 0.5 µg/ kg/h from 10 minutes before the start of surgery until completion. The CON group received the same calculated volume of normal saline. Pain outcomes and metabolic and coagulative changes after tourniquet application and after tourniquet release were investigated.Results: The frequency of fentanyl administration postoperatively, patient-controlled analgesia (PCA) volume at 24 hours postoperatively, total PCA volume consumed in 48 hours postoperatively, and VAS score for pain at 24 and 48 hours postoperatively were significantly lower in the DEX group than in the CON group.Ten minutes after tourniquet release, the DEX group showed significantly higher pH and lower lactate level than those in the CON group. Antithrombin III activity and body temperature 10 minutes after tourniquet release were significantly lower in the DEX group than in the CON group. Ca2+, K+, HCO3-, base excess, and PCO2 levels 10 minutes after tourniquet release were not significantly different between the two groups.Conclusion: We showed that DEX attenuated pain and hemodynamic, metabolic, and coagulative effects induced by tourniquet. However, these metabolic and coagulative changes were within normal limits. Therefore, DEX could be used as an analgesic adjuvant, but should not be considered for routine use to prevent the systemic effects induced by tourniquet use.
Factors associated with 30-day mortality in medical emergency team patients – a retrospective cohort study
Authors: Adielsson Anna , Danielsson Christian , Forkman Pontus , Karlsson Thomas , Pettersson Linda , Herlitz Johan , Lundin Stefan
Published: August 2020

Background: Medical emergency teams (METs) have been implemented to respond more efficiently to inpatient crises in order to reduce hospital mortality by the early recognition and treatment of potentially life-threatening conditions. The objective of this study was to identify factors associated with 30-day mortality risk among patients assessed by the MET.Methods: Observational retrospective register study in a tertiary university hospital in Sweden, comprising 2,601 patients, assessed by the MET from 2010 to 2015. Patient registry data at the time of MET assessment was analysed from an epidemiological perspective, using univariable and multivariable analyses with death within 30 days as the endpoint.Results: The overall 30-day mortality was high (29.0%) and almost twice as high on medical wards as on surgical wards (37.1% vs 19.8%). The acute medical conditions associated with the highest 30-day mortality were gastroenteritis (50.0%), acute coronary syndrome (43.0%), cardiac failure (41.1%) and renal failure (40.4%). The multivariable analysis indicated that factors with increased 30-day mortality were reflected in age, type of ward, vital parameters, laboratory findings, previous medical history and acute medical condition. Apart from age, the factor associated with the highest odds ratio for 30-day mortality was hypoglycaemia (OR 4.30 (95% CI 2.10, 8.81)).Conclusions: We found that factors reflecting the patients' age, co-morbidity and acute medical condition, along with clinical findings such as vital parameters and laboratory abnormalities, and also the type of ward for admittance, all contributed to identifying patients at risk of death within 30 days after MET assessment. Overall, medical ward patients have higher 30-day mortality than surgical ward patients. Abnormalities in vital parameters reflecting respiratory distress appeared to be more alarming than waning circulatory functions.
An Empirical Analysis of Policy Barriers Related to Trade Costs for Exporters
Authors: Noureen Shabana , Mahmood Zafar
Published: August 2020

The authors have withdrawn this preprint due to author disagreement.
Fractions of soil organic and inorganic carbon and their relationships in typical loess cropland of Fenggu Basin
Authors: Lu Tongping , Wang Xiujun Wendy , Zhang Wenxi
Published: August 2020

