bluuebunny/crossref_metadata_2025 huggingface dataset:
A Proposed Unified Conceptual Framework for Quality of Education in Schools
Authors: Garira Elizabeth
Published: January 2020

Quality of education in schools requires accurate descriptions of all its components to judge its realization and plan for its improvement. However, it can be difficult to obtain such descriptions in an effective manner. This article aims to propose a unified conceptual framework for quality of education in schools to facilitate an understanding of the quality of education. The conceptual framework proposed here is multi-dimensional in nature and based on operational experience by the authors with studying education systems’ performance in general, and particularly, quality of education in schools. The unified conceptual framework proposed here is informed by systems theory and acknowledges the interdependence among the components of quality of education and levels of the education system. In conclusion, we reiterate the importance of a conceptual framework for quality of education that explicates the relationships among the numerous education components (inputs, processes, and outputs) among the various education levels of the education system (national, tertiary, school, and pre-school) as a primary science for understanding the quality of education in schools as an essential step toward providing a scientific base for the study of education quality in schools.
Managing Diversity for Organizational Efficiency
Authors: Inegbedion Henry , Sunday Eze , Asaleye Abiola , Lawal Adedoyin , Adebanji Ayeni
Published: January 2020

The article examined “managing diversity for organizational efficiency.” It sought to find out the extent to which diversity management influences organizational efficiency through the management of conflict, cultural diversity, and employees’ perception of marginalization as well as teamwork and employee work attitude. The survey design was employed. A sample of 178 respondents from nine multinational companies in south-south Nigeria was employed. Research data were analyzed using structural equation modeling, with diversity management and organizational efficiency serving as latent variables. The results show that the management of cultural diversity, employees’ perception of marginalization, and conflict significantly influences diversity management. Furthermore, diversity management and teamwork significantly influence organizational efficiency. The need for managers of diverse workforces to give priority to diversity management, to ensure its effective implementation, was suggested, among others.
Switching Pharmacological Treatment in Wilson Disease: Case Report and Recommendations
Authors: Leung Marcia , Wu Lanzafame Jaimie , Medici Valentina
Published: January 2020

Background. Available treatments for Wilson disease (WD) prevent longterm complications of copper accumulation. Current anti-copper agents include zinc salts, penicillamine, and trientine. Patients with WD may switch between the agents for a number of reasons. Due to the different mechanisms of action between the copper chelators and zinc salts, transitioning could require a period of overlap and increased monitoring. There are no large studies that investigate the best transition strategies between agents. In this article, we review the treatments for WD and how to monitor for treatment efficacy. Case Summary. The patient had been diagnosed with WD for over 20 years prior to establishing care in our Hepatology Clinic. During his initial course, he was transitioned from penicillamine to zinc due to evidence suggesting penicillamine had greater adverse effects in the long term. Later, he was switched to trientine. His liver enzymes and 24-hour urine copper were monitored. During these years, he intermittently had some financial hardship, requiring him to be on penicillamine rather than trientine. He also had developed acute kidney injury. Overall, his liver disease remained under control and he never had signs of decompensated cirrhosis, but had fluctuations of liver enzymes over the years. Conclusion. Anti-copper treatment for WD has to be tailored to medication side effects profile, patient’s chronic and emerging comorbidities, as well as costs. Transitioning regimens is often challenging, and it requires closer monitoring, with no predictors of response.
Sex-Based Differences in Optimal Tunnel Placement for Acromioclavicular Joint Reconstruction
Authors: Benavent Kyra A. , Zhang Dafang , Matzkin Elizabeth G. , Earp Brandon E.
Published: January 2020

Background:

Tunnel placement is important for outcomes after acromioclavicular (AC) joint reconstruction, yet little has been written on sex-based differences in optimal tunnel positioning.

Hypothesis:

No sex-based or anatomic differences will be found in ideal tunnel position based on radiographic measurements.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

The records of 2382 patients were retrospectively examined for clavicle radiographs over a 20-year period. A random set of radiographs were reviewed until 200 radiographs from each sex met inclusion criteria per a priori power analysis. Anteroposterior clavicle radiographs were used to collect (1) length from lateral clavicle to lateral coracoid (LCLC), (2) length from lateral clavicle to medial coracoid (LCMC), (3) clavicle length (CL), and (4) clavicular depth at the midcoracoid (MCCD). The Student t test was used to compare differences between male and female patients. The Pearson correlation coefficient was used to measure linear correlations. Variables with a P < .1 were included in a multiple regression model.

Results:

The cohort included 200 men and 200 women. LCLC and LCMC were significantly greater for men than for women ( P < .0001). Clavicle length was significantly correlated with LCLC ( r = 0.63; P < .0001) and LCMC ( r = 0.74; P < .0001). MCCD was significantly correlated with LCLC ( r = 0.32; P < .0001) and LCMC ( r = 0.43; P < .0001). The approximate placement for the trapezoid tunnel was found to be 22.1 mm in women and 26.6 mm in men. The approximate placement for the conoid tunnel was found to be 40 mm in women and 46.6 mm in men. The ratios (LCLC:CL and LCMC:CL) were also significantly different between female and male patients. The LCLC:CL was 0.144 in women and 0.154 in men ( P < .0001). The LCMC:CL was 0.261 in women and 0.271 in men ( P < .0006).

