bluuebunny/crossref_metadata_2025 huggingface dataset:
Diversity for diversity: A “fast track” nursing service model to complement conventional emergency medicine service in a busy urban area emergency department
Authors: Hing Yin Ng , Kin Ping Fan , Chor Man Lo
Published: June 2020

Background:

In a busy local emergency department, patients with certain non-life-threatening conditions which only require relatively quick and straightforward management may encounter long waiting times. A new service model called the “Fast Track” Nursing Service attempts to lessen the service load of the regular service queues and to improve patient outcomes.

Objectives:

This article reports the service outcomes of the Fast Track Nursing Service.

Methods:

Nurses at our department are selected and trained under clinical protocols specially developed for this service. Assessments and quality assurance audits ensure the quality of service.

Results:

This service resulted in comparatively shorter waiting times for patients included in predetermined clinical protocols. There was also a high level of patient satisfaction with this service.

Conclusion:

Our Fast Track Enhanced Nursing service is a model of tailored service diversification to shorten waiting times, thus improving patient satisfaction and outcome.
Keeping the Family in Family Medicine
Authors: Woodruff Amelita
Published: June 2020

In this personal reflection, as a Family Medicine resident at an Academic Center in Northeast Florida, as well as being a chronic illness patient myself, I explore the notion of dying alone and away from family. Although COVID-19 has changed the practice of medicine in many ways, prior to that, and before the instillation of hospital no-visitor policies and stay at home orders, I experienced a case of a patient dying alone in the hospital. These chronicles that case and the impact it had on me afterward in regard to my own family and how I hope the future of medicine can address this.
Research Progress of Oxidative Stress and MicroRNAs in the Prevention of Catheter-Related Thrombus Under Resistance Exercise
Authors: Wen Cui , Ying Yanping , Yu Fu , Zhou Jianpeng
Published: June 2020

Central venous access devices (CVADs) have completely changed the care for patients who require long-term venous access. With the widespread use of CVADs, the incidence of catheter-related thrombus (CRT) has increased. Catheter-related thrombus is a common complication in patients who use CVADs and is mainly caused by endothelial injury, blood stasis, and hypercoagulability. In recent years, the correlations between oxidative stress (OS) and microRNA (miRNA) and CRT have become a hot topic in clinical research. When a catheter punctures the vessel wall, it causes OS damage to the vascular endothelial cells, leading to a series of CRT diseases. MicroRNAs can regulate the mechanism of thrombus and play an important role in the formation of anti-thrombus. Numerous studies have shown that resistance exercise can reduce the level of OS in vascular endothelial cells, inhibit vascular endothelial cell dysfunction, and maintain the stability of hemodynamics and biochemical state. In the current work, the recent studies on the effects of resistance exercise on OS and miRNA in vascular endothelial cells were reviewed.
Maternal Reminiscing Is Associated With Preschoolers’ Reports of Maltreatment During Forensic Interviews
Authors: Lawson Monica , Jaeger Bailey , McManus Evelyn , Speidel Ruth , Valentino Kristin
Published: June 2020

Children’s reports during forensic interviews regarding maltreatment allegations are often critical for legal processes and for guiding decisions regarding services for children and their families. Field research examining forensic interviews with children has identified a wide range in the amount of information children report to interviewers. Research examining associations between children’s forensic reports and their broader ecological and developmental contexts related to autobiographical memory would critically contribute to our understanding of children’s reports of trauma during forensic investigations. Guided by the sociocultural theory of autobiographical memory development and a self-determination perspective of interviewing child witnesses, associations between the number of allegation-relevant details reported by 52 preschoolers ( M = 4.59 years old, SD = 1.06) during forensic interviews concerning substantiated maltreatment allegations and later maternal elaborative and autonomy supportive reminiscing from observations of mother–child interactions during a laboratory assessment were examined. Consistent with previous research regarding children’s autobiographical memory, a positive association between maternal elaborative reminiscing about everyday experiences with their children and the number of unique allegation-relevant details children reported during forensic interviews was observed, but only when mothers reminisced with their children in an autonomy supportive manner. Theoretical and practical implications for interviewing child witnesses are discussed.
Identification of Transposable Elements in Conifer and Their Potential Application in Breeding
Authors: Wang Junhui , Lu Nan , Yi Fei , Xiao Yao
Published: June 2020

Transposable elements (TEs) are known to play a role in genome evolution, gene regulation, and epigenetics, representing potential tools for genetics research in and breeding of conifers. Recently, thanks to the development of high-throughput sequencing, more conifer genomes have been reported. Using bioinformatics tools, the TEs of 3 important conifers ( Picea abies, Picea glauce, and Pinus taeda) were identified in our previous study, which provided a foundation for accelerating the use of TEs in conifer breeding and genetic study. Here, we review recent studies on the functional biology of TEs and discuss the potential applications for TEs in conifers.
Relationship of Weight-Related Eating Behaviors and Weight Loss of Participants Enrolled in a Proprietary Weight Loss Program
Authors: Block Megan , Kattelmann Kendra K , Meendering Jessica , McCormack Lacey
Published: June 2020