There is evidence of connections between soil organic carbon (SOC) and inorganic carbon (SIC) in dryland of north China. However, fractions of SOC and SIC and the relationship are not well understood in the Loess Plateau that undergoes profound erosion and redeposition. A study was conducted in low-elevation cropland of Loess Plateau across two distinctive basins: Lingfeng basin (LFB) with lower soil pH (< 8.4) and subject to erosion-redeposition, and Yuncheng basin (YCB) with higher soil pH (> 8.6) and under the influence of the Yellow River. Soil samples were collected from 30 sites over 100 cm. We determined SOC, SIC, dissolved organic carbon (DOC) and other properties. Above 100 cm, SOC stock is significantly higher in LFB (10.0 ± 2.6 kg C m− 2) than in YCB (6.9 ± 1.5 kg C m− 2), but SIC lower in LFB (14.0 ± 2.5 kg C m− 2) than in YCB (17.0 ± 5.7 kg C m− 2). We find a significantly negative correlation between SOC and SIC stocks in LFB, but no clear relationship in YCB. On average, DOC:SOC ratio is significantly higher below 40 cm in YCB (1.9%) than LFB (1.2%), indicating stronger DOC desorption in YCB that has stronger hydrological process due to the influence of the Yellow River. Overall, SOC has a negative correlation with SIC and soil pH, and DOC:SOC ratio has a significantly positive correlation with soil pH. Our analyses suggest that erosion/re-deposition of topsoil is partly responsible for the negative SIC-SOC relationship in LFB, and high soil pH and stronger hydrological processes are attributable to relatively lower levels of SOC in YCB. This study highlights that soil carbon fractions in the lowland of Loess Plateau are influenced by many drivers, which leads to complex relationships between major soil carbon pools.
Development of a prognostic model for esophageal cancer based on nine immune related genes
Authors: Zhang zhi , chen cheng , fang ying , Li sheng , Wang xiaohua , Sun lei , Zhou guoren , ye jinjun
Published: August 2020

Background: Function of the immune system is correlated with the prognosis of the tumor. The effect of immune microenvironment on esophageal cancer (EC) development has not been fully investigated. This study aimed to explore a prognostic model based on immune-related genes (IRGs) for EC. Methods: We obtained the RNA-seq dataset and clinical information of EC from the Cancer Genome Atlas (TCGA). We identified 247 upregulated IRGs and 56 downregulated IRGs. Pathway analysis revealed that the most differentially expressed IRGs were enriched in Cytokine-cytokine receptor interaction. We further screened 13 survival-related IRGs and constructed regulatory networks involving related transcription factors (TFs). Finally, a prognostic model was constructed with 9 IRGs (HSPA6, S100A12, CACYBP, NOS2, DKK1, OSM ,STC2 ,NGPTL3 and NR2F2) by multivariate Cox regression analysis. Results: The patients were classified into two subgroups with different outcomes. When adjusted with clinical factors, this model was verified as an independent predictor, which performed accurately in prognostic prediction. Next, M0 and M2 macrophages and activated mast cells were significantly enriched in high-risk group, while CD8 T cells and regulatory T cells (Tregs) were significantly enriched in low-risk group. Conclusion: These molecules may serve as potential therapeutic targets and biomarkers for the new-immunotherapy of EC.
Covid-19 in Latin America countries: Course of the pandemic and the different responses towards control
Authors: Pescarini Julia Moreira , Silveira Ismael H , Souza-Filho Jaime A , Aquino Rosana , Barreto Mauricio L , Aquino Estela ML
Published: August 2020

