bluuebunny/crossref_metadata_2025 huggingface dataset:
Severe terminal ileitis induced by single-agent nivolumab administered every four weeks
Authors: Dasanu Constantin A , Plaxe Steven C , Gupta Varun , Popescu Iliana M , Grover Mayumi , Alvarez-Argote Juliana
Published: February 2020

Introduction

Use of immune checkpoint inhibitors has expanded to a variety of malignancies including hepatocellular carcinoma, where nivolumab and pembrolizumab have shown durable responses in approximately a sixth of patients.

Case report

We report herein a patient with metastatic hepatocellular carcinoma who achieved a durable response to the second-line agent nivolumab administered intravenous 240 mg every two weeks. After 18 months of therapy, nivolumab schedule was changed to intravenous 480 mg every four weeks, per patient’s request and for convenience of administration. Four days after this change, the patient developed severe terminal ileitis. Management and outcome: This condition was managed in hospital with intravenous steroids. The patient improved clinically and was discharged on an oral steroid taper. A month later, nivolumab was reinstated at 200 mg intravenous infusions every two weeks, without any re-occurrence of terminal ileitis to date as of six months after the probable drug reaction.

Discussion

To our knowledge, this is the first report of terminal ileitis with nivolumab administered every four weeks. As postmarketing evaluation of nivolumab continues, similar side effects may be observed. Prompt diagnosis and steroid therapy in these cases are imperative to ensure a favorable outcome. Resuming immunotherapy once the adverse event has resolved appears to be a safe option.
Tapered, fluted, modular, titanium stems in Vancouver B periprosthetic femoral fractures: an analysis of 87 consecutive revisions
Authors: van Laarhoven Simon N , Vles Georges F , van Haaren Emil H , Schotanus Martijn G M , van Hemert Wouter L W
Published: February 2020

Aims:

One of the instruments in the orthopaedic surgeon’s armamentarium to face the challenges associated with periprosthetic fracture around the stem of a hip replacement is the tapered, fluted, modular, titanium (TFMT) stem. Our aim was to study its clinical and radiological outcomes.

Patients and Methods:

During the period 2010–2016 86 patients (55 females; median age 78.2 years; mean BMI 26.3 kg/m2; median ASA classification 2) underwent 87 revisions for a Vancouver B periprosthetic fracture using a Stryker Restoration Cone-Conical stem.

Results:

After a median follow-up of 2.9 years no stem had to be revised and no case of stem fracture was found. Dislocation was the most common complication and occurred in 18% of patients. Other major complications were deep infection ( n = 4), subsidence >5 mm ( n = 7), and nonunion ( n = 5). 3-month and 1-year mortality was 10% and 15% respectively and was strongly correlated with age, deep infection, and ASA classification. The median EQ-5D health state index at final follow-up was 0.78 and all patients were ambulatory.

Conclusions:

The complication most commonly encountered was dislocation and can likely be prevented by the use of large heads, adequate reduction and fixation of the trochanteric area and restoration of the native anatomy. Contrary to previous concerns, fracture and subsidence of these modular stems do not appear to be a significant problem in this geriatric population.
Association between psychosocial working conditions in mid-life and leisure activity in old age
Authors: Nilsen Charlotta , Andel Ross , Agahi Neda , Fritzell Johan , Kåreholt Ingemar
Published: February 2020

Aims: Leisure activity helps people engage with life, and it promotes health and well-being as we age. This study investigated whether individuals with active jobs (high psychological demands, high control) in mid-life were more active during leisure time in old age compared with those with less active jobs. Methods: Two individually linked Swedish surveys were used ( N=776) with 23 years of follow-up. Data were analysed with logistic regression. Results: Having an active job in mid-life was associated with greater engagement in intellectual/cultural, social and physical activity in old age, even when leisure activity in mid-life was taken into account. Conclusions: The results suggest that active jobs in mid-life may be replaced by active leisure during retirement. Active job conditions may promote engagement in society in old age, which in turn may have positive health consequences.
Divisional Reconstruction Strategy: The Repair of Perineal Skin Defect After Tumor Resection
Authors: Xu J.-G. , Wu M.-L. , Dai H.-Y. , Wang Y.-C. , Xue C.-Y.
Published: February 2020

Background and Aims:

The unique anatomical and physiological function of the perineum region makes it difficult to be repaired after tumor resection. We aim to evaluate the efficacy of PSC divisional reconstruction strategy in the reconstruction of perineal skin defect.

Materials and Methods:

This study includes patients undergoing perineal skin defect reconstruction with PSC strategy—P (penis), S (scrotum), C (circum-penoscrotal skin) divisional reconstruction strategy.

Results:

From August 2013 to August 2018, 47 patients were enrolled in the surgical procedure. The defect area after resection measured 2 cm × 2.5 cm, minimum, and 12 cm × 18 cm, maximum. Among them, the cases involved one, two, and three zones are 12, 10, and 25, respectively. The skin defects were divisionally repaired. All flaps were well survived without complications or scar contracture. No tumor recurrence happened.