Background: There is a need for improving long-term success in meal replacement programs and identifying the variables that affect weight loss and maintenance in a proprietary weight loss program that includes health coaching. Objective: The aim of this study is to evaluate weight-related eating behaviors of participants with clinically significant weight loss (CSWL) in a proprietary weight loss program. Study Design, Setting, and Participants: A cross-sectional sample of participants (n=1,454) enrolled in a proprietary weight-loss program that includes meal replacements and health coaching were queried via an on-line survey for weight-related eating behaviors and weight history. Main Outcome Measures and Analysis: Weight-related eating behaviors of routine restraint (RR), compensatory restraint (CR), susceptibility to external cues (SEC), and emotional eating (EE) were assessed using the Weight Related Eating Questionnaire. CSWL was defined as having achieved a weight loss greater than 10% of starting weight. Participants were dichotomized into those with CSWL (n=973) and with no CSWL (n=481). The relationship between CSWL (controlling for age and sex) as the dependent variable and weight-related eating behaviors (RR, CR, SEC, and EE) as the independent variables was assessed using logistic regression (Stata/SE 14). Results: Those with CSWL have higher odds of having RR (OR: 1.3, p<0.05) and CR (OR: 1.1, p<0.05) and lower odds of SEC (OR: 0.7, p<0.05) and EE (OR: 0.8, p<0.05) eating behaviors than those without CSWL. Conclusions: Weight-related eating behaviors of participants in proprietary meal replacement weight-loss programs who have successfully lost weight differ compared to those who have not. Knowledge of the relationship between CSWL and weight-related eating behaviors can be used by coaches to assist participants in reinforcing those behaviors that support weight-loss. These results are limited to participants who self-select for proprietary meal-replacement weight-loss programs and cannot be generalized to other weight-loss or maintenance programs.
Is Noncardiac Chest Pain Truly Noncardiac?
Authors: Teragawa Hiroki , Oshita Chikage , Orita Yuichi
Published: June 2020

Many causes of noncardiac chest pain (NCCP) have been studied and gastroesophageal reflux disease is considered to be the major cause. However, studies have reported that treatment with a proton pump inhibitor does not effectively provide relief for NCCP-related symptoms, and these symptoms frequently recur. These findings suggest that patients with cardiac disease may be excluded completely from the NCCP group. Several examinations can be conducted to verify the presence of cardiac disease. Such examinations include the assessment of biochemical markers, rest and exercise electrocardiogram, echocardiography, cardiac computed tomography, stress myocardial perfusion imaging, cardiac magnetic resonance imaging, and coronary angiography (CAG). However, the presence of functional coronary artery diseases (CADs), such as vasospastic angina and/or microvascular angina, cannot be detected using these modalities. These functional CADs can be diagnosed by CAG with spasm-provocation testing and/or physiological coronary measurement. Thus, when a patient who is suspected of having NCCP takes a proton pump inhibitor and does not respond well, further examination—including assessment for possible functional CADs—may be needed.
(Inter)subjectivity in the research pair: Countertransference and radical reflexivity in organizational research
Authors: Duncan Carrie M. , Elias Sara R. S. T. A.
Published: June 2020

Destabilizing what we know, a central tenet of critical reflexive research, is difficult without making unconscious assumptions, beliefs, and emotions available for thought, articulation, and questioning. Articulating countertransference, a technique borrowed from psychoanalysis, informs our efforts to raise awareness of the unconscious dimensions of field experiences and thus foster radical reflexivity. Bridging the literatures on reflexivity and relational psychoanalysis, we develop a new four-dimension method of writing and analyzing fieldnotes— observing, capturing the story, articulating countertransference, and developing interpretations—that foregrounds unconscious dimensions of experience. We make visible the fieldnotes we generated during an organizational study. In doing so, we demonstrate how a research pair working together in real time can become aware of their intersubjective processes, fold together multiple dimensions of experience (conscious and unconscious), and co-construct a shared understanding of organizational dynamics. This article is valuable because it demonstrates how psychoanalytic concepts can be mobilized by psychoanalytically informed, but not formally trained, organizational researchers.
Modelling sound absorption properties for recycled polyethylene terephthalate-based material using Gaussian regression
Authors: Iannace Gino , Ciaburro Giuseppe
Published: June 2020

Plastic is widely used all over the world and its production has been increasing continuously in recent years. But plastic presents significant problems about its end-of-life given its important environmental impact. These problems impose recycling policies which provide for the collection and recycling of plastic materials. In this work, the acoustic properties of a recycled polyethylene terephthalate-based material were analyzed. The material showed good sound-absorbing characteristics, especially at high frequencies. In addition, a numerical model based on the Gaussian regression was developed to simulate the sound absorption coefficient of the material. The model returned an R-Squared value of 0.97 demonstrating excellent performance.
Understanding fear of childbirth among underrepresented populations in the United States
Authors: Roosevelt Lee K , Low Lisa Kane
Published: June 2020

The purpose of this study was to expand our understanding of fear of childbirth (FOC) by examining the interplay between individual, provider, identity, and culture among women historically underrepresented in FOC research to develop a deeper understanding of FOC. Purposive sampling was used to recruit 22 participants into three different focus groups, each with a unique demographic makeup. The results provide evidence that people’s birth experiences and their experiences with fear surrounding childbirth are affected by many other social mechanisms, including relationships with providers, birth setting, race, class, gender, sexual orientation, and ethnicity.
Dull as Dachau
Authors: kavoori anandam
Published: June 2020

