bluuebunny/crossref_metadata_2025 huggingface dataset:
Shortened red blood cell age in patients with end-stage renal disease who were receiving haemodialysis: a cross-sectional study
Authors: Matsumura Koichiro , Okumiya Toshika , Sugiura Tetsuro , Takahashi Nobuyuki , Yamamoto Yoshihiro , Kikuchi Sanae , Fujii Kenichi , Otagaki Munemitsu , Shiojima Ichiro
Published: September 2020

Background: The causes of anaemia in patients with end-stage renal disease include a relative deficiency in erythropoietin production and complex clinical conditions. We aimed to investigate the underlying mechanisms of anaemia in patients with end-stage renal disease who were undergoing maintenance dialysis by measuring erythrocyte creatine levels.Methods: In a cross-sectional study, we evaluated 69 patients with end-stage renal disease who were receiving haemodialysis (n = 55) or peritoneal dialysis (n = 14). Erythrocyte creatine level, a quantitative marker of mean red blood cell (RBC) age, was measured.Results: The mean RBC age was significantly shorter in the haemodialysis group than in the peritoneal dialysis group (47.7 days vs. 59.8 days, p<0.0001), although the haemoglobin levels were comparable between the groups. A Spearman correlation coefficient analysis revealed that shortened RBC age positively correlated with transferrin saturation (r = 0.54), ferritin level (r= 0.47), and haptoglobin level (r = 0.39) but inversely related with reticulocyte (r = −0.36), weekly doses of erythropoiesis-stimulating agents (ESAs; r = −0.62), erythropoietin resistance index (r = −0.64), and intradialytic ultrafiltration rate (r = −0.32).Conclusions: Shortened RBC age was observed in patients who were receiving maintenance haemodialysis and was associated with iron deficiency, greater haptoglobin consumption, higher ESA requirements, and poor erythropoietin responsiveness, as well as with greater intradialytic fluid extraction.
A latent class analysis of dietary behaviours associated with metabolic syndrome: a retrospective observational cross-sectional study
Authors: Park Jung Ha , Kim Ju Young , Kim So Hye , Kim Jung Hyun , Park Young Mi , Yeom Hye Seon
Published: September 2020

Background: Obesity defined solely by the Body Mass Index (BMI) may not reflect the true heterogeneity of the obese population. This study aimed to classify the dietary behaviours of overweight and obese individuals and to explore the relationship between patterns of dietary behaviour and cardiometabolic risk factors.Methods: A total of 259 patients who visited an outpatient weight management clinic at a tertiary hospital and underwent a dietary behaviour assessment between January 2014 and February 2019 were enrolled in the study. Dietary behaviours were assessed in three domains with nine categories, including choice of food (frequently eating out and consumption of instant/fast/takeaway food), eating behaviour (irregular meals; frequent snacking, including eating at night; emotional eating; and overeating/binge eating), and nutrient intake (high-fat/high-calorie foods, salty food, and poorly balanced diet). Latent class analysis (LCA) was used to classify the subjects according to these categories. Associations between latent class and metabolic syndrome were assessed by logistic regression.Results: The subjects were classified into three LCA-driven classes, including a referent class of healthy but unbalanced eaters (n=118), a class of emotional eaters (n=53), and a class of irregular unhealthy eaters (n=88). Compared with the referent class, emotional eaters had a significantly higher BMI (beta=3.40, P<0.001) accompanied by metabolic syndrome (odds ratio 2.88, 95% confidence interval 1.16–7.13).Conclusions: Our three LCA-driven obesity phenotypes could be useful for assessment and management of obesity and metabolic syndrome. The association between emotional eaters and higher BMI and metabolic syndrome was stronger than that with other eaters. Thus, emotional regulation strategies might have benefit for emotional eater’s diet.
The Prevalence and Causes of Visual Impairment among Children in Kenya – The Kenya Eye Study
Authors: Muma Shadrack , Obonyo Stephen
Published: September 2020

Background: Visual impairment is the partial or complete loss of vision in which the presenting visual acuity lie between 6/18-no perceptions of light. In Kenya, little attention has been directed towards children vision and causes of visual impairment. Therefore, this study was designed to investigate the prevalence and causes of visual impairment in the children population of Kenya.Methods: This cross-sectional population-based study included 3400 (1800, 52.9% female) randomly selected children with a mean age of 12 ± 2 years (range 5–16 years). Visual acuity was taken using Snellens chart at 6 meters. Anterior and posterior segment was assessed using slit lamp and indirect ophthalmoscope. The World Health Organization definition formed the baseline for calculating the mean prevalence of visual impairment.Results: Visual acuity measurements were available for 3240 (95.3%) participants. The mean prevalence of visual impairment based on pin-hole value was 1.7 ± 0.3% using World Health Organization definition. The prevalence of visual impairment based on presenting visual acuity value was 2.4 ± 0.7% using the World Health Organization definition. Multivariate analysis demonstrated that the presence of visual impairment on pin-hole increased significantly with increasing age (odds ratio 1.230, P=.021) and uncorrected refractive error (odds ratio 0.834, P = .032) according to World Health Organization definition. Cases of uncorrected refractive error remained the major cause for presenting visual impairment. Causes of visual impairment due to presenting visual acuity were nystagmus (14%), amblyopia (24%) and uncorrected refractive error (62%).Conclusion: The prevalence of visual impairment in Kenya is associated with age. Uncorrected refractive error remains the major causes of visual impairment.
Challenges and management of laparoscopic treatment of pyonephrosis caused by calculi
Authors: Liu Jun , Chen Liang , An Lizhe , Ma Kai , Ye Xiongjun , Xu Qingquan , Huang Xiaobo , Xiong Liulin
Published: September 2020

