bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of people at risk of developing type 2 diabetes mellitus and the involvement of community pharmacies in a national screening campaign: a pioneer action in Brazil
Authors: Correr Cassyano J. , Coura-Vital Wendel , Frade Josélia C. Q. P. , Nascimento Renata C. R. M. , Nascimento Lúbia G. , Pinheiro Eliete B. , Ferreira Wesley M. , Reis Janice S. , Melo Karla F. S. , Pontarolo Roberto , Lenzi Mônica S. A. , Almeida José V. , Pedrosa Hermelinda C. , João Walter S. J.
Published: October 2020

Background

Brazil is one of top 10 countries with the highest number of people with diabetes mellitus (DM), affecting 16.8 million peoples. It is estimated that 7.7 million people (20–79 years) in the country have not yet been diagnosed, representing an under-diagnosis rate of 46.0%. Herein we aimed to screen people for high blood glucose or risk for developing type 2 DM (T2DM) through community pharmacies in Brazil.

Methods

A cross-sectional study was carried out in November 2018, involving 977 pharmacists from 345 municipalities in Brazil. The study evaluated people between 20 and 79 years old without a previous diagnosis of DM. Glycemia was considered high when its value was ≥ 100 mg/dL fasting and ≥ 140 mg/dL in a casual feeding state. The FINDRISC (Finnish Diabetes Risk Score) was used to estimate the risk for developing T2DM. The prevalence of high blood glucose was estimated and the associated factors were obtained using Poisson's multivariate analysis with robust variance.

Results

During the national screening campaign, 17,580 people were tested with the majority of the consultations (78.2%) being carried out in private pharmacies. The population was composed mainly of women (59.5%) and people aged between 20 and 45 years (47.9%). The frequency of participants with high blood glucose was 18.4% (95% CI 17.9–19.0). Considering the FINDRISC, 22.7% of people had a high or very high risk for T2DM. The risk factors associated with high blood glucose were: Body Mass Index > 25 kg/m2, abdominal circumference > 94 cm for men and > 80 cm for women; education level below 15 years of study, no daily intake of vegetables and fruits; previous diagnosis of arterial hypertension; history of high blood glucose and family history of DM.

Conclusions

This is the largest screening study that evaluated the frequency of high blood glucose and its associated factors in a population without a previous diagnosis ever performed in community pharmacies in Brazil. These results may help to improve public health policies and reinforce the role of pharmacists in screening and education actions aimed at this undiagnosed population in a continent-size country such as Brazil.
Increased levels of circulating IL-10 in persons recovered from hepatitis C virus (HCV) infection compared with persons with active HCV infection
Authors: Owusu Dorcas Ohui , Phillips Richard , Owusu Michael , Sarfo Fred Stephen , Frempong Margaret
Published: October 2020

Objective

Approximately 70% of all hepatitis C (HCV) infections develop chronic disease. Active or exacerbated chronic hepatitis C infection subsequently progress to liver disease. The role of T-cells secretions in achieving viral clearance is still not well understood. Thus, the current study was set to determine the relationship between the T cell cytokine profiles, biochemical parameters and persistent HCV infection or spontaneous recovery.

Results

Twenty-five percent (41/163) of the anti-HCV positive participants had recovered from HCV and had significantly higher concentration of IL-10 compared to those with active HCV infection (P < 0.012). Other circulating cytokines measured; IL-2, IFN gamma, TNF alpha, IL-5 and IL-17 were similar in both groups. Participants with active HCV infection had significantly higher aspartate transaminase (AST) (35 units) and alanine transaminase (46 units) compared to those in the recovered state (P < 0.001). Thus, serum levels of IL10 could be explored in larger prospective cohort study as a predictive marker of recovering from an active HCV infection.
White matter hyperintensities across the adult lifespan: relation to age, Aβ load, and cognition
Authors: Garnier-Crussard Antoine , Bougacha Salma , Wirth Miranka , André Claire , Delarue Marion , Landeau Brigitte , Mézenge Florence , Kuhn Elizabeth , Gonneaud Julie , Chocat Anne , Quillard Anne , Ferrand-Devouge Eglantine , de La Sayette Vincent , Vivien Denis , Krolak-Salmon Pierre , Chételat Gaël
Published: October 2020

Background

White matter hyperintensities (WMH) are very frequent in older adults and associated with worse cognitive performance. Little is known about the links between WMH and vascular risk factors, cortical β-amyloid (Aβ) load, and cognition in cognitively unimpaired adults across the entire lifespan, especially in young and middle-aged adults.

Methods

One hundred and thirty-seven cognitively unimpaired adults from the community were enrolled (IMAP cohort). Participants underwent (i) a comprehensive neuropsychological assessment of episodic memory, processing speed, working memory, and executive functions; (ii) brain structural T1 and FLAIR MRI scans used for the automatic segmentation of total and regional (frontal, parietal, temporal, occipital, and corpus callosum) WMH; and (iii) a Florbetapir-PET scan to measure cortical Aβ. The relationships of total and regional WMH to age, vascular risk factors, cortical Aβ, and cognition were assessed within the whole sample, but also splitting the sample in two age groups (≤ or > 60 years old).

