bluuebunny/crossref_metadata_2025 huggingface dataset:
Motivations, experiences and aspirations of Trainee Nursing Associates in England. A qualitative study
Authors: King Rachel Louise , Wood Emily , Robertson Steve , Ryan Tony , Tod Angela
Published: August 2020

Background: The nursing associate role was developed in England in response to the ‘Shape of Caring’ review. It has been implemented to fulfil two aims; to bridge the gap between registered nurses and healthcare assistants, and to provide an alternative route into registered nursing in light of workforce shortages. Other high income countries deploy second level nurses within their healthcare systems, however the UK has a turbulent history with such roles. The previous state enrolled nurse was phased out in the 1990s, and more recently the assistant practitioner (AP) role has faced wide variation in titles, scope and pay. Little is known about those who have embarked on the new nursing associate training course and their experiences of the role. Methods: An exploratory qualitative study was undertaken using focus groups of trainee nursing associates to generate in-depth discussion about their motivations, experiences of training, and career aspirations.Three focus groups (n=15) took place in December 2018 using a purposive sample of trainee nursing associates registered at a University in the North of England. Two researchers facilitated each group discussion at a time and place convenient for participants. The discussions were audio recorded, transcribed and data was analysed thematically.Results: This study found that trainee nursing associates are motivated by affordable, local, career development. During training they face challenges relating to clinical support, academic workload and uncertainty about future career opportunities. They experience role ambiguity both individually and across the wider organisation. Trainee nursing associates rely on broad support networks to build their occupational identity.Conclusions: The barriers and facilitators of trainee nursing associate personal development have implications for policy and practice relating to recruitment and retention. The results increase our understanding of this emerging role, and have informed the development of a larger longitudinal cohort study. Further research is required to evaluate the impact of this new role.
Improved ascertainment of modes of HIV transmission in Ukraine indicates importance of drug injecting and homosexual risk
Authors: Dumchev Kostyantyn , Kornilova Marina , Kulchynska Roksolana , Azarskova Marianna , Vitek Charles
Published: August 2020

Background: It is important to understand how HIV infection is transmitted in the population in order to guide prevention activities and properly allocate limited resources. In Ukraine and other countries where injecting drug use and homosexuality are stigmatized, the information about mode of transmission in case registration systems is often biased.Methods: We conducted a cross-sectional survey in a random sample of patients registered at HIV clinics in seven regions of Ukraine in 2013-2015. The survey assessed behavioral risk factors and serological markers of viral hepatitis B and C. We analyzed the discrepancies between the registered mode of transmission and the survey data, and evaluated trends over three years.Results: Of 2,285 participants, 1,032 (45.2%) were females. The proportion of new HIV cases likely caused by injecting drug use based on the survey data was 59.7% compared to 33.2% in official reporting, and proportion of cases likely acquired through homosexual transmission was 3.8% compared to 2.8%. We found a significant decrease from 63.2% to 57.5% in the proportion of injecting drug use-related cases and a steep increase from 2.5 to 5.2% in homosexual transmission over three years. Conclusions: The study confirmed the significant degree of misclassification of HIV mode of transmission among registered cases. The role of injecting drug use in HIV transmission is gradually decreasing, but remains high. The proportion of cases related to homosexual transmission is relatively modest, but is rapidly increasing, especially in younger men. Improvements in ascertaining the risk factor information are essential to monitor the epidemic and to guide programmatic response.
Unraveling the molecular heterogeneity in type 2 diabetes: A potential subtype discovery followed by metabolic modeling
Authors: Khoshnejat Maryam , Kavousi Kaveh , Banaei-Moghaddam Ali Mohammad , Moosavi-Movahedi Ali Akbar
Published: August 2020

BackgroundType 2 diabetes mellitus (T2DM) is a complex multifactorial disease with a high prevalence worldwide. Insulin resistance and impaired insulin secretion are the two major abnormalities in the pathogenesis of T2DM. Skeletal muscle is responsible for over 75% of the glucose uptake and plays a critical role in T2DM. Here, we sought to provide a better understanding of the abnormalities in this tissue. MethodsThe muscle gene expression patterns were explored in healthy and newly diagnosed T2DM individuals using supervised and unsupervised classification approaches. Moreover, the potential of subtyping T2DM patients was evaluated based on the gene expression patterns.ResultsA machine-learning technique was applied to identify a set of genes whose expression patterns could discriminate diabetic subjects from healthy ones. A gene set comprising of 26 genes was found that was able to distinguish healthy from diabetic individuals with 94% accuracy. In addition, three distinct clusters of diabetic patients with different dysregulated genes and metabolic pathways were identified. Conclusions This study indicates that T2DM is triggered by different cellular/molecular mechanisms, and it can be categorized into different subtypes. Subtyping of T2DM patients in combination with their real clinical profiles will provide a better understanding of the abnormalities in each group and more effective therapeutic approaches in the future.
Soft tissue sarcoma in adolescent and young adult patients: A retrospective study using a nationwide bone and soft tissue tumor registry in Japan.
Authors: Fukushima Takashi , Ogura Koichi , Akiyama Toru , Takeshita Katsushi , Kawai Akira
Published: August 2020

