bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of genome-wide genetic variations between two varieties of tea plant (Camellia sinensis) and development of InDel markers for genetic research
Authors: Liu Shengrui , An Yanlin , Tong Wei , Qin Xiuju , Samarina Lidia , Guo Rui , Xia Xiaobo , Wei Chaoling
Published: December 2019

Background

Single nucleotide polymorphisms (SNPs) and insertions/deletions (InDels) are the major genetic variations and are distributed extensively across the whole plant genome. However, few studies of these variations have been conducted in the long-lived perennial tea plant.

Results

In this study, we investigated the genome-wide genetic variations betweenCamellia sinensis var. sinensis‘Shuchazao’ andCamellia sinensis var. assamica‘Yunkang 10’, identified 7,511,731 SNPs and 255,218 InDels based on their whole genome sequences, and we subsequently analyzed their distinct types and distribution patterns. A total of 48 InDel markers that yielded polymorphic and unambiguous fragments were developed when screening six tea cultivars. These markers were further deployed on 46 tea cultivars for transferability and genetic diversity analysis, exhibiting information with an average 4.02 of the number of alleles (Na) and 0.457 of polymorphism information content (PIC). The dendrogram showed that the phylogenetic relationships among these tea cultivars are highly consistent with their genetic backgrounds or original places. Interestingly, we observed that the catechin/caffeine contents between ‘Shuchazao’ and ‘Yunkang 10’ were significantly different, and a large number of SNPs/InDels were identified within catechin/caffeine biosynthesis-related genes.

Conclusion

The identified genome-wide genetic variations and newly-developed InDel markers will provide a valuable resource for tea plant genetic and genomic studies, especially the SNPs/InDels within catechin/caffeine biosynthesis-related genes, which may serve as pivotal candidates for elucidating the molecular mechanism governing catechin/caffeine biosynthesis.
Needs assessment of emergency medical and rescue services in Abuja/Nigeria and environs
Authors: Mac Peter Asaga , Kroeger Axel , Airiohuodion Philomena Ehi
Published: December 2019

Background

Nigeria is ranked second highest in the rate of road accidents and other emergencies (Deaths, disabilities) among 193 countries of the world. There is therefore the need for analyzing Emergency Medical Rescue Services (EMRS) in the country to identify options for improvement.

Method

The study was conducted from February, 2016 to March, 2017 in three EMRS organizations (FRSC, NEMA and MAITAMA Hospital) located in Abuja. The structure, resources, process of EMRS activities and outcome (delay times, case fatality as well as victims and service-providers satisfaction with services) were assessed through observation, time measurements and interviews.

Results

FRSC and NEMA offers (Road Traffic Injury) RTI and Disaster services, the ambulances consist of Intensive Care Unit(ICU) buses, Helicopters, Speed boats, motorbikes and other specialized vehicles. Mortality and morbidity recorded for 2016 was 1.1 and 2% respectively. MAITAMA is a specialist centre that offers general medical services. A total number 1227(88.8%) lives were saved during the observational period by three organizations, 60(4.9%) deaths, 132 (9.6%) disabilities, 793 (57.2%) NCDs and 593(42.8%) RTI.

Conclusion

Non-communicable diseases (NCDs) cause many deaths and morbidities in the developing world compared to infectious diseases. There is need for total revamping and education of EMRS institutions in Nigeria and Low- Middle Income Countries (LMICs). Abuja and its surroundings suffers from delays in rapid emergency services, lack of adequate awareness, functional ambulances, minimal specialists and inadequate consumables lead to the loss of many lives.
Healthy ageing and the prediction of mortality and incidence dependence in low- and middle- income countries: a 10/66 population-based cohort study
Authors: Daskalopoulou Christina , Prince Martin , Koukounari Artemis , Haro Josep Maria , Panagiotakos Demosthenes B. , Prina A. Matthew
Published: December 2019

Background

In the absence of a consensus on definition and measurement of healthy ageing, we created a healthy ageing index tallying with the functional ability framework provided by the World Health Organization. To create this index, we employed items of functional ability and intrinsic capacity. The current study aims to establish the predictive validity and discrimination properties of this healthy ageing index in settings in Latin American, part of the 10/66 cohort.

Methods

Population-based cohort studies including 12,865 people ≥65 years old in catchment areas of Cuba, Dominican Republic, Venezuela, Mexico and Peru. We employed latent variable modelling to estimate the healthy ageing scores of each participant. We grouped participants according to the quintiles of the healthy ageing score distribution. Cox’s proportional hazard models for mortality and sub-hazard (competing risks) models for incident dependence (i.e. needing care) were calculated per area after a median of 3.9 years and 3.7 years, respectively. Results were pooled together via fixed-effects meta-analysis. Our findings were compared with those obtained from self-rated health.

Results

Participants with lowest levels, compared to participants with highest level of healthy ageing, had increased risk of mortality and incident dependence, even after adjusting for sociodemographic and health conditions (HR: 3.25, 95%CI: 2.63–4.02; sub-HR: 5.21, 95%CI: 4.02–6.75). Healthy ageing scores compared to self-rated health had higher population attributable fractions (PAFs) for mortality (43.6% vs 19.3%) and incident dependence (58.6% vs 17.0%), and better discriminative power (Harrell’s c-statistic: mortality 0.74 vs 0.72; incident dependence 0.76 vs 0.70).