Conclusion:

Significant sex-based differences are found in the position of the coracoid relative to the lateral edge of the clavicle. Coracoid position relative to the lateral edge of the clavicle is correlated with anatomic parameters, most strongly with clavicle length.
Content Counts and Motivation Matters: Reading Comprehension in Third-Grade Students Who Are English Learners
Authors: Hwang HyeJin , Duke Nell K.
Published: January 2020

This study examined the role of science domain knowledge, reading motivation, and decoding skills in reading comprehension achievement in third-grade students who are English learners (ELs) and students who are monolingual, using a nationally representative data set. Multigroup probit regression analyses showed that third-grade science domain knowledge and motivation for reading, decoding skills, and early attainment of decoding skills were significantly associated with third-grade reading comprehension in both language groups. Also, using Wald chi-square tests, the study showed that the association between third-grade science domain knowledge and reading comprehension was stronger in students who were ELs than in students who were monolingual. These findings suggest that cultivating science domain knowledge is very important to supporting reading comprehension development in third grade, particularly for students who are ELs.
Assessing the Patient Safety Culture in Dentistry
Authors: Yansane A. , Lee J.H. , Hebballi N. , Obadan-Udoh E. , White J. , Walji M. , Easterday C. , Rindal B. , Worley D. , Kalenderian E.
Published: January 2020

Objectives:

Medical errors are among the leading causes of death within the United States. Studies have shown that patients can be harmed while receiving care, sometimes resulting in permanent injury or, in extreme cases, death. To reduce the risk of patient safety incidents, it is imperative that a robust culture of safety be established. The primary objective of this study was to evaluate the patient safety culture among providers at 4 US dental institutions, comparing the results with their medical counterparts in 2016.

Methods:

This cross-sectional study uses the Medical Office Survey on Patient Safety Culture that was modified for dentistry and administered at 4 US dental institutions during the 2016 calendar year. All dental team members were invited to complete electronic or paper-based versions of the questionnaire.

Results:

Among 1,615 invited participants, 656 providers responded (rate, 40.6%). Medical institutions outperformed the dental institutions on 9 of the 10 safety culture dimensions, 6 of the 6 overall quality items, and 8 of the 9 patient safety and quality issues. The surveyed dental institutions reported the strongest average percentage positive scores in organizational learning (85%) and teamwork (79%).

Conclusion:

These findings suggest that the patient safety culture progressed over time. However, there is still heterogeneity within safety culture among academic dental, private (nonacademic), and medical clinics.

Knowledge Transfer Statement:

Patient safety is the first dimension of quality improvement. Administering the Medical Office Survey on Patient Safety Culture within dental clinics represents a key measure to understand where improvements can be made with respect to patient care safety.
Quantitative and Qualitative Analysis on Sex and Gender in Preparatory Material for National Medical Examination in Germany and the United States
Authors: Schluchter Helena , Nauman Ahmad T , Ludwig Sabine , Regitz-Zagrosek Vera , Seeland Ute
Published: January 2020

Background:

Sex- and gender-based medicine (SGBM) should be a mandatory part of medical education. We compared the quantity and quality of sex- and gender-related content of e-learning materials commonly used by German and American medical students while preparing for national medical examinations.

Methods:

Quantitative, line-by-line analysis of the preparatory materials AMBOSS 2017 and USMLE Step 1 Lecture Notes (2017) by KAPLAN MEDICAL was performed between April and October 2017. Subjects were allocated to one of the three main fields: clinical subjects, behavioral and social science, and pharmacology. Qualitative analysis comprised binary categorization into sex- and gender-based aspects and qualification with respect to the presence of a pathophysiological explanation for the sex or gender difference.

Results:

In relation to the total content of AMBOSS and KAPLAN, the sex- and gender-based share of the clinical subjects content was 26.8% (±8.2) in AMBOSS and 21.1% (±10.2) in KAPLAN. The number of sex- and gender-based aspects in the behavioral and social science learning material differed significantly for AMBOSS and KAPLAN (4.4% ± 3.1% vs 10.7% ± 7.5%; P = .044). Most of the sex- and gender-related content covered sex differences. Most learning cards and texts did not include a detailed pathophysiological explanation for sex- or gender-based aspects. The knowledge provided in the preparatory documents represents only a small part of facts that are already known about sex and gender differences.