Conclusion:

The application of PSC divisional reconstruction strategy is a promising way to repair wounds in circum-penoscrotal skin area. Moreover, this strategy is easy to process and shows no significant complications during follow-up period.
Effects of anisotropy on single-crystal SiO2 in nano-metric cutting
Authors: Chen Jiaxuan , Li Mayan , Wang Fang , Lu Lihua , Qin Jianbo , Shang Qiqi , Miao Xinxiang , Niu Longfei , Liu Hao , Zhou Guorui , Yuan Xiaodong , Pen Hongmin
Published: February 2020

The nano-metric cutting process of single-crystal SiO2 was studied using molecular dynamics simulation, where the effects of anisotropy on material removal and surface integrity were analyzed. The typical crystal directions on different crystal planes of SiO2 were selected as cutting directions. The results show that the chip formation, temperature distribution in the machined area, cutting force, phase transformation and damage layer thickness vary according to the cutting direction. The crystal orientation of (110) [00−1] exhibits a large range of damage expansion while (110) [1−10] exhibits the smallest range. In addition, the radial distribution function results show that SiO2 workpieces cut in different directions vary in crystal phase type and content to some degree, while a new phase is produced in the cutting direction of (111) [−101]. Therefore, the anisotropy of the selection of crystal planes and crystal directions is of great significance for the nano-metric cutting of SiO2 to obtain quality machined surfaces of SiO2.
The Development and Psychometric Validation of the Diabetes Impact and Device Satisfaction Scale for Individuals with Type 1 Diabetes
Authors: Manning Michelle L. , Singh Harsimran , Stoner Keaton , Habif Steph
Published: February 2020

Background:

With the rapid development of new insulin delivery technology, measuring patient experience has become especially pertinent. The current study reports on item development, psychometric validation, and intended use of the newly developed Diabetes Impact and Device Satisfaction (DIDS) Scale.

Method:

The DIDS Scale was informed by a comprehensive literature review, and field tested as part of two focus groups. The finalized measure was used at baseline and 6 months post-assessment with a large US cohort. Exploratory factor analyses (EFAs) were conducted to determine and confirm factor structure and item selection. Internal reliability, test–retest reliability, and convergent/divergent validity of the emerged factors were tested with demographics, diabetes-specific information, and diabetes behavioral and satisfaction measures.

Results:

In all, 778 participants with type 1 diabetes (66% female, mean age 47.13 ± 17.76 years, 74% insulin pump users) completed surveys at both baseline and post-assessment. EFA highlighted two factors—Device Satisfaction (seven items, Cronbach’s α = 0.85-0.90) and Diabetes Impact (four items, Cronbach’s α = 0.71-0.75). DIDS Scale demonstrated good concurrent validity and test–retest reliability.

Conclusion:

The DIDS Scale is a novel and a brief assessment tool with robust psychometric properties. It is recommended for use across all insulin delivery devices and is considered appropriate for use in longitudinal studies. Future studies are recommended to evaluate the performance of DIDS Scale in diverse populations with diabetes.
The development of resilience in Japanese adults: A two-wave latent change model
Authors: Ueno Yuki , Hirano Mari , Oshio Atsushi
Published: February 2020

This study examined the development of resilience in Japanese adults using a two-wave latent change model with 1284 Japanese adults (865 men, aged 20–69 years). The Bidimensional Resilience Scale was administered at both waves over a 2-year interval: January 2017 (Time 1) and January 2019 (Time 2). The results showed no significant mean-level change between Time 1 and Time 2, and relatively high stability. The latent change model indicated that changes in resilience varied significantly among individuals; however, sociodemographic variables were not significantly associated with variations in resilience. Resilience appears relatively stable in Japanese adults, despite individual variation.
Words Unspoken: A Testimonial Discourse of Bama’s Karukku: A Gratification of Self-reflection and Inner Strength of the Subaltern Women
Authors: Rajendran Jayanthi
Published: February 2020

If untouchability lives, humanity must die.

—M.K. Gandhi

In this present and current global research scenario, the theme of subaltern has become a household word in regular usage and also in various disciplines other than literature. Literature, on the other hand, represents life in relation to social reality. The word ‘subaltern’ has its origin in the German word which means ‘inferior rank’ or ‘secondary importance’. Julian Wolfreys defines subaltern as a concept: ‘It contains the groups that are marginalized, oppressed and exploited on the cultural, political, social and religious grounds’. Thus, subaltern literature reflects various themes such as oppression, marginalization, gender discrimination, subjugation of lower and working classes, disregarded women, neglected sections of society and deprived classes of the existing society. As De Boland rightly confesses, ‘literature is an expression of society’. Literature in itself embodies life and life is a social reality of society. A writer, who is a member of a society, is influenced by specific social status and receives some degree of social recognition and recompense. Though this may benefit them in one way: it obviously helps them bring to limelight the sufferings and difficult paths the downtrodden tread upon. Thus, this article focuses on the voice of the voiceless in bringing out their voices to be heard in the outer world. In Bama’s Karukku, she testifies her situation of life and narrates her feelings in this small writing. In a world where problems relating to human privileges have been under perilous focus, literary portrayals of the experiences of demoted groups have assimilated great implication. The modern stream in Dalit literature in India is a challenge to bring to prime the experiences of discrimination, inequality, violence, injustice and poverty of the Dalits.
Opportunities and barriers to multimodal cities: lessons learned from in-depth interviews about attitudes towards mobility as a service
Authors: Matyas Melinda
Published: February 2020