Dull as Dachau is a reflexive, autoethnographic account of the contrived engagement of American undergraduates (from a privileged background) of a class-mandated visit to the Dachau Concentration Camp, near Munich, Germany. Written as a poem, with commentary/contextual referencing in end notes, the essay explores the transactional nature of dark tourism and offers a critique of such pedagogical engagements with history, especially in the context of American undergraduate education and the study abroad enterprise.
Internet of Green Things with autonomous wireless wheel robots against green houses and farms
Authors: Ram C Ramasamy Sankar , Ravimaran S , Krishnan R Santhana , Julie E Golden , Robinson Y Harold , Kumar Raghvendra , Son Le Hoang , Thong Pham Huy , Thanh Nguyen Quang , Ismail Mahmoud
Published: June 2020

Nowadays, smart farming involves the integration of advanced technologies that incorporate low-cost robots to meet the required knowledge and maintain the health of plants in farming. Technologies like precision agriculture are also used to optimize resources based on the field condition. Internet of Green Things is also one of the technologies to integrate and share the information between people and healthy farm things. Internet of Green Things gives the information like soil moisture, temperature, humidity, and nutrient level by means of respective sensors. Monitoring and information gathering in green houses with the help of robots is a tedious and expensive process. In this connection, information is shared among low-cost robots encouraging data availability of the current state of a plant with other robots. This will emphasize the monitoring of green houses in a well-organized way. In this article, a Flask-based framework through Raspberry Pi is proposed for interoperability among the low-cost ESP8266 robots. Data gathering is performed by smart robots that are accessible through Message Queuing Telemetry Transport subscribes by means of Representational State Transfer Application Programming Interface. A cloud-like database server is provided to stock up the data. The integration of robotics with Internet of Green Things gains more advantage in gathering about spatial information data that are connected with the irrigation. Visualization techniques and perspectives based on Internet of Green Things for precision agriculture in the field of farming are highlighted.
One-stage, radical laparoscopic endometriosis excision involving three different organ systems: A case report from tertiary referral center
Authors: Ćorić Mario , Gregov Marija , Šarić Marko Jakov , Mikuš Mislav , Grgić Franjo , Knežević Nikola , Matošević Petar , Brozović Ivo
Published: June 2020

Introduction:

We present a case of an extensive endometriosis involving left paracolpium and left parametrium, rectovaginal septum, urinary bladder, left interiliac region between artery and vein, left ureter and rectum, presenting as dysmenorrhoea, alternating bouts of diarrhea and constipation and hydronephrosis.

Methods:

Laparoscopic surgery made by a multidisciplinary team consist of gynecologic, abdominal surgeon and urologist.

Results:

Successfully managed deep infiltrated endometriosis.

Conclusion:

The aim of this report is to demonstrate benefit of one-stage, minimally invasive radical surgical procedure performed in a tertiary referral center. To the best of our knowledge, this report presents an extremely complex case because we successfully managed deep infiltrating endometriosis in three different organ systems at the same time, using minimally invasive nerve-sparing technique. A case with the same constellation has not been published yet since reported cases of extrapelvic endometriosis chiefly address one organ system involvement.
The prevalence of headache disorders in children and adolescents in Lithuania: a schools-based study
Authors: Genc Diana , Vaičienė-Magistris Nerija , Zaborskis Apolinaras , Şaşmaz Tayyar , Tunç Aylin Yeniocak , Uluduz Derya , Steiner Timothy J.
Published: June 2020

Background

While the Global Burden of Disease (GBD) study reports headache disorders as the second-highest cause of disability worldwide, the headache data in GBD come very largely from adults. This national study in Lithuania was part of a global schools-based programme within the Global Campaign against Headache contributing data from children (7–11 years) and adolescents (12–17 years).

Methods

The methods followed the generic protocol for the global study. The basic study design was a cross-sectional survey. Self-completed structured questionnaires were administered, within classes, in 24 schools selected from seven regions of Lithuania to be nationally representative. Headache diagnostic questions were based on ICHD-3 beta criteria but for the inclusion of undifferentiated headache (UdH).

Results

Of 3714 potential participants, 2505 (children 1382 [55.2%], adolescents 1123 [44.8%]; males 1169 [46.7%], females 1336 [53.3%]) completed the questionnaire. Adolescents and males were therefore relatively under-represented, with non-participation (32.6%) due in most cases to lack of parental consent. Observed lifetime prevalence of headache was 92.2%. Gender- and age-adjusted 1-year prevalence was 76.6% (migraine: 21.4%; tension-type headache [TTH]: 25.6%; UdH: 24.0%; all headache on ≥15 days/month: 3.9%; probable medication-overuse headache: 0.8%). All headache types except UdH were more prevalent among females than males, and among adolescents than children. UdH showed a complex relationship with age, but represented 38.0% of all reported headache in children, 27.4% in adolescents. Headache yesterday (HY) was reported by 17.5%, almost double the 9.8% predicted from prevalence and headache frequency to have headache on any day. The reason was unclear.