Background: Calculous pyonephrosis is a disease characterized by infectious hydronephrosis associated with pyogenic destruction of the renal parenchyma, with complete or almost complete loss of renal function.Methods: The clinical data of laparoscopic nephrolithotomy performed at Peking University People’s Hospital from May 2017 to June 2020 were analyzed retrospectively. Eight patients (2 men; 6 women) aged 27 to 65 years (average age, 45.8 years) were included. Among them, 7 patients were treated with retroperitoneal approach and 1 patient by transperitoneal approach. All patients had received more than one endoscopic lithotripsy before nephrectomy. Renal dynamic imaging and computed tomography revealed the absence of function in pyonephrosis before nephrectomy. General clinical data and perioperative data were recorded. All nephrectomies were performed by the same physician.Results: Laparoscopic surgery was successfully performed in 7 patients; however, 1 patient underwent open surgery because of bleeding. The operation time, average operation time, and blood loss were 1.5–4.5 hours, 3.4 hours, and 100–1000 ml (average, 300 ml), respectively. The postoperative pathology showed inflammatory renal disease in 6 patients, xanthogranulomatous pyelonephritis in 1 patient, and high-grade urothelial cancer in 1 patient. The average postoperative hospital stay was 4.4 days. None of the patients experienced severe complications and poor healing of endoscopic wounds.Conclusion: For patients with complicated calculous pyonephrosis, renal inflammation could not be effectively controlled, and renal function was seriously damaged. Thus, kidneys should be immediately resected. With laparoscopy, patients may recover quickly, but surgeons require enough experience when performing laparoscopy to achieve safety.
Computation offloading through mobile vehicles in IoT-edge-cloud network
Authors: Long Jun , Luo Yueyi , Zhu Xiaoyu , Luo Entao , Huang Mingfeng
Published: September 2020

With the developing of Internet of Things (IoT) and mobile edge computing (MEC), more and more sensing devices are widely deployed in the smart city. These sensing devices generate various kinds of tasks, which need to be sent to cloud to process. Usually, the sensing devices do not equip with wireless modules, because it is neither economical nor energy saving. Thus, it is a challenging problem to find a way to offload tasks for sensing devices. However, many vehicles are moving around the city, which can communicate with sensing devices in an effective and low-cost way. In this paper, we propose a computation offloading scheme through mobile vehicles in IoT-edge-cloud network. The sensing devices generate tasks and transmit the tasks to vehicles, then the vehicles decide to compute the tasks in the local vehicle, MEC server or cloud center. The computation offloading decision is made based on the utility function of the energy consumption and transmission delay, and the deep reinforcement learning technique is adopted to make decisions. Our proposed method can make full use of the existing infrastructures to implement the task offloading of sensing devices, the experimental results show that our proposed solution can achieve the maximum reward and decrease delay.
Time trends in the regional distribution of physicians, nurses and midwives in Europe
Authors: Winkelmann Juliane , Muench Ulrike , Maier Claudia B.
Published: September 2020

Background. Country-level data suggest large differences in the supply of health professionals among European countries. However, little is know about the regional supply of health professionals taking a cross-country comparative perspective. The aim of the study was to analyse the regional distribution of physicians, nurses and midwives in the highest and lowest density regions in Europe and examine time trends.Methods. We used Eurostat data and descriptive statistics to assess the density of physicians, nurses and midwives at national and regional levels (Nomenclature of Territorial Units for Statistics (NUTS) 2 regions) for 2017 and time trends (2005-2017). To ensure cross-country comparability we applied a set of criteria (working status, availability over time, geographic availability, source). This resulted in 14 European Union (EU) countries and Switzerland being available for the physician analysis and eight countries for the nurses and midwives analysis. Density rates per population were analysed at national and NUTS 2 level, of which regions with the highest and lowest density of physicians, nurses and midwives were identified. We examined changes over time in regional distributions, using percentage change and Compound Annual Growth Rate (CAGR).Results. There was a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria national average: 513, Poland 241.6 per 100,000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483.0). Differences by regions across Europe were higher than cross-country variations and varied up to 5.5-fold for physicians and 4.4-fold for nurses/midwives and did not improve over time. Capitals and/or major cities in all countries showed a markedly higher supply of physicians than more sparsely populated regions while the density of nurses and midwives tended to be higher in more sparsely populated areas. Over time, physician rates increased faster than density levels of nurses and midwives.Conclusions. The study shows for the first time the large variation in health workforce supply at regional levels and time trends by professions across the European region. This highlights the importance for countries to routinely collect data in sub-national geographic areas to develop integrated health workforce policies for health professionals at regional levels.
Permeability of the windows of the brain: Feasibility of dynamic contrast-enhanced MRI of the circumventricular organs
Authors: Verheggen Inge C.M. , de Jong Joost J.A. , Boxtel Martin P.J. van , Postma Alida A. , Verhey Frans R.J. , Jansen Jacobus F.A. , Backes Walter H.
Published: September 2020

