bluuebunny/crossref_metadata_2025 huggingface dataset:
The Clinical Application of Filmarray Respiratory Panel in Children with Acute Respiratory Tract Infections in a Pediatric Hospital
Authors: Zhang Hong , Pan Fen , Wang Bingjie , Shi Yingying , Xu Qi
Published: November 2020

Background: Acute respiratory tract infections (ARTIS) are the common diseases in children and common methods frequently fail to identify the infectious etiology especially for viruses. The Filmarray respiratory panel (FARP) can reliably and rapidly identify viruses and bacterial pathogens. This study is to evaluate the performance and clinical significance of FARP in children with ARTIS.Methods: A total of 90 nasopharyngeal secretion (NPS) samples from children with ARTIS were enrolled. The FARP assay for 17 pathogens and other common methods including direct fluorescence assay (DFA) were performed to analyze these samples. Clinical data of all patients was also collected and evaluated.Results: Among the 90 samples, 58 samples (64.4%) were positive for 13 pathogens by FARP and 18 positive samples were detected with multiple-virus (31.3%, 18/58). Human rhinovirus/ enterovirus (21.0%%, 17/58) were predominant pathogen, followed by adenovirus (18.5%). Higher proportions of various pathogens were identified in the infant and toddler (0–2 years) groups with human rhinovirus/enterovirus being mostly virus. Adenovirus were common in the group aged 3–5 years, but only three pathogens including M.pneumoniae, respiratory syncytial virus, and adenovirus were also found in age group (6-14 years). Among 58 FARP positive patients, significant differences were in antibiotic prescription and use of hormone the single-organism-positive group and the multi-organism-positive group (P<0.05). Furthermore, there was significant difference in use of anti-virus and usage of hormone between severe respiratory infections group and non severe respiratory infections group (P<0.05). Conclusions: This study demonstrated that FARP can provide the rapid detection of respiratory virus and atypical bacteria for children, especially with severe respiratory tract infections.
Tuberculosis Diagnosis Cascade in Blantyre, Malawi: A Prospective Cohort Study
Authors: Feasey Helena R A , Corbett Elizabeth L , Nliwasa Marriott , Mair Luke , Divala Titus H , Kamchedzera Wala , Khundi McEwen , Burchett Helen E D , Webb Emily L , Maheswaran Hendramoorthy , Squire S Bertel , MacPherson Peter
Published: November 2020

Background: Tuberculosis (TB) control relies on early diagnosis and treatment. International guidelines recommend systematic TB screening at health facilities, but implementation is challenging. We investigated completion of recommended TB screening steps in Blantyre, Malawi.Methods: A prospective cohort recruited adult outpatients attending Bangwe primary clinic. Entry interviews were linked to exit interviews. The proportion of participants progressing through each step of the diagnostic pathway were estimated. Factors associated with request for sputum were investigated using multivariable logistic regression.Results: Of 5,442 clinic attendances 2,397 (44%) had exit interviews. In clinically indicated participants (n=330) 203 (61.5%) were asked about cough, 35 (10.6%) of those were asked for sputum, 24 (7.3%) gave sputum and 1 (0.3%) received same-day results. Significant associations with request for sputum were: any TB symptom (aOR:3.20, 95%CI:2.02-5.06), increasing age (aOR:1.02, 95%CI:1.01-1.04 per year) and for HIV-negative participants only, a history of previous TB (aOR:3.37, 95%CI:1.45-7.81). Numbers requiring sputum survey (20/day) outnumbered diagnostic capacity (8-12/day).Conclusions: Patients were lost at every stage of the TB care cascade, with same day sputum submission following all steps of the diagnosis cascade achieved in only 7.3% if clinically indicated. Infection control strategies should be implemented, with reporting on early steps of the TB care cascade formalised. High-throughput screening interventions, such as digital CXR, that can achieve same-day TB diagnosis are urgently needed to meet WHO End TB goals.
Evaluation the Expression of Efflux Pump Genes “Tap & P55 in Mycobacterium Tuberculosis Clinical Isolates in Fars, Iran
Authors: Khoob Fardis , Abadi Milad Shahini Shams , Hadi Nahal , Avazzadeh Farzaneh , Zarei Zahra
Published: November 2020

BackgroundThe increasing drug resistance in Mycobacterium tuberculosis isolates has become a global problem for tuberculosis therapy programs. Genetic mutations in rifampin (RIF), one of the key drugs in the treatment of tuberculosis are main mechanism of resistant to this drug in M. tuberculosis. Absence of mutation in target genes, other mechanisms such as efflux pump suggests possible role of drug resistant.The objective of this study was to find out mutations in rpoB genes in rifampin resistant isolates and to compare the expression level of tap and p55 efflux pump genes in non mutated isolates, mutated isolates in rpoB genes and susceptible isolates.MethodsIn this study, antimicrobial sensitivity test on first line drugs was performed on 200 M. tuberculosis isolates, obtained from TB center in Shiraz (IRAN) and genetic mutations were evaluated in rpoB gene in RIF resistant isolates by multiplex PCR, followed expression level evaluated by Real-time PCR.Resultsout of the 200 isolates tested, 23 (34.33%) showed resistant to RIF. 12 of 23 RIF resistant isolates have mutation in rpoB gene, and frequency of mutations in codons 516, 526 and 531 were 3 (25%), 4 (33.33%) and 5 (41.67%) respectively. The expression level of tap and p55 genes was considerably higher in resistant isolates which had no mutation compared to the expression level of genes in the isolates which had mutation in target genes.Conclusion﻿The accumulating data suggest the probable role of efflux pump in M. tuberculosis drug resistance, the validation of data needs further phenotypic assays of these pumps.
Effects of Early Corticosteroid Use in Patients With Severe Coronavirus Disease 2019: A Case Control Study
Authors: Hyun JongHoon , Kim Moo Hyun , Sohn Yujin , Cho Yunsuk , Baek Yae Jee , Kim Jung Ho , Ahn Jin Young , Choi Jun Yong , Yeom Joon Sup , Ahn Mi Young , Kim Eun Jin , Baek Ji-Hyeon , Kim Young Keun , Choi Heun , Jeong Su Jin
Published: November 2020

BackgroundCoronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome, and corticosteroids have been considered as possible therapeutic agents. However, there is limited literature on the appropriate timing of corticosteroid administration to obtain the best possible patient outcomes.MethodsA retrospective multicenter study was designed to explore the effects of early corticosteroid use on clinical outcomes in 7 tertiary hospitals in South Korea. Twenty-two patients with severe COVID-19 were enrolled, and they were all treated with corticosteroids. ResultsOf the 22 patients who received corticosteroids, 12 patients (55%) were treated within 10 days from diagnosis. There was no significant difference in the baseline characteristics. The initial PaO2/FiO2 ratio was 168.75. The overall case fatality rate was 25%. The mean time from diagnosis to steroid use was 4.08 days and the treatment duration was 14 days in the early use group, and 12.80 days and 18.50 days in the late use group, respectively. The PaO2/FiO2 ratio, C-reactive protein level, and cycle threshold value improved over time in both groups. In the early use group, the time from onset of symptoms to discharge (32.4 days vs 60.0 days, P = 0.030), time from diagnosis to discharge (27.8 days vs 57.4 days, P = 0.024), and hospital stay (26.0 days vs 53.9 days, P = 0.033) were shortened.ConclusionsAmong patients with severe COVID-19, the early use of corticosteroids resulted in a significant improvement in the time to favorable clinical outcomes.
National Public Health Institutes: A Scoping Review
Authors: Myhre Sonja Lynn , French Steve Diaz , Bergh Anne
Published: November 2020

Background. During the last century, national public health institutes (NPHIs) emerged to address enduring and emergency public health challenges. Outbreaks have often compelled countries to establish NPHIs. Likewise, the Covid-19 pandemic may inspire countries to create or strengthen NPHIs. Despite their historic legacies and contributions to public health, no review of NPHI literature has been published to date. The aim of this scoping review is to provide an overview of the NPHI literature published since 2000 and map characteristics of articles including format, authorship, geographic focus, methods, language, and focal topic. We also investigate whether the NPHI literature addresses public health capacity building domains. Finally, the study identifies gaps and areas for future research. Methods. The scoping review was guided the Arksey and O’Malley methodological framework and utilized the PRISMA-ScR checklist. The search was conducted in Medline OVID and Scopus databases. Data extraction involved mapping article characteristics and reviewing public health capacity building framework domains. Results. The search yielded 5731 records. A total of 43 articles met the study eligibility criteria. Articles were published in English, Spanish, French and Russian including diverse perspectives and experiences emanating from more than 20 countries in Africa, Europe, North America and South America. Most articles were formatted as commentaries. Only three reported methods or collected primary data. Articles topics included organizational structure, networks, research, funding, and governance. Conclusion. Findings reveal a longstanding international interest in leveraging NPHIs to address complex public health challenges. Lack of studies reporting methods reveals the need for future research to utilize quantitative and qualitative methods. The NPHI literature addresses topics concerning public health capacity building which underscores NPHIs’ ability to tackle global and national public health threats. Many articles in this review recommend investment in NPHIs as a strategy to respond to crises and strengthen countries’ public health systems.
Development and Performance Assessment of Novel Machine Learning Models to Predict Pneumonia After Liver Transplantation
Authors: Chen Chaojin , Yang Dong , Gao Shilong , Zhang Yihan , Chen Liubing , Wang Bohan , Mo Zihan , Yang Yang , Hei Ziqing , Zhou Shaoli
Published: November 2020

Background Pneumonia is the most frequently encountered postoperative pulmonary complications (PPC) after orthotopic liver transplantation (OLT), which cause high morbidity and mortality rates. We aimed to develop a model to predict postoperative pneumonia in OLT patients using machine learning (ML) methods. Methods Data of 786 adult patients underwent OLT at the Third Affiliated Hospital of Sun Yat-sen University from January 2015 to September 2019 was retrospectively extracted from electronic medical records and randomly subdivided into a training set and a testing set. With the training set, six ML models including logistic regression (LR), support vector machine (SVM), random forest (RF), adaptive boosting (AdaBoost), extreme gradient boosting (XGBoost) and gradient boosting machine (GBM) were developed. These models were assessed by the area under curve (AUC) of receiver operating characteristic on the testing set. The related risk factors and outcomes of pneumonia were also probed based on the chosen model.Results 591 OLT patients were eventually included and 253 (42.81%) were diagnosed with postoperative pneumonia, which was associated with increased postoperative hospitalization and mortality (P< 0.05). Among the six ML models, XGBoost model performed best. The AUC of XGBoost model on the testing set was 0.734 (sensitivity: 52.6%; specificity: 77.5%). Pneumonia was notably associated with 14 items features: INR, HCT, PLT, ALB, ALT, FIB, WBC, PT, serum Na+, TBIL, anesthesia time, preoperative length of stay, total fluid transfusion and operation time. Conclusion Our study firstly demonstrated that the XGBoost model with 14 common variables can predict postoperative pneumonia in OLT patients.
Providing An Optimized Model to Detect Driver Genes From Heterogeneous Cancer Samples, Using Restriction in Subspace Learning
Authors: EBADI Ali Reza , Soleimani Ali , GHADERZADEH3 ABDULBAGHI
Published: November 2020