With the emergence of the Mobility as a Service (MaaS) concept, it is important to understand whether it has the potential to support behaviour change and the shift away from private vehicle ownership and use. This paper aims to identify potential ways that MaaS (specifically MaaS plans) could help encourage behavioural change; and understand the barriers to using alternative transport modes. In-depth interviews and qualitative analysis are applied to the case study of London. The results indicate that individuals segment the transport modes offered via MaaS into three categories: essential, considered and excluded. Soft measures should target each individuals’ consideration set as this is where the most impact can be made regarding behaviour change. Respondents also highlighted factors that make them apprehensive towards certain modes, such as safety, service characteristics and administration. Interventions that focus on the socio-demographic groups that are most affected could help make these modes more appealing.
Drug-target interaction prediction with tree-ensemble learning and output space reconstruction
Authors: Pliakos Konstantinos , Vens Celine
Published: February 2020

Background

Computational prediction of drug-target interactions (DTI) is vital for drug discovery. The experimental identification of interactions between drugs and target proteins is very onerous. Modern technologies have mitigated the problem, leveraging the development of new drugs. However, drug development remains extremely expensive and time consuming. Therefore, in silico DTI predictions based on machine learning can alleviate the burdensome task of drug development. Many machine learning approaches have been proposed over the years for DTI prediction. Nevertheless, prediction accuracy and efficiency are persisting problems that still need to be tackled. Here, we propose a new learning method which addresses DTI prediction as a multi-output prediction task by learning ensembles of multi-output bi-clustering trees (eBICT) on reconstructed networks. In our setting, the nodes of a DTI network (drugs and proteins) are represented by features (background information). The interactions between the nodes of a DTI network are modeled as an interaction matrix and compose the output space in our problem. The proposed approach integrates background information from both drug and target protein spaces into the same global network framework.

Results

We performed an empirical evaluation, comparing the proposed approach to state of the art DTI prediction methods and demonstrated the effectiveness of the proposed approach in different prediction settings. For evaluation purposes, we used several benchmark datasets that represent drug-protein networks. We show that output space reconstruction can boost the predictive performance of tree-ensemble learning methods, yielding more accurate DTI predictions.

Conclusions

We proposed a new DTI prediction method where bi-clustering trees are built on reconstructed networks. Building tree-ensemble learning models with output space reconstruction leads to superior prediction results, while preserving the advantages of tree-ensembles, such as scalability, interpretability and inductive setting.
Synergistic effects of vorinostat (SAHA) and azoles against Aspergillus species and their biofilms
Authors: Tu Bo , Yin Gendi , Li Hui
Published: February 2020

Background

Invasive aspergillosis is a fungal infection that occurs mainly in immunocompromised patients. It is responsible for a high degree of mortality and is invariably unresponsive to conventional antifungal treatments. Histone deacetylase inhibitors can affect the cell cycle, apoptosis and differentiation. The histone deacetylase inhibitor vorinostat (SAHA) has recently received approval for the treatment of cutaneous T cell lymphoma. Here, we investigated the interactions of SAHA and itraconazole, voriconazole, and posaconazole against Aspergillus spp. in vitro using both planktonic cells and biofilms.

Results

We investigated 20 clinical strains using broth microdilution checkerboard methods. The results showed synergy between SAHA and itraconazole, voriconazole, and posaconazole against 60, 40, and 25% of tested isolates of planktonic Aspergillus spp., respectively. Similar synergy was also observed against Aspergillus biofilms. The expression of the azole-associated multidrug efflux pumps MDR1, MDR2, MDR3 and MDR4, as well as that of HSP90, was measured by RT-PCR. The results indicated that the molecular mechanism of the observed synergistic effects in Aspergillus fumigatus may be partly associated with dampened expression of the efflux pump genes and, furthermore, that HSP90 suppression may be a major contributor to the observed synergistic effects of the drugs.

Conclusions

SAHA has potential as a secondary treatment to enhance the effects of azoles against both biofilm and planktonic cells of Aspergillus spp. in vitro. This effect occurs mostly by inhibition of HSP90 expression.
The DELLA proteins interact with MYB21 and MYB24 to regulate filament elongation in Arabidopsis
Authors: Huang Huang , Gong Yilong , Liu Bei , Wu Dewei , Zhang Min , Xie Daoxin , Song Susheng
Published: February 2020

Background

Gibberellin (GA) and jasmonate (JA) are two essential phytohormones for filament elongation in Arabidopsis. GA and JA trigger degradation of DELLAs and JASMONATE ZIM-domain (JAZ) proteins through SCFSLY1 and SCFCOI1 separately to activate filament elongation. In JA pathway, JAZs interact with MYB21 and MYB24 to control filament elongation. However, little is known how DELLAs regulate filament elongation.

Results

Here we showed that DELLAs interact with MYB21 and MYB24, and that R2R3 domains of MYB21 and MYB24 are responsible for interaction with DELLAs. Furthermore, we demonstrated that DELLA and JAZ proteins coordinately repress the transcriptional function of MYB21 and MYB24 to inhibit filament elongation.