BackgroundCompared to young children or older adults, the prognoses of adolescent and young adult (AYA) patients with cancer, i.e., those aged from 15 to 39 years, have not improved. In this study, we focused on soft tissue sarcoma (STS) in AYA patients and aimed to determine whether there is a correlation between the AYA age group and overall poor cancer survival in STS. We further aimed to determine which histologic subtypes are more common in AYA patients and investigate the cause of poor outcomes in this group.MethodsThe medical records of 5853 Japanese patients diagnosed with STS between 2006 and 2013 were accessed from the Bone and Soft Tissue Tumor registry (BSTT). We analyzed and compared the epidemiological features of AYA patients with those of other age groups. The cancer survival rates were calculated using the Kaplan-Meier method. Cox proportional hazards models were used to analyze the prognostic factors for cancer survival. The primary endpoint for prognosis was the occurrence of tumor-related death.ResultsOn multivariate analysis, age was not a prognostic factor for poor cancer survival among these patients. Compared to the same categories in other age groups, the proportions of myxoid/round cell liposarcomas, synovial sarcomas, malignant peripheral nerve sheath tumors (MPNST), primitive neuroectodermal tumor, and rhabdomyosarcoma in AYA patients were the highest, but none of the categories were significantly more prevalent in AYA patients. The cancer survival rates of AYA patients with MPNST were poorer than those of the other age groups; however, AYA age was not a prognostic factor on multivariate analysis in MPNST patients.ConclusionsOur study is the first to investigate STS in AYA patients using the nationwide BSTT registry. Our findings demonstrate that AYA age is not a prognostic factor for poor cancer survival among those with STS in Japan.
Classifying maternal deaths in Suriname using WHO ICD-MM: different interpretation by physicians, national and international maternal death review committees
Authors: Kodan Lachmi , Verschueren Kim J.C. , McCaw-Binns Affette M. , Fat Ray Tjon Kon , Browne Joyce L. , Rijken Marcus J. , Bloemenkamp Kitty W.M.
Published: August 2020

Background Insight into the underlying causes of pregnancy-related deaths is essential to develop policies to avert preventable deaths. The WHO International Classification of Diseases-Maternal Mortality (ICD-MM) guidelines provide a framework to standardize maternal death classifications and enable comparison in and among countries over time. However, despite the implementation of these guidelines, differences in classification remain. We evaluated consensus on maternal death classification using the ICD-MM guidelines. Methods The classification of pregnancy-related deaths in Suriname during 2010-2014 was compared in the country (between the attending physician and the national maternal death review (MDR) committee), and among the MDR committees from Suriname, Jamaica and the Netherlands. All reviewers applied the ICD-MM guidelines. The inter-rater reliability (Fleiss kappa [κ]) was used to measure agreement.Results Out of the 89 cases certified by attending physicians, 47% (n=42) were classified differently by the Surinamese MDR committee. The three MDR committees agreed that 18% (n=16/89) of these cases were no maternal deaths, and, therefore, excluded from further analyses. However, opinions differed whether 15% (n=11) of the remaining 73 cases were maternal deaths. The MDR committees achieved moderate agreement classifying the deaths into type (direct, indirect and unspecified) (κ=0.53) and underlying cause group (κ=0.52). The Netherlands MDR committee classified more maternal deaths as unspecified (19%), than the Jamaican (7%) and Surinamese (4%) committees did. The mutual agreement between the Surinamese and Jamaican MDR committees (κ=0.69 vs κ=0.63) was better than between the Surinamese and the Netherlands MDR committees (κ=0.48 vs κ=0.49) for classification into type and underlying cause group, respectively. Agreement on the underlying cause category was excellent for abortive outcomes (κ=0.85) and obstetric hemorrhage (κ=0.74) and fair for unspecified (κ=0.29) and other direct causes (κ=0.32). Conclusions Maternal death classification differs in Suriname and among MDR committees from different countries, despite using the ICD-MM guidelines on similar cases. Specific challenges in applying these guidelines included attribution of underlying cause when comorbidities occurred, the inclusion of deaths from suicides, and maternal deaths that occurred outside the country of residence.
Genome-wide association studies of ionomic and agronomic traits in USDA mini core collection of rice and comparative analyses of different mapping methods
Authors: Liu Shuai , Zhong Hua , Meng Xiaoxi , Sun Tong , Li Yangsheng , Pinson Shannon R. M. , Chang Sam , Peng Zhaohua
Published: August 2020