Background Circumventricular organs (CVOs) are small structures without a blood-brain barrier surrounding the brain ventricles that serve homeostasic functions and facilitate communication between the blood, cerebrospinal fluid and brain. Secretory CVOs release peptides and sensory CVOs regulate signal transmission. However, pathogens may enter the brain through the CVOs and trigger neuroinflammation and neurodegeneration. We investigated the feasibility of dynamic contrast-enhanced (DCE) MRI to assess the CVO permeability characteristics in vivo, and expected significant contrast uptake in these regions, due to blood-brain barrier absence.Methods Twenty healthy, middle-aged to older males underwent brain DCE MRI. Pharmacokinetic modeling was applied to contrast concentration time-courses of CVOs, and in reference to white and gray matter. We investigated whether a significant and positive transfer from blood to brain could be measured in the CVOs, and whether this differed between secretory and sensory CVOs or from normal-appearing brain matter.Results In both the secretory and sensory CVOs, the transfer constants were significantly positive, and all secretory CVOs had significantly higher transfer than each sensory CVO. The transfer constants in both the secretory and sensory CVOs were higher than in the white and gray matter.Conclusions Current measurements confirm the often-held assumption of highly permeable CVOs, of which the secretory types have the strongest blood-to-brain transfer. The current study suggests that DCE MRI could be a promising technique to further assess the function of the CVOs and how pathogens can potentially enter the brain via these structures.Trial registration Netherlands Trial Register number: NL6358, date of registration: 2017-03-24
The dual HDAC-PI3K inhibitor CUDC-907 displays single-agent activity and synergizes with PARP inhibitor olaparib in small cell lung cancer
Authors: Ma Liying , Bian Xing , Lin wenchu
Published: September 2020

Background: Small cell lung cancer (SCLC) is a deadly neuroendocrine tumor with limited therapeutic options. Recent data suggest that histone deacetylases (HDACs) and the phosphatidylinositol 3-kinase (PI3K) pathway play essential roles in SCLC cell proliferation and survival. Methods: The inhibition of the PI3K signaling and HDAC activity by CUDC-907 was analysized by western bloting. The effect of CUDC-907 on olaprib-induced DNA damage response was assessed by western blotting and Immunofluorescence staining. The cytotoxcity of CUDC-907 alone or in combination with olaparib in a panel of SCLC cell lines were evaluated by the CellTiter-Glo Luminescent Cell Viability Assay and flow cytometry. The in vivo effects of CUDC-907 and olaparib alone or in combination were examined using a patient-derived xenografts (PDX) model of SCLC. Results: CUDC-907 treatment downregulated MYC paralogs and FoxM1, induced G1 cell-cycle arrest, and impaired DNA double-strand break (DSB) repair capacity in SCLC cells, which produced a potent antiproliferative effect. Furthermore, we showed that CUDC-907 treatment enhanced the therapeutic efficacy of PARP inhibitor olaparib in SCLC cellular models and a PDX model. Mechanistic investigations demonstrated that CUDC-907 synergized with olaparib through the blockade of DSB repair pathways and downregulation of MYC paralogs and FoxM1. Conclusions: Our study uncovers that dual PI3K and HDAC inhibition by CUDC-907 exerts significant single-agent activity and strong synergistic effects with PARP inhibitor olaparib in SCLC, which thus provides a rational combination treatment strategy for SCLC clinical investigation.
Are weight status and weight perception associated with academic performance among youth?
Authors: Livermore Maram , Duncan Markus J , Leatherdale Scott T. , Patte Karen Allison
Published: September 2020

Background: Emerging evidence suggests perceptions of being overweight account for many of the psychosocial consequences commonly associated with obesity. Previous research suggests an obesity achievement gap, yet limited research has explored weight perception in association with academic performance. Moreover, underweight perceptions have typically been excluded from research. The current study examined how BMI classification and weight perception relate to academic performance in a large cohort of youth.Methods: We used cross-sectional survey data from 61,866 grade 9-12 students attending the 122 Canadian schools that participated in Year 6 (2017/2018) of the COMPASS study. Mixed effect regression models were used to examine associations between students’ BMI classification and weight perceptions and their math and English/French course grades. All models were stratified by sex and adjusted for sociodemographic covariates and school clustering. Results: For English/French grades, males and females with overweight or underweight perceptions were less likely to achieve higher grades than their peers with perceptions of being at “about the right weight”, controlling for BMI and covariates. For math grades, females with overweight perceptions, and all students with underweight perceptions, were less likely to achieve higher grades than their peers with “about the right weight” perceptions. All students with BMIs in the obesity range were less likely to report grades of 60% or higher than their peers with “normal-weight” BMIs, controlling for weight perception and covariates. Overweight BMIs were predictive of lower achievement in females for English/French grades, and in males for math grades, relative to “normal-weight” BMIs. Results for students that did not respond to the weight and weight perception items resembled those for obesity BMI and overweight/underweight perceptions, respectively.Conclusions: Overall, this study demonstrates that an obesity achievement gap remains when controlling for students’ perceptions of their weight, and that both underweight and overweight perceptions predict lower academic performance, regardless of BMI classification. Results suggest barriers to academic success exist among youth with larger body sizes, and those with perceptions of deviating from “about the right weight”.
Factorial design study of total petroleum contaminated soil treatment using land farming technique
Authors: Okonofua Ehizonomhen Solomon , Lasisi Kayode Hassan , Atikpo Eguakhide
Published: September 2020