Conclusion

We discovered that DELLAs interact with MYB21 and MYB24, and that DELLAs and JAZs attenuate the transcriptional function of MYB21 and MYB24 to control filament elongation. This study reveals a novel cross-talk mechanism of GA and JA in the regulation of filament elongation in Arabidopsis.
With a grain of salt? Supervisor credibility and other factors influencing trainee decisions to seek in-consultation assistance: a focus group study of Australian general practice trainees
Authors: Sturman Nancy , Jorm Christine , Parker Malcolm
Published: February 2020

Background

‘Ad hoc’ help-seeking by trainees from their supervisors during trainee consultations is important for patient safety, and trainee professional development. We explored trainee objectives and activities in seeking supervisor assistance, and trainee perceptions of the outcomes of this help-seeking (including the utility of supervisor responses).

Methods

Focus groups with Australian general practice trainees were undertaken. All data was audio-recorded and transcribed, coded using in-vivo and descriptive codes, and analysed by the constant comparison of provisional interpretations and themes with the data. Findings are reported under the over-arching categories of help-seeking objectives, activities and outcomes.

Results

Early in their general practice placements trainees needed information about practice facilities, and the “complex maze” of local patient resources and referral preferences: some clinical presentations were also unfamiliar, and many trainees were unaccustomed to making patient management decisions. Subsequent help-seeking was often characterised informally as “having a chat” or “getting a second opinion” so as not to “miss anything” when trainees were “not 100% sure”. Trainees emphasised the importance of being (and demonstrating that they were) clinically safe. Workflow constraints, and supervisory and doctor-patient relationships, had a powerful influence on trainee help-seeking activities. An etiquette for providing help in front of patients was described. Trainees assessed the credibility of supervisors based on their approach to risk and their clinical expertise in the relevant area. Several trainees reported reservations about their supervisor’s advice on occasions.

Conclusion

A trainee’s subsequent help-seeking is strongly influenced by how their supervisor responds when their help is sought. Trainees prefer to seek help from credible supervisors who respond promptly and maintain trainee ‘face’ in front of patients. Trainees learn through help-seeking to make their own clinical decisions but may remain uncertain about professional and societal expectations, and curious about how other general practitioners practise. Trainees value opportunities throughout their training to observe expert general practice.
Vitamin D supplementation improves SIRT1, Irisin, and glucose indices in overweight or obese type 2 diabetic patients: a double-blind randomized placebo-controlled clinical trial
Authors: Safarpour Peivasteh , Daneshi-Maskooni Milad , Vafa Mohammadreza , Nourbakhsh Mitra , Janani Leila , Maddah Mohsen , Amiri Fatemeh-Sadat , Mohammadi Fereshteh , Sadeghi Homa
Published: February 2020

Background

Vitamin D (VD) may increase sirtuin 1 (SIRT1) and subsequently PPAR-γ coactivator 1α (PGC-1α) and irisin levels and these improvements may reduce insulin resistance (IR). The aim was to assess the effects of vitamin D supplementation on SIRT1, irisin, and IR in overweight/obese type 2 diabetes (T2D) patients.

Methods

Ninety T2D males and females were recruited as a clinical trial study (mean of age and body mass index (BMI) of intervention and placebo groups were 50.05 ± 10.17 and 50.36 ± 10.2 yrs. and 31.37 ± 3.4 and 30.43 ± 3.2 kg/m2, respectively). The inclusion criteria were T2D, VD deficient, BMI > 25 kg/m2, and serum HbA1c < 8.5%. The exclusion criteria were using vitamin and mineral supplements, having any acute disease, recent modifying dose or type of drugs. The supplementation was 50,000 IU/week VD or placebo for 8 weeks. The demographic characteristics, anthropometrics, dietary intakes and physical activity status, sun exposure status, fasting blood sugar (FBS) and insulin, glycosylated hemoglobin (HbA1c), irisin, SIRT1, 25-hydroxy D3 (25(OH)VD), homeostasis model assessment of insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI) were determined. The significantP-value was ≤0.05.

Results

The increase of serum VD, SIRT1, and irisin in the intervention group was significant (p < 0.001). HbA1c was decreased significantly by 1%. The changes in the other glucose indices (FBS, insulin, and IR) were non-significant.

Conclusions

VD supplementation may improve T2D by decreasing HbA1c and increasing SIRT1 and irisin in VD deficient T2D patients. Further trials are suggested.

Trial registration

Iranian Registry of Clinical Trials, IRCT201604202365N11. Registered 21/08/2016,http://en.irct.ir/trial/2019.
Targeted antenatal anti-D prophylaxis for RhD-negative pregnant women: a systematic review
Authors: Runkel Britta , Bein Gregor , Sieben Wiebke , Sow Dorothea , Polus Stephanie , Fleer Daniel
Published: February 2020

Background

All non-sensitized Rhesus D (RhD)-negative pregnant women in Germany receive antenatal anti-D prophylaxis without knowledge of fetal RhD status. Non-invasive prenatal testing (NIPT) of cell-free fetal DNA in maternal plasma could avoid unnecessary anti-D administration. In this paper, we systematically reviewed the evidence on the benefit of NIPT for fetal RhD status in RhD-negative pregnant women.

