bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnitude, trend, and causes of under-five mortality from Kilite-Awlaelo health demographic surveillance database, northern Ethiopia, 2009–2017
Authors: Abraha Hiluf Ebuy , Belachew Abate Bekele , Ebrahim Mohamedawel Mohammedniguss , Tequare Mengistu Hagazi , Adhana Mache Tsadik , Assefa Natnael Etsay
Published: September 2020

Background

Globally, neonatal and child mortality remains still high. Under-five mortality accounts for four-fifth of child and young adolescent deaths. In Ethiopia, though there has been a remarkable progress over the past years, under-five mortality is still high. Evidence from population-based longitudinal studies on under-five mortality is limited. Thus, this study aims to investigate the magnitude, trend, and causes of under-five mortality in the Kilite-Awlaelo Health Demographic Surveillance System, Northern Ethiopia.

Methods

Kilite-Awlaelo health and demographic surveillance system was established in 2009 in the northern part of Ethiopia. Population-based longitudinal study design was carried out through extracting data for nine consecutive years (2009–2017). After smoothing the data revealed a visually decreasing trend. Linear, quadratic, exponential, and autoregressive time-series models were checked. Accordingly, the exponential trend model provided the best fit with the lowest standard error of estimate, lowest sum square error and highest adjusted R2 value. Cause-specific mortality was determined by cross tabulating cause of death with specific age death.

Results

The overall under-five mortality rate was 35.62 per 1000 livebirths. The under-five mortality rate of rural and urban residents was 37.58 and 12.99 deaths per 1000 livebirths respectively. The exponential trend model showed the under-five mortality rate was declining exponentially. Bacterial sepsis 67(20.6%), prematurity 37(11.08%), intestinal infection disease 30(8.98%), acute lower respiratory infections 26(7.78%), and birth asphyxia 24(7.19%) were the major causes of under-five mortality.

Conclusion

The overall under-five mortality rate for the surveillance period was comparatively lower. A statistically significant difference in under-five mortality rate was observed between urban and rural residents. A statistically significant declining trend in the under-five mortality rate was observed. Bacterial sepsis, prematurity, intestinal infection disease, acute lower respiratory infections, and birth asphyxia were the major causes of under-five mortality. We recommend the huge discrepancy in under-five mortality rate between urban and rural dwellers could be narrowed to some level by increasing healthcare access for rural residents.
Does socioeconomic position affect knowledge of the risk factors and warning signs of stroke in the WHO European region? A systematic literature review
Authors: Stack Katie , Robertson Wendy , Blackburn Clare
Published: September 2020

Background

Strokes are one of the leading causes of death worldwide. People with a lower socioeconomic position (SEP) (i.e. with regards to education, income and occupation) are at a higher risk of having a stroke and have worse clinical outcomes compared to the general population. Good knowledge levels about stroke risk factors and warning signs are key to prolonging life and reducing health issues caused by stroke. This systematic review examined differences in knowledge of stroke risk factors and warning signs with regards to SEP in the WHO European region.

Methods

MEDLINE, Embase, Web of Science, PsycINFO and CINAHL were systematically searched using appropriate Medical Subject Headings (MeSH) terms and free text, combining search terms with Boolean operators. Two independent reviewers selected studies in two stages (title and abstract, and full-text), and screened reference lists of included studies. Only studies in English and based in the WHO European region were included.

Results

Screening identified 2118 records. In the final review, 20 articles were included, with 67,309 study participants between them. Out of 17 studies that looked at stroke risk factors, 11 found increasing knowledge to be associated with higher SEP, four found no difference by SEP, one showed a mixed pattern and one outlier study found increasing knowledge of risk factors to be associated with a lower SEP. Out of 19 studies that looked at stroke warning signs or symptoms, 15 found there to be better knowledge of warning signs with a higher SEP, three found there to be no difference, and the same outlier study found increasing knowledge of warning signs with a lower SEP. Studies that seemed to have a higher quality rating found increasing knowledge of stroke with a higher SEP. A meta-analysis was not possible due to heterogeneity of studies.