Conclusion

These results provide evidence that our healthy ageing index could be a valuable tool for prevention strategies as it demonstrated predictive and discriminative properties. Further research in other cultural settings will assist moving from a theoretical conceptualisation of healthy ageing to a more practical one.
Privacy-protecting estimation of adjusted risk ratios using modified Poisson regression in multi-center studies
Authors: Shu Di , Young Jessica G. , Toh Sengwee
Published: December 2019

Background

Multi-center studies can generate robust and generalizable evidence, but privacy considerations and legal restrictions often make it challenging or impossible to pool individual-level data across data-contributing sites. With binary outcomes, privacy-protecting distributed algorithms to conduct logistic regression analyses have been developed. However, the risk ratio often provides a more transparent interpretation of the exposure-outcome association than the odds ratio. Modified Poisson regression has been proposed to directly estimate adjusted risk ratios and produce confidence intervals with the correct nominal coverage when individual-level data are available. There are currently no distributed regression algorithms to estimate adjusted risk ratios while avoiding pooling of individual-level data in multi-center studies.

Methods

By leveraging the Newton-Raphson procedure, we adapted the modified Poisson regression method to estimate multivariable-adjusted risk ratios using only summary-level information in multi-center studies. We developed and tested the proposed method using both simulated and real-world data examples. We compared its results with the results from the corresponding pooled individual-level data analysis.

Results

Our proposed method produced the same adjusted risk ratio estimates and standard errors as the corresponding pooled individual-level data analysis without pooling individual-level data across data-contributing sites.

Conclusions

We developed and validated a distributed modified Poisson regression algorithm for valid and privacy-protecting estimation of adjusted risk ratios and confidence intervals in multi-center studies. This method allows computation of a more interpretable measure of association for binary outcomes, along with valid construction of confidence intervals, without sharing of individual-level data.
Maternal characteristics and outcomes affected by hypothyroidism during pregnancy (maternal hypothyroidism on pregnancy outcomes, MHPO-1)
Authors: Kiran Zareen , Sheikh Aisha , Malik Sarwar , Meraj Areeba , Masood Maha , Ismail Safana , Rashid Muhammad Owais , Shaikh Quratulain , Majeed Numan , Sheikh Luman , Islam Najmul
Published: December 2019

Background

Hypothyroidism in pregnancy is an arena of ongoing research, with international conflicts regarding screening, management, and outcomes. Various studies have described the outcomes depending on geographical and international diagnostic criteria. No study has been conducted in this regard from the region of Pakistan. Therefore, we aim to report the clinical features and maternal outcomes of hypothyroid pregnancies and compare the maternal outcomes between uncontrolled and controlled TSH levels in the preconception as well as the gestational period.

Methods

We conducted a cross-sectional retrospective study on 718 cases in the Aga Khan University Hospital after ethical approval. We collected information on pregnant females who have diagnosed hypothyroidism before conception or during their antenatal period. We noted the maternal characteristics and maternal comorbidities. Laboratory data were recorded for thyroid stimulating hormone levels before conception and during gestation. We recorded maternal outcomes as pregnancy loss (including miscarriage, stillbirth/intrauterine death, medical termination of pregnancy and ectopic pregnancy), gestational hypertension, pre-eclampsia, postpartum hemorrhage, placental abruption, and modalities of delivery. Data analysis was performed on Statistical Package for the Social Sciences version 20.0.

Results

Among 708 hypothyroid women 638 had live births. Postpartum hemorrhage was the most frequent maternal outcome (38.8%). The emergency cesarean section occurred in 23.4% of cases. We determined TSH levels in 53.2, 56.7, 61.7 and 66.6% of cases in preconception, 1st, 2nd, and 3rd trimester periods. A significant association existed between cesarean section and preconception thyrotropin levels > 2.5 mIU/L, whereas postpartum hemorrhage was significantly associated with thyrotropin levels > 2.5 mIU/L in the preconception and third trimester.

Conclusion

Successful live births in our patients were complicated by maternal postpartum hemorrhage and a frequent number of emergency cesarean section.
Serum metallome in pregnant women and the relationship with congenital malformations of the central nervous system: a case-control study
Authors: Troisi Jacopo , Giugliano Luigi , Sarno Laura , Landolfi Annamaria , Richards Sean , Symes Steven , Colucci Angelo , Maruotti Giuseppe , Adair David , Guida Marco , Martinelli Pasquale , Guida Maurizio
Published: December 2019

Background

Congenital malformations of the central nervous system (CNS) consist of a wide range of birth defects of multifactorial origin.

Methods

Concentrations of 44 metals were determined by Inductively Coupled Plasma Mass Spectrometry in serum of 111 mothers in the second trimester of pregnancy who carried a malformed fetus and compared them with serum concentrations of the same metals in 90 mothers with a normally developed fetus at the same week of pregnancy.

Data are reported as means ± standard deviations.