Conclusions

Findings were not very different from those reported in Turkey and Austria, but with more TTH. Headache has, therefore, again been shown to be common in children and adolescents, and UdH confirmed as a headache type that must be recognised and included in accounts of headache in these age groups.
Enhancing Water-Splitting Efficiency Using a Zn/Sn-Doped PN Photoelectrode of Pseudocubic α-Fe2O3 Nanoparticles
Authors: Yang Jie-Xiang , Meng Yongtao , Tseng Chuan-Ming , Huang Yan-Kai , Lin Tung-Ming , Wang Yang-Ming , Deng Jin-Pei , Wu Hsiang-Chiu , Hung Wei-Hsuan
Published: June 2020

α-Phase hematite photoelectrodes can split water. This material is nontoxic, inexpensive, and chemically stable; its low energy gap of 2.3 eV absorbs light with wavelengths lower than 550 nm, accounting for approximately 30% of solar energy. Previously, we reported polyhedral pseudocubic α-Fe2O3 nanocrystals using a facile hydrothermal route to increase spatial charge separation, enhancing the photocurrent of photocatalytic activity in the water-splitting process. Here, we propose a p-n junction structure in the photoanode of pseudocubic α-Fe2O3 to improve short carrier diffusion length, which limits its photocatalytic efficiency. We dope Zn on top of an Fe2O3 photoanode to form a layer of p-type semiconductor material; Sn is doped from the FTO substrate to form a layer of n-type semiconductor material. The p-n junction, n-type Fe2O3:Sn and p-type Fe2O3:Zn, increase light absorption and charge separation caused by the internal electric field in the p-n junction.
Acute respiratory symptoms and its associated factors among mothers who have under five-years-old children in northwest, Ethiopia
Authors: Andualem Zewudu , Azene Zelalem Nigussie , Azanaw Jember , Taddese Asefa Adimasu , Dagne Henok
Published: June 2020

Background

Poor air quality of the household is likely to be the largest public health concern in resource-constrained countries. Exposure to household air pollution, poor working environment, and fuel type used at household level have been associated with respiratory symptoms. This study aimed to assess acute respiratory symptoms and its associated factors among mothers who have under five-years-old children in Gondar city, northwest Ethiopia.

Method

A cross-sectional study was carried out from February 15, 2019 to June 20, 2019. Study participants were selected using simple random sampling, and data were collected via face-to-face interviews. Binary logistic regression analysis was used to test the association of explanatory and outcome variables. Variables withp < 0.05 were considered as significantly associated with the outcome variable.

Results

The prevalence of respiratory symptoms among mothers of under-five years-old children in this study was 46.1%. Education (vocational training compared to cannot read and write) (adjusted odd ratio (AOR) = 0.26 at 95% confidence interval (CI): 0.08–0.82), working in dusty environment (AOR = 2.90 at 95% CI: 1.39–6.08), wood fire use (AOR = 0.37 at 95% CI: 0.16–0.85), living in mud- and wood-walled houses (AOR = 0.53 at CI: 0.32–0.89), recent house painting (AOR = 1.95 at 95% CI: 1.03–3.69), new carpet (AOR = 2.02 at 95% CI: 1.08–3.77), pesticide use (AOR = 1.71 at 95% CI: 1.03–2.84), damp stain (AOR = 2.45 at 95% CI: 1.04–5.75), spending longer time in house for 6 to 11 h (AOR = 2.59 at 95% CI: 1.53–4.37) and 11 to 15 h (AOR = 3.47 at 95% CI: 1.87–6.43), and living less than 100 m from unpaved roads/streets (AOR = 4.35 at 95% CI: 2.64–7.18) were significantly associated with respiratory symptoms among mothers of under-five years-old children.

Conclusion

Respiratory symptoms were common among mothers who have under five-years-old children. Air quality improvement, fuel selection, and residential planning will help to reduce respiratory symptoms.
Analysis of oral microbiome from fossil human remains revealed the significant differences in virulence factors of modern and ancient Tannerella forsythia
Authors: Philips Anna , Stolarek Ireneusz , Handschuh Luiza , Nowis Katarzyna , Juras Anna , Trzciński Dawid , Nowaczewska Wioletta , Wrzesińska Anna , Potempa Jan , Figlerowicz Marek
Published: June 2020

Background

Recent advances in the next-generation sequencing (NGS) allowed the metagenomic analyses of DNA from many different environments and sources, including thousands of years old skeletal remains. It has been shown that most of the DNA extracted from ancient samples is microbial. There are several reports demonstrating that the considerable fraction of extracted DNA belonged to the bacteria accompanying the studied individuals before their death.

Results

In this study we scanned 344 microbiomes from 1000- and 2000- year-old human teeth. The datasets originated from our previous studies on human ancient DNA (aDNA) and on microbial DNA accompanying human remains. We previously noticed that in many samples infection-related species have been identified, among themTannerella forsythia, one of the most prevalent oral human pathogens. Samples containing sufficient amount ofT. forsythiaaDNA for a complete genome assembly were selected for thorough analyses. We confirmed that theT. forsythia-containing samples have higher amounts of the periodontitis-associated species than the control samples. Despites, other pathogens-derived aDNA was found in the tested samples it was too fragmented and damaged to allow any reasonable reconstruction of these bacteria genomes. The anthropological examination of ancient skulls from which theT. forsythia-containing samples were obtained revealed the pathogenic alveolar bone loss in tooth areas characteristic for advanced periodontitis. Finally, we analyzed the genetic material of ancientT. forsythiastrains. As a result, we assembled four ancientT. forsythiagenomes - one 2000- and three 1000- year-old. Their comparison with contemporaryT. forsythiagenomes revealed a lower genetic diversity within the four ancient strains than within contemporary strains.We also investigated the genes ofT. forsythiavirulence factors and found that several of them (KLIKK protease andbspAgenes) differ significantly between ancient and modern bacteria.