Background: The emergence of COVID-19 in Latin America occurred within a troubled political, economic and social context, with growing trends of poverty and social inequality challenging already overburdened and underfinanced local healthcare systems. In the absence of a vaccine or of any treatment for COVID-19, public health measures such as social distancing had to be adopted. The objective of this paper is to describe the course of the COVID-19 pandemic in Latin American countries and to summarize the social distancing measures implemented in each one of these countries, discussing the changes that took place in the social mobility of the populations and their potential effects on the course of the epidemic up to June 2020. Results: Brazil has the highest cumulative number of cases and deaths; however, cumulative incidence rates are higher in Peru and Chile, while the highest cumulative mortality rates are in Ecuador, Peru and Brazil. Some countries implemented social distancing measures before the first case was registered, culminating in lockdown in eight countries before detection of the 100th case. The measures that appear to have had the greatest impact in reducing mobility include, in addition to lockdown, the closure of schools and prohibition of events. In general, the countries that implemented social distancing measures earlier and where the reduction in social mobility was greatest also recorded lower incidence and mortality rates. Brazil and Mexico failed to adopt lockdown and the number of cases of the disease continues to grow. Conclusions: As occurred in other continents, control of the COVID-19 pandemic was better in countries that were faster in adopting more restrictive measures. Nevertheless, this equation does not appear to guarantee a positive outcome in all settings, possibly due to the considerable social inequalities and chronic deficiencies of the healthcare systems, with the scenario being even more complex in view of the recurring political crises and the negationist view of some national leaders. The COVID-19 pandemic continues to spread in Latin America and exposes these contradictions. Further studies are required to gain a greater understanding and generate lessons on how to manage such a complex crisis.
Depicting developing trend and core knowledge of hip fracture research using bibliometric and visualized analysis
Authors: Peng Guanrong , Guan Zhenhua , Hou Yunfei , Gao Jiaxiang , Rao Wenqun , Yuan Xianyun , Guo Jiusheng , Huang Xiaohua , Zhong Zhangrong , Lin Jianhao
Published: August 2020

Background Among all osteoporotic fractures, hip fracture is common and carries high morbidity and mortality. We aim to analyze the present status and worldwide trends of hip fracture research in various clinical aspects.Methods Publications from 2010 to 2019 were retrieved from Web of Science database and analyzed through bibliometric methodology. The software VOS viewer was utilized for visualized analysis.Results Totally, 6139 publications were included, and publications increased annually, from 152 (2000) to 592 (2019). The USA has made huge contributions with the most publications, the highest H-index, and citations. Osteoporosis International has published the most papers. Leading researchers, contributing institutions, their cooperation relationships and scientific masterpieces have been identified. Research could be divided into five clusters: "mortality", "surgical management", “rehabilitation”, “osteoporosis” and "epidemiology". A clear developing trend was described, which initiated from fracture epidemiology and prevention, transitioned to perioperative management, orthogeriatric care and patient safety, and then to functional recovery, disease burden along with national audit and initiatives in recent time.Conclusions Hip fractures resulted in conditions that extend far beyond orthopaedics, concerning epidemiology & preventive medicine, internal medicine & endocrinology, as well as critical care and gerontology. And a growing volume of publications in the future could be expected.
Physicians’ Prescribing Behaviour and Clinical Practice Patterns for Allergic Rhinitis Management in Italy
Authors: Passalacqua Giovanni , Musarra Antonino , Senna Gianenrico , Bousquet Jean , Ferrara Carmen , Lonati Caterina , Canonica Giorgio Walter
Published: August 2020

Background: Despite availability of clinical guidelines, underdiagnosis, undertreatment, and poor adherence are still significant concerns in allergic rhinitis (AR) therapeutic management. We investigated clinical practice patterns and prescribing behavior of Italian healthcare professionals (HCPs) specialized in AR management. Methods: One-hundred allergologists, 100 ear, nose and throat (ENT) specialists, and 150 general practitioners (GPs) were recruited. The survey assessed: socio-demographic, work experience, monthly caseload, prescription drivers. Next, HCPs were invited to retrospectively recover patients’ clinical data to investigate: AR clinical characteristics, therapy management, prescription patterns, patient adherence. Descriptive statistics, Chi-square, One-Way analysis of variance, and Two-Way Analysis of Variance were performed.Results: Allergologists visited more AR patients (31% of monthly caseload) than ENTs (21%, p<0.001), while GPs’ caseload was the lowest (6%). Clinical information of 2823 patients were retrieved of whom 1906 (67,5%) suffered from moderate/severe AR (discomfort score: 7,7±1,3) and 917 (32,4%) from mild AR (5.7±1.9). About one-third of mild patients had a discomfort score >=7. Main prescription drivers were “effective on all symptoms” (54,3% patients) and “quick symptom relief” (47,8%), whereas minor drivers were “affordable price” (13,4%) and “refundable” (8,7%). The most prescribed drugs were antihistamines and intranasal corticosteroids (79% and 55% prescriptions), followed by fixed-dose-combination of intranasal azelastine/fluticasone (19%). Polytherapy was the most common treatment strategy (59,6%). HCPs’ believe that the majority of the patients was adherent to treatment (88% with score>7).Conclusions: This survey describes AR pharmacological management by Italian physicians. HCPs underestimated AR severity and had a non-realistic perception of patients’ adherence. These findings suggest that further efforts are required to improve AR clinical management in Italy.
High Number of RNA Copies in Asymptomatic Individuals Infected with SARS-CoV-2 in an Area of the Colombian Caribbean
Authors: Mattar Salim , Martinez-Bravo Caty , Rivero Ricardo , Contreras Hector , Faccini_Martinez Alvaro , Guzman Camilo , Galeano Ketty , Alvis Nelson , Contreras Veronica , Arrieta German , Gonzalez Marco , Miranda Jorge , Ospina Martha Lucia , Camargo-Assis Francisco , Mercado-Reyes Marcela , Garay Evelyn , Garcia-Perez Alejandra , Lopez Yesica , Tique Vaneza
Published: August 2020