Results

We found a direct relationship between congenital defects of the CNS and maternal serum concentration of aluminum: it was statistically higher in women carrying a fetus with this class of malformation, compared both to mothers carrying a fetus with another class of malformation (6.45 ± 15.15 μg/L Vs 1.44 ± 4.21 μg/L, p < 0.0006) and to Controls (i.e. mothers carrying a normally-developed fetus) (6.45 ± 15.15 μg/L Vs 0.11 ± 0.51 μg/L, p < 0.0006). Moreover, Aluminum abundances were below the limit of detection in the majority of control samples.

Conclusion

CAluminum may play a role in the onset of central nervous system malformations, although the exact Aluminum species and related specific type of malformation needs further elucidation.
Family dissolution and children’s social well-being at school: a historic cohort study
Authors: Laursen Line Lund , Madsen Kathrine Bang , Obel Carsten , Hohwü Lena
Published: December 2019

Background

Family dissolution has become more common and one third of the child population in most Western countries now experience family dissolution. Studies show that children from dissolved families have lower levels of social well-being than children from intact families, but only few studies have examined the impact on social well-being specifically in the school setting. We investigated the association between family dissolution and children’s social well-being at school, including the possible influence of the child’s age at the time of the family dissolution.

Methods

We defined a historic cohort study of 219,226 children and adolescents aged 9–16 years and combined demographic registry data of family structure with questionnaire data on social well-being based on the Danish National Well-being Questionnaire completed in 2015. The definition of social well-being was constructed on the children’s perception of sense of belonging in the school setting, in the class and the school community, as well as perceptions on safety, loneliness and bullying. We examined low social well-being according to family dissolution and used multiple logistic regression analyses to adjust for parental educational level, ethnicity and siblings and further stratified for gender and age.

Results

A total of 5% of the children had a low social well-being at school. Among the 31% who lived in dissolved families, we found more children with a low level of social well-being at school (adjusted OR 1.41, 95% CI 1.36;1.47) than those in intact families; especially among those who at the time of family dissolution were in the preschool age (1.55, 95% CI 1.47;1.64).

Conclusion

Children from dissolved families had higher odds for low social well-being at school compared with children from intact families, especially those who experienced family dissolution in the preschool age. The school may be an important setting for identifying and providing help and support in children experiencing family dissolution.
Participatory development and pilot testing of the Makasi intervention: a community-based outreach intervention to improve sub-Saharan and Caribbean immigrants’ empowerment in sexual health
Authors:   for the MAKASI Study Group, Gosselin Anne , Carillon Séverine , Coulibaly Karna , Ridde Valéry , Taéron Corinne , Kohou Veroska , Zouménou Iris , Mbiribindi Romain , Derche Nicolas , Desgrées du Loû Annabel
Published: December 2019

Background

Sub-Saharan and Caribbean immigrants are particularly affected by HIV in Europe, and recent evidence shows that a large portion of them acquired HIV after arrival. There is a need for efficient interventions that can reduce immigrants’ exposure to HIV. We describe the pilot phase of a community-based empowerment outreach intervention among sub-Saharan and Caribbean immigrants in the greater Paris area aimed at 1) constructing the intervention, 2) assessing its feasibility, and 3) assessing the feasibility of its evaluation based on a stepped-wedge approach.

Methods

1) To develop the intervention, a literature review was conducted on existing interventions and participatory approaches developed, including the constitution of peer groups. 2) To assess the intervention’s feasibility, a pilot was conducted between April 2018 and December 2018. A daily register was used to collect data on sociodemographic characteristics of all persons who visited the mobile team to assess eligibility and acceptability. 3) To assess the feasibility of performing a stepped-wedge trial to evaluate the intervention, we compared eligibility, enrolment and retention at 3 months in two arms (immediate vs deferred). Chi-squared tests were used to compare reach and retention between the two arms.

Results

Intervention development.The Makasi intervention was designed as an outreach intervention that starts with the persons’ capacities and helps them appropriate existing resources and information and obtain knowledge about sexual health,based upon motivational interviewing techniques.

Intervention Feasibility.Between April 2018 and December 2018, a total of 485 persons were identified as eligible. Participation in the intervention was proposed to 79% of eligible persons. When proposed, the persons enrolled in the intervention with a response rate of 69%. Some were lost to follow-up, and 188 persons were finally included.

Evaluation Feasibility.The proportions of eligible (45 and 42%) individuals and of enrolled individuals (65 and 74%) were similar and not significantly different in the immediate and deferred arms, respectively.

Conclusions

A community-based outreach intervention aimed at improving sub-Saharan and Caribbean immigrants’ empowerment in sexual health is feasible. The pilot phase was key to identifying challenges, designing a relevant intervention and validating the stepped-wedge protocol for evaluation.
Influence of Glenosphere and baseplate parameters on Glenoid bone strains in reverse shoulder Arthroplasty
Authors: Pauzenberger Leo , Dwyer Cory , Obopilwe Elifho , Nowak Michael D. , Cote Mark , Romeo Anthony A. , Mazzocca Augustus D. , Dyrna Felix
Published: December 2019

Background

Little is known about the strains at the glenoid near the bone-implant interface in reverse shoulder arthroplasty. The purpose of the current study was to evaluate the strains on the glenoid bone under a compressive load after implantation of three different sizes of metal-backed baseplates in either inferior or superior position in combination with three different sizes of glenospheres and three different glenosphere designs.