Conclusions

In summary, we showed that NGS screening of the ancient human microbiome is a valid approach for the identification of disease-associated microbes. Following this protocol, we provided a new set of information on the emergence, evolution and virulence factors ofT. forsythia,the member of the oral dysbiotic microbiome.
Correction to: Ionizing radiation modulates the phenotype and function of human CD4+ induced regulatory T cells
Authors: Beauford Samantha S. , Kumari Anita , Garnett-Benson Charlie
Published: June 2020

An amendment to this paper has been published and can be accessed via the original article.
The role of NMDA receptors in rat propofol self-administration
Authors: Chen Bei-ping , Huang Xi-xi , Dong Dong-mei , Wu Hui , Zhu Tian-qi , Wang Ben-fu
Published: June 2020

Background

Propofol is among the most frequently used anesthetic agents, and it has the potential for abuse. The N-methyl-D-aspartate (NMDA) receptors are key mediators neural plasticity, neuronal development, addiction, and neurodegeneration. In the present study, we explored the role of these receptors in the context of rat propofol self-administration.

Methods

Sprague-Dawley Rats were trained to self-administer propofol (1.7 mg/kg/infusion) using a fixed-ratio (FR) schedule over the course of 14 sessions (3 h/day). After training, rats were intraperitoneally administered the non-competitive NDMA receptor antagonist MK-801, followed 10 min later by a propofol self-administration session.

Results

After training, rats successfully underwent acquisition of propofol self-administration, as evidenced by a significant and stable rise in the number of active nose-pokes resulting in propofol administration relative to the number of control inactive nose-pokes (P < 0.01). As compared to control rats, rats that had been injected with 0.2 mg/kg MK-801 exhibited a significantly greater number of propofol infusions (F (3, 28) = 4.372, P < 0.01), whereas infusions were comparable in the groups administered 0.1 mg/kg and 0.4 mg/kg of this compound. In addition, MK-801 failed to alter the numbers of active (F (3, 28) = 1.353, P > 0.05) or inactive (F (3, 28) = 0.047, P > 0.05) responses in these study groups. Animals administered 0.4 mg/kg MK-801 exhibited significantly fewer infusions than animals administered 0.2 mg/kg MK-801 (P = 0.006, P < 0.01). In contrast, however, animals in the 0.4 mg/kg MK-801 group displayed a significant reduction in the number of active nose-poke responses (F (3, 20) = 20.8673, P < 0.01) and the number of sucrose pellets (F (3, 20) = 23.77, P < 0.01), while their locomotor activity was increased (F (3, 20) = 22.812, P < 0.01).

Conclusion

These findings indicate that NMDA receptors may play a role in regulating rat self-administration of propofol.
Sex difference in the prognostic role of body composition parameters in Taiwanese patients undergoing transcatheter aortic valve implantation
Authors: Chang Hsiao-Huang , Chen Po-Lin , Leu Hsin-Bang , Chen I-Ming , Wu Nai-Yuan , Chen Ying-Hwa
Published: June 2020

Background

Evidence on association between body composition and outcomes of transcatheter aortic valve implantation (TAVI) is limited for Asian patients. This study investigated the prognostic role of body composition parameters in Taiwanese patients undergoing TAVI.

Materials and methods

Data of consecutive patients undergoing TAVI for severe aortic stenosis between May 1, 2010 and August 31, 2019 were prospectively collected in this observational study. The association between body composition parameters (body mass index [BMI], body surface area [BSA], lean body mass [LBM], and LBM index) and cumulative mortality was analyzed using Cox proportional hazard regression model.

Results

A total of 221 patients (mean age 81.4 years), including 125 (56.6%) males, were included with median follow-up duration of 23.8 months. In males, multivariate analysis revealed that higher BMI (P = 0.035), BMI ≥ 20 kg/m2 (P = 0.026), and higher LBM index (P = 0.023) significantly predicted lower overall all-cause cumulative mortality. In females, none of the body composition parameters was significantly associated with all-cause cumulative mortality. Paradoxical association between BMI and estimated all-cause cumulative mortality was only significant among male patients.

Conclusion

In Taiwanese TAVI patients, the prognostic effects of BMI and LBM index on cumulative mortality were only observed in males, not in females. Sex differences must be considered when stratifying risk among patients undergoing TAVI.
Cardiovascular risk factor mapping and distribution among adults in Mukono and Buikwe districts in Uganda: small area analysis
Authors: Musinguzi Geofrey , Ndejjo Rawlance , Ssinabulya Isaac , Bastiaens Hilde , van Marwijk Harm , Wanyenze Rhoda K.
Published: June 2020

Background

Sub-Saharan Africa (SSA) is experiencing an increasing burden of Cardiovascular Diseases (CVDs). Modifiable risk factors including hypertension, diabetes, obesity, central obesity, sedentary behaviours, smoking, poor diet (characterised by inadequate vegetable and fruit consumption), and psychosocial stress are attributable to the growing burden of CVDs. Small geographical area mapping and analysis of these risk factors for CVD is lacking in most of sub-Saharan Africa and yet such data has the potential to inform monitoring and exploration of patterns of morbidity, health-care use, and mortality, as well as the epidemiology of risk factors. In the current study, we map and describe the distribution of the CVD risk factors in 20 parishes in two neighbouring districts in Uganda.