Land farming technique was used to treat hydrocarbon contaminated soil collected from a crude oil spill sites in Edo State, Nigeria. Calibrated standard auger was used to collect soil samples from the site at depth below 30 cm. The samples were characterized and classified. Cow dung and NPK fertilizer were added as additives to complement the nutriments of the soil samples before total petroleum hydrocarbon quantification and remediation procedures. Factorial design was applied to vary the input parameters such as pH, mass of substrate, moisture content and turning times of land farming so to ascertain the optimal conditions for the procedure. The result revealed that the in-situ total petroleum hydrocarbon (TPH) value was 5,000 mg kg-1 on the average and after 90 days of treatment, TPH reduced to 645.907 mg kg-1. The turning rate, pH, moisture content and mass of substrate had 82.79%, 4.36%, 0.48% and 0.046% contributions respectively to the degradation process using land farming treatment. Numerical optimization techniques applied in the optimum point for land farming input parameters to achieve predicted maximum removal of 98.60% were evaluated as pH, mass of substrate, moisture content and turning rate to be 6.01, 1 kg, 10% and 5 times in a week respectively. TPH removed at this optimum point was 97.83% reducing from 5,000 to 635.907 mg kg-1. The high coefficient of determination (r2 = 0.9865) as observed in the closeness of predicted and experimental values reflects the reliability of the model and hence, land farming practice with close attention on turning rate as revealed by this study, is recommended for TPH contaminated soil remediation.
Koala Retrovirus Diversity, Transmissibility, and Disease Associations
Authors: Zheng HaoQiang , Pan Yi , Tang Shaohua , Pye Geoffrey W. , Stadler Cynthia K , Vogelnest Larry , Herrin Kimberly Vinette , Rideout Bruce A , Switzer William M.
Published: September 2020

BackgroundKoalas are infected with the koala retrovirus (KoRV) that exists as exogenous or endogenous viruses. KoRV is genetically diverse with co-infection with up to ten envelope subtypes (A-J) possible; KoRV-A is the prototype endogenous form. KoRV-B, first found in a small number of koalas with an increased leukemia prevalence at one US zoo, has been associated with other cancers and increased chlamydial disease. To better understand the molecular epidemiology of KoRV variants and the effect of increased viral loads (VLs) on transmissibility and pathogenicity we developed subtype-specific quantitative PCR (qPCR) assays and tested blood and tissue samples from koalas at US zoos (n=78), two Australian zoos (n=27) and wild-caught (n=21) in Australia. We analyzed PCR results with available clinical, demographic, and pedigree data.ResultsAll koalas were KoRV-A-infected. A small number of koalas (10.3%) at one US zoo were also infected with non-A subtypes, while a higher non-A subtype prevalence (59.3%) was found in koalas at Australian zoos. Wild koalas from one location were only infected with KoRV-A. We observed a significant association of infection and plasma VLs of non-A subtypes in koalas that died of leukemia/lymphoma and other neoplasias and report cancer diagnoses in KoRV-A-positive animals. Infection and VLs of non-A subtypes was not associated with age or sex. Transmission of non-A subtypes occurred from dam-to-offspring and likely following adult-to-adult contact, but associations with contact type were not evaluated. Brief antiretroviral treatment of one leukemic koala infected with high plasma levels of KoRV-A, -B, and -F did not affect VL or disease progression. ConclusionsOur results show a significant association of non-A KoRV infection and plasma VLs with leukemia and other cancers. Although we confirm dam-to-offspring transmission of these variants, we also show other routes are possible. Our validated qPCR assays will be useful to further understand KoRV epidemiology and its zoonotic transmission potential for humans exposed to koalas because KoRV can infect human cells.
CD137 agonist induces gastric cancer cell apoptosis by enhancing the functions of CD8+ T cells via NF-κB signaling
Authors: Hu Ben-Shun , Tang Tian , Jia Jun-Li , Xie Bi-Chen , Wu Tie-Long , Sheng Ying-Yue , yuzheng xue , Tang Hua-Min
Published: September 2020

Background: CD137 is a target for tumor immunotherapy. However, the role of CD137 in gastric cancer (GC), especially in inducing GC cell apoptosis, has not been studied. Methods: Foxp3+ and CD8+ T cells in GCs were investigated using immunohistochemistry (IHC). CD137 expression in GCs was detected using flow cytometry, IHC and immunofluorescence (IF). Peripheral blood mononuclear cells (PBMCs) and CD8+ T cells isolated from peripheral blood were stimulated with a CD137 agonist in vitro. CD8+ T cell proliferation and p65 expression was examined using flow cytometry. P65 nuclear translocation was analyzed using IF. IL-10, TGF-β, IFN-γ, perforin and granzyme B were detected using real-time quantitative PCR (real-time PCR). PBMCs and primary GC cells were cocultured and stimulated with a CD137 agonist in vitro. Apoptosis of primary GC cells was detected using flow cytometry. Results: Our data demonstrated that GC tumors showed characteristics of an immunosuppressive microenvironment. CD137 was predominantly expressed in CD8+ T cells in GCs and had a positive correlation with tumor cell differentiation. The CD137 agonist promoted CD8+ T cell proliferation and increased the secretion of IFN-γ, perforin and granzyme B, which induced primary GC cell apoptosis. Mechanistically, this study found that the CD137 agonist induced NF-κB nuclear translocation in CD8+ T cells. Conclusion: Our results demonstrated that a CD137 agonist induced primary GC cell apoptosis by enhancing CD8+ T cells via activation of NF-κB signaling.
Psyllium Supplementation is Associated with Changes in the Fecal Microbiota of Horses
Authors: Mienaltowski Michael J. , Belt Ashley , Henderson John D. , Boyd Tannah N. , Marter Nicole , Maga Elizabeth A. , DePeters Edward J.
Published: September 2020