Methods

Three sizes of baseplates (small, medium, large) were implanted in thirty-six paired human cadaveric scapulae either inferior, flush with the glenoid neck, or with a 5 mm superior offset. Glenospheres were available in three sizes (36 mm, 39 mm, 42 mm) and designs (standard, 4 mm lateralized, 2.5 mm inferiorized). Specimens were mounted in a servo-hydraulic testing apparatus at a 60° angle between the glenoid and actuator holding the humeral component. Four strain-gauge rosettes were placed around the glenoid rim to measure strains transferred to the scapular bone under a compressive load (750 N) relative to the various baseplate-glenosphere combinations. Following repeated compression, a load-to-failure test was performed.

Results

Mean overall registered strains were 161με (range: − 1165 to 2347) at the inferior sensor, −2με (range: − 213 to 90) at the superior sensor, −95με (range: − 381 to 254) at the anterior sensor, and 13με (range: − 298 to 128) at the posterior sensor. Measured bone strains did not show any significant differences across tested baseplate and glenosphere design, size, or positioning combinations (p > 0.05for all sensors). Furthermore, linear regression analysis did not identify any of the evaluated parameters as an independent influential factor for strains (p > 0.05for all sensors). Mean load-at-failure was significantly higher in the group of inferior (3347.0 N ± 704.4 N) compared to superior (2763.8 N ± 927.8 N) positioned baseplates(p = 0.046).

Conclusion

Different baseplate positions, baseplate sizes, glenosphere sizes, and glenosphere design or various combinations of these parameters did not significantly influence the measured bone strains at the glenoid near the bone-implant interface in a contemporary reverse shoulder arthroplasty system.

Level of evidence

Basic Science Study, Biomechanical Study.
Natural language processing for populating lung cancer clinical research data
Authors: Wang Liwei , Luo Lei , Wang Yanshan , Wampfler Jason , Yang Ping , Liu Hongfang
Published: December 2019

Background

Lung cancer is the second most common cancer for men and women; the wide adoption of electronic health records (EHRs) offers a potential to accelerate cohort-related epidemiological studies using informatics approaches. Since manual extraction from large volumes of text materials is time consuming and labor intensive, some efforts have emerged to automatically extract information from text for lung cancer patients using natural language processing (NLP), an artificial intelligence technique.

Methods

In this study, using an existing cohort of 2311 lung cancer patients with information about stage, histology, tumor grade, and therapies (chemotherapy, radiotherapy and surgery) manually ascertained, we developed and evaluated an NLP system to extract information on these variables automatically for the same patients from clinical narratives including clinical notes, pathology reports and surgery reports.

Results

Evaluation showed promising results with the recalls for stage, histology, tumor grade, and therapies achieving 89, 98, 78, and 100% respectively and the precisions were 70, 88, 90, and 100% respectively.

Conclusion

This study demonstrated the feasibility and accuracy of automatically extracting pre-defined information from clinical narratives for lung cancer research.
RCorp: a resource for chemical disease semantic extraction in Chinese
Authors: Sun Yueping , Hou Li , Qin Lu , Liu Yan , Li Jiao , Qian Qing
Published: December 2019

Background

To robustly identify synergistic combinations of drugs, high-throughput screenings are desirable. It will be of great help to automatically identify the relations in the published papers with machine learning based tools. To support the chemical disease semantic relation extraction especially for chronic diseases, a chronic disease specific corpus for combination therapy discovery in Chinese (RCorp) is manually annotated.

Methods

In this study, we extracted abstracts from a Chinese medical literature server and followed the annotation framework of the BioCreative CDR corpus, with the guidelines modified to make the combination therapy related relations available. An annotation tool was incorporated to the standard annotation process.

Results

The resulting RCorp consists of 339 Chinese biomedical articles with 2367 annotated chemicals, 2113 diseases, 237 symptoms, 164 chemical-induce-disease relations, 163 chemical-induce-symptom relations, and 805 chemical-treat-disease relations. Each annotation includes both the mention text spans and normalized concept identifiers. The corpus gets an inter-annotator agreement score of 0.883 for chemical entities, 0.791 for disease entities which are measured by F score. And the F score for chemical-treat-disease relations gets 0.788 after unifying the entity mentions.

Conclusions

We extracted and manually annotated a chronic disease specific corpus for combination therapy discovery in Chinese. The result analysis of the corpus proves its quality for the combination therapy related knowledge discovery task. Our annotated corpus would be a useful resource for the modelling of entity recognition and relation extraction tools. In the future, an evaluation based on the corpus will be held.
Applying a deep learning-based sequence labeling approach to detect attributes of medical concepts in clinical text
Authors: Xu Jun , Li Zhiheng , Wei Qiang , Wu Yonghui , Xiang Yang , Lee Hee-Jin , Zhang Yaoyun , Wu Stephen , Xu Hua
Published: December 2019

Background

To detect attributes of medical concepts in clinical text, a traditional method often consists of two steps: named entity recognition of attributes and then relation classification between medical concepts and attributes. Here we present a novel solution, in which attribute detection of given concepts is converted into a sequence labeling problem, thus attribute entity recognition and relation classification are done simultaneously within one step.