Extracting the drivers from genes with mutation, and segregation of driver and passenger genes are known as the most controversial issues in cancer studies. According to the heterogeneity of cancer, it is not possible to identify indicators under a group of associated drivers, in order to identify a group of patients with diseases related to these subgroups. Therefore, the precise identification of the related driver genes using artificial intelligence techniques is still considered as a challenge for researchers. In this research, a new method has been developed using the subspace learning method, unsupervised learning, and with more constraints. Accordingly, it has been attempted to extract the driver genes with more precision and accurate results. The obtained results show that the proposed method is more efficient for more genes compared to other methods. The p-value of the proposed method was 9.21e-7 better than previous methods for 200 genes. The results show that the p. value of the proposed method is about 2.7 times less than the driver sub method, indicating that the proposed method can identify driver genes in cancerous tumors with greater accuracy and reliability.
Trademark Background Analysis Method Based on Human Cognition of Visual Psychology
Authors: Hung Kuo-Ming , Chen Li-Ming , Chen Ting-Wen
Published: November 2020

Trademark is a symbol that can be seen everywhere in life. In the case of effective use of trademark, people can quickly identify the organization, its image and reputation, so that the trademark owner can obtain resources for maintenance and development. However, there are unfair competitors in the market that would imitate similar trademarks to steal or damage the reputation and interests of the original trademark owners. Failure of preventing counterfeit trademarks from affecting the interests of others will make developers hard to develop novel technologies that contribute to the progress of the country and society due to insufficient or scarce resources. In the past research in this field,many studies have proposed protection methods for protecting trademark interests. These related studies have obtained excellent results in the search and analysis of trademarks. Nevertheless, some unfair competitors use the human cognition of visual psychology in the human vision system (HVS) to circumvent similar methods of trademark images to steal or damage the credit and interests of the original trademark owners. In order to deter unfair competitors or the abuse of such confusing trademarks, this article proposes a method for trademark background analysis. This article also proposes a method to generate a large amount of background trademark data. Then, we use that large amount of generated data for training neural networks that can analyze trademarks that are easily confused due to background. Eventually, we use the testing independent data for system verification. This experiment uses two common deep learning network architecture for testing. The experimental results show that the proposed system can achieve a true positive rate (TPR) over 98% in the face of this confusing trademark plagiarism method. And the comparison result is better than existing methods. This result confirms that the system proposed in this article can prevent infringement problems that used background.
The Influence of Medical Insurance and Social Security Cards on The Floating Population's Settlement Intention
Authors: Li Yulin , Huang Lingling , Xiang Li , Dou Dongmei
Published: November 2020

Background: There are many studies on the factors influencing the floating population's intentions to settle down. Medical insurance and social security cards are an important incentive for the floating population to live a stable life in their current residence, but there are limited studies on the influence of medical insurance and social security cards on settlement intentions. Therefore, the purpose of this paper was to study the impact of basic medical insurance for urban employees and the decision as to whether to apply for individual social security cards on the settlement intentions of the floating population. As the willingness to settle has increased, the development of health management and public health in the place of residence has improved. Methods: Based on the 2017 survey data from the dynamic monitoring of China's floating population, we explored the influence of basic medical insurance for urban employees and social security cards on the floating population's settlement intentions with binary logistic regression and structural equation models. Additionally, this study also examined the comprehensive causal relationship, with social integration as the mediator variable.Results: The settlement intention of members of the floating population after participating in basic medical insurance for urban employees was 23.2 percent higher than that of those who did not participate. The decision as to whether to apply for a personal social security card is related to their settlement intention. The standardized regression coefficients among social insurance and security, social integration, and settlement intention were positive values, and the Z values of the overall effect, indirect effect, and direct effect were all greater than 1.96; the confidence interval of the indirect effect did not include 0. We found that this model is a partial intermediary model, with an intermediary ratio of 10.66 percent. Conclusions: This article highlights the important impact of basic medical insurance for urban employees and individual social security cards on the floating population. The conclusions of this study provide suggestions for the government to use when designing policies to enhance the settlement intentions of the floating population and to improve the development of public health undertakings.
Unsheltered homeless and unstably housed adults have higher levels of stress and more health risk factors than sheltered homeless adults
Authors: Ra Chaelin K. , Hébert Emily T. , Alexander Adam , Kendzor Darla E. , Suchting Robert , Businelle Michael S.
Published: November 2020