BackgroundRice is an important human staple food vulnerable to heavy metal contamination leading to serious concerns. High yield with low heavy metal contamination is a common but highly challenging goal for rice breeders worldwide due to lack of genetic knowledge and markers. ResultsTo identify candidate QTLs and develop molecular markers for rice yield and heavy metal content, a total of 191 accessions from the USDA Rice mini-core collection with over 3.2 million SNPs were employed to investigate the QTLs. Sixteen ionomic and thirteen agronomic traits were analyzed utilizing two univariate (GLM and MLM) and two multivariate (MLMM and FarmCPU) GWAS methods. 106, 47, and 97 QTLs were identified for ionomics flooded, ionomics unflooded, and agronomic traits, respectively, with the criterium of p-value <1.53×10-8, which was determined by the Bonferroni correction for p-value of 0.05. While 49 (~20%) of the 250 QTLs were coinciding with previous reported QTLs/genes, about 201 (~80%) were new. In addition, several new candidate genes involved in ionomic and agronomic traits control were identified by analyzing the DNA sequence, gene expression, and the homologs of the QTL regions. Our results further showed that each of the four GWAS methods can identify unique as well as common QTLs, suggesting that using multiple GWAS methods can complement each other in QTL identification, especially by combining univariate and multivariate methods. ConclusionsWhile 49 previously reported QTLs/genes were rediscovered, over 200 new QTLs for ionomic and agronomic traits were found in the rice genome. Moreover, multiple new candidate genes for agronomic and ionomic traits were identified. This research provides novel insights into the genetic basis of both ionomic and agronomic variations in rice, establishing the foundation for marker development in breeding and further investigation on reducing heavy-metal contamination and improving crop yields. Finally, the comparative analysis of the GWAS methods showed that each method has unique features and different methods can complement each other.
Analysis of Risk Factor for Anastomotic Leakage after Lower Rectal Cancer Resection, Including Drain Type: A Retrospective Single-Center Study
Authors: Kinugasa Tetsushi , Nagasu Sachiko , Murotani Kenta , Mizobe Tomoaki , Ochi Takafumi , Isobe Taro , Fujita Fumihiko , Akagi Yoshito
Published: August 2020

Abstract
Background: We investigated the correlations between surgery-related factors and the incidence of leakage after low anterior resection (LAR) for lower rectal cancer.
Methods: A total of 630 patients underwent colorectal surgery between 2011 and 2014 in our department. Of these, 97 patients (15%) underwent LAR and were included in this retrospective study. Temporary ileostomy was performed in each patient.
Results: Anastomotic leakage occurred in 21 patients (21.7%). Univariate analysis showed that operative duration (p=0.005), transanal hand-sewn anastomosis (p=0.014), and operation procedure (p=0.019) were significantly associated with the occurrence of leakage. Multivariate analysis showed that underlying disease (p=0.044), transanal hand-sewn anastomosis (p=0.019) and drain type (p=0.025) were significantly associated with the occurrence of leakage. Propensity-score analysis showed that closed drainage were 6.3 times more likely to have anastomotic leakage than open drainage in relation to the amount of postoperative drainage (ml), according to inverse probability of treatment-weighted analysis .
Conclusions: Our results indicate that underlying disease, transanal hand-sewn anastomosis, and drain type may be risk factors for anastomotic after LAR for lower rectal cancer. The notable finding was that the type of drainage was related to the occurrence of anastomotic leakage: closed drainage was correlated with the less volume of postoperative drain discharge than open drain.
The Challenges of Ethical Behaviors for Drug Supply in the Iran Pharmacies by Principles-Based Approach
Authors: Iranmanesh Mahla , Yazdi-Feyzabadi Vahid , Mehrolhassani Mohammad Hossein
Published: August 2020

Background: Pharmacists as the trustee of pharmacy services must adhere to ethical principles and evaluate their professionalism. Pharmacists may sometimes show different unethical behaviors in their interactions, so it is essential to understand these behaviors. The present study aimed to determine the challenges of ethical behaviors based on a principles-based approach in the area of drug supply in pharmacies.Methods: This qualitative content analysis was conducted in Kerman in 2018. Several key players in the field of medication supply were selected using snowball sampling to be interviewed. An effort was made to select samples with maximum variation. Exclusion criteria include having less than 3 years of experience in pharmacy and supervision, not willing to participate in the interview, and canceling the interview 3 times. The participants in this study consisted of pharmacy technicians (n=5), patients (n=6), pharmacists (n=8), inspectors of insurance companies (n=4), and inspectors of food and drug administration (n=3). Data were analyzed using directed content analysis by Maxqda software version 10 (VERBI Software, Berlin, Germany). The principles of the “Beauchamp and Childress Ethics” theory including autonomy, beneficence, non-maleficence, and justice were selected as the main principles. Results: After data analysis, 8 main categories and 26 subcategories were obtained. The main categories include patient privacy, patient independence, communication principles, patient-centered services, drug supplier, patient harm avoidance, supervision, and distributive, procedural, and interactive justice. The subcategories include increasing patient awareness, culturizing prescription, and rational drug use, confidentiality and privacy, and pharmacist-patient relationship/communication, which were the biggest ethical challenges in the area of drug supply at pharmacies. Conclusions: According to the Principles-based approach, two principles of autonomy and beneficence had the greatest challenges. The policymakers in the health care system should emphasize patient independence, patient privacy, and patient-centered services. The results of this study can be used as a tool to introduce ethical challenges to policymakers and develop educational contents, the charter of professional ethics in pharmacies, and measures of pharmacy accreditation.
Acquisition of Oral Microbiota is Driven by Environment, Not Host Genetics
Authors: Mukherjee Chiranjit , Moyer Christina O. , Steinkamp Heidi M. , Hashmi Shahr B. , Guo Xiaohan , Ni Ai , Leys Eugene J. , Griffen Ann L.
Published: August 2020