Conclusions:

The preparatory materials focused almost exclusively on biological sex differences and the sociocultural dimension in particular is underrepresented. A lot more evidence-based facts are known and should be integrated into the materials to reflect the importance of SGBM as an integral component of patient-centered medicine.
On the consistency of urban cellular automata models based on hexagonal and square cells
Authors: Nugraha Aditya Tafta , Waterson Ben J , Blainey Simon P , Nash Frederick J
Published: January 2020

Cellular automata have found extensive applications in the modelling of urban systems. Calculations in cellular automata models are based on cell centroids and therefore cellular automata models are sensitive to the choices of cell size and shape. While the effect of cell size for urban simulation has been studied, discussions on the effect of cell shape on urban cellular automata models have been limited. Applications in other fields suggest there are advantages of using hexagonal cells over square cells, yet most urban cellular automata models use square cells. Using connectivity indices from graph theory, experiments in this study compared models based on hexagonal and square cells to examine the potential advantage of hexagonal cells in urban cellular automata models. This paper finds that simulation results from the model with hexagonal cells are more consistent and concludes that hexagonal cells would increase the robustness of model simulation.
The system Pd–Ag–S: phase relations and mineral assemblages
Authors: Vymazalová Anna , Laufek František , Kristavchuk Alexandr V. , Chareev Dmitriy A.
Published: January 2020

Phase equilibria in the system Pd–Ag–S were studied using the silica-glass tube method at 400°C and 550°C. In the system we synthesised three ternary phases: coldwellite (Pd3Ag2S), kravtsovite (PdAg2S) and a new phase Pd13Ag3S4. At 400°С, coldwellite forms a stable association with vysotskite (PdS) and vasilite (Pd16S7); vysotskite and kravtsovite; phase Pd4S and a Ag–Pd alloy; it also coexists with a new phase Pd13Ag3S4. Kravtsovite is stable up to 507°C; the presence of kravtsovite in the mineral assemblage reflects its formation below this temperature. The occurrence of coldwellite, vysotskite and Ag2S together in equilibrium reflects the formation of this mineral assemblage above this temperature (507°C). Coldwellite is stable up at 940°С. Mineral assemblages defined in this study can be expected in Cu–Ni–PGE mineral deposits, associated with mafic and ultramafic igneous rocks, in particular in mineralisations with known silver–palladium sulfides.
Venomics of the ectoparasitoid wasp Bracon nigricans
Authors: Becchimanzi Andrea , Avolio Maddalena , Bostan Hamed , Colantuono Chiara , Cozzolino Flora , Mancini Donato , Chiusano Maria Luisa , Pucci Pietro , Caccia Silvia , Pennacchio Francesco
Published: January 2020

Background

Venom is one of the most important sources of regulation factors used by parasitic Hymenoptera to redirect host physiology in favour of the developing offspring. This has stimulated a number of studies, both at functional and “omics” level, which, however, are still quite limited for ectophagous parasitoids that permanently paralyze and suppress their victims (i.e., idiobiont parasitoids).

Results

Here we present a combined transcriptomic and proteomic study of the venom of the generalist idiobiont waspBracon nigricans, an ectophagous larval parasitoid of different lepidopteran species, for which we recently described the host regulation strategy and the functional role of the venom in the induction of physiological changes in parasitized hosts. The experimental approach used led to the identification of the main components ofB. nigricansvenom involved in host regulation. Enzymes degrading lipids, proteins and carbohydrates are likely involved in the mobilization of storage nutrients from the fat body and may concurrently be responsible for the release of neurotoxic fatty acids inducing paralysis, and for the modulation of host immune responses.

Conclusion

The present work contributes to fill the gap of knowledge on venom composition in ectoparasitoid wasps, and, along with our previous physiological study on this species, provides the foundation on which to develop a functional model of host regulation, based both on physiological and molecular data. This paves the way towards a better understanding of parasitism evolution in the basal lineages of Hymenoptera and to the possible exploitation of venom as source of bioinsecticidal molecules.
Zoonotic transmission of Teladorsagia circumcincta and Trichostrongylus species in Guilan province, northern Iran: molecular and morphological characterizations
Authors: Ashrafi Keyhan , Sharifdini Meysam , Heidari Zahra , Rahmati Behnaz , Kia Eshrat Beigom
Published: January 2020

Background

Parasitic trichostrongyloid nematodes have a worldwide distribution in ruminants and frequently have been reported from humans in Middle and Far East, particularly in rural communities with poor personal hygiene and close cohabitation with herbivorous animals. Different species of the genus Trichostrongylus are the most common trichostrongyloids in humans in endemic areas. Also, Ostertagia species are gastrointestinal nematodes that mainly infect cattle, sheep and goats and in rare occasion humans. The aim of the present study was to identify the trichostrongyloid nematodes obtained from a familial infection in Guilan province, northern Iran, using morphological and molecular criteria.

Methods

After anthelmintic treatment, all fecal materials of the patients were collected up to 48 h and male adult worms were isolated. Morphological identification of the adult worms was performed using valid nematode keys. Genomic DNA was extracted from one male worm of each species. PCR amplification of ITS2-rDNA region was carried out, and products were sequenced. Phylogenetic analysis of the nucleotide sequence data was performed using MEGA 6.0 software.

Results

Adult worms expelled from the patients were identified as T. colubriformis, T. vitrinus and Teladorsagia circumcincta based on morphological characteristics of the males. Phylogenetic analysis illustrated that each species obtained in current study was placed together with reference sequences submitted to GenBank database.