Background: In the United States, approximately 568,000 individuals are homeless on a single night. Homelessness can be categorized into three subgroups: sheltered homeless, unsheltered homeless, and unstably housed. Few studies have examined the relations between homelessness subtypes, shelter service utilization, levels of stress experienced, and health risk factors. This study aimed to empirically examine whether shelter status the previous night was related to current stress, recent utilization of shelter-based mental health services, and current health risk factors.Methods: Data were collected at multiple homeless shelters in 2016 in the Oklahoma City area (N=575). All participants completed assessments of demographic characteristics, including age, sex, race, marital status, years of education, and incarceration history and victimization. Multiple linear and logistic regression analyses were conducted to examine relations between homelessness subgroups and outcomes (shelter-based service utilization, health risk factors, and stressors). Results: Results indicated that the sheltered group was younger and more likely to be White than the unsheltered group, had higher levels of education, and reported more lifetime months in jail than the unstably housed group. In addition, unsheltered homeless and unstably housed adults used fewer shelter-based health services, exhibited more health risk factors, experienced greater levels of stress, and had higher levels of food insecurity than sheltered homeless adults.Conclusion: Homeless adults who reside at shelters benefit most from available shelter services. The development of policies and programs targeted toward increasing sheltering options for unsheltered and unstably housed adults is needed.
Delphi consensus on strategies in the management of opioid-induced constipation in cancer patients
Authors: Sarrió Regina Gironés , Calsina-Berna Agnès , García Adoración Gozalvo , Esparza-Miñana José Miguel , Ferrer Esther Falcó , Porta-Sales Josep
Published: November 2020

Background: Opioid-induced constipation (OIC) is a frequent and bothersome adverse event related with opioid therapy in cancer patients. Despite the high prevalence, medical management of OIC is often uncertain. The current project aimed to investigate expert opinion on OIC management and provide practical recommendations to improve the clinical approach of OIC in cancer patient.Methods: A modified Delphi method was conducted involving 46 different physicians experts in OIC. Using a structured questionnaire of 67 items this project intended to seek consensus on aspects related to diagnosis, treatment, and quality of life of cancer patients suffering with OIC.Results: After two rounds, a consensus was reached in 91% of the items proposed, all in agreement. Agreement was obtained on OIC definition (95.7%). Objective and patient-reported outcomes included in that definition should be assessed routinely in clinical practice. Responsive to symptom changes and easy-to-use assessment tools were recommended (87.2%). Successful diagnosis of OIC requires increase clinicians awareness of OIC and proactivity to discuss symptoms with their patients (100%). Successful management of OIC requires individualization of the treatment (100%), regular revaluation once is established, and keeping it for the duration of opioid treatment (91.5%). Oral Peripherally Acting µ-Opioid Receptor Agonists (PAMORAs), were considered good alternatives for the treatment of OIC in cancer patients (97.9%). This drugs and laxatives can be co-prescribed if OIC coexist with functional constipation.Conclusions: The panelists, based on their expert clinical practice, presented a set of recommendations for the management of OIC in cancer patients.
Hepatic encephalopathy increases the risk of hip fracture: a nationwide cohort study
Authors: Yeh Kuang-Ting , Yu Tzai-Chiu , Lee Ru-Ping , Wang Jen-Hung , Liu Kuan-Lin , Peng Cheng-Huan , Chen Hao-Wen , Chen Ing-Ho , Hsu Chung-Yi , Wu Wen-Tien
Published: November 2020

Background: Osteoporotic hip fracture is a common general health problem with a significant impact on human life because it debilitates the patients and largely decreases their quality of life. Early prevention of fractures has become essential in recent decades. This can be achieved by evaluating the related risk factors, as a reference for further intervention. This is especially useful for the vulnerable patient group with comorbidities. Hepatic encephalopathy (HE), a major complication of liver cirrhosis, may increase the rate of falls and weaken the bone. This study evaluated the correlation between hepatic encephalopathy and osteoporotic hip fracture in the aged population using a national database.
Methods: This retrospective cohort study used data from Taiwan’s National Health Insurance Research Database between 2000 and 2012. We included people who were older than 50 years with hepatic encephalopathy or other common chronic illnesses. Patients with and without hepatic encephalopathy were matched at a ratio of 1:4 for age, sex, and index year. The incidence and hazard ratios of osteoporotic hip fracture between the both cohorts were calculated using Cox proportional hazard regression models.
Results: The mean age of the enrolled patients was 66.5 years. The incidence ratio of osteoporotic hip fracture in the HE group was significantly higher than that in the non-HE group (68/2496 [2.7%] vs 98/9984 [0.98%]). Patients with HE were 2.15-times more likely to develop osteoporotic hip fractures than patients without HE in the whole group. The risk ratio was also significantly higher in female and older individuals. The results were also similar in the comorbidity subgroups of hypertension, diabetes mellitus, hyperlipidemia, senile cataract, gastric ulcer, and depression. Alcohol-related illnesses seemed to not confound the results of this study.
Conclusions: HE is significantly associated with an increased risk of osteoporotic hip fractures, and the significance is not affected by the comorbidities in people aged more than 50 years. The cumulative risk of fracture increases with age.
An analysis of perioperative hidden blood loss in femoral intertrochanteric fractures: Bone density is an important influencing factor
Authors: Cui Haidong , Chen Kai , Lv Shujun , Yuan Chaoqun , Wang Youhua
Published: November 2020