Methods

A baseline survey benchmarking a type-2 hybrid stepped wedge cluster randomised trial design was conducted in December 2018 and January 2019. A sample of 4372 adults aged 25–70 years was drawn from 3689 randomly selected households across 80 villages in 20 parishes in Mukono and Buikwe districts in Uganda. Descriptive statistics and generalized linear modelling controlled for clustering were conducted for this analysis in Stata 13.0, and a visual map showing risk factor distribution developed in QGIS.

Results

Mapping the prevalence of selected CVD risk factors indicated substantial gender and small area geographic heterogeneity which was masked on aggregate analysis. Patterns and clustering were observed for hypertension, physical inactivity, smoking, alcohol consumption and risk factor combination. Prevalence of unhealthy diet was very high across all parishes with no significant observable differences across areas.

Conclusion

Modifiable cardiovascular risk factors are common in this low-income context. Moreover, across small area geographic setting, it appears significant differences in distribution of risk factors exist. These differences suggest that underlying drivers such as sociocultural, environmental and economic determinants may be promoting or inhibiting the observed risk factor prevalences which should be further explored. In addition, the differences emphasize the value of small geographical area mapping and analysis to inform more targeted risk reduction interventions.
Development of an integrative coding framework for evaluating context within implementation science
Authors: Rogers L. , De Brún A. , McAuliffe E.
Published: June 2020

Background

This research aims to explore an identified gap in implementation science methodology, that is, how to assess context in implementation research. Context is among the strongest influences on implementation success but is a construct that is poorly understood and reported within the literature. Consequently, there is little guidance on how to research context. This study addresses this issue by developing a method to account for the active role of context during implementation research. Through use of a case study, this paper demonstrates the value of using our context coding framework.

Methods

The developed context coding framework was guided by the sub-elements of the Consolidated Framework for Implementation Research (CFIR). Employing a constructivist approach, this framework builds on the CFIR and enables a deeper exploration of context at multiple levels of the health system. The coding framework enables the collation of various data sources such as organisational reports, culture audits, interview, survey, and observational data. It may be continuously updated as new data emerge and can be adapted by researchers as required. A pre-existing rating criterion has been integrated to the context coding framework to highlight the influence and relative strength of each contextual factor prior to and during implementation.

Results

It is anticipated that the context coding framework will facilitate a standardised approach to assessing context. This will provide a deeper understanding of how to account for the influence of context, ultimately providing guidance that should increase the likelihood of implementation success. The coding framework enables implementation progress to be monitored, facilitating the identification of contextual changes and variations across settings at different levels of the healthcare system. It is expected this framework will inform the selection of appropriate implementation strategies and enable the monitoring of such strategies regarding their impact on local context.

Conclusions

This research contributes to the extant literature by advancing methodologies for the consideration and assessment of context in implementation research. This context coding framework may be used in any setting to provide insight into the characteristics of particular contexts throughout implementation processes.
Nomogram based on blood lipoprotein for estimation of mortality in patients with hepatitis B virus-related acute-on-chronic liver failure
Authors: Xiao Cuicui , Gong Jiao , Zhu Shuguang , Zhang Zhiwei , Xi Sujuan , Chong Yutian , Jie Yusheng , Zhang Qi
Published: June 2020

Background

Acute-on-chronic liver failure (ACLF) is a clinic syndrome with substantial high short-term mortality. It is very important to stratify patients according to prognosis to decide management strategy. This study aimed to formulate and validate a nomogram model based on blood lipoprotein for prediction of 3-month mortality in patients with hepatitis B virus (HBV)-related ACLF.

Methods

Data on 393 consecutive patients who were diagnosed as HBV-related ACLF at the Third Affiliated Hospital of Sun Yat-sen University between June 1, 2013, and February 1, 2015, were prospectively collected. Of these, 260 patients who were collected in an earlier period formed the training cohort for the development of nomogram, while 133 patients who were collected thereafter formed the validation cohort for confirming the performance of nomogram.

Results

Multivariate analysis showed that low density lipoprotein cholesterol (LDL-C), age, prothrombin time, and creatinine were independently associated with 3-month mortality of patients with HBV-related ACLF. Kaplan–Meier survival analysis revealed that the high LDL-C (LDL-C ≥ 1.0 mmol/L, cut-off value) was significantly associated with elevated overall survival (P < 0.001). All independent factors for survival were selected into the nomogram. The calibration plot for the probability of survival showed good agreement between prediction by nomogram and actual observation.