Methods

We systematically searched several bibliographic databases, trial registries, and other sources (up to October 2019) for controlled intervention studies investigating NIPT for fetal RhD versus conventional anti-D prophylaxis. The focus was on the impact on fetal and maternal morbidity. We primarily considered direct evidence (from randomized controlled trials) or if unavailable, linked evidence (from diagnostic accuracy studies and from controlled intervention studies investigating the administration or withholding of anti-D prophylaxis). The results of diagnostic accuracy studies were pooled in bivariate meta-analyses.

Results

Neither direct evidence nor sufficient data for linked evidence were identified. Meta-analysis of data from about 60,000 participants showed high sensitivity (99.9%; 95% CI [99.5%; 100%] and specificity (99.2%; 95% CI [98.5%; 99.5%]).

Conclusions

NIPT for fetal RhD status is equivalent to conventional serologic testing using the newborn’s blood. Studies investigating patient-relevant outcomes are still lacking.
Women’s experiences of a diagnosis of gestational diabetes mellitus: a systematic review
Authors: Craig Louise , Sims Rebecca , Glasziou Paul , Thomas Rae
Published: February 2020

Background

Gestational diabetes mellitus (GDM) - a transitory form of diabetes induced by pregnancy - has potentially important short and long-term health consequences for both the mother and her baby. There is no globally agreed definition of GDM, but definition changes have increased the incidence in some countries in recent years, with some research suggesting minimal clinical improvement in outcomes. The aim of this qualitative systematic review was to identify the psychosocial experiences a diagnosis of GDM has on women during pregnancy and the postpartum period.

Methods

We searched CINAHL, EMBASE, MEDLINE and PsycINFO databases for studies that provided qualitative data on the psychosocial experiences of a diagnosis of GDM on women across any stage of pregnancy and/or the postpartum period. We appraised the methodological quality of the included studies using the Critical Appraisal Skills Programme Checklist for Qualitative Studies and used thematic analysis to synthesis the data.

Results

Of 840 studies identified, 41 studies of diverse populations met the selection criteria. The synthesis revealed eight key themes: initial psychological impact; communicating the diagnosis; knowledge of GDM; risk perception; management of GDM; burden of GDM; social support; and gaining control. The identified benefits of a GDM diagnosis were largely behavioural and included an opportunity to make healthy eating changes. The identified harms were emotional, financial and cultural. Women commented about the added responsibility (eating regimens, appointments), financial constraints (expensive food, medical bills) and conflicts with their cultural practices (alternative eating, lack of information about traditional food). Some women reported living in fear of risking the health of their baby and conducted extreme behaviours such as purging and starving themselves.

Conclusion

A diagnosis of GDM has wide reaching consequences that are common to a diverse group of women. Threshold cut-offs for blood glucose levels have been determined using the risk of physiological harms to mother and baby. It may also be advantageous to consider the harms and benefits from a psychosocial and a physiological perspective. This may avoid unnecessary burden to an already vulnerable population.
Associations between hydration state and pregnancy complications, maternal-infant outcomes: protocol of a prospective observational cohort study
Authors: Zhang Na , Zhang Fan , Chen Su , Han Feng , Lin Guotian , Zhai Yufei , He Hairong , Zhang Jianfen , Ma Guansheng
Published: February 2020

Background

Water requirements increases with gestational age. Insufficient water intake causes dehydration, which may adversely affect maternal health and birth outcomes. However, few related studies have been conducted. The purposes are to assess the water intake and hydration state among pregnant women, and to investigate the associations with pregnancy complications and maternal and infant outcomes.

Methods

A prospective observational cohort study will be applied. A total of 380 pregnant women will be recruited from the First Affiliated Hospital of Hainan Medical University. Hydration biomarkers and health outcomes will be tested during 15~17 weeks’ gestation, 20~22 weeks’ gestation, 30~32 weeks’ gestation, during childbirth and 42 days after childbirth. Daily fluid intake will be collected using a 24-h fluid intake record for 7 consecutive days. A semi-quantified food frequency method will be used to assess food intake and water intake from food. Anthropometric measurement will be taken following standardized processes. Intracellular fluid (ICF) and extracellular fluid (ECF) will be measured using a body composition analyzer. Morning fasting urine and blood osmolality will be tested by laboratory physicians using an osmotic pressure molar concentration meter. Pregnancy complications will be assessed and diagnosed throughout pregnancy and childbirth. Maternal-infant outcomes will be monitored using related indicators and technologies. In order to explore the internal mechanism and interactions from the perspective of endocrine, pregnancy related hormones (estradiol, prolactin, progesterone) and the hydration-related hormones (copeptin) will be tested during pregnancy. A mixed model of repeated measures ANOVA will be analyzed using SAS 9.2.

Results

The results may provide basic data on water intake among pregnant women. The association between hydration state and maternal-infant outcomes will also be explored.