Objective: Prophylactic supplementation of psyllium husk is recommended to enhance passage of ingested sand from the gastrointestinal tracts of horses. We hypothesized that psyllium supplementation would increase fecal sand passage and favorably alter bacterial populations in the hindgut. Six yearlings and six mature mares were fed a psyllium supplement in the diet daily for seven days. Voluntarily-voided feces were collected over the course of 29 days, prior, during, and after treatment. Feces were analyzed for acid detergent fiber (ADF) and acid detergent insoluble ash analyses. Microbial DNA was also isolated, and the V4 region of the 16S ribosomal RNA gene was PCR-amplified and sequenced using MiSeq technology.Results: Fecal ADF concentration was greater in adults while silica concentration was greater in yearlings. Mature mare fecal ADF decreased during and just after supplementation but thereafter increased. No changes in silica levels were noted in either group over time. Fecal microbial population phylogenetic diversity was greatest mid-supplementation and lowest at 11 days post-supplementation. Functional profiles of the microbial communities presented some benefits for psyllium supplementation. These findings provide compelling evidence for further detailed studies of prophylactic psyllium supplementation.
Clinical Hypertension Guidelines and Social Determinants of Health: A Systematic Scoping Review
Authors: Razon Na'amah , Hessler-Jones Danielle , Bibbins-Domingo Kirsten , Gottlieb Laura
Published: September 2020

Background

Social and economic factors impact hypertension risk and control. We examined the integration of social determinants of health (SDH) guidance into adult US hypertension guidelines to explore how existing hypertension guidelines reference social care activities.
Objective

To explore how existing hypertension management guidelines reference social care activities.
Methods

Systematic scoping review of clinical guidelines (guidelines, protocols, and professional organization statements) for adult hypertension management. We employed a PubMed search strategy to identify all hypertension guidelines and protocols published in the US between 1977 and 2019. We reviewed all titles to identify the most updated versions focused on non-pregnant adults with essential hypertension. We extracted instances where included guidelines referred to social determinants of health or social care. The primary outcome was how guidelines covered topics related to social care, defined using a framework adapted from the National Academies of Sciences, Engineering and Medicine (NASEM).
Results

Search terms yielded 126 guidelines. Thirty-six guidelines met inclusion criteria. Of those 72% (26/36) recommended social care activities as part of hypertension management; 58% recommended clinicians change clinical care practice based on social risk information. These recommendations often lacked specific guidance around how to address SDH. When guidelines referred to specific social factors, patient financial security was the most common social determinant highlighted (n = 101). Ten guidelines (28%) did not reference social care activities.
Conclusion

Information about social determinants of health is included in many adult hypertension management guidelines, but few guidelines provide clear guidance for clinicians on how to identify and address actionable social risk factors in the context of care delivery.
Patients’ Assessment of Care for Type 2 Diabetes: Results of the Patient Assessment of Chronic Illness Care Scale in A Danish Population
Authors: Frølich Anne , Nielsen Ann , Glümer Charlotte , Birke Hanne , Eriksen Christian U , Stockmarr Anders
Published: September 2020

Background: The Patient Assessment of Chronic Illness Care (PACIC) scale is the most appropriate for assessing self-reported experience in chronic care. However, it has yet to be validated in a Danish diabetes population. We aimed to validate the PACIC, assess the quality of care for Danish patients with type 2 diabetes, and identify factors associated with quality of care. Methods: A survey of 7,745 individuals randomly selected from the National Diabetes Registry. Descriptive statistics inter-item and item-rest correlations and factor analysis assessed the PACIC properties. Quality of care was analysed with descriptive statistics; linear and multiple regression assessed the effect of forty-nine covariates on total and subscale scores. Results: In total, 2,696 individuals with type 2 diabetes completed ≥ 50% of items. The floor effect for individual items was 8.5-74.5%; the ceiling effect was 4.1- 47.8 %. Cronbach’s alpha was 0.73-0.86 for the five subscales. The comparative fit index (CFI) and the Tucker–Lewis index (TLI) were 0,87, and 0,84, respectively. Mean PACIC score was 2.44 (± 0.04). Respondents receiving rehabilitation and reporting primary of diabetes care had higher total mean scores; those 70 years or older had lower mean total and subscale scores. A higher number of diabetes visits were associated with higher total scores; higher number of emergency department visits were associated with lower total scores. The effect of healthcare utilisation on subscale scores varied. Conclusions: Floor effects suggest a need for further evaluation of the PACIC questionnaire in Danish settings. Total PACIC scores were lower than in other healthcare systems, possibly being a result of different contexts and cultures, and of a need for improving diabetes care in Denmark.
Evidence-Based Practice in Primary Health Care From The Managerial Point of View: – A National Survey
Authors: Abelsson Tobias , Morténius Helena , Karlsson Ann-Kristin , Bergman Stefan , Baigi Amir
Published: September 2020