Background To explore the influencing factors of perioperative hidden blood loss of intertrochanteric fractures.Method We undertook a retrospective analysis from January 2016 to October 2019. Clinical data of 118 patients with intertrochanteric fractures was included in. Hidden blood loss was calculated from the hematocrit changes before and after surgery, using the Gross equation, based on height, weight, and hematocrit (HCT) changes before and after surgery. Patients’ gender, age, presence of underlying diseases (hypertension and diabetes), fracture types, anesthesia methods, time from injury to surgery, whether to take antiplatelet drugs within 6 months before surgery, use of anticoagulant drugs after surgery, bone density were statistically analyzed. The factors with statistical significance were screened out. And then the hidden blood loss was used as the dependent variable and each influencing factor was the independent variable. Multivariate linear regression analysis was used to analyze the related risk factors that affect the hidden blood loss during the perioperative period of intertrochanteric fractures. Result The apparent blood loss during operation was (203.81 ±105. 51) ml, and the hidden blood loss was (517.55±191.47) ml. There were significant differences in the hidden blood loss of patients with different fracture types, anesthesia methods, antiplatelet or postoperative anticoagulant drugs, and different bone density(P＜0. 05). Multiple linear regression analysis showed that internal fixation, age, fracture type, anesthesia method, anticoagulant application, and bone density were related risk factors that affected hidden blood loss during surgical treatment of intertrochanteric fracture. Conclusion Hidden blood loss is the main cause of perioperative blood loss in intertrochanteric fractures, and the risk factors for hidden blood loss include internal fixation, fracture type, anesthesia, use of anticoagulant drugs. Specially, we found bone density was a risk factor for hidden blood loss. It is not reliable to use the apparent blood loss as the basis for fluid replacement and transfusion. We must fully consider the existence of hidden blood loss and intervene as soon as possible to prevent complications.
Intraoperative three-dimensional imaging in ankle syndesmotic reduction.
Authors: Beck Markus , Brunk Manuela , Wichelhaus Alice , Mittlmeier Thomas , Rotter Robert
Published: November 2020

Background: Injuries of the distal syndesmosis in ankle fractures are traditionally treated with a temporary adjusting screw fixation. Conventional fluoroscopic and X-ray examinations cannot reliably diagnose malpositions of the fixed tibiofibular syndesmosis. Postoperative computer tomography allows a reliable control of the transfixed region.The aim of the retrospective single-study was to clarify whether an intraoperative 3D image intensifier examination can detect malpositions of the syndesmosis already intraoperatively and whether the examination has an influence on the postoperative revision rate. Methods: In 200 patients with tibiofibular syndesmosis injuries, an intraoperative 3D scan was performed after reduction of the distal tibiofibular syndesmosis and placement of the adjusting screw. Postoperative computer tomography of both ankle joints was performed in all patients. Results: 15% of all intraoperative 3D scans (30 patients) showed a finding requiring correction in the area of the ankle joint. In 7% of the cases, a malposition of the fibula in the tibial incisura requiring correction was found. Further corrections were necessary due to the extent and position of the osteosynthesis material (7%) and for the removal of joint bodies (1%). Postoperative computer tomographies of the ankle joints showed no deformities requiring revision. Conclusion: An intraoperative 3D scan allows a reliable assessment of the injured ankle region and reduces the postoperative revision rate. This makes a postoperative routine CT examination of the ankle joint dispensable.
Association of serum 25-Hydroxyvitamin D with Vitamin D Intervention and outdoor activity among children in North China: an observational study
Authors: Zhang Xuguang , Chen Yanping , Jin Shanshan , Bi Xinxin , Chen Dongkai , Zhang Dongmei , Liu Li , Jing Hong , Na Lixin
Published: November 2020

Background: Living at high latitudes is one of the risk factors for vitamin D deficiency in children. However, evidence on vitamin D improvement for this pediatric population to date is limited. This study aims at evaluating the association of different vitamin D intervention methods and outdoor activity on the vitamin D status of children in North China. Methods: In this observational study, a total of 55,925 children aged 1 month to 18 years old were recruited from pediatric outpatient departments from July 2016 to June 2017. Data on demographics, anthropometric measurements, vitamin D intervention (either prescribed by physicians or given by parents) and outdoor activity were recorded. The serum levels of 25-hydroxycholecalciferol (25(OH)D) were determined by high performance liquid chromatography tandem–mass spectrometry. Logistic regression analysis was performed to assess the association of vitamin D intervention or outdoor activity with blood vitamin D status, adjusted for age, gender, BMI for age, and seasons.Results: The overall rate of hypovitaminosis D was 65.60%. Of the children’s outdoor activity, 35.63%, 31.95%, and 32.42% were below 30min/d, 30-60 min/d and over 60min/d, respectively. Furthermore, the proportion of therapeutic intervention, supplementation intervention and no vitamin D intervention among the children was 16.48%, 32.87%, and 50.65%, respectively. After adjusted for confounding factors, vitamin D intervention was associated with a lower risk of hypovitaminosis D, with OR (95% CI) of 0.191 (0.180, 0.202) in children with therapeutic doses and 0.423 (0.404, 0.443) in those with supplementation doses, compared with children without vitamin D intervention. In addition, longer outdoor time was associated with a lower risk of hypovitaminosis D [0.479 (0.456, 0.504) for 60 min/d, 0.737 (0.701, 0.776) for 30–60 min/d], independent of vitamin D intervention. Conclusions: High prevalence of vitamin D deficiency was found in children living at high latitudes. Vitamin D intervention and outdoor activity are all negatively associated with children’s vitamin D deficiency. Routine vitamin D intervention combined with increased outdoor time might be an effective approach to prevent hypovitaminosis D among children, especially those at school, living at high latitudes.
Retrospective cohort study on radial head arthroplasty comparing long-term outcomes between valgus type injury and fracture dislocation
Authors: Chen Alvin Chao-Yu , Weng Chun-Jui , Chiu Chih-Hao , Chang Shih-Sheng , Cheng Chun-Ying , Chan Yi-Sheng
Published: November 2020