Background. Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) is an emerging pandemical virus. The virus has caused millions of reported cases and hundreds of thousands of deaths in less than six months. South America has suffered the pandemic because it lacks the hospital and economic capacities needed to contain the pandemic's advance. Public health implications of transmission, while asymptomatic is a critical concern at the current pandemic.Objective: Describe the socio-demographic, clinical, and viral kinetics features of a cohort of SARS-CoV-2 infected individuals from the Colombian Caribbean. Methods: Six hundred eighty-six clinical samples from several hospital centers in the province were received between April 9th and May 16th, 2020. RNA was extracted using lysis buffers and spin columns. The samples were tested for SARS-CoV-2 by RT-qPCR (Reverse transcription real-time polymerase chain reaction) using commercially available multiplex real-time PCR assay for simultaneous detection of 3 target genes of SARS-CoV-2 (AllplexTM, 2019-nCoV assay, Korea). Viral copies quantification was done using a standard curve constructed from seriated dilutions of a SARS-CoV-2 positive control. Statics descriptive methods were used. Results: Thirty-five nasopharyngeal samples were positive for SARS-CoV-2 infection; the average age was 43 (range, 1-95 years). Seventeen of 35 (49%) of the patients showed symptoms. Most of them had cough, fever, and odynophagia, 3 of the patients reported having arthralgia. Only two patients required hospitalization. None of the patients had known co-morbidities. RT-qPCR results show that two of the symptomatic patients had significantly higher RNA copies than the rest of them. Eighteen of 35 (51%) individuals were asymptomatic, the average age was 30 (range, 6-61 years. Four individuals showed a higher copy than some symptomatic patients. Nonetheless, the average of RNA copies 8.26 x10+10 was lower than the symptomatic.Conclusions: the population studied was young, with an average of 43 years in symptomatic and 30 years of asymptomatic; this is important because of the high impact in the economy. It is probably the cause of the reduced lethality observed in the department. Because a large proportion of infections probably result from transmission from asymptomatic, pre-symptomatic persons. The usefulness of public health interventions in Colombian provinces should be based on molecular screening in a vast conglomerate population and quantify the viral load.
Brief Problem-solving Therapy for Antenatal Depressive Symptoms in Primary Care in Rural Ethiopia: Protocol for a Randomised, Controlled Feasibility Trial
Authors: Bitew Tesera , Keynejad Roxanne , Myers Bronwyn , Honikman Simone , Medhin Girmay , Girma Fikirte , Howard Louise , Sorsdahl Katherine , Hanlon Charlotte
Published: August 2020