Results

WMH increased with age across the adult lifespan, i.e., even in young and middle-aged adults. Systolic blood pressure, diastolic blood pressure, and glycated hemoglobin were all associated with higher WMH before, but not after, adjusting for age and the other vascular risk factors. Higher frontal, temporal, and occipital WMH were associated with greater Aβ, but this association was no longer significant when adjusting for age and vascular risk factors. Higher total and frontal WMH were associated with worse performance in executive functions, with no interactive effect of the age group. In contrast, there was a significant interaction of the age group on the link between WMH and working memory, which was significant within the subgroup of young/middle-aged adults only. Adding cortical Aβ load in the models did not alter the results, and there was no interaction between WMH and Aβ on cognition.

Conclusion

WMH increased with age and were associated with worse executive functions across the adult lifespan and with worse working memory in young/middle-aged adults. Aβ load was weakly associated with WMH and did not change the relationship found between WMH and executive functions. This study argues for the clinical relevance of WMH across the adult lifespan, even in young and middle-aged adults with low WMH.
De novo missense variants disrupting protein–protein interactions affect risk for autism through gene co-expression and protein networks in neuronal cell types
Authors: Chen Siwei , Wang Jiebiao , Cicek Ercument , Roeder Kathryn , Yu Haiyuan , Devlin Bernie
Published: October 2020

Background

Whole-exome sequencing studies have been useful for identifying genes that, when mutated, affect risk for autism spectrum disorder (ASD). Nonetheless, the association signal primarily arises from de novo protein-truncating variants, as opposed to the more common missense variants. Despite their commonness in humans, determining which missense variants affect phenotypes and how remains a challenge. We investigate the functional relevance of de novo missense variants, specifically whether they are likely to disrupt protein interactions, and nominate novel genes in risk for ASD through integrated genomic, transcriptomic, and proteomic analyses.

Methods

Utilizing our previous interactome perturbation predictor, we identify a set of missense variants that are likely disruptive to protein–protein interactions. For genes encoding the disrupted interactions, we evaluate their expression patterns across developing brains and within specific cell types, using both bulk and inferred cell-type-specific brain transcriptomes. Connecting all disrupted pairs of proteins, we construct an “ASD disrupted network.” Finally, we integrate protein interactions and cell-type-specific co-expression networks together with published association data to implicate novel genes in ASD risk in a cell-type-specific manner.

Results

Extending earlier work, we show that de novo missense variants that disrupt protein interactions are enriched in individuals with ASD, often affecting hub proteins and disrupting hub interactions. Genes encoding disrupted complementary interactors tend to be risk genes, and an interaction network built from these proteins is enriched for ASD proteins. Consistent with other studies, genes identified by disrupted protein interactions are expressed early in development and in excitatory and inhibitory neuronal lineages. Using inferred gene co-expression for three neuronal cell types—excitatory, inhibitory, and neural progenitor—we implicate several hundred genes in risk (FDR $$\le \hspace{0.17em}$$

≤

0.05), ~ 60% novel, with characteristics of genuine ASD genes. Across cell types, these genes affect neuronal morphogenesis and neuronal communication, while neural progenitor cells show strong enrichment for development of the limbic system.

Limitations

Some analyses use the imperfect guilt-by-association principle; results are statistical, not functional.

Conclusions

Disrupted protein interactions identify gene sets involved in risk for ASD. Their gene expression during brain development and within cell types highlights how they relate to ASD.
Uncontrollable uterine atony after replacement of uterine inversion managed by hysterectomy: a case report
Authors: Katsura Daisuke , Moritani Suzuko , Tsuji Shunichiro , Suzuki Kounosuke , Yamada Kazutaka , Ohashi Mizuki , Kimura Fuminori , Murakami Takashi
Published: October 2020

Background

Uterine inversion may cause massive hemorrhage, resulting in maternal deterioration and death. Replacement of the inverted uterus must be performed as soon as possible. As time passes, the inverted uterus becomes atonic and necrotic, and a surgical approach may be required.

Case presentation

A 27-year-old Japanese woman was admitted to our hospital 4 hours postpartum with increased hemorrhage after the replacement of an inverted uterus. Recurrent inversion was diagnosed, and though the atonic uterus was replaced again by the Johnson maneuver, hemorrhage persisted. Balloon tamponade was not successful in stopping the hemorrhage, and uterine artery embolization was performed. Bleeding resumed the next day on removal of the balloon, and hysterectomy was performed. Massive hemorrhage, coagulopathy, and uterine necrosis caused uterine atony, and the reperfused blood flow on replacement of the ischemic uterus increased hemorrhage.