Conclusion

This study highlighted that reduction of serum LDL-C level was an independent risk factor for the survival in patients with HBV-related ACLF, and the nomogram based on serum LDL-C was an accurate and practical model for predicting the 3-month mortality in patients with this disease.
CO2 or air cholangiography reduces the risk of post-ERCP cholangitis in patients with Bismuth type IV hilar biliary obstruction
Authors: Zhang Wen-hui , Ding Peng-peng , Liu Lei , Wang Yan-ling , Lai Wen-hui , Han Jing-jing , Han Jun , Li Han-wei
Published: June 2020

Background

Endoscopic biliary stenting by endoscopic retrograde cholangiopancreatography (ERCP) is the most common form of palliation for malignant hilar obstruction. However, ERCP in such cases is associated with a risk of cholangitis. The incidence of post-ERCP cholangitis is particularly high in Bismuth type IV hilar obstruction, and this risk is further increased when the contrast injected for cholangiography is not drained. The present study aims to compare the incidence of cholangitis associated with the use of a contrast agent, air and CO2 for cholangiography in type IV hilar biliary lesions.

Methods

The clinical data of consecutive 70 patients with type IV hilar obstruction, who underwent ERCP from October 2013 to November 2017, were retrospectively analyzed. These patients were divided into three groups based on the agent used for cholangiography: group A, contrast (n = 22); group B, air (n = 18); group C, CO2 (n = 30). These three methods of cholangiography were chronologically separated. Prior to the ERCP, MRCP was obtained from all patients to guide the endoscopic intervention.

Results

At baseline, there was no significant difference in terms of the patient’s age, gender, symptoms and liver function tests among the three groups (P > 0.05). The complication rates were significantly higher in group A than in groups B and C (63.6% vs. 26.7 and 27.8%, P < 0.05). The incidence of post-ERCP cholangitis was significantly higher in group A (P < 0.05), while the incidence of post-ERCP pancreatitis and bleeding were similar in the three groups. After the ERCP, the mean hospital stay was shorter in groups B and C, when compared to group A (P < 0.05). However, there was no significant difference in the 30-day mortality rate among the three groups (P > 0.05). Furthermore, there was no significant difference between groups B and C in terms of primary end points.

Conclusion

CO2 or air cholangiography during ERCP for type IV hilar obstruction is associated with reduced risk of post-ERCP cholangitis, when compared to conventional contrast agents.
Healthy aging through the lens of community-based practitioners: a focus group study
Authors: Dev Rubee , Zaslavsky Oleg , Cochrane Barbara , Eagen Thomas , Woods Nancy F.
Published: June 2020

Background

Nearly one in every seven Americans is 65 years and older, facing day-to-day challenge of aging. Although interest in healthy aging is growing, most of the efforts are directed towards understanding the perceptions of older adults. Little is known about the perspectives of community-based practitioners who work with older adults and deliver programs to promote healthy aging. The purpose of this project was to expand knowledge on healthy aging by exploring the perspectives of community-based practitioners working directly with older adults.

Methods

We purposively sampled community-based practitioners (n = 12, including nurses, physician, social workers, and other community services professionals) working with older adults, who then participated in one of three in-depth focus group discussions conducted between March and June 2016. Each focus group discussion lasted for about 2 h. Verbatim transcript data were analyzed in Atlas.ti 7 using a conventional content analysis with an inductive approach, and consensual validation of coding was achieved.

Results

Three core categories of healthy aging were identified: (1) characteristics of healthy aging; (2) healthy aging attainment; and (3) programs and activities for healthy aging. Practitioners identified a number of characteristics of healthy aging under person-specific (physiological, basic, psych-emotional, and cognitive needs), social aspects (creating community and contributing to the community), and spiritual dimensions (cultural views and beliefs) of healthy aging. Healthy aging attainment was represented as facilitators and barriers both with respect to care recipients and care providers, and programs and activities through promoting fitness and wellness.

Conclusions

The rapidly changing demographics and aging population in the United States and their various needs suggest the implications for recognizing opportunities and developing and implementing programs to promote healthy aging. Although practitioners’ perspectives had some overlap with traditional research and medical views on healthy aging, the unique and holistic conceptual framework derived in the study might provide a more refined foundation for delivering appropriate health care services to the American aging population.
Prognostic value of soluble ST2 and soluble LR11 on mortality and cardiovascular events in peritoneal dialysis patients
Authors: Choi Yu Bum , Lee Mi Jung , Park Jung Tak , Han Seung Hyeok , Kang Shin-Wook , Yoo Tae-Hyun , Kim Hyung Jong
Published: June 2020

Background

Although the soluble form of suppression of tumorigenicity 2 (sST2) and soluble low-density lipoprotein receptor relative with 11 ligand-binding repeats (sLR11) have emerged as novel cardiovascular biomarkers in patients with cardiovascular disease, their prognostic value has not been fully investigated in peritoneal dialysis (PD) patients.

Methods

We included 74 prevalent PD patients from a prospective cohort and measured serum sST2 and sLR11 concentrations by an enzyme-linked immunosorbent assay. The association of these biomarkers and all-cause mortality and major adverse cardiac and cerebrovascular events (MACCEs) was evaluated.

Results

During a follow-up of 38.5 months, all-cause deaths and MACCEs were observed in 13 (17.6%) patients and 23 (31.3%) patients. Multivariable Cox analyses demonstrated that greater sST2 was independently associated with higher risk of all-cause mortality (≥75.8 ng/mL; hazard ratio [HR] = 5.551; 95% confidence interval [CI] = 1.360–22.660) and MACCEs (≥72.5 ng/mL; HR = 4.609; 95% CI = 1.608–13.208). Furthermore, sST2 showed additive predictive value for mortality to the base model including traditional risk factors (net reclassification index = 0.598, P = 0.04). sLR11 was not significantly associated with all-cause mortality or MACCE.