Methods

A neural architecture combining bidirectional Long Short-Term Memory networks and Conditional Random fields (Bi-LSTMs-CRF) was adopted to detect various medical concept-attribute pairs in an efficient way. We then compared our deep learning-based sequence labeling approach with traditional two-step systems for three different attribute detection tasks: disease-modifier, medication-signature, and lab test-value.

Results

Our results show that the proposed method achieved higher accuracy than the traditional methods for all three medical concept-attribute detection tasks.

Conclusions

This study demonstrates the efficacy of our sequence labeling approach using Bi-LSTM-CRFs on the attribute detection task, indicating its potential to speed up practical clinical NLP applications.
Type 2 diabetes and healthcare resource utilisation in the Kingdom of Bahrain
Authors: Salman Rabha AbdulAziz , AlSayyad Adel Salman , Ludwig Craig
Published: December 2019

Background

Type 2 diabetes is a growing health challenge in the Kingdom of Bahrain, and the disease exerts significant pressure on the healthcare system. The aim of this study was to assess the annual costs and understand the drivers of those costs in the country.

Methods

A sample of 628 patients diagnosed with type 2 diabetes were randomly selected from primary healthcare diabetes clinics, and the direct medical and indirect costs due to type 2 diabetes were analysed for a one-year period. The study used patients’ medical records, interviews and standardised frequency questionnaires to obtain data on demographic and clinical characteristics, complication status, treatment profile, healthcare resource utilisation and absenteeism due to diabetes. The indirect costs were estimated by using the human capital approach. The direct medical and indirect costs attributable to type 2 diabetes were extrapolated to the type 2 diabetes population in Bahrain.

Results

In 2015, the total direct medical cost of type 2 diabetes was 104.7 million Bahraini dinars (BHD), or 277.9 million US dollars (USD), and the average unit cost per person with type 2 diabetes (1162 BHD, or 3084 USD) was more than three times higher than for a person without the condition (372 BHD, or 987 USD). The healthcare costs for patients with both micro- and macrovascular complications were more than three times higher than for patients without complications. Thus, 9% of the patients consumed 21% of the treatment costs due to complications. Complications often lead to hospital admission, and 20% of the patients consumed almost 60% of the healthcare costs attributable to type 2 diabetes due to hospital admissions. The indirect cost due to absenteeism was 1.23 million BHD (3.26 million USD).

Conclusion

Type 2 diabetes exerts significant pressure on Bahrain’s healthcare system – primarily due to costly diabetes-related complications. It is therefore important to optimise the management and control of type 2 diabetes, thereby reducing the risk of disabling and expensive complications.
Association of glycemic variability with left ventricular diastolic function in type 2 diabetes mellitus
Authors: Yokota Shun , Tanaka Hidekazu , Mochizuki Yasuhide , Soga Fumitaka , Yamashita Kentaro , Tanaka Yusuke , Shono Ayu , Suzuki Makiko , Sumimoto Keiko , Mukai Jun , Suto Makiko , Takada Hiroki , Matsumoto Kensuke , Hirota Yushi , Ogawa Wataru , Hirata Ken-ichi
Published: December 2019

Background

Type 2 diabetes mellitus (T2DM) is a major cause of heart failure (HF) with preserved ejection fraction (HFpEF), usually presenting as left ventricular (LV) diastolic dysfunction. Thus, LV diastolic function should be considered a crucial marker of a preclinical form of DM-related cardiac dysfunction. However, the impact of glycemic variability (GV) on LV diastolic function in such patients remains unclear.

Methods

We studied 100 asymptomatic T2DM patients with preserved LV ejection fraction (LVEF) without coronary artery disease (age: 60 ± 14 years, female: 45%). GV was evaluated as standard deviation of blood glucose level using continuous glucose monitoring system for at least 72 consecutive hours. LV diastolic function was defined as mitral inflow E and mitral e’ annular velocities (E/e’), and > 14 was determined as abnormal.

Results

E/e’ in patients with high GV (≥ 35.9 mg/dL) was significantly higher than that in patients with low GV (11.3 ± 3.9 vs. 9.8 ± 2.8, p = 0.03) despite similar age, gender-distribution, and hemoglobin A1c (HbA1c). Multivariate logistic regression analysis showed that GV ≥ 35.9 mg/dL (odds ratio: 3.67; 95% confidence interval: 1.02–13.22; p < 0.05) was an independently associated factor, as was age, of E/e’ > 14. In sequential logistic models for the associations of LV diastolic dysfunction, one model based on clinical variables including age, gender and hypertension was not improved by addition of HbA1c (p = 0.67) but was improved by addition of high GV (p = 0.04).

Conclusion

Since HFpEF is a syndrome caused by diverse agents, reducing GV may represent a potential new therapeutic strategy for the prevention of the development of HFpEF in T2DM patients.
Assessing the role of the private sector in surveillance for malaria elimination in Haiti and the Dominican Republic: a qualitative study
Authors: Sidibe Abigail , Maglior Alysse , Cueto Carmen , Chen Ingrid , Le Menach Arnaud , Chang Michelle A. , Eisele Thomas P. , Andrinopolous Katherine , Cherubin Joseph , Lemoine Jean Frantz , Bennett Adam
Published: December 2019

Background

Haiti and the Dominican Republic (DR) are targeting malaria elimination by 2022. The private health sector has been relatively unengaged in these efforts, even though most primary health care in Haiti is provided by non-state actors, and many people use traditional medicine. Data on private health sector participation in malaria elimination efforts are lacking, as are data on care-seeking behaviour of patients in the private health sector. This study sought to describe the role of private health sector providers, care-seeking behaviour of individuals at high risk of malaria, and possible means of engaging the private health sector in Hispaniola’s malaria elimination efforts.