Background: Despite a high prevalence of antenatal depression in low- and middle-income countries, there is very little evidence for contextually adapted psychological interventions delivered in rural African settings. The aims of this study are: (1) to examine the feasibility of procedures for a future fully powered efficacy trial of contextually adapted brief Problem Solving Therapy (PST) for antenatal depression in rural Ethiopia, and (2) to investigate the acceptability, fidelity and feasibility of delivery of PST in routine antenatal care. Methods: Design: A randomized, controlled, feasibility trial and mixed method process evaluation. Participants: Consecutive women attending antenatal clinics in two primary care facilities in rural Ethiopian districts. Eligibility criteria: 1) Disabling levels of depressive symptoms (Patient Health Questionnaire (PHQ-9) score of five or more and positive for the 10th disability item); 2) gestational age 12-34 weeks; 3) aged 16 years and above, 4) planning to live in the study area for at least six months; 5) no severe medical or psychiatric conditions. Intervention: Four sessions of adapted PST delivered by trained and supervised antenatal care staff over a maximum period of eight weeks. Control: enhanced usual care (EUC). Sample size: n=50. Randomisation: individual randomisation stratified by intimate partner violence (IPV). Allocation: central phone allocation. Outcome assessors and statistician masked to allocation status. Primary feasibility trial outcome: dropout rate. Primary future efficacy trial outcome: change in PHQ-9 score, assessed nine weeks after recruitment. Secondary outcomes: anxiety symptoms, trauma symptoms, intimate partner violence, disability, healthcare costs at 9 weeks; postnatal outcomes (perinatal and neonatal complications, onset of breast feeding, child health) assessed 4-6 weeks postnatal. Other trial feasibility indicators: recruitment, number and duration of sessions attended. Audio-recording of randomly selected sessions and in-depth interviews with purposively selected participants, healthcare providers and supervisors will be analysed thematically to explore the acceptability and feasibility of the trial procedures and fidelity of the delivery of PST. Discussion: The findings of the study will be used to inform the design of a fully-powered efficacy trial of brief PST for antenatal depression in routine care in rural Ethiopia. Trial registration: The protocol was registered in the Pan-African clinical trials registry, (PACTR): registration number: _____________________ on 03 December, 2019; UR: https://pactr.samrc.ac.za/Researcher/ManageTrials.aspx.Funding: This work is supported through the DELTAS Africa Initiative [DEL-15-01].
An Exploratory Study to Estimate Cost-effectiveness Threshold Value for Life Saving Treatments in Western Iran
Authors: Moradi Najmeh , Woldemichael Abraha , Malekian Parisa , Rotavandi Delnia Moradi , Rezaei Satar
Published: August 2020

Background: Cost-effectiveness analysis provides a crucial means for evidence-informed decision-making on resource allocation. This study aims to elicit individuals' willingness to pay (WTP) for one additional quality-adjusted life-year (QALY) gained from life-saving treatment and associated factors in Kermanshah city, western Iran.Methods: We conducted a cross-sectional study on a total of 847 adults aged 18 years and above to elicit their WTP for one additional QALY gained by oneself and a family member using a hypothetical life-saving treatment. We used a multistage sampling technique to select the samples, and the Iranian version of EQ-5D-3L, and visual analogue scale (VAS) measures was used to obtain the participants’ health utility value. The Tobit regression model was used to identify the factors affecting WTP per QALY values.Results: The mean WTP value and standard deviation (SD) was US$ 862 (3224) for the respondents and US$ 1355 (3993) for the family members. The mean utility values using EQ-5D-3L and VAS methods were 0.779 and 0.800, respectively. The WTP for the additional QALY gained by the individual participants using the EQ-5D-3L and VAS methods were respectively US$ 1202 and US$ 1101, while the estimated value of the family members was US$ 1355 (SD= 3993). The Tobit regression models indicated that monthly income, education level, sex, and birthplace were statistically significantly associated (p < 0.05) with both the WTP for the extra QALY values using the EQ-5D-3L and the VAS methods. Besides, education level and monthly income showed statistically significant relationships with the WTP for the additional QALY gained by the family members (p < 0.05). Conclusion: Our findings indicated that the participants' WTP value of the additional QALY gained from the hypothetical life-saving treatment was in the rage of 0.20 to 0.24 of Iran’s gross domestic product (GDP) per capita, which is far lower than the World Health Organization (WHO) recommended CE threshold value of one. This wide gap reflects the challenges the health system is facing and requires further research for defining the most appropriate CE threshold at the local level.
Covid-19 and low molecular weight heparin therapy: retrospective study of 257 patients.
Authors: Stabile Marco , Aschieri Daniela , Maestri Cristina , Rosato Luca , Novara Paola , Lanati Gianluca , Dio Mariateresa Di , Franco Cosimo , Bisceglie Giuseppina , Leddi Giuseppe , fabrizi Enrico , Rucci Paola , Taliani Gloria
Published: August 2020