Background: The vast availability of and demand for evidence in modern primary health care forces clinical decisions to be made based on condensed evidence in the form of policies and guidelines. Primary health care managers play a key role in implementing these governing documents. Thus, the aim of this article was to investigate the use and availability of evidence-based practice resources from the perspective of first-line primary health care managers.Methods: The study utilized a quantitative method based on a national survey of primary health care managers. The study population was recruited nationally from Sweden and consisted of 186 respondents. The data were analysed using empirically constructed themes and validated using factor analysis. To determine the statistical significance in making comparisons, the chi-square test was utilized. Associations between variables were calculated using Spearman’s correlation. All tests were two-sided, and the significance level was set to 0.05.Results: A majority (97%) of managers stated there was an impact of guidelines and policy documents on primary health care; 84% of managers could see a direct influence in daily practices. Most of the managers (70%) stated that some adaptation had to be made when new evidence was introduced. The managers emphasised the importance of keeping themselves updated and open to new information about work routines (96%). Conclusions: Evidence-based practice has a fundamental impact on Swedish primary health care. The study illustrated a nearly unanimous response about evidence influencing daily practice. The emphasis on the importance of all staff members keeping their professional knowledge up to date can be seen as a direct result of this. An information-dense organization such as a primary health care organization would have much to gain from cooperation with regional information resources such as clinical libraries.Trial registration: Not applicable.
Determinants of Attitude and Intention Towards Private Health Insurance: A Comparison of Insured and Uninsured Young Adults in Australia
Authors: Tam Lisa , Tyquin Ellen , Mehta Amisha , Larkin Ingrid
Published: September 2020

Background: Since the introduction in 1984 of Australia’s publicly-funded universal healthcare system, Medicare, healthcare financing has relied on a mix of public and private sources to meet the needs of the population [1]. However, in recent years, there has been a decline in the number of Australians choosing to purchase private health insurance (PHI), particularly within the young adult age group with the proportion of insurance customers aged 20 to 29 falling from 10.3% to 9.4% between 2012 and 2017 [2]. Young adults are critical to private health insurance funding models as their involvement offsets the drawdown by older adults[3]. While this issue is widely reported in the Australian media, few empirical studies have explored the factors that enable or constrain young adults’ enrolment in PHI. Methods: To address the scarcity of research about the motivational factors behind young adult decision-making, this study conducted a survey of 594 Australian young adults aged between 18 and 30 years. Within this age group, the survey sought an equal split of participants who were members and non-members of PHI schemes.Conclusion: The findings identified perceived value and trust in insurers as additional motivational factors alongside traditional measures of recognition of the problem and involvement in the problem. Differences between the insured and uninsured groups were identified which help to shape a more holistic understanding of the key motivational factors and barriers in relation to Australian young adults’ enrolment in PHI.
Identification and determination of toxin genes of Vibrio strains causing hemorrhagic disease on red drum (Sciaenops ocellatus) using PCR method
Authors: Linh Nguyen Quang , Pham Yen Thi Hai , Nguyen Tram Duy Quynh
Published: September 2020

Data were collected from 30 strains of Vibrio and sampled on different organs (brain, hemorrhagic site and digestive tract) of Sciaenops ocellatus infection. The results showed that the nucleotide sequences 16S rRNA region are highly similar to those of V. alginolyticus, V. azureus, V. fluvialis and V. orientalis which is published on Genebank, ranging from 98.05 to 100 %. The digestive tract has the most common Vibrio strains (V. alginolyticus, V. azureus and V. fluvialis). Thereout, 25 of 30 strains of Vibrio contained 1 to 3 toxin genes, except V. parahaemolyticus. Six parameters were used to measure the DNA polymorphism of 33 homologous DNA sequences in this Vibrio bacteria population. The results indicated that number of separate polymorphic sites (S), total number of mutant sites (Eta), number of haplotype (h), haplotype diversity (Hd), average number of nucleotide differences (k), nucleotide diversity (Pi) were 98 (S), 103 (Eta), 9 (h), 0.887 ± 0.032 (Hd), 25.789 (k) and 17.980x10-3 ± 0.003 (Pi), respectively (P < 0,05). The G+C content above 1434 sites positions of nucleotide sequences accounted for 0.542. The phylogenetic tree showed that these strains are divided into six groups. As observed, the appearance of isolated Vibrio on 3 organs of fish (S. ocellatus) hemorrhagic are V. azureus (27,67 %), V. alginolyticus (50 %), V. orientalis (6,67 %) and V. fluvialis (16,67 %). Through this result, we found that the diversity of Vibrio species that appeared on the red drum was used in the 16S rRNA region and the presence of toxin genes in these Vibrio species.
Public Oral Health Services Coverage and Socioeconomic Indicators’ Effect on The Number of Hospitalized Cases of Oral Cancer in Brazil
Authors: Freire Aldelany Ramalho , Freire Deborah Ellen Wanderley Gomes , de Araújo Elza Cristina Farias , de Lucena Edson Hilan Gomes , Cavalcanti Yuri Wanderley
Published: September 2020