Methods

In-depth interviews with 26 key informants (e.g. government officials), 62 private providers, and 63 patients of private providers, as well as 12 focus group discussions (FGDs) with community members, were conducted within seven study sites in Haiti and the DR. FGDs focused on local definitions of the private health sector and identified private providers for interview recruitment, while interviews focused on private health sector participation in malaria elimination activities and treatment-seeking behaviour of febrile individuals.

Results

Interviews revealed that self-medication is the most common first step in the trajectory of care for fevers in both Haiti and the DR. Traditional medicine is more commonly used in Haiti than in the DR, with many patients seeking care from traditional healers before, during, and/or after care in the formal health sector. Private providers were interested in participating in malaria elimination efforts but emphasized the need for ongoing support and training. Key informants agreed that the private health sector needs to be engaged, especially traditional healers in Haiti. The Haitian migrant population was reported to be one of the most at-risk groups by participants from both countries.

Conclusion

Malaria elimination efforts across Hispaniola could be enhanced by engaging traditional healers in Haiti and other private providers with ongoing support and trainings; directing educational messaging to encourage proper treatment-seeking behaviour; and refining cross-border strategies for surveillance of the high-risk migrant population. Increasing distribution of rapid diagnostic tests (RDTs) and bi-therapy to select private health sector facilities, accompanied by adopting regulatory policies, could help increase numbers of reported and correctly treated malaria cases.
Antiplasmodial natural products: an update
Authors: Tajuddeen Nasir , Van Heerden Fanie R.
Published: December 2019

Background

Malaria remains a significant public health challenge in regions of the world where it is endemic. An unprecedented decline in malaria incidences was recorded during the last decade due to the availability of effective control interventions, such as the deployment of artemisinin-based combination therapy and insecticide-treated nets. However, according to the World Health Organization, malaria is staging a comeback, in part due to the development of drug resistance. Therefore, there is an urgent need to discover new anti-malarial drugs. This article reviews the literature on natural products with antiplasmodial activity that was reported between 2010 and 2017.

Methods

Relevant literature was sourced by searching the major scientific databases, including Web of Science, ScienceDirect, Scopus, SciFinder, Pubmed, and Google Scholar, using appropriate keyword combinations.

Results and Discussion

A total of 1524 compounds from 397 relevant references, assayed against at least one strain of Plasmodium, were reported in the period under review. Out of these, 39% were described as new natural products, and 29% of the compounds had IC50 ≤ 3.0 µM against at least one strain of Plasmodium. Several of these compounds have the potential to be developed into viable anti-malarial drugs. Also, some of these compounds could play a role in malaria eradication by targeting gametocytes. However, the research into natural products with potential for blocking the transmission of malaria is still in its infancy stage and needs to be vigorously pursued.
Pesticides and the evolution of the genetic structure of Anopheles coluzzii populations in some localities in Benin (West Africa)
Authors: Fassinou Arsène Jacques Y. H. , Koukpo Come Z. , Ossè Razaki A. , Agossa Fiacre R. , Azondékon Roseric , Sominahouin André , Kpanou Casimir , Sagbohan Hermann , Yovogan Boulais , Akogbéto Martin C. , Sezonlin Michel
Published: December 2019

Background

Changes in the natural habitats of insect groups are determined the genetic polymorphisms between individuals. The objective of this study was to establish the genetic structure of theAnopheles coluzziipopulations in four localities of Benin.

Methods

Insecticide surveys and larval sampling were conducted on 4 study localities, including Cotonou, Ketou, Zagnanado, and Sô-Ava. Molecular characterizations were performed on theAnophelesmosquitoes collected with the allelic and genotypic frequencies ofkdrgene determined. The multiple comparison Chi square test for proportions was performed with R version 3.3.3. Next, the observed heterozygosity, expected heterozygosity, and indices of fixation, and genetic differentiation were estimated. Finally, the Hardy–Weinberg equilibrium (EHW) was determined to assess whether panmixia exists in the different populations of mosquitoes of the agroecological zones under study.

Results

Carbamates, pyrethroids, organophosphorus and organochlorines use have been reported in all localities except Sô-Ava.Anopheles coluzziiwas strongly represented across all study localities. TheL1014Fallele was observed in the localities of Kétou, Cotonou and Zagnanado. Likewise, insecticide selection pressure of homozygous resistant individuals (L1014F/L1014F) was significantly higher in Kétou, Cotonou and Zagnanado (pvalue < 0.05). Surprisingly in Sô-Ava, a relatively high frequency of theL1014Fallele despite the reported absence of pesticide use was observed. All mosquito populations were found to be deficient in heterozygosity across the study sites (FIS< 0). No genetic differentiation (FST< 0) was observed in the localities of Zagnanado and Kétou.