Background: The oral microbiota is acquired very early, but the factors shaping its acquisition are not well understood. Previous studies comparing monozygotic (MZ) and dizygotic (DZ) twins have suggested that host genetics plays a role. However, all twins share an equal portion of their parent’s genome, so this model is not informative for studying parent-to-child transmission. We used a novel study design that allowed us to directly examine the genetics of transmission by comparing the oral microbiota of biological versus adoptive mother-child dyads. Results: No difference was observed in how closely oral bacterial community profiles matched for adoptive versus biological mother-child pairs, indicating little if any effect of host genetics on the fidelity of transmission. Both adopted and biologic children more closely resembled their own mother as compared to unrelated women, supporting the role of contact and environment. Mother-child strain similarity increased with the age of the child, ruling out early effects of host genetic influence that are lost over time. No effect on the fidelity of mother-child strain sharing from vaginal birth or breast feeding was seen. Analysis of extended families showed that fathers and mothers were equally similar to their children, and that cohabitating couples showed even greater strain similarity than mother-child pairs. These findings support the role of contact and shared environment, and age, but not genetics, as determinants of microbial transmission, and were consistent at both species and strain level resolutions, and across multiple oral habitats. In addition, analysis of individual species all showed similar results. Conclusions: The host is clearly active in shaping the composition of the oral microbiome, since only a few of the many bacterial species in the larger environment are capable of colonizing the human oral cavity. Our findings suggest that these host mechanisms are universally shared among humans, since no effect of genetic relatedness on fidelity of microbial transmission could be detected. Instead our findings point towards contact and shared environment being the driving factors of microbial transmission, with a unique combination of these factors ultimately shaping the highly personalized human oral microbiome.
Market orientations, product innovation and organizational performance: A case study on selected beer factories found in Ethiopia
Authors: Fentaw Nigist Kelemu
Published: August 2020

Overview was led to explore the relationship between advertise direction, creation process, item execution, authoritative execution and budgetary execution. The motivation behind this overview was to research connections among showcase direction, dispatch technique, item execution, hierarchical execution, gainfulness and budgetary execution. Target populaces were representatives of chose Ethiopian lager processing plants BGI Ethiopia who are as of now devouring the item; from which test was resolved through critical inspecting strategy. Asked information was gathered by means of study poll, direct relapse examination was led to check the relationship among driving variable. At last it was discovered that organizations' gainfulness and money related execution are being impacted by advertise direction, dispatch technique, item execution and hierarchical execution. Firms are prescribed to concentrate on improving business sector direction, dispatch system, item execution and hierarchical execution to support productivity and budgetary execution.
Model to assess workload of village doctors in the National Essential Public Health Services Program in six provinces of China
Authors: Yin Delu , Yin Tao , Yang Huiming , Wang Lihong , Chen Bowen
Published: August 2020

Background: No studies, particularly quantitative analyses, have been conducted regarding the workload of village doctors in the National Essential Public Health Services (NEPHS) program and differences in service delivery by village doctors, according to region and services. In this study, we developed a quantitative analysis approach to measure the workload of NEPHS provided by village doctors in six provinces of China in 2016. We aimed to identify areas and services of the NEPHS needing improvement, so as to implement targeted measures to ensure adequate delivery of NEPHSs in rural remote underserved areas.Methods: Based on survey data from 300 town hospital centers (THCs) located in 60 counties in the six selected provinces, we calculated village doctors’ share of workload under the NEPHS using the equivalent value (EV) model. To define the workload and corresponding EV of each NEPHS, a series of five meetings was held with THC managers, public health workers, family physicians, nurses and village doctors. Field observations were conducted to verify the workload and EV of each service.Results: Village doctors’ share of the workload under the NEPHS program was 43.71% across the 300 sampled THCs in six provinces. The village doctors’ workload shares for different NEPHS ranged from 17.14% to 57.00%. The percentage workload undertaken by village doctors under the NEPHS program varied across different provinces, with the highest proportion 63.4% and the lowest 28.5%.Conclusions: The total NEPHS workload assigned to village doctors by THCs in the six sampled provinces exceeded the Chinese government’s requirement of 40%, but the workload proportion in some provinces was less than 40%. In addition, the percentage workload for some NEPHS undertaken by village doctors was lower than others. We suggest conducting district-level analysis of the workload among village doctors under the NEPHS program using the EV method, to identify areas and services needing improvement, to implement targeted measures to expand and promote health service provision in China’s rural underserved areas.
The Diagnostic Accuracy of Direct Agglutination Test for Serodiagnosis of Human Visceral Leishmaniasis: A Systematic Review with Meta-analysis
Authors: Mohebali Mehdi , Keshavarz Hossein , Shirmohammad Sedigheh , Akhoundi Behnaz , Borjian Alireza , Hassanpour Gholamreza , Mamishi Setareh , Mahmoudi Shima
Published: August 2020