Conclusions

The finding of current study confirms the zoonotic aspect of Trichostrongylus species and T. circumcincta in inhabitants of Guilan province. The occurrence of natural human infection by T. circumcincta is reported for the first time in Iran and the second time in the world.
P53, Somatostatin receptor 2a and Chromogranin A immunostaining as prognostic markers in high grade gastroenteropancreatic neuroendocrine neoplasms
Authors: Nielsen Kirstine , Binderup Tina , Langer Seppo W. , Kjaer Andreas , Knigge Pauline , Grøndahl Veronica , Melchior Linea , Federspiel Birgitte , Knigge Ulrich
Published: January 2020

Background

High grade gastroenteropancreatic (GEP) neuroendocrine neoplasms (NEN) with a Ki67 proliferation index > 20%, include well-differentiated tumours grade 3 (NET G3) and poorly differentiated (PD) neuroendocrine carcinomas (NEC). Abnormal p53-expression is a feature of PD tumours, while expression of chromogranin A (CgA) and somatostatin-receptor 2a (SSTR-2a) may be a feature of well-differentiated tumours. The aim of this study was to elucidate the expression and prognostic value of these three markers in 163 GEP-NEN patients with a Ki67-index > 20%.

Method

Clinical data, histopathology and overall survival were analysed according to Kaplan-Meier’s method and Cox regression. The expression of SSTR-2a, CgA and synaptophysin was analysed in tumour specimens by immunohistochemistry, and semi-quantitatively scored as negative (< 5%), heterogeneously positive (5–30%) or strongly positive (> 30%). P53 was defined as normal when scored as heterogeneously positive (1–30%), and abnormal when negative (0%) or strongly positive (> 30%).

Results

In multivariate analysis, better survival was observed among patients with heterogeneously positive p53 compared to strongly positive (p < 0.001). When dichotomised, tumours with a heterogeneously positive p53 vs. negative and strongly positive p53 also showed a significantly better survival (p = 0.002).

Survival was significantly worse for negative CgA compared to heterogeneously positive CgA (p = 0.02). Strongly positive SSTR-2a expression was found in 26% of the 163 included patients. Well-differentiated morphology correlated with strong expression of SSTR-2a and CgA, and heterogeneously positive p53-staining, and was more frequent in pancreatic primaries. In pancreatic primaries, strongly positive SSTR-2a was associated with longer survival (univariate analysis, p = 0.02). A significantly lower Ki67 proliferation index was found in patients with a heterogeneously positive p53, a positive SSTR-2a and CgA expression.

Conclusion

Our results suggest that abnormal p53-expression is an independent negative prognostic marker in GEP-NEN with a Ki67-index > 20%. Patients with heterogeneously positive p53 had the best prognosis. SSTR-2a was a positive prognostic marker in pancreatic NEN. Negative CgA was associated with a significantly worse OS compared to heterogeneously positive CgA-expression in a multivariate sub-analysis. Lower Ki67 index correlated significantly with heterogeneously positive p53, positive SSTR-2a and CgA expression.
Nasolabial cyst: case report and review of management options
Authors: Almutairi Abdulhakeem , Alaglan Abeer , Alenezi Mazyad , Alanazy Sultan , Al-Wutayd Osama
Published: January 2020

Background

Nasolabial cysts are rare, non-odontogenic, soft-tissue cysts that develop between the upper lip and nasal vestibule with an overall incidence of 0.7% out of all maxillofacial cysts. The predominant presentation of a nasolabial cyst is a painless localized swelling with varying degrees of nasal obstruction. Several treatment modalities have described in the management of the nasolabial cyst. In this paper, we present a case of a nasolabial cyst in a 44 years old man with discussions of the treatment modalities in the lights of the literature.

Case presentation

We present a case of a nasolabial cyst in a 44-year-old man that slowly increased in size through a period of 3 years, with associated mild pain and nasal obstruction. It had caused a mass effect upon the maxilla, resulting in scalloping. The cyst was excised entirely with no evidence of recurrence at the two months follow up.

Conclusions

The nasolabial cyst is a rare soft-tissue cyst. Complete surgical excision using an open approach performed to our case, which considered with the complete endoscopic removal of the best treatment for the nasolabial cysts with a rare recurrence rate.
Utilisation of rehabilitation services for non-migrant and migrant groups of higher working age in Germany – results of the lidA cohort study
Authors: Schröder Chloé Charlotte , Dyck Maria , Breckenkamp Jürgen , Hasselhorn Hans Martin , du Prel Jean-Baptist
Published: January 2020

Background

An ageing and a shrinking labour force implies that the prevention of a premature exit from work due to poor health will become more relevant in the future. Medical rehabilitation is a health service that aims at active participation in working life. The provision of this service will be relevant for an increasing part of the ageing labour force, namely, employees with a migrant background and their different subgroups. Thus, this study examines whether first- and second-generation employees with migrant background differ from non-migrants in their utilisation of rehabilitation services and whether within the subsample of migrant employees, those persons with foreign nationality differ from those with German nationality.

Methods

Socially insured employees born in 1959 or 1965 were surveyed nationwide in 2011 as part of the lidA cohort study (n=6303). Survey data of the first study wave were used to identify the dependent variable of the utilisation of rehabilitation (in- and outpatient), the independent variable of migrant status and the covariates of sociodemographic, work- and non-work-related factors. Applying bivariate statistics with tests of independence and block-wise logistic regressions, differences between the groups were investigated. Additionally, average marginal effects were computed to directly compare the adjusted models.