Conclusions

Cases of uterine inversion with coagulopathy lasting for more than 4 hours may require a surgical intervention, and uterine replacement may have to be delayed until the maternal hemodynamic condition is stabilized. Uterine replacement under laparotomy may be also be considered due to the risk of increased hemorrhage.
Brain SPECT perfusion and PET metabolism as discordant biomarkers in major depressive disorder
Authors: Tastevin Maud , Boyer Laurent , Korchia Theo , Fond Guillaume , Lançon Christophe , Richieri Raphaëlle , Guedj Eric
Published: October 2020

Background

Brain SPECT perfusion and PET metabolism have been, most often interchangeably, proposed to study the underlying pathological process in major depressive disorder (MDD). The objective of this study was to specify similarities and inconsistencies between these two biomarkers according to global characteristics of the disease. We conducted a retrospective study in 16 patients suffering from treatment-resistant MDD who underwent, during the same current episode, a cerebral perfusion SPECT with 99mTc-HMPAO and a metabolic PET with 18F-FDG. Whole-brain voxel-based SPM(T) maps were generated in correlation with the number of depressive episodes and in correlation with the depression duration, separately for the two exams (p-voxel < 0.001 uncorrected, k > 20).

Results

No significant correlations were found between brain metabolism and either the number of depressive episodes or the duration of the disease, even at an uncorrected p-voxel < 0.005. On the other hand, the increased number of depressive episodes was correlated with decreased perfusion of the right middle frontal cortex, the right anterior cingulum cortex, the right insula, the right medial temporal cortex and the left precuneus. The increased depression duration was correlated with decreased perfusion of the right anterior cingulum cortex.

Conclusions

This preliminary study demonstrates more significant results with brain perfusion compared with glucose metabolism in treatment-resistant MDD, highlighting the value of brain SPECT despite less favourable instrumentation detection compared to PET.
Best-practice IgM- and IgA-enriched immunoglobulin use in patients with sepsis
Authors: Nierhaus Axel , Berlot Giorgio , Kindgen-Milles Detlef , Müller Eckhard , Girardis Massimo
Published: October 2020

Background

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Despite treatment being in line with current guidelines, mortality remains high in those with septic shock. Intravenous immunoglobulins represent a promising therapy to modulate both the pro- and anti-inflammatory processes and can contribute to the elimination of pathogens. In this context, there is evidence of the benefits of immunoglobulin M (IgM)- and immunoglobulin A (IgA)-enriched immunoglobulin therapy for sepsis. This manuscript aims to summarize current relevant data to provide expert opinions on best practice for the use of an IgM- and IgA-enriched immunoglobulin (Pentaglobin) in adult patients with sepsis.

Main text

Sepsis patients with hyperinflammation and patients with immunosuppression may benefit most from treatment with IgM- and IgA-enriched immunoglobulin (Pentaglobin). Patients with hyperinflammation present with phenotypes that manifest throughout the body, whilst the clinical characteristics of immunosuppression are less clear. Potential biomarkers for hyperinflammation include elevated procalcitonin, interleukin-6, endotoxin activity and C-reactive protein, although thresholds for these are not well-defined. Convenient biomarkers for identifying patients in a stage of immune-paralysis are still matter of debate, though human leukocyte antigen–antigen D related expression on monocytes, lymphocyte count and viral reactivation have been proposed. The timing of treatment is potentially more critical for treatment efficacy in patients with hyperinflammation compared with patients who are in an immunosuppressed stage. Due to the lack of evidence, definitive dosage recommendations for either population cannot be made, though we suggest that patients with hyperinflammation should receive an initial bolus at a rate of up to 0.6 mL (30 mg)/kg/h for 6 h followed by a continuous maintenance rate of 0.2 mL (10 mg)/kg/hour for ≥ 72 h (total dose ≥ 0.9 g/kg). For immunosuppressed patients, dosage is more conservative (0.2 mL [10 mg]/kg/h) for ≥ 72 h, without an initial bolus (total dose ≥ 0.72 g/kg).

Conclusions

Two distinct populations that may benefit most from Pentaglobin therapy are described in this review. However, further clinical evidence is required to strengthen support for the recommendations given here regarding timing, duration and dosage of treatment.
Retraction Note: A note on the boundary behavior for a modified Green function in the upper-half space
Authors: Zhang Yulian , Piskarev Valery
Published: October 2020

This article has been retracted. Please see the retraction notice for more detail: 10.1186/s13661-015-0363-z.
A sharp oscillation criterion for a difference equation with constant delay
Authors: Benekas Vasileios , Kashkynbayev Ardak , Stavroulakis Ioannis P.
Published: October 2020

It is known that all solutions of the difference equation$$\Delta x(n)+p(n)x(n-k)=0, \quad n\geq0, $$Δx(n)+p(n)x(n−k)=0,n≥0,where$\{p(n)\}_{n=0}^{\infty}${p(n)}n=0∞is a nonnegative sequence of reals andkis a natural number, oscillate if$\liminf_{n\rightarrow\infty}\sum_{i=n-k}^{n-1}p(i)> ( \frac {k}{k+1} ) ^{k+1}$lim infn→∞∑i=n−kn−1p(i)>(kk+1)k+1. In the case that$\sum_{i=n-k}^{n-1}p(i)$∑i=n−kn−1p(i)is slowly varying at infinity, it is proved that the above result can be essentially improved by replacing the above condition with$\limsup_{n\rightarrow\infty}\sum_{i=n-k}^{n-1}p(i)> ( \frac{k}{k+1} ) ^{k+1}$lim supn→∞∑i=n−kn−1p(i)>(kk+1)k+1. An example illustrating the applicability and importance of the result is presented.
Crowdsourcing to identify social innovation initiatives in health in low- and middle-income countries
Authors: van Niekerk Lindi , Ongkeko Arturo , Hounsell Rachel Alice , Msiska Barwani Khaura , Mathanga Don Pascal , Mothe Josselyn , Juban Noel , Awor Phyllis , Balabanova Dina
Published: October 2020