Background: Radial head arthroplasty (RHA) has been commonly adopted for irreparable radial head fractures while little information is addressed on valgus type injury. The purpose of this study is to report long-term outcomes and radiographic analysis in RHA for valgus type injury with comparison to fracture dislocation injury.Methods: A retrospective cohort study was conducted in patients receiving unilateral RHA with loose-fit, modular metal prosthesis for irreparable radial head fractures between 2004 and 2012. Totally, 33 patients with a mean follow up of nine years (range, 7 to 15 years) were enrolled and divided into two groups including 14 valgus injuries and 19 fracture-dislocations. Demographics of the patients, injury details, clinical and radiographic outcomes, and correlation analysis were investigated and compared between two groups.Results: In patient demographics, significant difference was noted in sex distribution (p = 0.001), lateral collateral ligament involvement (p = 0.000) and time from injury to RHA (p = 0.031) between two groups. No patient underwent subsequent removal or revision of prosthesis. Good to excellent results according to Mayo Elbow Performance Score (MEPS) was achieved in 13 and 14 patients in group A and B respectively. Final motion range and Disabilities of the Arm, Shoulder, and Hand score was significantly better in valgus injury group. Radiographic analysis demonstrated fewer patients in valgus injury group presented periprosthetic osteolysis with weak to moderate negative correlation between radiolucency score and MEPS.Conclusions: With an average of nine years follow-up, RHA using loose-fit, modular metal prosthesis achieves encouraging outcomes for both valgus injury and fracture dislocation. In valgus type injury, better motion range, lower disability score and lower incidence of periprosthetic osteolysis is noted while correlation analysis of radiolucency score suggests extended, long-term investigation.
Clinical characteristics of Epstein–Barrvirus infection in the pediatric nervous system
Authors: Cheng Huan , Chen Doudou , Peng XiaoLing , wu Peng , Jang Li , Hu Yue
Published: November 2020

Background: To investigate the clinical characteristics of Epstein–Barr virus (EBV) infection in the pediatric nervous system (NS).Methods: We retrospectively analyzed the clinical data and follow-up results of 89 children with neurological damage caused by EBV who were hospitalized in the children's hospital of Chongqing Medical University from January 2008 to April 2019.Results: EBV infection of the NS can occur at any time of the year. The highest incidence was seen in the age group of 0–4 years. Fever is the main clinical feature (74/89, 83.1%). The main clinical types were encephalitis/meningoencephalitis (64/89, 71.9%), acute myelitis (2/89, 2.2%), acute disseminated encephalomyelitis (ADEM) (3/89, 3.4%), Guillain–Barré Syndrome (GBS) (15/89, 16.9%), neurological damage caused by EBV-hemophagocytic lymphohistiocytosis (EBV-HLH) (4/89, 4.5%), and NS-post-transplant lymphoproliferative disorder (NS-PTLD) (1/89, 1.1%). Anti-N-methyl-D-aspartate receptor encephalitis was found during the convalescence of EBV encephalitis. EBV encephalitis/meningitis showed no symptoms of tonsillitis, lymph node enlargement, skin rash, hepatosplenomegaly. Acute motor axonal neuropathy is the chief complication in GBS caused by EBV.Conclusion: There were significant differences in neurological complications caused by EBV. The prognosis of EBV infection in the NS is generally good. These illnesses are often self-limiting. A few cases may show residual sequelae.
Altered Metabolism of Mothers of Young Children with Autism Spectrum Disorder: A Case Control Study
Authors: Hollowood-Jones Kathryn , Adams James B. , Coleman Devon M. , Ramamoorthy Sivapriya , Melnyk Stephan , James S. Jill , Woodruff Bryan K. , Pollard Elena L. , Snozek Christine L. , Kruger Uwe , Chuah Joshua , Hahn Juergen
Published: November 2020

Background: Previous research studies have demonstrated abnormalities in the metabolism of mothers of young children with autism.Method: Metabolic analysis was performed on blood samples from 30 mothers of young children with Autism Spectrum Disorder (ASD-M) and from 29 mothers of young typically-developing children (TD-M). Targeted metabolic analysis focusing on the folate one-carbon metabolism (FOCM) and the transsulfuration pathway (TS) as well as broad metabolic analysis were performed. Statistical analysis of the data involved both univariate and multivariate statistical methods.Results: Univariate analysis revealed significant differences in 5 metabolites from the folate one-carbon metabolism and the transsulfuration pathway and differences in an additional 48 metabolites identified by broad metabolic analysis, including lower levels of many carnitine-conjugated molecules. Multivariate analysis with leave-one-out cross-validation allowed classification of samples as belonging to one of the two groups of mothers with 93% sensitivity and 97% specificity with five metabolites. Furthermore, each of these five metabolites correlated with 8-15 other metabolites indicating that there are five clusters of correlated metabolites. In fact, all but 5 of the 50 metabolites with the highest area under the receiver operating characteristic curve were associated with the five identified groups. Many of the abnormalities appear linked to low levels of folate, vitamin B12, and carnitine-conjugated molecules.Conclusions: Mothers of children with ASD have many significantly different metabolite levels compared to mothers of typically developing children at 2-5 years after birth.
Transmission potential and forecasting of the number of Coronavirus disease 2019 cases in Hubei Province, China
Authors: Wang Ke-wei , Gao Jie , Wang Hua , Wu Xiao-long , Yuan Qin-fang , Cheng Yang
Published: November 2020