Background: Oral cancer still representing one of the most frequent neoplasms worldwide, especially in developing countries. Socioeconomic factors and access to health services may be associated with the risk of oral cancer. This study analyzed the frequency of new hospitalized cases of oral cancer in Brazil, according to socioeconomic variables and data on oral health coverage in its public health system. Methods: Observational study, with a retrospective cohort design, whose sampling units was composed of all Brazilian cities that registered at least one hospitalized case of oral cancer in the National Cancer Institute database, between 2002-2017. For each city included, were collected the population size, Municipal Human Development Index (M-HDI), Gini Coefficient, as well as data regarding oral health coverage in primary care and the number of Dental Specialized Center (DSC). The COX regression was used to determine the risk ratio for a city to present a new hospitalized case of oral cancer, and the effect of the predictor variables on the incidence of cases was verified by the Hazard Ratio measure. Accumulated risk curves were obtained for the adjusted model, and for each variable. Results: All predictor variables were considered significant in the regression model (p<0.05). Cities above 50 thousand inhabitants, with high or very high M-HDI, more unequal (Gini>0.4), with less oral health coverage in primary care (<50%) and without the presence of DSC demonstrated a greater accumulated risk of having 1 or more hospitalized cases of oral cancer. Conclusions: The risk of hospitalization for oral cancer in Brazil is greater in cities with a larger population size, more developed, with greater inequality of income distribution and with less availability of public oral health services.
Elucidation of transient protein-protein interactions within carrier protein-dependent biosynthesis
Authors: Burkart Michael , Bartholow Thomas , Sztain Terra , Patel Ashay , Lee D , Young Megan , Abagyan Ruben
Published: September 2020

Fatty acid biosynthesis (FAB) is an essential and highly conserved metabolic pathway. In bacteria, this process is mediated by an elaborate network of protein•protein interactions (PPIs) involving a small, dynamic acyl carrier protein that interacts with dozens of other partner proteins (PPs). These PPIs have remained poorly characterized due to their dynamic and transient nature. Using a combination of solution-phase NMR spectroscopy and protein-protein docking simulations, we report a comprehensive residue-by-residue comparison of the PPIs formed during FAB in Escherichia coli. This work reveals the molecular basis of six discrete binding events responsible for E. coli FAB and offers insights into a method to characterize these events and those in related carrier protein-dependent pathways. ONE SENTENCE SUMMARY: Through a combination of structural and computational analysis, a comparative evaluation of protein-protein interactions in de novo fatty acid biosynthesis in E. coli is performed.
Transcriptome Profiling Unveils GAP43 Regulates ABC Transporters and EIF2 Signaling in Colorectal Cancer Cells
Authors: Chen Xi , Wu Hongjin , Xiao Li , Feng Jia , Sun Danmeng , Jiang Mingfeng , SHI MING
Published: September 2020

BackgroundThe growth- and plasticity-associated protein-43 (GAP43) is biasedly expressed in indigestive system and nervous system. Recent study has shown that GAP43 is responsible for the development of neuronal growth and axonal regeneration in normal nervous tissue, while serves as a specific biomarker of relapsed or refractory neuroblastoma. However, its expression pattern and function in digestive system cancer still remains to be clarified.ResultsIn this study, we found GAP43 was downregulated in colorectal cancer (CRC) compared to the adjacent tissues. DNA methylase inhibitor 5-Aza-CdR treatment could significantly induce GAP43, indicated that the silencing of GAP43 gene in CRC is closely related to DNA methylation and histone deacetylation. Bisulfite genomic sequencing confirmed the promoter methylation of GAP43 in CRC. To explore the transcriptional alterations by overexpressed GAP43 in CRC, we performed RNA-seq and found that upregulated genes were significantly enriched in the signaling pathways of ABC transporters and ECM-receptor interaction, while downregulated genes were significantly enriched in Ribosome signaling pathway. Further Ingenuity Pathway Analysis (IPA) showed that EIF2 signaling pathway was significantly repressed by overexpression of GAP43.ConclusionOur findings provide a novel mechanistic insight of GAP43 in CRC. Transcriptome profiling of overexpressed GAP43 in CRC uncovered the functional roles of GAP43 in the development of human CRC.
What should medical students be taught about abortion? An evaluation of student attitudes towards their abortion teaching and their future involvement in abortion care
Authors: Cohen Pollyanna , Mayhew Jonathan , Gishen Faye , Potts Henry W. W. , Lohr Patricia A. , Kavanagh Jayne
Published: September 2020