Background

Crowdsourcing is a distributed problem-solving and production mechanism that leverages the collective intelligence of non-expert individuals and networked communities for specific goals. Social innovation (SI) initiatives aim to address health challenges in a sustainable manner, with a potential to strengthen health systems. They are developed by actors from different backgrounds and disciplines. This paper describes the application of crowdsourcing as a research method to explore SI initiatives in health.

Methods

The study explored crowdsourcing as a method to identify SI initiatives implemented in Africa, Asia and Latin America. While crowdsourcing has been used in high-income country settings, there is limited knowledge on its use, benefits and challenges in low- and middle-income country (LMIC) settings. From 2014 to 2018, six crowdsourcing contests were conducted at global, regional and national levels.

Results

A total of 305 eligible projects were identified; of these 38 SI initiatives in health were identified. We describe the process used to perform a crowdsourcing contest for SI, the outcome of the contests, and the challenges and opportunities when using this mechanism in LMICs.

Conclusions

We demonstrate that crowdsourcing is a participatory method, that is able to identify bottom-up or grassroots SI initiatives developed by non-traditional actors.
Application of the normalized largest eigenvalue of structure tensor in the interpretation of potential field tensor data
Authors: Yuan Yuan , Zhang Xiangyu , Zhou Wenna , Wu Guochao , Luo Weidong
Published: October 2020

Obtaining horizontal edges and the buried depths of geological bodies, using potential field tensor data directly is an outstanding question. The largest eigenvalue of the structure tensor is one of the commonly used edge detectors for delineating the horizontal edges without depth information of the potential field tensor data. In this study, we presented a normalized largest eigenvalue of structure tensor method based on the normalized downward continuation (NDC) to invert the source location parameters without any priori information. To improve the stability and accuracy of the NDC calculation, the Chebyshev–Pade´ approximation downward continuation method was introduced to obtain the potential field data on different depth levels. The new approach was tested on various models data with and without noise, which validated that it can simultaneously obtain the horizontal edges and the buried depths of the geological bodies. The satisfactory results demonstrated that the normalized largest eigenvalue of structure tensor can describe the locations of geological sources and decrease the noise interference magnified by the downward continuation. Finally, the method was applied to the gravity data over the Humble salt dome in USA, and the near-bottom magnetic data over the Southwest Indian Ridge. The results show a good correspondence to the results of previous work.
d4PDF: large-ensemble and high-resolution climate simulations for global warming risk assessment
Authors: Ishii Masayoshi , Mori Nobuhito
Published: October 2020

A large-ensemble climate simulation database, which is known as the database for policy decision-making for future climate changes (d4PDF), was designed for climate change risk assessments. Since the completion of the first set of climate simulations in 2015, the database has been growing continuously. It contains the results of ensemble simulations conducted over a total of thousands years respectively for past and future climates using high-resolution global (60 km horizontal mesh) and regional (20 km mesh) atmospheric models. Several sets of future climate simulations are available, in which global mean surface air temperatures are forced to be higher by 4 K, 2 K, and 1.5 K relative to preindustrial levels. Nonwarming past climate simulations are incorporated in d4PDF along with the past climate simulations. The total data volume is approximately 2 petabytes. The atmospheric models satisfactorily simulate the past climate in terms of climatology, natural variations, and extreme events such as heavy precipitation and tropical cyclones. In addition, data users can obtain statistically significant changes in mean states or weather and climate extremes of interest between the past and future climates via a simple arithmetic computation without any statistical assumptions. The database is helpful in understanding future changes in climate states and in attributing past climate events to global warming. Impact assessment studies for climate changes have concurrently been performed in various research areas such as natural hazard, hydrology, civil engineering, agriculture, health, and insurance. The database has now become essential for promoting climate and risk assessment studies and for devising climate adaptation policies. Moreover, it has helped in establishing an interdisciplinary research community on global warming across Japan.
Integrated Pliocene-Pleistocene magnetostratigraphy and tephrostratigraphy of deep-sea sediments at IODP Site U1424 (Yamato Basin, Japan Sea)
Authors: Xuan Chuang , Jin Yuxi , Sugisaki Saiko , Satoguchi Yasufumi , Nagahashi Yoshitaka
Published: October 2020