Background: Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, Hubei Province, China. We aimed to describe the temporal and spatial distribution and the transmission dynamics of COVID-19 and to assess whether a hybrid model can forecast the trend of COVID-19 in Hubei Province.Method: The data of COVID-19 cases were obtained from the website of the Chinese Center for Disease Control and Prevention, whereas the data on the resident population were obtained from the website of the Hubei Provincial Bureau of Statistics. The temporal and spatial distribution and the transmission dynamics of COVID-19 were described. A combination of an autoregressive integrated moving average (ARIMA) and a support vector machine (SVM) was constructed to forecast the trend of COVID-19.Results: A total of 56,062 confirmed COVID-19 cases, which were mainly concentrated in Wuhan, were reported from 16 January to 16 March 2020 in Hubei Province. The daily number of confirmed cases exponentially increased to 3,156 before 4 February 2020, fluctuated on an upward trend to 4,823 before 13 February 2020, and then markedly decreased to one case after 16 March 2020. The highest mean reproduction number R(t) of 9.48 was recorded on 16 January 2020, after which it decreased to 2.15 on 2 February 2020 and further dropped to less than one on 13 February 2020. In the modelling stage, the mean square error, mean absolute error and mean absolute percentage error of the hybrid ARIMA–SVM model decreased by 98.59%, 89.19% and 89.68%, and those of SVM decreased by 98.58%, 87.71% and 88.94% compared with the ARIMA model. Similar results were obtained in the forecasting stage.Conclusion: Public health interventions resulted in the terminal phase of COVID-19 in Hubei Province. The hybrid ARIMA–SVM model may be a reliable tool for forecasting the trend of the COVID-19 epidemic.
Survival Benefit of Ixazomib, Lenalidomide and Dexamethasone (IRD) over Lenalidomide and Dexamethasone (Rd) in Relapsed and Refractory Multiple Myeloma Patients in Routine Clinical Practice
Authors: Minarik Jiri , Pika Tomas , Radocha Jakub , Jungova Alexandra , Straub Jan , Jelinek Tomas , Pour Ludek , Pavlicek Petr , Mistrik Martin , Brozova Lucie , Krhovska Petra , Machalkova Katerina , Jindra Pavel , Spicka Ivan , Plonkova Hana , Stork Martin , Bacovsky Jaroslav , Capkova Lenka , Sykora Michal , Kessler Petr , Stejskal Lukas , Heindorfer Adriana , Ullrychova Jana , Skacel Tomas , Maisnar Vladimir , Hajek Roman
Published: November 2020

Background: We have performed a head to head comparison of all-oral triplet combination of ixazomib, lenalidomide and dexamethasone (IRD) versus lenalidomide and dexamethasone (RD) in patients with relapsed and refractory multiple myeloma (RRMM) in the routine clinical practice. Methods: A total of 344 patients treated with IRD (N=127) or RD (N=217) were selected for analysis from the Czech Registry of Monoclonal Gammopathies (RMG). Descriptive statistics were used to assess patient’s characteristics associated with the respective therapy. The primary endpoint was progression free survival (PFS), secondary end points included response rates and overall survival (OS). Survival endpoints were plotted using Kaplan-Meier methodology at 95% Greenwood confidence interval. Univariable and multivariable Cox proportional hazards models were used to evaluate the effect of treatment regimens and the significance of uneven variables. Statistical tests were performed at significance level 0.05.Results: In the whole cohort, median PFS for IRD was 17.5 and for RD was 11.5 months favoring the all-oral triplet, p = 0.005; in patients within relapse 1-3, the median PFS was 23.1 vs 11.6 months, p = 0.001. The hazard ratio for PFS was 0.67 (95% confidence interval [CI] 0.51 – 0.89, p = 0.006). The PFS advantage translated into improved OS for patients treated with IRD, median 36.6 months vs 26.0 months (p = 0.008). The overall response rate (ORR) was 73.0 % in the IRD group vs 66.2 % in the RD group with a complete response rate (CR) of 11.1 % vs 8.8 %, and very good partial response (VGPR) 22.2 % vs 13.9 %, IRD vs RD respectively. The IRD regimen was most beneficial in patients ≤75 years with ISS I, II, and in the first and second relapse. Patients with the presence of extramedullary disease did not benefit from IRD treatment (median PFS 6.5 months). Both regimens were well tolerated, and the incidence of total as well as grade 3/4 toxicities was comparable. Conclusions: Our analysis confirms the results of the TOURMALINE-MM1 study and shows benefit of all-oral triplet IRD treatment versus RD doublet. It demonstrates that the addition of ixazomib to RD improves key survival endpoints in patients with RRMM in a routine clinical setting.
Addressing the quality of paediatric primary care: Health worker and caregiver perspectives from a process evaluation of PACK Child, a health systems intervention in South Africa
Authors: Curran Robyn Leigh , Murdoch Jamie , Bachmann Max , Bateman Eric , Cornick Ruth , Picken Sandy , Simelane Makhosazana Lungile , Fairall Lara
Published: November 2020