Results

The study showed that first-generation migrants had a significantly lower likelihood of utilising outpatient rehabilitation than non-migrants (fully adj. OR 0.42, 95% CI 0.22-0.82) and that average marginal effects indicated higher differences in the full model than in the null model. No significant differences were found between the first- or second-generation migrants and non-migrants when comparing the utilisation of inpatient rehabilitation or any rehabilitation or when analysing German and foreign employees with migrant background (n=1148).

Conclusions

Significant differences in the utilisation of outpatient rehabilitation between first-generation migrants and non-migrants were found, which could not be explained by sociodemographic, work- and non-work-related factors. Thus, further factors might play a role. The second-generation migrants resemble the non-migrants rather than their parent generation (first-generation migrants). This detailed investigation shows the heterogeneity in the utilisation of health services such as medical rehabilitation, which is why service sensitive to diversity should be considered.
The patient voice: a survey of worries and anxieties during health system transition in HIV services in Vietnam
Authors: Matsumoto Shoko , Nguyen Hoai Dung Thi , Nguyen Dung Thi , Van Tran Giang , Tanuma Junko , Mizushima Daisuke , Van Nguyen Kinh , Oka Shinichi
Published: January 2020

Background

Vietnam is shifting toward integrating HIV services into the public health system using social health insurance (SHI), and the HIV service delivery system is becoming decentralized. The study aim was to investigate current SHI coverage and patients’ perspectives on this transition.

Methods

A survey of 1348 HIV-positive patients on antiretroviral therapy (aged ≥18 years) was conducted at an HIV outpatient clinic at a central-level hospital in Hanoi, Vietnam, in October and November 2018. Insurance coverage, reasons for not having a SHI card, perceived concerns about receiving HIV services in SHI-registered local health facilities, and willingness to continue regularly visiting the current hospital were self-reported. Logistic regression analyses were performed to analyze factors associated with not having a SHI card and having concerns about receiving HIV services in SHI-registered hospitals/clinics.

Results

SHI coverage was 78.0%. The most frequently reported reason for not having a SHI card was that obtaining one was burdensome, followed by lack of information on how to obtain a card, and financial problems. Most patients (86.6%) had concerns about receiving HIV services at SHI-registered local health facilities, and disclosure of HIV status to neighbors and low quality of HIV services were the main concerns reported. Participants aged < 40 years old and unmarried were more likely to report lack of SHI cards, and women and those aged ≥40 years were more likely to have concerns. However, 91.4% of patients showed willingness to continue regular visits to the current hospital.

Conclusions

Although SHI coverage has been rapidly improving among HIV patients, most participants had concerns about the current system transition in Vietnam. In response to their voiced concerns, strengthening the link between higher-level and lower-level facilities may help to ensure good quality HIV services at all levels while mitigating patients’ worries and anxieties.
Full genomic characterization of a porcine rotavirus strain detected in an asymptomatic piglet in Accra, Ghana
Authors: Stubbs Samuel C. B. , Quaye Osbourne , Acquah Maame Ekua , Adadey Samuel Mawuli , Kean Iain R. L. , Gupta Srishti , Blacklaws Barbara A.
Published: January 2020

Background

The introduction of rotavirus A vaccination across the developing world has not proved to be as efficacious as first hoped. One cause of vaccine failure may be infection by zoonotic rotaviruses that are very variable antigenically from the vaccine strain. However, there is a lack of genomic information about the circulating rotavirus A strains in farm animals in the developing world that may be a source of infection for humans. We therefore screened farms close to Accra, Ghana for animals sub-clinically infected with rotavirus A and then sequenced the virus found in one of these samples.

Results

6.1% of clinically normal cows and pigs tested were found to be Rotavirus A virus antigen positive in the faeces. A subset of these (33.3%) were also positive for virus RNA. The most consistently positive pig sample was taken forward for metagenomic sequencing. This gave full sequence for all open reading frames except segment 5 (NSP1), which is missing a single base at the 5′ end. The virus infecting this pig had genome constellation G5-P[7]-I5-R1-C1-M1-A8-N1-T7-E1-H1, a known porcine genotype constellation.

Conclusions

Farm animals carry rotavirus A infection sub-clinically at low frequency. Although the rotavirus A genotype discovered here has a pig-like genome constellation, a number of the segments most closely resembled those isolated from humans in suspected cases of zoonotic transmission. Therefore, such viruses may be a source of variable gene segments for re-assortment with other viruses to cause vaccine breakdown. It is recommended that further human and pig strains are characterized in West Africa, to better understand this dynamic.
Cellular receptors for enterovirus A71
Authors: Kobayashi Kyousuke , Koike Satoshi
Published: January 2020