Objective To evaluate the role of low molecular weight heparin in COVID-19 treatment.Design Retrospective cohort studySetting Patients with COVID-19 pneumonia consecutively admitted to Castel San Giovanni COVID- Hospital from February 29, to April 7, 2020.Main outcome measure Hospital mortality and safety in patients treated with low molecular weight hep- arin.Results Of the 257 patients enrolled, 49 (19.1%) died during the hospitalization. Hospital mortality was significantly lower in patients treated with therapeutic dose of low molecular weight heparin (T-LMWH) (17/126, 13.5%), compared with patients treated with prophylactic dose (P-LMWH) (32/131, 24.4%; χ²=4.98, p = 0.02). Crude and adjusted odds ratios of mortality for patients treated with T-LMWH were OR=0.483, 95% CI 0.252-0.923 and OR=0.374, 95% CI 0.177-0.792. In a stratified analysis by ventila- tion type, the only subgroup of patients who benefited from therapeutic doses of heparin were those re- ceiving non-invasive mechanical ventilation (OR=0.099, 95% CI 0.028-0.354, p<0.001). No fatal bleed- ings were observed.Conclusion Treatment with therapeutic doses of T-LMWH is safe and seems to reduce mortality in COVID-19 patients with pneumonia, especially among those who need non-invasive mechanical ventila- tion. We look forward to prospective studies to confirm this observation and evaluate the appropriate dose of LMWH in the treatment of COVID-19 patients.
Dysplasia of Ovary Without Abnormal Development of Uterus and Urinary System: A Report of Four Cases
Authors: Wei Weixia , Luo Wenji , Hu Qicai , Zeng Liping , Tang Huiru , Wu Ruifang
Published: August 2020

Background Congenital anatomic abnormalities of fallopian tubes and ovaries are rarely reported. Herein, we describe four cases of abnormal ovarian descent during laparoscopic surgery with abnormal anatomy of fallopian tube, without abnormal uterine development and urinary system abnormalities. These cases are analyzed by their clinical features and their effects on reproductive function. Case presentation For patients with undescended ovary, the upper part of the unilateral/bilateral ovary decline was much higher than that of the common iliac vessel bifurcation, and the fallopian tube on the same side opened in the para-colonic sulcus. Among four patients, two cases had primary infertility, one case had tubal pregnancy rupture and bleeding, and one case had uterine leiomyoma. The development of uterus was normal in all the four patients, and there was no abnormal development of urinary system. During the infertility examination, hysterosalpingography (HSG) suggestion of oviduct lift was a sign for possible undescended ovarian. The pelvic B-ultrasound examination was limited to discover ovarian maldescent. Conclusion Laparoscopy was the gold standard for the diagnosis of poor ovarian decline. When B-ultrasound prompts one-sided or double-sided "ovary display is unclear" or detects "shrinking small ovaries", it might be ovarian maldescent. When there is periodic post-sacral spinal pain, MRI positioning or HSG can be used for diagnosis.
Prediction of Fruit Free Amino Acids by Foliar Nutrient Diagnosis in Longan (Dimocarpus longan Lour.)
Authors: Xu Han , Bai Cuihua , Wang Wei , Zhou Changmin , Zhu Luwei , Yao Lixian
Published: August 2020