Sediments from the semi-enclosed Japan Sea are sensitive to paleoclimatic perturbations and they offer great opportunities for many regional and global paleoceanographic and paleoclimatic studies. These studies often require a robust chronology. However, due to rare preservation of calcareous microfossils and drastic changes in surface water salinity during glacial lowstands, the construction of a traditional oxygen isotope stratigraphy for Japan Sea sediments is often difficult. Here, we use sediments recovered at Integrated Ocean Drilling Program (IODP) Expedition 346 Site U1424 to build an integrated Pliocene-Pleistocene reference magnetostratigraphy and tephrostratigraphy for sedimentary sequences from the region. Rock magnetic experiments indicate that magnetic remanence of Site U1424 sediments are carried primarily by (titano)magnetite with small contributions from high coercivity minerals (e.g., hematite) and possibly iron sulphides (pyrrhotite and/or greigite). Dark-colored sediments appear to contain less (titano)magnetite probably due to reductive diagenesis under euxinic conditions. Natural remanent magnetization (NRM) of u-channel samples covering a continuous ~ 167.6 m sediment sequence at Site U1424 was repeatedly measured at 1 cm intervals before and after stepwise demagnetization. Despite lower NRM intensity in dark-colored sediments, NRM directional data from both dark- and light-colored sediments are considered suitable for the construction of magnetostratigraphy. Site U1424 sediments clearly recorded the majority of the polarity chrons and subchrons within the last ~ 4.89 Myr, with the Cobb Mountain subchron, the end of Kaena subchron, and the onset of Nunivak subchron less well preserved. Sixteen tephra layers from the site were sampled for chemical composition analyses and the results were correlated to reference tephrostratigraphy of the region. Ages of the identified tephras are consistent with and can be well integrated with the magnetostratigraphy. The resulting age model suggests that sedimentation rates at Site U1424 range between ~ 1.7 and 7.6 cm/kyr with an average of ~ 3.3 cm/kyr. The acquired magnetostratigraphy and tephrostratigraphy at Site U1424 provide a reference chronology that can be correlated with and transferred to other sediment sequences in the region to study paleoceanographic and paleoclimatic changes of the region as well as their links to other regional and global changes.

Graphical abstract
Effect of hydraulic and mechanical characteristics of sediment layers on water film formation in submarine landslides
Authors: Kawakita Shogo , Asahina Daisuke , Takemura Takato , Hosono Hinako , Kitajima Keiji
Published: October 2020

Through two lab-scale experiments, we investigated the hydraulic and mechanical characteristics of sediment layers during water film formation, induced by elevated pore pressure—considered one of the triggers of submarine landslides. These involved (1) sandbox experiments to prove the effect of water films on mass movement in low slope gradients and (2) experiments to observe the effect of the tensile strength of semi-consolidated sediment layers on water film formation. Portland cement was used to mimic the degree of sediment cementation. We observed a clear relationship between the amount of cement and pore pressure during water film formation; pressure evolution and sediment deformation demonstrated the hydraulic and mechanical characteristics. Based on the results of these experiments, conditions of the sediment layers during water film formation are discussed in terms of pore pressure, permeability, tensile strength, overburden pressure, and tectonic stresses. The results indicate that the tensile strength of the sediment interface provides critical information on the lower limit of the water film formation depth, which is related to the scale of potential submarine landslides.
Pancreaticoduodenectomy with reconstructing blood flow of the gastric conduit after esophagectomy with concomitant celiac axis stenosis: a case report
Authors: Minagawa Masaaki , Ichida Hirofumi , Yoshioka Ryuji , Gyoda Yu , Mizuno Tomoya , Imamura Hiroshi , Mise Yoshihiro , Yoshimatsu Hidehiko , Fukumura Yuki , Kato Kota , Kajiyama Yoshiaki , Saiura Akio
Published: October 2020

Background

Pancreaticoduodenectomy after esophageal resection is technically difficult, because blood flow of the gastric conduit should be preserved. Celiac axis stenosis (CAS) is also a problem for pancreaticoduodenectomy, because arterial blood supply for the liver comes mainly through the collateral route from the superior mesenteric artery (SMA) via the gastroduodenal artery (GDA). Herein, we report the case of a patient with pancreatic head cancer who underwent a pancreaticoduodenectomy after esophagectomy with concomitant CAS.

Case presentation

A 76-year-old man with pancreatic head cancer was referred to our department. He had a history of esophagectomy with retrosternal gastric conduit reconstruction for esophageal cancer. Computed tomography showed severe CAS and a dilated collateral route between the SMA and the splenic artery (SPA). We prepared several surgical options depending on the intraoperative findings, and performed radical pancreaticoduodenectomy with concomitant resection of the distal gastric conduit. The right gastroepiploic artery (RGEA) of the remnant gastric conduit was fed from the left middle colic artery (MCA) with microvascular anastomosis. Despite CAS, when the GDA was dissected and clamped, good blood flow was confirmed, and the proper hepatic artery did not require reconstruction. The patient was discharged on postoperative day 90.

Conclusions

We successfully performed radical pancreaticoduodenectomy after esophagectomy with concomitant CAS, having prepared multiple surgical options depending upon the intraoperative findings.
Researchers, patients, and other stakeholders’ perspectives on challenges to and strategies for engagement
Authors: Heckert Andrea , Forsythe Laura P. , Carman Kristin L. , Frank Lori , Hemphill Rachel , Elstad Emily A. , Esmail Laura , Lesch Julie Kennedy
Published: October 2020

Background

There is growing interest in patient and stakeholder engagement in research, yet limited evidence about effective methods. Since 2012, the Patient-Centered Outcomes Research Institute (PCORI) has funded patient-centered comparative effectiveness research with a requirement for engaging patients and other stakeholders as research partners in study planning, conduct, and dissemination. This requirement, unique among large healthcare research funders in the US, provides an opportunity to learn about challenges encountered and specific strategies used by PCORI-funded study teams. The primary objective of this study is to describe -- from the perspective of PCORI investigators and research partners—the most common engagement challenges encountered in the first two years of the projects and promising strategies to prevent and overcome these challenges.