Conclusions

This preliminary exploratory study findings will fill the gaps in the research on water intake, hydration and maternal health, birth outcomes, provide scientific reference data for updating recommendation on water adequate intake among pregnant women, and provide suggestion for developing water intake interventions.

Trial registration

The protocol has been registered on the website of Chinese Clinical Trial Registry. The Identifier code is ChiCTR1800019284. The Registry date is 3 November, 2018. Registry name is “Study for the correlation between hydration state and pregnancy complications, maternal and infant outcomes during pregnancy”.
A low cost surrogate eye model for corneal foreign body removal
Authors: Lin Jingping , Chua Mui Teng
Published: February 2020

Background

Patients commonly present to the Emergency Department with a corneal foreign body (FB). There is currently a lack of adequate training for junior doctors in the management of this condition. Our self-made surrogate eye model aims to address this void in our junior doctors’ knowledge.

Methods

Participants were guided through a hands-on session with a slit-lamp using our eye model, which is made of a hemispherical agar embedded with pencil lead fragments simulating as FBs. Using a 7-point Likert scale, all participants completed a questionnaire both before and after training, for: (1) knowledge in corneal FB removal, (2) confidence in corneal FB removal, and (3) effectiveness of the model.

Results

Out of 73 participants, 82.2% (60/73) had no prior experience in corneal FBs removal. After the training session, their knowledge improved from a median score of 2 (interquartile range [IQR] 1 to 3) to 5 (IQR 5 to 6), with improvement in confidence levels from 2 (IQR 1 to 2) to 5 (IQR 4 to 6). The effectiveness of our eye model scored a median of 6 (IQR 5 to 7).

Conclusions

Our surrogate eye model is low-cost, quick and easy to reproduce. After use, our learners expressed greater confidence in managing the removal of corneal FBs and use of slit lamp. With a recent focus in patient safety and quality, teaching this procedure via simulation is a safe way of bridging the gap between traditional didactic teaching and the clinical environment.
Prioritizing suicide prevention guideline recommendations in specialist mental healthcare: a Delphi study
Authors: Setkowski Kim , van Balkom Anton J. L. M. , Dongelmans Dave A. , Gilissen Renske
Published: February 2020

Background

The Delphi technique is a proven and reliable method to create common definitions and to achieve convergence of opinion. This study aimed to prioritize suicide prevention guideline recommendations and to develop a set of quality indicators (QIs) for suicide prevention in specialist mental healthcare.

Methods

This study selected 12 key recommendations from the guideline to modify them into QIs. After feedback from two face-to-face workgroup sessions, 11 recommendations were rephrased and selected to serve as QIs. Next, a Delphi study with the 11 QIs was performed to achieve convergence of opinion among a panel of 90 participants (23 suicide experts, 23 members of patients’ advisory boards or experts with experiences in suicidal behavior and 44 mental healthcare professionals). The participants scored the 11 QIs on two selection criteria: relevance (it affects the number of suicides in the institution) and action orientation (institutions or professionals themselves can influence it) using a 5-point Likert scale. Also, data analysts working in mental healthcare institutions (MHIs) rated each QI on feasibility (is it feasible to monitor and extract from existing systems). Consensus was defined as 70% agreement with priority scores of four or five.

Results

Out of the 11 recommendations, participants prioritized five recommendations as relevant and action-oriented in optimizing the quality of care for suicide prevention: 1) screening for suicidal thoughts and behavior, 2) safety plan, 3) early follow-up on discharge, 4) continuity of care and 5) involving family or significant others. Only one of the 11 recommendations early follow-up on discharge reached consensus on all three selection criteria (relevance, action orientation, and feasibility).

Conclusions

The prioritization of relevant and action-oriented suicide prevention guideline recommendations is an important step towards the improvement of quality of care in specialist mental healthcare.
Protocol for a multi-site study of the effects of overdose prevention education with naloxone distribution program in Skåne County, Sweden
Authors: Troberg Katja , Isendahl Pernilla , Blomé Marianne Alanko , Dahlman Disa , Håkansson Anders
Published: February 2020

Background

Continuously high rates of overdose deaths in Sweden led to the decision by the Skåne County to initiate the first regional take-home naloxone program in Sweden. The project aims to study the effect of overdose prevention education and naloxone distribution on overdose mortality in Skåne County. Secondary outcome measures include non-fatal overdoses and overdose-related harm in the general population, as well as cohort-specific effects in study participants regarding overdoses, mortality and retention in naloxone program.

Methods

Implementation of a multi-site train-the-trainer cascade model was launched in June 2018. Twenty four facilities, including opioid substitution treatment units, needle exchange programs and in-patient addiction units were included for the first line of start-up, aspiring to reach a majority of individuals at-risk within the first 6 months. Serving as self-sufficient naloxone hubs, these units provide training, naloxone distribution and study recruitment. During 3 years, questionnaires are obtained from initial training, follow up, every sixth month, and upon refill. Estimated sample size is 2000 subjects. Naloxone distribution rates are reported, by each unit, every 6 months. Medical diagnoses, toxicological raw data and data on mortality and cause of death will be collected from national and regional registers, both for included naloxone recipients and for the general population. Data on vital status and treatment needs will be collected from registers of emergency and prehospital care.