Background: Direct agglutination test (DAT) as simple, accurate and reliable method that has been used widely for serodiagnosis of visceral leishmaniasis (VL) during the last three decades. We conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of DAT for serodiagnosis of human VL.Methods: Electronic databases, including MEDLINE (via PubMed), SCOPUS, Web of Science, SID and Mag Iran (two Persian scientific search engines) were searched from December 2004 to April 2019. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic (ROC) curves parameters. Results: Of the 2928 records identified in the mentioned electronic databases and through articles’ reference lists, 25 articles met inclusion criteria and enrolled into the systematic review and among them 20 records were qualified for meta-analysis. The pooled sensitivity and specificity of DAT was 96% [(95% CI, 92–98] )and 95% [(95 % CI, 86–99]), respectively. The likelihood ratio of a positive test (LR+) was found to be 21 [CI95%, 6.6–66.5] and the likelihood ratio of a negative test (LR−) was found to be 0.04 [CI95%, 0.02–0.08]. The combined estimate of the diagnostic odds ratio for DAT was high [467 )114-1912]) ].We found that the summary receiver operating characteristic curve (SROC) is positioned near the upper left corner of the curve and the area under curve (AUC) was 0.98 (95% CI, 0.97 to 0.99).Conclusion: Based on our analysis, we find DAT can be considered as a valuable tool for the serodiagnosis and seroprevalence of human VL with high sensitivity and specificity rates. As DAT is simple, accurate and efficient serological test, it can be used for serodiagnosis of human VL particularly in endemic areas..
Integrating transcriptomic and metabolomic analysis of hormone pathways in Acer rubrum during developmental leaf senescence
Authors: Zhu Chen , Xiaoyu Lu , Junlan Gao , Yun Xuan , Ren Jie
Published: August 2020

Background: To fully elucidate the roles and mechanisms of plant hormones in leaf senescence, we adopted an integrated analysis of both non-senescing and senescing leaves from red maple with transcriptome and metabolome data. Results: Transcription and metabolite profiles were generated through a combination of deep sequencing, third-generation sequencing data analysis, and ultrahigh-performance liquid chromatograph Q extractive mass spectrometry (UHPLC-QE-MS), respectively. We investigated the accumulation of compounds and the expression of biosynthesis and signaling genes for eight hormones. The results revealed that ethylene and abscisic acid concentrations increased during the leaf senescence process, while the contents of cytokinin, auxin, jasmonic acid, and salicylic acid continued to decrease. Correlation tests between the hormone content and transcriptional changes were analyzed, and in six pathways, genes closely linked with leaf senescence were identified. Conclusions: These results will enrich our understanding of the mechanisms of plant hormones that regulate leaf senescence in red maple, while establishing a foundation for the genetic modification of Acer in the future.
The roles of vicariance and isolation by distance in shaping biotic diversification across an ancient archipelago: evidence from a Seychelles caecilian amphibian
Authors: Maddock Simon T , Nussbaum Ronald A , Day Julia J , IV Leigh Latta , Miller Mark , Fisk Debra L , Wilkinson Mark , Rocha Sara , Gower David , Pfrender Michael E
Published: August 2020

Background: Island systems offer excellent opportunities for studying the evolutionary histories of species by virtue of their restricted size and easily identifiable barriers to gene flow. However, most studies investigating evolutionary patterns and processes shaping biotic diversification have focused on more recent (emergent) rather than ancient oceanic archipelagos. Here, we focus on the granitic islands of the Seychelles, which are unusual among island systems because they have been isolated for a long time and are home to a monophyletic radiation of caecilian amphibians that has been separated from its extant sister lineage for ca. 65 – 62 Ma. We selected the most widespread Seychelles caecilian species, Hypogeophis rostratus, to investigate intraspecific morphological and genetic (mitochondrial and nuclear) variation across the archipelago (782 samples from nine islands) to identify patterns and test processes that shaped their evolutionary history within the Seychelles.Results: Overall a signal of strong geographic structuring with distinct northern- and southern-island clusters were identified across all datasets. We suggest that these distinct groups have been isolated for ca. 1.26 Ma years without subsequent migration between them. Populations from the somewhat geographically isolated island of Frégate showed contrasting relationships to other islands based on genetic and morphological data, clustering alternatively with northern-island (genetic) and southern-island (morphological) populations.Conclusions: Although variation in H. rostratus across the Seychelles is explained more by isolation-by-distance than by adaptation, the genetic-morphological incongruence for affinities of Frégate H. rostratus might be caused by local adaptation over-riding the signal from their vicariant history. Our findings highlight the need of integrative approaches to investigate fine-scale geographic structuring to uncover underlying diversity and to better understand evolutionary processes on ancient, continental islands.
The diagnostic value of quantitative analysis of ASL, DSC-MRI and DKI in the Grading of Cerebral Gliomas: A Meta-Analysis 
Authors: Luan Jixin , Wu Mingzhen , Wang Xiaohui , Qiao Lishan , Guo Guifang , Zhang Chuanchen
Published: August 2020