Conclusions

sST2, but not sLR11, indicated a significant prognostic value for all-cause mortality and cardiovascular events in PD patients. Further research is needed to validate emerging biomarkers in these populations.
Development and validation of hybrid Brillouin-Raman spectroscopy for non-contact assessment of mechano-chemical properties of urine proteins as biomarkers of kidney diseases
Authors: Gaipov Abduzhappar , Utegulov Zhandos , Bukasov Rostislav , Turebekov Duman , Tarlykov Pavel , Markhametova Zhannur , Nurekeyev Zhangatay , Kunushpayeva Zhanar , Sultangaziyev Alisher
Published: June 2020

Background

Proteinuria is a major marker of chronic kidney disease (CKD) progression and the predictor of cardiovascular mortality. The rapid development of renal failure is expected in those patients who have higher level of proteinuria however, some patients may have slow decline of renal function despite lower level of urinary protein excretion. The different mechanical (visco-elastic) and chemical properties, as well as the proteome profiles of urinary proteins might explain their tubular toxicity mechanism. Brillouin light scattering (BLS) and surface enhanced Raman scattering (SERS) spectroscopies are non-contact, laser optical-based techniques providing visco-elastic and chemical property information of probed human biofluids. We proposed to study and compare these properties of urinary proteins using BLS and SERS spectroscopies in nephrotic patient and validate hybrid BLS-SERS spectroscopy in diagnostic of urinary proteins as well as their profiling. The project ultimately aims for the development of an optical spectroscopic sensor for rapid, non-contact monitoring of urine samples from patients in clinical settings.

Methods

BLS and SERS spectroscopies will be used for non-contact assessment of urinary proteins in proteinuric patients and healthy subjects and will be cross-validated by Liquid Chromatography-Mass Spectrometry (LC-MS). Participants will be followed-up during the 1 year and all adverse events such as exacerbation of proteinuria, progression of CKD, complications of nephrotic syndrome, disease relapse rate and inefficacy of treatment regimen will be registered referencing incident dates. Associations between urinary protein profiles (obtained from BLS and SERS as well as LC-MS) and adverse outcomes will be evaluated to identify most unfavored protein profiles.

Discussion

This prospective study is focused on the development of non-contact hybrid BLS - SERS sensing tool and its clinical deployment for diagnosis and prognosis of proteinuria. We will identify the most important types of urine proteins based on their visco-elasticity, amino-acid profile and molecular weight responsible for the most severe cases of proteinuria and progressive renal function decline. We will aim for the developed hybrid BLS - SERS sensor, as a new diagnostic & prognostic tool, to be transferred to other biomedical applications.

Trial registration

The trial has been approved by ClinicalTrials.gov (Trial registration ID NCT04311684). The date of registration was March 17, 2020.
An evaluation of the quality of self-harm incident reporting across the Australian asylum seeker population according to World Health Organization (WHO) guidelines
Authors: Hedrick Kyli , Armstrong Gregory , Coffey Guy , Borschmann Rohan
Published: June 2020

Background

Asylum seekers are at elevated risk of self-harm, and the personal and public health costs of self-harm are high; yet the monitoring and reporting of self-harm has been limited and lacking in transparency. This study aims to evaluate the quality of self-harm incident reporting across the Australian asylum seeker population, including by processing arrangements (i.e. community-based, community detention, onshore detention, Nauru, and Manus Island).

Methods

All self-harm incidents reported across the entire Australian asylum seeker population between 1 August 2014 and 31 July 2015 were obtained via the Freedom of Information Act. We assessed the quality of self-harm incident reporting according to the World Health Organization (WHO)'s self-harm reporting guidelines.

Results

A total of 949 self-harm incident reports were assessed. Date, location (processing arrangement), and time of self-harm were routinely reported. Gender was recorded in less than two thirds (62.1%) of all incidents. Method(s) used to self-harm was reported in 81.5% of all incidents, though IDC-10 codes were not reported in any episodes. Psychological or psychiatric assessments were recorded after 4.0% of all incidents, most frequently on Manus Island (10.9%), and in Nauru (10.0%), and least frequently in community-based arrangements (1.7%) and in onshore detention (1.4%), and not at all in community detention. Ambulances were reported as attending 2.8% of all episodes. Hospital attendances were reported following 6.0% of all self-harm incidents, with attendances most commonly reported in incidents occurring in community detention (30.3%), and in community-based arrangements (19.4%). Medevac (air ambulances) were recorded as being utilised in 0.4% of all incidents (2.1% of episodes on Nauru, 1.8% on Manus Island).

Conclusions

The findings of our study indicate that the accessibility and quality of self-harm data is substandard and inconsistent with WHO self-harm reporting guidelines. Such variable reporting makes the identification of self-harm trends, the implementation of prevention strategies – including those at a policy level - and the clinical management of self-harm, extremely challenging. Improved self-harm reporting and monitoring is urgently needed for mitigating and responding to self-harm risk among asylum seekers.