Background
One in three women in the United Kingdom (UK) will have an abortion before age 45, making abortion provision an essential aspect of reproductive healthcare. Despite this, abortion remains ethically contested and stigmatised, with variable teaching in UK medical schools and concerns about falling numbers of doctors willing to participate in abortion care. University College London Medical School (UCLMS) has designed practical, inclusive, teaching that aims to give students an understanding of the importance of abortion care and prepare them to be competent practitioners in this area. This study aimed to determine students’ opinions of this teaching and their wider attitudes towards abortion.
Methods
We invited all 357 final-year UCL medical students to complete an online survey consisting of closed-ended questions, exploring their opinions on their abortion teaching, their personal beliefs about abortion and their future willingness to be involved in abortion care. We analysed responses using non-parametric tests.
Results
146 questionnaires (41% response rate) showed 83% of students identified as pro-choice (agree with the right to choose an abortion). 57% felt they received the right amount of abortion teaching, 39% would have liked more and 4% stated they received too much. There was no correlation between students’ attitudes to abortion and the rating of teaching; both pro-choice and pro-life (opposed to the right to choose an abortion) students generally rated the teaching as important and valued the range of methods used. Students requested more simulated practice speaking to patients requesting an abortion. Students with pro-life beliefs expressed lower willingness to discuss, refer, certify and provide future abortions. Students interested in careers in specialties where they may encounter abortion were more likely to be pro-choice than pro-life.
Conclusions
The majority of participating UCL medical students were pro-choice and willing to be involved in future abortion care. Efforts to make teaching on abortion practical, engaging, sensitive and inclusive were appreciated. As well as preparing students to be competent and caring practitioners, the teaching appears to contribute towards them viewing abortion as an essential aspect of women’s healthcare, and may contribute to destigmatising abortion.
Targeting Spindle-Associated Protein HAUS6 Prevents Cell Growth of Colorectal Cancer Cells by Activating the p53/p21 Pathway
Authors: Shen Aling , Liu Liya , Huang Yue , Shen Zhiqing , Wu Meizhu , Chen Xiaoping , Wu Xiangyan , Lin Xiaoying , Chen Youqin , Li Li , Cheng Ying , Chu Jianfeng , Sferra Thomas , Wei Lihui , Zhuang Qunchuan , Peng Jun
Published: September 2020

Background: HAUS6 participates in microtubule-dependent microtubule amplification, but its role in malignancies including colorectal cancer (CRC) has not been explored. We therefore assessed the potential oncogenic activities of HAUS6 in CRC.Methods: We investigated HAUS6 expression and its prognostic value in CRC by microarray, analysis of public datasets, quantitative reverse transcription - polymerase chain reaction (qRT-PCR) and immunohistochemistry. Biological functions of HAUS6 were investigated using loss-of-function and gain-of-function assays in vivo and/or in vitro. Effectors downstream of HAUS6 were identified using cDNA microarray, bioinformatics analysis, qRT-PCR and western-blotting in CRC cells. The putative mechanism by which HAUS6 knockdown elevated p53 and p21 expression were assessed by rescue experiment. The combination effects of HAUS6 knockdown and 5-fluorouracil (5-FU) treatment in cultured CRC cells were further evaluated. Results: HAUS6 mRNA and protein expression is higher in CRC tissues, and high HAUS6 expression is correlated with shorter overall survival in CRC patients. HAUS6 knockdown in CRC cell lines suppressed cell growth in vitro and in vivo by inhibiting cell viability, survival and arresting cell cycle progression at G0/G1, while HAUS6 over-expression increased cell viability. We showed that these effects are dependent on activation of the p53/p21 signalling pathway by reducing p53 and p21 degradation. Moreover, HAUS6 knockdown enhanced the effects of 5-FU treatment in CRC cells by increasing activation of the p53/p21 pathway.Conclusions: Our study highlights a potential oncogenic role for HAUS6 in CRC. Targeting HAUS6 may be a promising novel prognostic marker and chemotherapeutic target for treating CRC patients.
Developing and Validating an Integrated Gross Tumor Volume (GTV)-TNM Stratification System for Supplementing Unresectable Locally Advanced Non-small Cell Lung Cancer Treated With Concurrent Chemoradiotherapy
Authors: Chen NaiBin , Li QiWen , Zhu ZhengFei , Wang YiMing , Cheng ZhangKai , Hui ZhouGuang , Guo SuPing , He HaoQiang , Wang Bin , Huang XiaoYan , Li JiBin , Guo JinYu , Hu Nan , Ai XinLei , Zhou Yin , Wang DaQuan , Liu FangJie , Xie ChuanMiao , Qiu Bo , Liu Hui
Published: September 2020

PurposeThe gross tumor volume (GTV) could be an independent prognostic factor for unresectable locally advanced non-small cell lung cancer (LANSCLC). We aimed to develop and validate a novel integrated GTV-TNM stratification system to supplement LANSCLC sub-staging in patients treated with concurrent chemoradiotherapy (CCRT).MethodsWe performed a retrospective review of 340 patients with unresectable LANSCLC receiving definitive CCRT. All included patients were divided into two randomized cohorts. Then the Kaplan-Meier method and Cox regression were calculated to access the prognostic value of the integrated GTV-TNM stratification system, which was further validated by the area under the receiver operating characteristic curve (AUC) score and F1-score.ResultsThe optimal outcome-based GTV cut-off values (70 and 180 mL) of the modeling cohort were used to determine each patient’s integrated GTV-TNM stratum in the whole cohort. Our results indicated that a lower integrated GTV-TNM stratum could had better overall survival and progression-free survival (all P<0.001), which was recognized as an independent prognostic factor. Also, its prognostic value was robust in both the modeling and validation cohorts. Furthermore, the prognostic validity of the integrated GTV-TNM stratification system was validated by significantly improved AUC score (0.636 vs. 0.570, P=0.027) and F1-score (0.655 vs. 0.615, P<0.001), compared with TNM stage. The discordance rates between the GTV-TNM stratum and TNM stage were 49.3% and 49.6% in the modeling and validation cohort, respectively.ConclusionsWe proposed a novel integrated GTV-TNM stratification system to supplement unresectable LANSCLC sub-staging due to its prognostic value independent of TNM stage and other clinical characteristics, suggesting that it could be considered in pretreatment assessment and individual treatment decision-making process.