Discussion

Despite a growing body of literature on naloxone distribution, studies on population effect on mortality are scarce. Most previous studies and reports have been uncontrolled, thus not being able to link naloxone distribution to survival, in relation to a comparison period. As Swedish registers present the opportunity to monitor individuals and entire populations over time, conditions for conducting systematic follow-ups in the Swedish population are good, serving the opportunity to study the impact of large scale overdose prevention education and naloxone distribution and thus fill the knowledge gap.

Trial registration

Naloxone Treatment in Skåne County - Effect on Drug-related Mortality and Overdose-related Complications, NCT 03570099, registered on 26 June 2018.
The reduction in anemia through normative innovations (RANI) project: study protocol for a cluster randomized controlled trial in Odisha, India
Authors: Yilma Hagere , Sedlander Erica , Rimal Rajiv N. , Pant Ichhya , Munjral Ashita , Mohanty Satyanarayan
Published: February 2020

Background

More than half of women in India are anemic. Anemia can result in fatigue, poor work productivity, higher risk of pre-term delivery, and maternal mortality. The Indian government has promoted the use of iron-folic acid supplements (IFA) for the prevention and treatment of anemia for the past five decades, but uptake remains low and anemia prevalence high. Current programs target individual-level barriers among pregnant women and adolescents, but a more comprehensive approach that targets multiple levels among all women of reproductive age is needed to increase uptake of IFA and iron-rich foods.

Methods

The Reduction in Anemia through Normative Innovations (RANI) project is a norms-based intervention to reduce anemia among women of reproductive age. We will evaluate the intervention through a clustered randomized controlled trial in Odisha, India. We will collect data at three time points (baseline, midline, and end line). For the study, we selected 89 clusters of villages, which we randomized into treatment and control on a 1:1 basis. The treatment arm will receive the RANI project components while the control arm will receive usual care. Fifteen clusters (40–41 villages) were selected and 4000 women (2000 in each arm) living in the selected clusters will be randomly selected to take part in data collection. Women in both study arms will have their hemoglobin concentrations measured. They will also complete in-person surveys about their knowledge, attitudes, perceptions of iron folic acid supplements, and nutritional intake. We will also select a smaller cohort of 300 non-pregnant women (150 in each arm) from this cohort for additional physical activity and cognitive testing. We will conduct both within- and between-group comparisons (treatment and control) at baseline, midline and end line using t-tests. We will also conduct structural equation modeling to examine how much each factor accounts for IFA use and hemoglobin levels.

Discussion

This RCT will enable us to examine whether a social norms-based intervention can increase uptake of iron folic acid supplements and iron rich foods to reduce anemia.

Trial registration

This trial was registered with Clinical Trial Registry- India (CTRI) (CTRI/2018/10/016186) on 29 October 2018.
The maximal gait speed is a simple and useful prognostic indicator for functional recovery after total hip arthroplasty
Authors: Shibuya Manaka , Nanri Yuta , Kamiya Kentaro , Fukushima Kensuke , Uchiyama Katsufumi , Takahira Naonobu , Takaso Masashi , Fukuda Michinari , Matsunaga Atsuhiko
Published: February 2020

Purpose

The present study aimed to compare the capabilities of preoperative usual and maximal gait speeds in predicting functional recovery in patients who have undergone total hip arthroplasty (THA).

Methods

Primary and unilateral THAs were performed in 317 patients, and the proportion of patients who achieved unassisted walking (functional recovery) 5 days postoperatively was recorded as an outcome measure. Preoperative functional assessment included hip pain, leg muscle strength, range of motion (ROM), and gait speed evaluations. The capabilities of preoperative usual and maximal gait speeds in predicting functional recovery were compared based on the areas under the curves (AUCs) of receiver operating characteristic (ROC) curves. Further, ROC curves were constructed using two models: 1. a model of gait speed only and 2. a clinical model including age, sex, leg muscle strength, and ROM.

Results

On the AUCs for predictive ability of functional recovery, maximal gait speed was greater than usual gait speed (0.66 and 0.70, respectively). The AUC for maximal gait speed was as large as that of the clinical model (0.70 and 0.70, respectively).

Conclusion

Our results suggest that maximal gait speed is a simple and useful prognostic indicator of functional recovery in patients who have undergone THA.
The value of dynamic MRI in the treatment of cervical spondylotic myelopathy: a protocol for a prospective randomized clinical trial
Authors: Xu Nanfang , Zhang Youyu , Zhou Guangjin , Zhao Qiang , Wang Shaobo
Published: February 2020

Background

Cervical spondylotic myelopathy (CSM) is the most severe type of cervical spondylosis and the most common cause of spinal cord dysfunction among adults over 55 years old. MRI plays an important role in the diagnosis and evaluation of CSM, which can directly demonstrate the correlation between disc, spinal cord, posterior structures and abnormal signal in spinal cord. Static MRI can only show the static and neutral position of spinal cord, which is not enough to understand the pathogenesis of CSM. Dynamic MRI demonstrating the extension and flexion position of spinal cord can be a better tool for the treatment of CSM, especially the surgical decision making.