Methods

Descriptive information about investigators, partners, and their engagement was collected from investigators via annual (N = 235) and mid-year (N = 40) project progress reporting to PCORI, and from their partners (N = 260) via voluntary survey. Qualitative data were analyzed using content and thematic analyses.

Results

Investigators and partners most often described engagement challenges in three domains: (1) infrastructure to support engagement, (2) building relationships, and (3) maintaining relationships. Infrastructure challenges related to financial and human resources, including funding support and dedicated staff, identifying diverse groups of partners, and partners’ logistical needs. Challenges for both building and maintaining relationships encompass a variety of aspects of authentic, positive interactions that facilitate mutual understanding, full participation, and genuine influence on the projects. Strategies to prevent or mitigate engagement challenges also corresponded overall to the same three domains. Both groups typically described strategies more generally, with applicability to a range of challenges rather than specific actions to address only particular challenges.

Conclusion

Meaningful engagement of patients and other stakeholders comes with challenges, as does any innovation in the research process. The challenges and promising practices identified by these investigators and partners, related to engagement infrastructure and the building and maintenance of relationships, reveal actionable areas to improve engagement, including organizational policies and resources, training, new engagement models, and supporting engagement by viewing it as an investment in research uptake and impact.
A patient with myotonic dystrophy diagnosed after experiencing sudden respiratory failure: a case report
Authors: Nishihara Noriaki , Tachibana Shunsuke , Sonoda Hajime , Yamakage Michiaki
Published: October 2020

Background

Myotonic dystrophy is a disorder affecting multiple organs including skeletal muscles and causes respiratory failure. We describe a patient who developed respiratory failure, with delayed diagnosis of myotonic dystrophy type 1 as the cause.

Case presentation

A 62-year-old woman developed acute onset of dyspnea after showing hypertension and tachycardia and was transported to our hospital. On arrival at our institution, SpO2 was 80% with a non-rebreather mask. With a diagnosis of acute phase heart failure, she underwent tracheal intubation. However, weaning from the respirator was difficult in the intensive care unit (ICU). A detailed interview revealed that her brother was affected with myotonic dystrophy type 1. She was also diagnosed with myotonic dystrophy type 1 by a genetic test.

Conclusions

Taking a careful past and family history and prompt genetic testing is required on suspicion of neuromuscular diseases in a patient with respiratory failure by an unknown cause.
Assessment of diversity of Indian aromatic rice germplasm collections for morphological, agronomical, quality traits and molecular characters to identify a core set for crop improvement
Authors: Prasad G. S. V. , Padmavathi G. , Suneetha K. , Madhav M. S. , Muralidharan K.
Published: October 2020

Background

Besides the Basmati, the aromatic rice germplasm (ARG) accessions are treasured for quality, medicinal value and aroma. The demand for aromatic rice is ever increasing. Genetic diversity is the source of variability to identify superior alleles controlling morphological, agronomic and quality traits, and molecular attributes. This study reports on the characterization of traits in ARG to identify a core set for breeding high-yielding varieties.

Methods

The genetic diversity was measured on the distinctness, uniformity and stability (DUS) of 46 traits in 208 Indian ARG in field, greenhouse and laboratory tests. We performed individual and combined analysis of DUS traits and molecular data generated using 55 SSR markers. The genetic distances between genotypes were estimated using Mahalanobis D
2
analysis and clustering by standardized Euclidean
2
distances, Ward Minimum variance, Gowers’ similarity index and PowerMarker. The aim was to derive a core set of non-Basmati ARG using PowerCore to deploy in crop improvement.

Results

Eighty-two alleles were detected. Alleles per marker ranged from 2 (RM505) to 5 (RM276) with an average of 3.04 alleles. The markers are informative in analyzing the diversity as the PIC values estimated varied from 0.17 (RM577 on chromosome 1) to 0.72 (RM276 on chromosome 6) with an average of 0.54 per locus. RM276 with repeat motif of (AG)8A3(GA) 33 on chromosome 6 was the most informative (amplified 5 alleles). The combined analysis had shown genotypes in a few clusters to be more diverse than others. SSR markers RM289, RM505, RM577 and RM22866 were identified as genotype specific markers. With PowerCore, 46 genotypes (22%) were identified as a core set of ARG that represent all the alleles detected in the entire set investigated. 2-Acetyl-1-pyrroline is considered to impart aroma; it was not detected by GC–MS tests in many ARG.