Objective: To perform quantitative analysis on the efficacy of using relative cerebral blood flow (rCBF) in arterial spin labeling (ASL), relative cerebral blood volume (rCBV) in dynamic magnetic sensitivity contrast-enhanced magnetic resonance imaging (DSC-MRI), and mean kurtosis (MK) in diffusion kurtosis imaging (DKI) to grade cerebral gliomas.Methods: Literature regarding ASL, DSC-MRI, or DKI in cerebral gliomas grading in both English and Chinese were searched from PubMed, Embase, Web of Science, CBM, China National Knowledge Infrastructure (CNKI), and Wanfang Database as of 2019. A meta-analysis was performed to evaluate the efficacy of ASL, DSC-MRI, and DKI in the grading of cerebral gliomas. Result: A total of 54 articles (11 in Chinese and 43 in English) were included. Three quantitative parameters in the grading of cerebral gliomas, rCBF in ASL, rCBV in DSC-MRI, and MK in DKI had the pooled sensitivity of 0.88 [95%CI (0.83,0.92)], 0.92 [95%CI (0.83,0.96)], 0.88 [95%CI (0.82,0.92)], and the pooled specificity of 0.91 [95%CI (0.84,0.94)], 0.81 [95%CI (0.73,0.88)], 0.86 [95%CI (0.78,0.91)] respectively. The pooled area under the curve (AUC) were 0.95 [95%CI (0.93,0.97)], 0.91 [95%CI (0.89,0.94)], 0.93 [95%CI (0.91,0.95)] respectively.Conclusion: Quantitative parameters rCBF, rCBV and MK have high diagnostic accuracy for preoperative grading of cerebral gliomas.
Intravenous Calcium as a Pressor in a Swine Model of Hypoxic Pseudo-Pulseless Electrical Mechanical Activity - A Preliminary Report
Authors: Lindqwister Alexander , Lampe Joshua W. , Gould Jeffrey R. , Kaufman Christopher L. , Moodie Karen , Paradis Norman
Published: August 2020

Background: Pseudo-pulseless electrical activity (pseudo-PEA) is a lifeless form of profound cardiac shock characterized by measurable cardiac mechanical activity without clinically detectable pulses. Pseudo-PEA may constitute up to 40% of reported cases of cardiac arrest. Resuscitation from pseudo-PEA is often associated with hypotension refractory to catecholamine pressors. We hypothesized that this post-resuscitation state may be associated with hypocalcemic hypotension responsive to intravenous calcium. Methods: Using pre-existing data from our hypoxic swine pseudo-PEA model, we measured blood pressure, hemodynamics, and electrolytes. Physiological data were analyzed on a heartbeat by heartbeat basis. The midpoint of the calcium response was defined using change of curvature feature detection. Hemodynamic parameters were shifted such that the value at the midpoint was equal to zero.Results: In 9 animals with refractory hypotension we administered 37 boluses of intravenous calcium in the dosage range of 5 -20 mg. Comparisons were made between the average values in the time period 40-37 seconds before the midpoint and 35-40 seconds after the midpoint. Of the 37 administered boluses, 34 manifested a change in the blood pressure, with mean aortic pressure, systolic and diastolic pressures all increasing post bolus administration. Conclusions: Administration of intravenous calcium may be associated with a pressor-like response in refractory hypotension after resuscitation from pseudo-PEA. Relative ionized hypocalcemia may cause hypotension after resuscitation from pseudo-PEA. Therapy with intravenous calcium should be further investigated in this setting.
Prevalence of Metabolic Syndrome among Breast Cancer Survivors in East Coast of Peninsular Malaysia
Authors: Shahril Mohd Razif , Amirfaiz Syed , Lua Pei Lin , Nurnazahiah Ali , Zakarai Nor Syamimi , Lok Ving , Ahmad Aryati , Sulaiman Suhaina
Published: August 2020

To date, limited data are available on metabolic syndrome prevalence among breast cancer survivors in Malaysia. Therefore, this study was conducted to determine the prevalence of metabolic syndrome and abnormal metabolic syndrome components among breast cancer survivors in East Coast of Peninsular Malaysia. This cross-sectional study included 95 breast cancer survivors (age 53.7±7.6 years) who have completed main cancer treatments for ≥6 months. Cancer survivors were recruited from two main government hospitals in Kelantan and Terengganu using a purposive sampling method. According to the Harmonized criteria, the metabolic syndrome prevalence was 50.5%. Among those with metabolic syndrome, the most prevalent abnormal metabolic components were triglycerides (91.2%), fasting blood glucose (79.6%) and HDL-c level (78.4%). Except for total cholesterol and LDL-c, all other metabolic syndrome components were significantly different (p<0.05) between those with and without metabolic syndrome. Significant differences between metabolic syndrome and non-metabolic syndrome groups were found for weight, BMI, waist circumference, body fat percentage and cancer stages (p<0.05). However, no significant relationship was reported between sociodemographic, clinical parameters and metabolic syndrome among breast cancer survivors in this study. In conclusion, metabolic syndrome was highly prevalent among breast cancer survivors. It is recommended for health care professionals to closely monitor and improve the triglycerides, blood glucose and HDL-c level of the breast cancer survivors under their care to control the detrimental effect of metabolic syndrome.
Methodology in core outcome set (COS) development: the impact of patient interviews and using a 5-point versus a 9-point Delphi rating scale on core outcome selection in a COS development study.
Authors: Remus Alexandria , Smith Valerie , Wuytack Francesca
Published: August 2020