Free amino acid (FAA) profile is an important indicator of the quality of fruit and fruit product. Foliar nutrient diagnosis has been used for crop yield prediction for decades but not for fruit quality evaluation. Concentrations of 11 leaf nutrients including N, P, K, Ca, Mg, S, Fe, Mn, Cu, Zn, and B at stages of terminal shoot maturation and fruit development and fruit FAA profile at harvest were examined in longan in South China. The relation between leaf nutrient and fruit FAA was then investigated by multiple stepwise regression analysis. Foliar N content was greatest among the nutrients among the detected elements at both stages. Twenty-nine FAAs were determined in longan flesh, with alanine (19.9%), γ-aminobutyric acid (17.5%), glutamic acid (15.2%), and asparagine (10.7%) as the main components. Flesh individual FAA, essential amino acid (AA), umami-, and sweet and bitter taste AA strongly depended on foliar nutrients. However, the relation between flesh FAAs and foliar nutrients varied with FAA species. Leaf N was the dominant indicator for most pulp FAAs at two growth stages, while other nutrients (e.g., B, Zn, P, K, Ca, Mg) also played versatile roles on flesh FAAs. This work provides a novel tool to predict fruit FAAs via foliar nutrient diagnosis, which supports the practicality of producing specific target fruit or improving fruit quality through regulation of fertilization strategies in fruit production.
Antioxidant, Enzyme Inhibitory and Calcium Oxalate Anti-crystallization Activities of Equisetum telmateia Ehrn.
Authors: TAŞKIN Turgut , YILMAZ Beyza , DOĞAN Ahmet
Published: August 2020

Equisetum L. is the only genus of the Equisetaceae family, which commonly known as horsetails, in English and atkuyruğu or kırkkilit in Turkish. In traditional medicine, Equisetum telmateia Ehrh. is used in diseases of the urinary system, such as pyelonephritis, prostatic hypertrophy, and cystitis. Besides, this species is known to be used by humans to treat kidney stones or kidney sand. The extracts were obtained from the aerial parts of the E. telmateia using three different extraction methods (maceration, Soxhlet, ultrasonic bath) and their antioxidant (ABTS, CUPRAC), anti-urease and anticholinesterase activities were examined. Also, calcium oxalate anti-crystallization activity of Soxhlet methanol extract showing strong antioxidant activity was determined. Soxhlet methanol extract exhibited stronger ABTS radical scavenging (0.0676 mM Trolox/mg extract) and cupric ion reducing/antioxidant (4.351 mM Trolox/mg extract) activity than other extracts. Soxhlet methanol (65.528%) and maceration methanol (61.965%) extracts showed the strongest anticholinesterase activity. In the anti-urease assay, it was found that Soxhlet petroleum ether extract (15.302%) had the highest anti-urease activity. Furthermore, the data obtained showed that the Soxhlet methanol extract had high efficacy in the nucleation and aggregation phase of calcium oxalate crystals. These results prove that Soxhlet methanol extract has antioxidant, anticholinesterase and anti-crystallization capabilities. Therefore, this extract can be used in the future as an antioxidant and anticholinesterase agent as well as the treatment and / or prevention of stone formation.
Toward a 3d Ising model with a weakly-coupled string theory dual
Authors: Iqbal Nabil , McGreevy John
Published: August 2020

It has long been expected that the 3d Ising model can be thought of
as a string theory, where one interprets the domain walls that separate
up spins from down spins as two-dimensional string worldsheets. The
usual Ising Hamiltonian measures the area of these domain walls. This
theory has string coupling of unit magnitude. We add new local terms to
the Ising Hamiltonian that further weight each spin configuration by a
factor depending on the genus of the corresponding domain wall,
resulting in a new 3d Ising model that has a tunable bare string
coupling g_sgs.
We use a combination of analytical and numerical methods to analyze the
phase structure of this model as g_sgs
is varied. We study statistical properties of the topology of
worldsheets and discuss the prospects of using this new deformation at
weak string coupling to find a worldsheet description of the 3d Ising
transition.