Enterovirus 71 (EV-A71) is one of the major causative agents of hand, foot, and mouth disease. EV-A71 infection is sometimes associated with severe neurological diseases such as acute encephalitis, acute flaccid paralysis, and cardiopulmonary failure. Therefore, EV-A71 is a serious public health concern. Scavenger receptor class B, member 2 (SCARB2) is a type III transmembrane protein that belongs to the CD36 family and is a major receptor for EV-A71. SCARB2 supports attachment and internalization of the virus and initiates conformational changes that lead to uncoating of viral RNA in the cytoplasm. The three-dimensional structure of the virus-receptor complex was elucidated by cryo-electron microscopy. Two α-helices in the head domain of SCARB2 bind to the G-H loop of VP1 and the E-F loop of VP2 capsid proteins of EV-A71. Uncoating takes place in a SCARB2- and low pH-dependent manner. In addition to SCARB2, other molecules support cell surface binding of EV-A71. Heparan sulfate proteoglycans, P-selectin glycoprotein ligand-1, sialylated glycan, annexin II, vimentin, fibronectin, and prohibitin enhance viral infection by retaining the virus on the cell surface. These molecules are known as “attachment receptors” because they cannot initiate uncoating. In vivo, SCARB2 expression was observed in EV-A71 antigen-positive neurons and epithelial cells in the crypts of the palatine tonsils in patients that died of EV-A71 infection. Adult mice are not susceptible to infection by EV-A71, but transgenic mice that express human SCARB2 become susceptible to EV-A71 infection and develop neurological diseases similar to those observed in humans. Attachment receptors may also be involved in EV-A71 infection in vivo. Although heparan sulfate proteoglycans are expressed by many cultured cell lines and enhance infection by a subset of EV-A71 strains, they are not expressed by cells that express SCARB2 at high levels in vivo. Thus, heparan sulfate-positive cells merely adsorb the virus and do not contribute to replication or dissemination of the virus in vivo. In addition to these attachment receptors, cyclophilin A and human tryptophanyl aminoacyl-tRNA synthetase act as an uncoating regulator and an entry mediator that can confer susceptibility to non-susceptibile cells in the absence of SCARB2, respectively. The roles of attachment receptors and other molecules in EV-A71 pathogenesis remain to be elucidated.
Multifactor consciousness level assessment of participants with acquired brain injuries employing human–computer interfaces
Authors: Czyżewski Andrzej , Kurowski Adam , Odya Piotr , Szczuko Piotr
Published: January 2020

Background

A lack of communication with people suffering from acquired brain injuries may lead to drawing erroneous conclusions regarding the diagnosis or therapy of patients. Information technology and neuroscience make it possible to enhance the diagnostic and rehabilitation process of patients with traumatic brain injury or post-hypoxia. In this paper, we present a new method for evaluation possibility of communication and the assessment of such patients’ state employing future generation computers extended with advanced human–machine interfaces.

Methods

First, the hearing abilities of 33 participants in the state of coma were evaluated using auditory brainstem response measurements (ABR). Next, a series of interactive computer-based exercise sessions were performed with the therapist’s assistance. Participants’ actions were monitored with an eye-gaze tracking (EGT) device and with an electroencephalogram EEG monitoring headset. The data gathered were processed with the use of data clustering techniques.

Results

Analysis showed that the data gathered and the computer-based methods developed for their processing are suitable for evaluating the participants’ responses to stimuli. Parameters obtained from EEG signals and eye-tracker data were correlated with Glasgow Coma Scale (GCS) scores and enabled separation between GCS-related classes. The results show that in the EEG and eye-tracker signals, there are specific consciousness-related states discoverable. We observe them as outliers in diagrams on the decision space generated by the autoencoder. For this reason, the numerical variable that separates particular groups of people with the same GCS is the variance of the distance of points from the cluster center that the autoencoder generates. The higher the GCS score, the greater the variance in most cases. The results proved to be statistically significant in this context.

Conclusions

The results indicate that the method proposed may help to assess the consciousness state of participants in an objective manner.
Epidemiology and drug allergy results in children investigated in allergy unit of a tertiary-care paediatric hospital setting
Authors: Piccorossi A. , Liccioli G. , Barni S. , Sarti L. , Giovannini M. , Verrotti A. , Novembre E. , Mori F.
Published: January 2020

Background and objective

Drug Hypersensitivity Reactions (DHRs) are considered adverse effects of medications that resemble allergy symptoms. The reported positive clinical history of pediatric drug reactions is about 10%, however, after allergy investigations, only a small percent is confirmed as hypersensitivity.

The aim of this study was to analyze the clinical history, allergy work-up results and sensitization profile of children and adolescents referred to our Allergy Unit for suspected DHRs.

Methods

The study evaluated data related to a group of children with a positive history of drug reactions during a two-year period. The allergy work-up consisted of in vivo and in vitro tests, in accordance with the recommendations of the ENDA/EAACI guidelines.

Results

Data from a group of 637 patients [348 M (54.6%); 289 F (45.4%)] were retrospectively analyzed. Beta lactams (BLs) were the most common drugs involved in the reported clinical history, followed by non-steroidal anti-inflammatory drugs (NSAIDs). Severe cutaneous adverse reactions (SCARs) were most frequently observed during BL treatment. The confirmation of BL hypersensitivity was higher for immediate reactions (IRs) [9.4%; 5.1% through positive skin tests (STs) and 5.5% through drug provocation test (DPT)] compared to non-immediate reactions (non-IRs) (8.1%; 2.2% through STs and 6.2% through DPT). A higher number of positive results was obtained for BLs and macrolides when the tests were performed within 12 months after the index reaction (p < 0.05). During DPTs with amoxicillin-clavulanic acid, four hypersensitivity reactions (including one anaphylaxis) occurred despite negative STs.