Background: As the development of core outcome sets (COS) increases, guidance for developing and reporting high-quality COS continues to evolve; however, a number of methodological uncertainties still remain. The objectives of this study were: (1) to explore the impact of including patient interviews in developing a COS, (2) to examine the impact of using a 5-point versus a 9-point rating scale during Delphi consensus methods on outcome selection and the COS and (3) to inform and contribute to COS development methodology by advancing the evidence base on COS development techniques.Methods: Semi-structured patient interviews and a nested randomised controlled parallel group trial as part of the Pelvic Girdle Pain Core Outcome Set project (PGP-COS). Patient interviews, as an adjunct to a systematic review of outcomes reported in previous studies, were undertaken to identify preliminary outcomes for including in a Delphi consensus survey. In the Delphi survey, participants were randomised (1:1) to a 5-point or 9-point scale for rating the importance of the list of preliminary outcomes.Results: None of the outcomes identified from the patient interviews were included in the final PGP-COS. The 5-point rating scale resulted in twice as many outcomes reaching consensus after the 3-round Delphi survey compared to the 9-point scale. Consensus on all five outcomes included in the final PGP-COS was achieved by participants allocated the 5-point rating scale, whereas consensus on four of these was achieved by those using the 9-point scale.Conclusions: Using patient interviews to identify preliminary outcomes as an adjunct to conducting a systematic review of outcomes measured in the literature does not appear to influence outcome selection in developing a COS. The use of different rating scales in a Delphi survey, however, does appear to impact on outcome selection. The 5-point scale demonstrated greater congruency than the 9-point scale with the outcomes included in the final PGP-COS. Use of a 5-point scale might be considered for Delphi surveys in COS development studies. Future research to substantiate our findings and to explore the impact of other rating scales on outcome selection during COS development, however, is still warranted.
Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma
Authors: Zheng Wenwen , Zhu Weiwei , Yu Shengqiang , Li Kangqi , Ding Yuexia , Wu Qingna , Tang Qiling , Zhao Quan , Lu Congxiao , Guo Chenyu
Published: August 2020

Background: The prognosis of metastatic renal cell carcinoma (RCC) patients vary widely because of clinical and pathological heterogeneity. We aimed to develop a novel nomogram to predict overall survival (OS) for this population. Methods: Metastatic RCC patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. These patients were randomly assigned to a training set and a validation set at a ratio of 1:1. Significant prognostic factors of survival were identified through Cox regression models and then integrated to form a nomogram to predict 1-, 3- and 5-year OS. The nomogram was subsequently subjected to validations via the training and the validation sets. The performance of this model was evaluated by using Harrell’s concordance index (C-index), calibration curve, integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA). Results: Overall, 2315 eligible metastatic RCC patients were enrolled from the SEER database. A nomogram of survival prediction for patients of newly diagnosed with metastatic RCC was established, in which eight clinical factors significantly associated with OS were involved, including Fuhrman grade, lymph node status, sarcomatoid feature, cancer-directed surgery, bone metastasis, brain metastasis, liver metastasis, and lung metastasis. The new model presented better discrimination power than the American Joint Committee on Cancer (AJCC) staging system (7th edition) in the training set (C-indexes, 0.701 vs. 0.612, P <0.001) and the validation set (C-indexes, 0.676 vs. 0.600, P <0.001). The calibration plots of the nomogram exhibited optimal agreement between the predicted values and the observed values. The results of NRI and IDI also indicated the superior predictive capability of the nomogram relative to the AJCC staging system. The DCA plots revealed higher clinical use of our model in survival prediction. Conclusions: We developed and validated an effective nomogram to provide individual OS prediction for metastatic RCC patients, which would be beneficial to clinical trial design, patient counseling, and therapeutic modality selection.
Analysis of Six Chloroplast Genomes Provides Insight into the Evolution of Chrysosplenium (Saxifragaceae)
Authors: Wu Zhihua , Liao Rui , Yang Tiange , Dong Xiang , Lan Deqing , Qin Rui , Liu Hong
Published: August 2020

Background: Chrysosplenium L. (Saxifragaceae) is a genus of plants widely distributed in Northern Hemisphere and usually found in moist, shaded valleys and mountain slopes. This genus is ideal for studying plant adaptation to low-light conditions. Although some progress has been made in the systematics and biogeography of Chrysosplenium , its chloroplast genome evolution remains to be investigated.Results: To fill this gap, we sequenced the chloroplast genomes of six Chrysosplenium species and analyzed their genome structure, GC content, and nucleotide diversity. Moreover, we performed a phylogenetic analysis and calculated non-synonymous (Ka) /synonymous (Ks) substitution ratios using the combined protein-coding genes of 29 species within Saxifragales and two additional species as outgroups, as well as a pair-wise estimation for each gene within Chrysosplenium . Compared with the outgroups in Saxifragaceae, the six Chrysosplenium chloroplast genomes had lower GC contents; they also had conserved boundary regions and gene contents, as only the rpl32 gene was lost in four of the Chrysosplenium chloroplast genomes. Phylogenetic analyses suggested that the Chrysosplenium separated to two major clades (the opposite group and the alternate group). The selection pressure estimation (Ka/Ks ratios) of genes in the Chrysosplenium species showed that matK and ycf2 were subjected to positive selection.Conclusion: This study provides genetic resources for exploring the phylogeny of Chrysosplenium and sheds light on plant adaptation to low-light conditions. The lower average GC content and the lacking gene of rpl32 indicated selective pressure in their unique habitats. Different from results previously reported, our selective pressure estimation suggested that the genes related to photosynthesis (such as ycf2 ) were under positive selection at sites in the coding region.
Clinical characteristics, treatment and outcome of adnexal torsion in pregnant women: a retrospective study
Authors: Wang Yong-xue , Deng Shan
Published: August 2020