Conclusions

Forty-six genotypes in the core set have different maturity periods, plant statures, grain types and grain quality traits. A parent can be selected from the core set to improve aromatic rice depending on the breeding objective. The olfactory sensing of strong aroma emitted by cooked kernels of all ARG was found more decisive than the costly GC–MS tests.
The W transform
Authors: Wang Yanghua
Published: October 2020

Time-frequency spectral analysis methods such as the S transform cannot appropriately present low-frequency anomalies in seismic traces because they generate a time-frequency spectrum with a low resolution in time at low frequencies. I have developed the W transform to improve the time resolution of the spectrum at low frequencies, for an effective detection of seismic anomalies related to hydrocarbon reservoirs in petroleum exploration and abnormal features in near-surface geophysics. The W transform has three features: (1) the spectral energy is concentrated around the dominant frequency of a seismic waveform, rather than being shifted toward higher frequencies by the S transform; (2) the implementation is numerically stable because it avoids any potential frequency singularity in the S transform; (3) the Gaussian window function is defined using a nonstationary frequency weight, rather than using a stationary frequency weight in the S transform, because the dominant frequency is a time-dependent function. Therefore, the time-frequency spectrum generated by the W transform appropriately represents seismic properties varying with geologic depth, and it has an improved time resolution at low frequencies that makes it suitable for characterizing reservoirs in petroleum geophysics and for detecting karsts in construction engineering.
Green care in psychiatry
Authors: Cuthbert Sharon , Kellas Alan , Page Lisa A.
Published: October 2020

Engagement with natural environments is associated with improved health and well-being in the general population. This has implications for mental healthcare. Implementation of targeted nature-based interventions (green care) meets recovery needs and would enable research to develop, clarifying what works best for whom.
Physician-reported comorbidities and treatment management in patients with non-metastatic castration-resistant prostate cancer.
Authors: Appukkuttan Sreevalsa , Patel Bindi , Parkin Jacqueline , Jaffe Dena H. , Wright Jonathon , Cyhaniuk Annissa
Published: October 2020

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Background: With the emergence of potent therapies in non-metastatic castration-resistant prostate cancer (nmCRPC) there is a need to understand the impact of nmCRPC treatments on patient comorbidities and concomitant medications. The goal of this study was to understand treatment management of nmCRPC in patients with pre-existing comorbidities from a physician perspective. Methods: Physicians who treated nmCRPC patients with systemic therapy were recruited from a US physician panel for an online survey (Sept-Oct 2019). Physician responses included physician treatment practice, demographic characteristics, and their 'typical' nmCRPC patient profile from the past 6 months (e.g., health profile, disease management, and quality of life [QOL]). Results: Fifty US physicians (56% urologists, 44% oncologists) with 21±6 years in practice, treated on average 30 nmCRPC patients in the past 6 months. The most common nmCRPC treatments were leuprolide acetate (82%), enzalutamide (80%) and apalutamide (70%). The most common comorbidities reported were hypertension (96%), sexual dysfunction (94%), diabetes (92%), myocardial infarction (88%) and urinary issues (88%). 78% of the physicians reported taking comorbidities and medications for comorbidities into consideration when prescribing nmCRPC treatments. Between 15%-28% of physicians reported a change in nmCRPC prostate treatment and 19%-26% reported a dose change in nmCRPC treatment for up to 1/3 of their patients due to comorbidities (Table). For QOL, urologists versus oncologists indicated more days with poor health status among nmCRPC patients (e.g., median poor mental health days 30-days prior to treatment: urologists=15 days vs oncologists=5 days). Conclusions: Many physicians take into account pre-existing comorbidities and their medications when prescribing nmCRPC treatments. Differences in perceived QOL were observed between physician specialty. These findings highlight the importance of considering therapies that lessen the treatment burden in nmCRPC. [Table: see text]
An evaluation of adult cancer-related neuropathic pain treatment at a large academic medical center.
Authors: Ko Elizabeth Kyung , Glode Ashley Elizabeth , Wright Garth C.
Published: October 2020

168

Background: Cancer-related neuropathic pain (CNP) is a common comorbidity among patients due to treatment and/or tumors that can cause neuronal damage. At present, there is no proven method to prevent CNP and no published widely followed national guideline for CNP management with a defined treatment algorithm. Further evaluation of CNP treatment is needed to help guide the development of clinical algorithms for CNP management. Methods: Health Data Compass, a data mining warehouse, was used to identify adults treated at the University of Colorado Hospital (UCH) who had a new diagnosis of cancer between January 1, 2014 and May 31, 2019 in addition to neuropathy during the same time frame. Individual patient electronic medical records were then reviewed for information unable to be obtained through Health Data Compass. The primary objective of the study was to describe CNP treatment at our facility. Descriptive statistics were used to define study population demographics and the primary outcome. Results: A total of 316 patients met study inclusion. The majority of the patients were white (86.7%) and female (67.4%). The most commonly included cancer types were breast (39.4%) and gastrointestinal (35.6%). Patients with all cancer stages were represented in the study. The majority of patients (n = 283) had a diagnosis code of neuropathy on or after the date of their cancer diagnosis; 33 patients had neuropathy documented prior to their cancer diagnosis. The most common CNP management strategies included: opioids only (37.7%), opioids, gabapentin or pregabalin, and an antidepressant (20.3%), opioids and antidepressants (19.6%), or opioids and gabapentin or pregabalin (17.7%). Nearly half of medications used in CNP were not prescribed prior to the patient’s neuropathy diagnosis date (47.3%). Approximately one-third of the patients (33%) had no dose changes from their initial CNP treatment dose. Conclusions: We completed a large single center study to identify the most commonly used medications for CNP treatment. The study included a wide variety of cancer types and all stages. Opioids were the most commonly used medication to treat CNP at UCH. Next steps will be to evaluate the efficacy of opioids compared to other treatment combinations for the management of CNP.
Shared decision-making attitudes and practices in multidisciplinary cancer care teams.
Authors: Mangir Christina , Boehmer Leigh , Kurtin Sandra E. , Wilfong Lalan S. , Kass Rena , Shockney Lillie D. , Politi Mary C. , Jagsi Reshma , LeBlanc Thomas William , Sonet Ellen , Studts Jamie L , Hutton Andrea , Plotkin Elana , Lucas Lorna , Copeland Amy
Published: October 2020