Conclusion

The survey on the use of insecticides showed that insecticide selection pressures differ across the investigated localities. It would be desirable to rotate or apply formulations of combined products with different modes of action. Doing so would enable a better management of resistant homozygous individuals, and mitigate the resistance effect of commonly used insecticides.
Combining dual-tree complex wavelets and multiresolution in iterative CT reconstruction with application to metal artifact reduction
Authors: Us Defne , Ruotsalainen Ulla , Pursiainen Sampsa
Published: December 2019

Background

This paper investigates the benefits of data filtering via complex dual wavelet transform for metal artifact reduction (MAR). The advantage of using complex dual wavelet basis for MAR was studied on simulated dental computed tomography (CT) data for its efficiency in terms of noise suppression and removal of secondary artifacts. Dual-tree complex wavelet transform (DT-CWT) was selected due to its enhanced directional analysis of image details compared to the ordinary wavelet transform. DT-CWT was used for multiresolution decomposition within a modified total variation (TV) regularized inversion algorithm.

Methods

In this study, we have tested the multiresolution TV (MRTV) approach with DT-CWT on a 2D polychromatic jaw phantom model with Gaussian and Poisson noise. High noise and sparse measurement settings were used to assess the performance of DT-CWT. The results were compared to the outcome of the single-resolution reconstruction and filtered back-projection (FBP) techniques as well as reconstructions with Haar wavelet basis.

Results

The results indicate that filtering of wavelet coefficients with DT-CWT effectively removes the noise without introducing new artifacts after inpainting. Furthermore, adoption of multiple resolution levels yield to a more robust algorithm compared to varying the regularization strength.

Conclusions

The multiresolution reconstruction with DT-CWT is also more robust when reconstructing the data with sparse projections compared to the single-resolution approach and Haar wavelets.
One opioid user saving another: the first study of an opioid overdose-reversal and naloxone distribution program addressing hard-to-reach drug scenes in Denmark
Authors: Thylstrup Birgitte , Hesse Morten , Jørgensen Marian , Thiesen Henrik
Published: December 2019

Background

Overdose education and naloxone distribution programs decrease opioid overdose deaths. However, no studies of such programs have been carried out in Denmark. The aim of this study was to evaluate the feasibility and the effect of a broader “training-the-trainers” model in low-threshold settings after participation in the “Danish Save Lives” [SL] program.

Methods

Between May 2013 and November 2015, 552 participants from four municipalities took part in the SL program. The program is built on the train-the-trainers model where a central trainer trains others (trainers), who in turn train others (helpers). Participants were 30 police officers (5%), 188 people who use opioids (34%), 23 significant others (4%), and 217 social workers (39%). Ninety-four participants could not be classified (17%). At follow-up, participants were interviewed to determine the number and outcomes of opioid overdoses. Logistic regression was used to assess predictors of treating an overdose.

Results

In all, 37 (7%) participants had intervened in 45 opioid overdose events (two trainers and 35 helpers). Detailed descriptions of the overdose event were available from 32 follow-up interviews (70%). In 16 cases, the person who intervened was already present at the site when the overdose occurred, and in 17 cases, the overdose victim recovered without complications. All overdose victims survived except one. People who used opioids were more likely to have treated an overdose than other participants (adjusted odds ratio [AOR] = 8.50, p = 0.001), and the likelihood of treating and overdose declined over time AOR = 0.37 (0.13, 0.93), p = 0.034).

Conclusions

Prevention programs that target people who use opioids are more likely to be effective than programs that target professionals, especially in high-risk settings that can be hard for paramedics to reach. A future goal is to explore how prevention programs can be adapted to new user groups.

Trial registration

The Danish Data Protection Agency, 2015-57-0002, Aarhus University, 2016-051-000001, 184, retrospectively registered
Career mobility of maternal care providers in Mali: a mixed method study on midwives and obstetric nurses
Authors: Sidibé Cheick Sidya , Touré Ousmane , Codjia Laurence , Keïta Assa Sidibé , Broerse Jacqueline E. W. , Dieleman Marjolein
Published: December 2019

Background

An important strategy to reduce maternal and child mortality in Mali is to increase the number of deliveries assisted by qualified personnel in primary care facilities, especially in rural areas. However, placements and retention of healthcare professionals in rural areas are a major problem, not only in Mali but worldwide, and are a challenge to the health sector. The purpose of this study was to map the mobility of midwives and obstetric nurses during their work lives, in order to better understand their career paths and the role that working in rural areas plays. This article contributes to the understanding of career mobility as a determinant of the retention of rural health professionals.

Methods

A mixed method study was conducted on 2005, 2010, and 2015 cohorts of midwives and obstetric nurses. The cohorts have been defined by their year of graduation.

Quantitative data were collected from 268 midwives and obstetric nurses through questionnaires. Qualitative data had been gathered through semi-structured interviews from 25 midwives and stakeholders. A content analysis was conducted for the qualitative data.

Results

Unemployment rate was high among the respondents: 39.4% for midwives and 59.4% for obstetric nurses. Most of these unemployed nurses and midwives are working, but unpaid. About 80% of the employed midwives were working in urban facilities compared to 64.52% for obstetric nurses. Midwives were employed in community health centers (CSCom) (43%), referral health centers (CSRef) (20%), and private clinics and non-governmental organizations (NGO) (15%). The majority of midwives and obstetric nurses were working in the public sector (75.35%) and as civil servants (65.5%). The employment status of midwives and obstetric nurses evolved from private to public sector, from rural to urban areas, and from volunteer/unpaid to civil servants through recruitment competitions. Qualitative data supported the finding that midwives and obstetric nurses prefer to work as civil servant and preferably in urban areas and CSRef.