Background: Adnexal torsion during pregnancy is a gynecological emergency. Delayed diagnosis and treatment can cause ovarian necrosis and fetal loss. This study assessed the clinical characteristics, treatment and outcomes of adnexal torsion in pregnant women.Methods: A retrospective study was conducted at a tertiary center between January 2008 and January 2018. Eighty-two pregnant women with surgically confirmed adnexal torsion were included. The clinical characteristics, ultrasound data, surgical interventions and pregnancy outcomes were analyzed.Results: The median age of the patients was 28 (range, 18-38) years. The median gestational age was 11 (range, 6-31) weeks: 53 (64.6%) were in the first trimester, 21 (25.6%) were in the second trimester, and 8 (9.8%) were in the third trimester. The most common symptoms and signs were sudden pelvic pain (100%) and adnexal or pelvic masses (97.6%), followed by nausea and vomiting (61%). The Doppler blood flow signal disappeared in 62.5% of the patients. Sixty-three (76.8%) patients underwent laparoscopy, and 29 (24.2%) underwent laparotomy. The median gestational age in patients undergoing laparotomy was higher than that in those undergoing laparoscopy (26 weeks vs 10 weeks, p<0.001). Fifty-three (64.6%) patients underwent conservative surgery, with 48 detorsions and cystectomies, 2 detorsions and cyst fenestrations, 1 detorsion only and 2 salpingectomies only. Twenty-nine (25.4%) patients underwent unilateral salpingo-oophorectomy. There were no cases of postoperative thrombosis, spontaneous abortion or recurrence during the same pregnancy. Seven patients underwent simultaneous artificial abortion. One patient experienced intrauterine fetal death, and 74 patients had live births.Conclusion: Surgical intervention was required as soon as possible. Laparoscopic conservative surgery is safe and may be appropriate to preserve ovarian function.
Improving precision of field inventory estimation of above ground biomass through an alternative view on plot biomass
Authors: Kleinn Christoph , Magnussen Steen , Noelke Nils , Magdon Paul , Álvarez-González Juan Gabriel , Fehrmann Lutz , Pérez-Cruzado César
Published: August 2020

We contrast a new continuous approach (CA) to estimation of plot level above-ground biomass (AGB) in forest inventories with the current approach of deriving the AGB estimate exclusively from the tree-level AGB predicted for each tree in a plot; henceforth called DA (discrete approach). In CA the AGB in a forest is modelled as a continuous surface and the AGB estimate for a fixed area plot is computed as the integral of the AGB surface taken over the plot. Hence with CA, the portions of biomass in plot-trees that extend across a plot perimeter is ignored while the biomass from trees outside the plot reaching inside the plot is added. We use a sampling simulation with data from a fully mapped 2 ha area to illustrate, that important differences in plot-level AGB estimates can emerge, and that one should expect CA-based estimates of AGB to be less variable than with the DA, which translates to a higher precision of estimates from field plots: in our case study, for a target precision of estimation of 5%, the required sample size was 27% lower for small plots of 100m 2 when using the CA and 10% lower for larger plots of 1700m 2 . We discuss practical issues to implementing CA in field inventories and discuss the expected potential for applications that model biomass from remote sensing data.
Cross-cultural adaptation, validity, and reliability of the Nepali version of the Exercise Adherence Rating Scale: A methodological study
Authors: Adhikari Shambhu Prasad , Dev Rubee , Shrestha Jayana N
Published: August 2020

Background: The Exercise Adherence Rating Scale (EARS) is a commonly used outcome tool, which helps to identify the adherence rate of exercises and reasons for adherence and non-adherence. There is no evidence of the availability of any measurement tools to assess exercise adherence in the Nepalese context and cultural background. Therefore, we conducted a cross-cultural adaptation of the EARS into the Nepali language and investigated its reliability and validity. Methods: Cross-cultural adaptation of the EARS was done based on Beaton guidelines. Psychometric properties were evaluated among 18 participants aged 18 years or older with pre-diabetes or confirmed diagnosis of any disease who were prescribed with home exercises by physiotherapists. Any disease that limited participants from doing exercise and individuals unwilling to participate were excluded. Reliability was evaluated through internal consistency, using Cronbach’s alpha. Exploratory Factor Analysis (EFA) was performed to explore construct validity and confirm its unidimensionality. Receiver Operating Characteristic (ROC) curve was analyzed to identify cut-off score, sensitivity and specificity of the tool.Results: The Cronbach’s alpha was 0.94 for EARS-adherence behavior. The EFA of 6-items adherence behavior revealed the presence of one factor with an eigenvalue exceeding one. The scree-plot suggested for extraction of only one factor with strong loading (75.84%). The Area Under the Curve was 0.91 with 95% confidence interval 0.77 to 1.00 at p = 0.004. The cutoff score was found 17.5 with 89% sensitivity and 78% specificity.Conclusions: The EARS was cross-culturally adapted to the Nepali language. The reliability and construct validity of the Nepali version of the EARS were acceptable to assess exercise adherence in Nepali-speaking individuals. This validated tool might facilitate the evaluation of exercise-related interventions. Future studies could investigate other psychometric properties of the Nepali EARS.