180

Background: Patients who engage in decision making are more likely to experience confidence in treatment decisions, satisfaction with treatment, and trust in clinicians. The Association of Community Cancer Centers (ACCC) conducted a survey to explore multidisciplinary team attitudes and practices around shared decision-making (SDM) and health literacy. Methods: ACCC convened a steering committee of multidisciplinary specialists and advocacy representatives to guide this research. The survey included 26 mostly closed-ended questions and was open to multidisciplinary cancer programs from 10/29/19 to 2/20/20. Exploratory analysis was performed on this data set of 305 complete responses. Results: While most respondents reported engaging patients in decision-making to some degree, only 50% reported that SDM is a top organizational priority. 33% reported organizational efforts to formally integrate SDM into the clinical workflow, with only 15% indicating staff opportunities for basic SDM training. The three most frequently cited perceived barriers to engaging in SDM were patients feeling overwhelmed (53%), wanting to defer decisions to clinicians (46%), and having limited health literacy (46%). Only 13% indicated that lack of time was a barrier. Less than half (41%) of respondents reported using patient decision aids to support SDM. Respondents represented a wide range of multidisciplinary team members, though surgical oncologists and general surgeons (20% and 16% respectively) are overrepresented in the results. Conclusions: SDM is commonly accepted as essential to patient engagement but clarity in terminology and prioritizing formal integration of SDM into practice is limited. Strategies to improve integration of SDM into oncology practice should include: 1) Educational initiatives and tools to overcome barriers to SDM, including patient decision aids and SDM training, 2) Initiatives to address health literacy as it relates to patient and caregiver engagement in decision making, 3) Psychosocial support for patients whose emotional upset is a barrier to SDM, 4) Healthcare policies that encourage and incentive providers to engage in SDM. Future analyses will require concurrent assessment of patient, caregiver, healthcare professional, and administrator perspectives.
Closing the gap in health care disparities by improving the rate of lung cancer screening in an intercity hospital.
Authors: Bhargava Anika , Kohli Akshay , Veytsman Irina
Published: October 2020

195

Background: The National Lung Cancer Screening Trial showed reduced lung cancer mortality with low-dose computed tomography (LDCT) screening. Although LDCT is generally covered by private and government insurance, the rate of LDCT screening has been reported to be very low (2-3%) in previous studies. One of the main barriers in adequate screening was assessment of smoking history to identify eligible populations. Purpose: To increase the rate of lung cancer screening in Medstar Washington Hospital Center Internal Medicine (WHCIM) clinics from a baseline rate of 2.88% by 50% over a 3-month period. Methods: Retrospective baseline data was collected over a 2-week period 01/06/2020–01/17/2020 from patients visits at WHCIM to assess the rate of lung cancer screening. A session was held with physicians and nursing staff to find the barriers in identifying eligible patients for lung cancer screening and to create a fishbone diagram. The first plan-do-study act cycle (PDSA) was initiated from 02/24/2020–03/13/2020 where we piloted a clinical reminder in the form of a print-out filled out by the medical assistants at check in and then given to physicians. The form included the patient's age and simple smoking questionnaire according to the lung cancer screening guidelines. Data was collected during this time period which included documentation of patient’s smoking history, lung cancer screening eligibility and referral to LDCT. Results: By retrospective analysis from the time period of 01/06/2020-01/17/2020 providers documented a smoking history in only 16% of patients seen and only 2.88% of all patients seen over the age of 55 were referred for lung cancer screening. Post intervention for the time period of 02/24/2020-03/13/2020 increased the amount of documented smoking history by providers to 26% and number of patients sent for lung cancer screening to 6.0%. Of patients who met the criteria for lung cancer screening, prior to the intervention only 42% of patients were referred. However, after the clinical reminder has been initiated, 86% of patients who did meet the criteria were sent for screening. Conclusions: The clinical reminder has increased documentation of smoking history by 62% and lung cancer screening for those who meet the criteria according to the guidelines by a relative increase of 105%. We are currently working on PDSA cycle 2 to incorporate education materials in the encounter room and PDSA cycle 3 to incorporate this clinical reminder into the electronic medical record and to implement hospital wide.