Conclusion

Our data demonstrated that only 9.1% of patients resulted in being positive to allergy tests which is in line with the data in literature. An allergy work-up is mandatory for excluding suspected hypersensitivity.
Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication
Authors: Schuierer Lukas , Gebhard Michael , Ruf Hans-Georg , Jaschinski Ulrich , Berghaus Thomas M. , Wittmann Michael , Braun Georg , Busch Dirk H. , Hoffmann Reinhard
Published: January 2020

Background

Herpes simplex virus (HSV) replication can be detected in the respiratory secretions of a high proportion of ventilated intensive care unit (ICU) patients. However, the clinical significance remains poorly defined. We investigated whether patients with ventilator-associated pneumonia not responding to antibiotics and in whom high levels of HSV could be detected in respiratory secretions benefit from acyclovir treatment.

Methods

Respiratory secretions (bronchoalveolar lavage fluid or tracheal aspirates) were tested for HSV replication by quantitative real-time PCR. ICU survival times, clinical parameters, and radiographic findings were retrospectively compared between untreated and acyclovir treated patients with high (> 105HSV copies/mL) and low (103–105HSV copies/mL) viral load.

Results

Fifty-seven low and 69 high viral load patients were identified. Fewer patients with high viral load responded to antibiotic treatment (12% compared to 40% of low load patients,p = 0.001). Acyclovir improved median ICU survival (8 vs 22 days,p = 0.014) and was associated with a significantly reduced hazard ratio for ICU death (HR = 0.31, 95% CI 0.11–0.92,p = 0.035) in high load patients only. Moreover, circulatory and pulmonary oxygenation function of high load patients improved significantly over the course of acyclovir treatment: mean norepinephrine doses decreased from 0.05 to 0.02 μg/kg body weight/min between days 0 and 6 of treatment (p = 0.049), and median PaO2/FiO2ratio increased from 187 to 241 between day 3 and day 7 of treatment (p = 0.02). Chest radiographic findings also improved significantly (p < 0.001).

Conclusions

In patients with ventilator-associated pneumonia, antibiotic treatment failure, and high levels of HSV replication, acyclovir treatment was associated with a significantly longer time to death in the ICU and improved circulatory and pulmonary function. This suggests a causative role for HSV in this highly selected group of patients.
Impact of sodium–glucose cotransporter 2 inhibitors on renal function in participants with type 2 diabetes and chronic kidney disease with normoalbuminuria
Authors: Nakamura Akinobu , Miyoshi Hideaki , Kameda Hiraku , Yamashita Kumiko , Kurihara Yoshio
Published: January 2020

Background

We compared the effects of sodium–glucose cotransporter 2 (SGLT2) inhibitors on renal function in participants with type 2 diabetes and chronic kidney disease (CKD) classified by degree of albuminuria.

Methods

A retrospective review of the clinical records of Japanese participants with type 2 diabetes (age > 20 years; SGLT2 inhibitor treatment > 2 years; estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2) was conducted. Based on the urinary albumin-to-creatinine ratio (UACR) or urinary protein-to-creatinine ratio (UPCR) at the start of SGLT2 inhibitor administration, participants were categorized into three groups: normoalbuminuria (A1; UACR < 30 mg/g Cr or UPCR < 0.15 g/g Cr), microalbuminuria (A2; UACR 30 to < 300 mg/g Cr or UPCR 0.15 to < 0.50 g/g Cr), and macroalbuminuria (A3; UACR ≥ 300 mg/g Cr or UPCR ≥ 0.50 g/g Cr). The study outcome was a comparison of the rates of change in renal function evaluated by eGFR at 2 years after starting SGLT2 inhibitor among the three groups.

Results

A total of 87 participants (40 females, 47 males) were categorized into three groups: A1 (n = 46), A2 (n = 25), and A3 (n = 16). eGFR was similarly decreased at 2 years before starting SGLT2 inhibitor in all three groups. However, the decline in eGFR was ameliorated at 2 years after starting SGLT2 inhibitor, and eGFR was rather increased in the A1 and A2 groups. Interestingly, the rate of change in eGFR at 2 years after starting SGLT2 inhibitor in the A1 group was significantly higher than that in the A3 group.

Conclusions

These results demonstrate that more favorable effects of SGLT2 inhibitors on renal function were observed in participants with type 2 diabetes and CKD with normoalbuminuria compared with those with macroalbuminuria.

Trial registration UMIN-CTR: UMIN000035263. Registered 15 December 2018
Futureproofing triathlon: expert suggestions to improve health and performance in triathletes
Authors: Kennedy Michael D. , Knight Camilla J. , Falk Neto Joao Henrique , Uzzell Katie S. , Szabo Sara W.
Published: January 2020

Background

Given the multi-modal nature of triathlon (swimming, cycling, running), training for a triathlon event has numerous potential health benefits including physical fitness. However, triathletes also have a high prevalence of health issues including overuse injury, illness, fatigue, and burnout. To address the ongoing prevalence of health issues, roundtable discussions were organized at the International Triathlon Union Science of Triathlon 2017 conference to develop strategic objectives deemed necessary to “futureproof triathlon”. Futureproofing as a concept serves to design new approaches and ways of thinking to reduce consequences in the future. In this case, the futureproof process aimed to develop key recommendations for triathlon.