Background: The WHO’s Integrated Management of Childhood Illness (IMCI) has resulted in progress in addressing infant and child mortality. However, unmet needs of children continue to present a burden upon primary healthcare services. The capacity of services and quality of care offered require greater support to address these needs by extending and integrating curative and preventive care for the child with a long-term health condition and the child older than 5, not prioritised in IMCI. In response to these needs, the PACK Child intervention was developed and piloted in 2017-2019 in the Western Cape Province of South Africa,. We report health worker and caregiver perspectives of the existing paediatric primary care context as well as the extent to which PACK Child functions to address perceived problems within the current local healthcare system. Methods: This process evaluation involved 52 individual interviews with caregivers, 10 focus group discussions with health workers, 3 individual interviews with trainers, and 31 training observations. Interviews and focus groups explored participants’ experiences of paediatric primary care, perspectives of the PACK Child intervention, and tensions with implementation in each context. Inductive thematic analysis was used to analyse verbatim interview and discussion transcripts.Results: Perspectives of caregivers and health workers suggest an institutionalised focus of paediatric primary care to treating children’s symptoms as acute episodic conditions. Health workers’ reports imply that this focus is perpetuated by interactions between contextual features such as, IMCI policy, documentation-driven consultations, overcrowded clinics and verticalised care. Whilst these contextual conditions constrained health workers’ ability to translate skills developed within PACK Child training into practice, the intervention initiated expanded care of children 0-13 years and those with long-term health conditions, enhanced professional competence, improved teamwork and referrals, streamlined triaging, and facilitated probing for psychosocial risk.Conclusion: PACK Child appears to be catalysing paediatric primary care to address the broader needs of children, including long-term health conditions and the identification of psychosocial problems. However, to maximise this requires primary care to re-orientate from risk minimisation on the day of attendance towards a view of the child beyond the day of presentation at clinics.
Out-of-sample Predictability of Economic Efficiency Measures of U.S. Banks: Evidence of capital adequacy requirements
Authors: Sakouvogui Kekoura
Published: November 2020

This paper contributes to the sparse debate on the effect of capital adequacy requirements on banks' economic efficiency measures. Precisely, we evaluate the out-of-sample predictability of capital adequacy requirements on banks' economic efficiency measures using Support Vector Regression (SVR) model with Linear, Polynomial and Radial Basis Function kernels and ordinary least squares (OLS) model. This analysis is important because a prediction of economic efficiency measures allows for an untangle view of bank's progress that is useful for management as it gains a high degree of transparency in the evaluation of future events. Our framework adapts optimization of h-block cross-validation to account for serial correlation of economic variables to produce robust sets of tuning parameters for SVR model. Using a total of 10,380 December quarterly observations of U.S Commercial and Domestic banks spanning from 2008 through 2019, empirical results show that SVR model provides better benchmarking in-sights in the evaluation of economic efficiency measures compared to the OLS model. Furthermore, in contrast to previous approaches identifying a single "best" model among competing models, the results of Model Confidence Test suggests that the out-of-sample forecasting confidently identifies superior predictive accuracy of SVR model-based forecasts over OLS model.
Adenovirus Viremia Predicts Adenovirus Pneumonia Severity in Immunocompetent Children
Authors: Zhang Ruimu , Wang Hongmei , Tian Shufeng , Deng Jikui
Published: November 2020

Background: Previous studies have demonstrated an association between adenovirus viremia and disease severity in immunocompromised children. However, few studies focused on the use of this approach in immunocompetent children. This study explored the association between adenovirus viremia and adenovirus pneumonia severity in immunocompetent children. Methods: We did a retrospective, observational study of immunocompetent children with adenovirus pneumonia admitted in Shenzhen Children’s hospital in Shenzhen, China. Pneumonia was classified as severe or mild, based on the Chinese guideline of pneumonia severity classification. The serum of all the children in the study was tested for adenovirus DNA with quantitative polymerase chain reaction (PCR). Clinical manifestations, laboratory examinations, and disease severity were compared between these two groups. Results: A total of 111 immunocompetent children with adenovirus pneumonia (60 severe, 51 mild) were included. The median age was 40 months and 64 patients were male. Five patients were admitted to intensive care unit and two were endotracheal intubated. All the patients were discharged with recovery or improvement. Univariate analysis and binary logistic regression analysis showed leukocytosis (OR = 1.1; 95% CI: 1.0 to 1.2; P = 0.033), co-infection of mycoplasma pneumoniae (OR = 5.0; 95% CI: 2.1 to 12.3; P < 0.001), and high blood viral load (OR = 1.5; 95% CI: 1.2 to 2.0; P = 0.001) were risk factors for severe adenovirus pneumonia. Conclusions: Leukocytosis, co-infection of mycoplasma pneumoniae, and high blood viral load are risk factors for severe adenovirus pneumonia in immunocompetent children. Blood viral load predicts pneumonia severity.