Method

A total of 180 CSM patients who have indications for surgery will be recruited in outpatient of Peking University Third Hospital and assigned to three groups (Group A, B and C) based on their static MRI after consent. Group A (incomplete dura compression) means the signal of cerebral spinal fluid (CSF) is still visible. Group B (complete dura compression) means no CSF signal and no shape change of spinal cord. Group C (spinal cord compression) means shape change of spinal cord. Two surgical plans will be made for each participant by one professional surgeon according to the static MRI and dynamic MRI respectively and we will randomly choose one to perform via a random number system. Follow-up will be maintained at 3, 6, and 12 months after surgery through outpatient or telephone interview, including mJOA score, 10-s G&R (grip and release) and 10-s step test, SF-36 score, radiographic examination and complications. Finally, data collection and statistical analysis will be finished by researchers who are blinded to recruitment and treatment.

Discussion

This study will help us to explore the indication of dynamic MRI and the value of dynamic MRI in the treatment of CSM, especially the surgical decision making. Dynamic MRI can be a useful tool in the treatment of CSM patients.

Trial registration

ChiCTR1900023014. Registered on May 7th, 2019.
A cross-sectional evaluation of HIV testing practices among women in the rural Dominican Republic
Authors: Montgomery Madeline C. , Alholm Zachary , Almonte Alexi , Sykes Kevin J. , Rudolph Gregory , Cusick Brandon , Castello Laura , Sowemimo-Coker Genoviva , Tang Irene , Haberlack Sarah , Chan Philip A.
Published: February 2020

Background

The Dominican Republic (DR) ranks among nations with the highest burden of HIV in the Caribbean. Cultural and gender roles in rural areas of the DR may place women at increased HIV risk. However, little is known about sexual health and HIV testing behaviors among women in the rural DR.

Methods

We conducted a needs assessment among a systematic sample of adult women in a rural DR community in 2016. Demographic and behavioral attributes related to HIV testing, sexual health, and healthcare utilization were evaluated. Poisson regression analysis was used to identify demographics and behaviors associated with having had a previous HIV test. Significance was defined as a p-value < 0.05.

Results

Among 105 women evaluated, 77% knew someone with HIV and 73% of women reported that they would be very or extremely likely to take an HIV test if offered. Only 68% reported a previous HIV test, including 47% who were tested over 2 years prior. Barriers to HIV testing included low risk perception (23%), distance or requisite travel (13%), and discomfort being tested (11%). Women who had never been tested for HIV were more likely than those who had been tested to be older (p = 0.03), to have a lower level of education (p = 0.04), and to have never been tested for other sexually transmitted infections (STI; p <  0.01). In the Poisson multiple regression model, the only significant predictor of having had an HIV test was having had an STI test (p = 0.03).

Conclusions

In the rural DR, numerous barriers contribute to low prevalence of HIV testing among women. Most women report willingness to have an HIV test and many engage in routine health care, indicating that this population may benefit from incorporating HIV testing and other sexual health promotion activities into routine medical care.
The methanol extract of Guettarda speciosa Linn. Ameliorates acute lung injury in mice
Authors: Kim Kyun Ha , Lee Ji Yeon , Ahn Seonju , Won Ran , Kim Sang-Jun , Jeong Seung-Il , Lee Jung Ju , Kim Jong-In , Choi Jun-Yong , Joo Myungsoo
Published: February 2020

Background

Guettarda speciosa is mainly found in tropical areas in Asia. Although G. speciosa is traditionally used to treat some of the inflammatory disorders, the experimental evidence supporting the anti-inflammatory effect of G. speciosa is limited. Here, we sought to obtain evidence that G. speciosa has anti-inflammatory activity using an acute lung injury (ALI) mouse model and to explore possible underlying mechanisms for the activity.

Methods

The methanol extract of G. speciosa Linn. (MGS) was fingerprinted by HPLC. Cytotoxicity was determined by MTT and flow cytometer. As for an ALI mouse model, C57BL/6 mice received an intratracheal (i.t.) injection of lipopolysaccharide (LPS). The effects of MGS on lung inflammation in the ALI mice were assessed by differential cell counting and FACS of inflammatory cells and hematoxylin and eosin staining of lung tissue. Proteins were analyzed by immunoprecipitation and immunoblotting, and gene expression was by real-time qPCR. Neutrophil elastase activity was measured by ELISA.

Results

MGS did not cause metabolic disarray or produce reactive oxygen species that could induce cytotoxicity. Similar to ALI patients, C57BL/6 mice that received an i.t. LPS developed a high level of neutrophils, increased pro-inflammatory cytokines, and inflicted tissue damage in the lung, which was suppressed by i.t. MGS administered at 2 h after LPS. Mechanistically, MGS activated Nrf2, which was related to MGS interrupting the ubiquitin-dependent degradation of Nrf2. MGS suppressed the nuclear localization of NF-κB induced by LPS, suggesting the inhibition of NF-κB activity. Furthermore, MGS inhibited the enzymatic activity of neutrophil elastase.

Conclusion

MGS could suppress lung inflammation in an ALI mouse model, the effect of which could be attributed to multiple mechanisms, including the activation of Nrf2 and the suppression of NF-κB and neutrophil elastase enzymatic activity by MGS.