Methods

This qualitative study had 22 participants including athletes, coaches, practitioners, academics, and policy makers who participated in roundtable discussions at the Science of Triathlon conference. Seven of these participants completed follow-up semi-structured interviews on the same topics. The data collected from the roundtable discussions and the semi-structured interviews was analyzed using thematic analysis.

Results

Five main themes were produced: “Critical appraisal and application of knowledge”; “Integrated approaches to developing, disseminating, and using research and expertise”; “Appropriate development and use of measures for monitoring training and recovery”; “Knowing your athletes and adopting holistic approaches to athlete/person-development”, and; “Challenging accepted cultural and sporting norms”. Participants indicated the need to reduce the knowledge gap between research and practice as well as a more collaborative approach to triathlon research development amongst coaches/practitioners and academics. It was stated that current monitoring tools require more research to determine which are most useful to informed decision making for coaches/practitioners. It was cautioned that data driven assessments should be used judiciously and be athlete centered. Triathlon as a sport should also have a greater focus on healthy participation and development of youth athletes.

Conclusions

A series of applied implications were developed based on these five themes as guiding principles for how to futureproof triathlon. Additionally, roundtable and interview participants who held varying positions and opinions within the sport of triathlon agreed that the unique challenge of training for and competing in a triathlon should not be forgotten in the futureproofing of the sport.
Intensive, personalized multimodal rehabilitation in patients with primary or revision total knee arthroplasty: a retrospective cohort study
Authors: Larsen Jesper Bie , Mogensen Lisbeth , Arendt-Nielsen Lars , Madeleine Pascal
Published: January 2020

Background

Recent evidence has shown that many patients suffer from persistent pain and impaired function after primary or revision total knee arthroplasty (TKA). Post-surgical complications may in addition decrease physical performances and lead to more pain and impacted quality of life.

The purpose of the study was to assess the changes in pain intensity and functional capacity among patients with post-surgical complications after TKA three weeks of intensive, personalized multimodal rehabilitation.

Methods

A retrospective cohort study consisting of 217 patient of which 166 had primary TKA and 51 had revision TKA was conducted. On average, primary TKA patients and revision TKA patients were 3.7 and 2.7 months post-surgical, respectively. All patients have had post-surgical complications and were referred to an inpatient rehabilitation department, where they received a personalized three-week intensive, multimodal rehabilitation protocol. The rehabilitation consisted of sessions targeting neuromuscular function, postural control, and flexibility, sessions focusing on improving muscle strength and cardiovascular function and sessions with focus on gait retraining. The frequency of training was 2–4 sessions/day. The primary outcome was the Knee injury and Osteoarthritis Outcome Score (KOOS) and secondary outcomes were pain intensities measured using numerical rating scale, 6 min. walking test, stair-climbing test and range of motion for knee flexion and extension. Outcome measures were assessed at baseline upon referral and at follow-up before discharge.

Results

All outcomes, except pain at rest in the revision group, improved significantly. KOOS subscales, improved 8.5 to 14.2 in the primary TKA group (p < 0.001) and 6.9 to 10.8 in the revision group (p < 0.001). For the TKA group, effect sizes were medium-to-large for all KOOS subscales, 6 min. walking test, stair-climbing test, and pain intensity during activity. For the revision group, effect sizes were medium-to-large for KOOS subscales symptoms and activity of daily living, 6 min. walking test, stair-climbing test, and knee flexion.

Conclusion

Patients with post-surgical complications after primary or revision TKA experienced clinical relevant improvement in self-reported outcomes, pain relief, and improved physical performances after three weeks of personalized multimodal rehabilitation. The results suggest that an intensive, multimodal approach might be useful to obtain clinically relevant improvements.
Program for data extraction in primary health records: a valid tool for knowledge production in general practice?
Authors: Holte Martin , Holmen Jostein
Published: January 2020

Objectives

Research in general practice demands it-tools which give the practitioner trusty results. Medrave 4 is a program designed for extraction of data from all areas of the health record. We wanted to do research on the database in a health center, but found no proof of the quality of the data extracted by Medrave 4. Today the database contains about 40,000 records. In this study we wanted to examine if the program could extract correct data.

Results

From the database 20 records were randomly selected from five different time periods, making a total of 100 records. 14 records did not meet the inclusion criteria, resulting in 86 records included in the study. In phase one these variables were registered manually from the records: Age, gender, systolic and diastolic blood pressure (from free text) and six different laboratory tests. In phase two, Medrave 4 extracted the same variables from the same records. Medrave 4 found correct systolic and diastolic blood pressure values in 79 records (92%). The laboratory results were extracted correct in all 86 records (100%). We conclude that Medrave 4 can be a useful tool in quantifying the work of general practitioners.