Conclusion

The current mobility pattern of midwives and obstetric nurses that brings them from rural to urban areas and towards a civil servant status in CSRef shows that it is not likely to increase their numbers in the short term in places where qualified midwives are most needed.
Analysing how physical activity competes: a cross-disciplinary application of the Duplication of Behaviour Law
Authors: Wilson Amy L. , Nguyen Cathy , Bogomolova Svetlana , Sharp Byron , Olds Timothy
Published: December 2019

Background

Despite the ongoing promotion of physical activity, the rates of physical inactivity remain high. Drawing on established methods of analysing consumer behaviour, this study seeks to understand how physical activity competes for finite time in a day – how Exercise and Sport compete with other everyday behaviours, and how engagement in physical activity is shared across Exercise and Sport activities. As targeted efforts are common in physical activity intervention and promotion, the existence of segmentation is also explored.

Methods

Time-use recall data (n = 2307 adults) is analysed using the Duplication of Behaviour Law, and tested against expected values, to document what proportion of the population that engage in one activity, also engage in another competing activity. Additionally, a Mean Absolute Deviation approach is used to test for segmentation.

Results

The Duplication of Behaviour Law is evident for everyday activities, and Exercise and Sport activities – all activities ‘compete’ with each other, and the prevalence of the competing activity determines the extent of competition. However, some activities compete more or less than expected, suggesting the combinations of activities that should be used or avoided in promotion efforts. Competition between everyday activities is predictable, and there are no specific activities that are sacrificed to engage in Exercise and Sport. How people share their physical activity across different Exercise and Sport activities is less predictable – Males and younger people (under 20 years) are more likely to engage in Exercise and Sport, and those who engage in Exercise and Sport are slightly more likely to Work and Study. High competition between Team Sports and Non-Team Sports suggests strong preferences for sports of different varieties. Finally, gender and age-based segmentation does not exist for Exercise and Sport relative to other everyday activities; however, segmentation does exist for Team Sports, Games, Active Play and Dance.

Conclusions

The Duplication of Behaviour Law demonstrates that population-level patterns of behaviour can yield insight into the competition between different activities, and how engagement in physical activity is shared across different Exercise and Sport activities. Such insights can be used to describe and predict physical activity behaviour and may be used to inform and evaluate promotion and intervention.
Proteomic analysis of cerebrospinal fluid extracellular vesicles reveals synaptic injury, inflammation, and stress response markers in HIV patients with cognitive impairment
Authors: Guha Debjani , Lorenz David R. , Misra Vikas , Chettimada Sukrutha , Morgello Susan , Gabuzda Dana
Published: December 2019

Background

Extracellular vesicles (EVs) are nano-sized particles present in most body fluids including cerebrospinal fluid (CSF). Little is known about CSF EV proteins in HIV+ individuals. Here, we characterize the CSF EV proteome in HIV+ subjects and its relationship to neuroinflammation, stress responses, and HIV-associated neurocognitive disorders (HAND).

Methods

CSF EVs isolated from 20 HIV+ subjects with (n = 10) or without (n = 10) cognitive impairment were characterized by electron microscopy, nanoparticle tracking analysis, immunoblotting, and untargeted LC/MS/MS mass spectrometry. Functional annotation was performed by gene ontology (GO) mapping and expression annotation using Biobase Transfac and PANTHER software. Cultured astrocytic U87 cells were treated with hydrogen peroxide for 4 h to induce oxidative stress and EVs isolated by ultracentrifugation. Selected markers of astrocytes (GFAP, GLUL), inflammation (CRP), and stress responses (PRDX2, PARK7, HSP70) were evaluated in EVs released by U87 cells following induction of oxidative stress and in CSF EVs from HIV+ patients by immunoblotting.

Results

Mass spectrometry identified 2727 and 1626 proteins in EV fractions and EV-depleted CSF samples, respectively. CSF EV fractions were enriched with exosomal markers including Alix, syntenin, tetraspanins, and heat-shock proteins and a subset of neuronal, astrocyte, oligodendrocyte, and choroid plexus markers, in comparison to EV-depleted CSF. Proteins related to synapses, immune/inflammatory responses, stress responses, metabolic processes, mitochondrial functions, and blood-brain barrier were also identified in CSF EV fractions by GO mapping. HAND subjects had higher abundance of CSF EVs and proteins mapping to GO terms for synapses, glial cells, inflammation, and stress responses compared to those without HAND. GFAP, GLUL, CRP, PRDX2, PARK7, and HSP70 were confirmed by immunoblotting of CSF EVs from subjects with HAND and were also detected in EVs released by U87 cells under oxidative stress.

Conclusions

These findings suggest that CSF EVs derived from neurons, glial cells, and choroid plexus carry synaptic, immune/inflammation-related, and stress response proteins in HIV+ individuals with cognitive impairment, representing a valuable source for biomarker discovery.