Conclusions

In the WHO European region, better knowledge of stroke risk factors and warning signs is associated with a higher SEP. Public health campaigns and educational interventions aiming to increase stroke knowledge should be targeted at people with a lower SEP.
Knowledge and practice of physicians during COVID-19 pandemic: a cross-sectional study in Lebanon
Authors: Abou-Abbas Linda , Nasser Zeina , Fares Youssef , Chahrour Mohammad , El Haidari Rana , Atoui Rola
Published: September 2020

Background

As the Coronavirus disease 2019 (COVID-19) pandemic continues to evolve, physicians must be equipped with adequate knowledge, skills on the prevention measures, and confidence in diagnosing and treating COVID-19 patients. Therefore, it is of great interest to assess the knowledge and practices of Physicians to identify existing gaps and improve occupational safety and viral surveillance.

Methods

A cross-sectional study was conducted in Lebanon between 28th March and 11th April 2020. Data was collected through an online survey that included information on socio-demographic characteristics, knowledge, practice, physicians fear towards COVID-19 as well as their perceptions regarding actions/policies implemented by the Ministry of Public Health (MOPH) and their health care facilities. Multivariable logistic regression analyses were carried out to identify the factors associated with good knowledge of COVID-19 and good practice toward its prevention. Adjusted odds ratio and their 95% confidence intervals were reported.

Results

Our survey revealed that the majority of Lebanese physicians had good knowledge about the disease (89.5%) while approximately half of the respondents adopted good preventive practices (49.7%). The odds of having good knowledge was 2.16 times higher among physicians aged 40 and above (adjusted OR = 2.16 with a 95% confidence interval (CI) of 1.08 to 4.34) compared to their counterparts aged less than 40 years old. Our results also showed that the odds of good practice was 2 times higher among frontline compared to the second line workers (adjusted OR = 2.01 with 95% CI of 1.21 to 3.34). Physicians with an experience of 10 years and above were 3.35 times more likely to have good practice compared to their counterparts (adjusted OR = 3.35 with 95% CI of 1.60 to 7.02). Finally, participants with good knowledge of COVID-19 were 2.04 times more likely to have a good practice (OR = 2.04 with 95% CI of 1.01 to 4.12).

Conclusion

Lebanese physicians revealed a good level of knowledge; however, they had limited comprehension of the precautionary measures that protect them from this virus. Our findings have important implications for the development of strategies suitable for improving the level of practice among physicians and enhance prevention programs.
Experiences of discrimination and self-reported health in Chinese migrants: a structural equation model
Authors: Tong Lian , Kawachi Ichiro
Published: September 2020

Background

Many migrants suffer from discrimination and poor health in China. We sought to examine the associations between experiences of discrimination and self-reported health among internal migrants in China, as well as the mediators of social integration and perceived stress.

Methods

The data was obtained from a specific survey of migrants, as a part of the National Health and Family Planning Dynamic Monitoring for Migrants conducted in 2014. A total of 15,999 migrants aged 15 to 59 years were recruited by a stratified, multistage clustered sampling procedure in eight Chinese cities. Structural Equation Modeling (SEM) was conducted.

Results

The results indicated that experiences of discrimination were associated with worse self-reported health (β = − 0.32,P < 0.001), less social integration (β = − 0.25,P < 0.001), as well as higher perceived stress (β = 0.21,P < 0.01). Both objectively measured socioeconomic status (β = 0.21,P < 0.001) and subjective social status (β = 0.21,P < 0.01) had significantly positive correlations with self-reported health.

Conclusions

The discrimination, social exclusion and perceived stress experienced by migrants have significant implications on their health.
Meta-analysis reveals severe pollen limitation for the flowering plants growing in East Himalaya-Hengduan Mountains region
Authors: Jiang Xianfeng , Xie Yanping
Published: September 2020

Background

Pollen limitation occurs widely and has an important effect on flowering plants. The East Himalaya-Hengduan Mountains region is a global biodiversity hotspot. However, to our knowledge, no study has synthetically assessed the degree of pollen limitation in this area. The present study aims to reveal the degree of pollen limitation for the flowering plants growing on East Himalaya-Hengduan Mountains and to test whether the reproductive features or the elevation is closely correlated with the degree of pollen limitation in this area.

Results

We complied data from 76 studies, which included 96 species and 108 independent data records. We found that the flowering plants in this area undergo severe pollen limitation [overall Hedges’ d = 2.004, with a 95% confidence interval (1.3264, 2.6743)] that is much higher than that of the flowering plants growing in many other regions around the world. The degree of pollen limitation was tested to determine the correlation with the capacity for autonomous self-reproduction and with the pollination pattern (generalized vs. specialized pollination) of plants. In addition, we found a clear relationship between elevation and the degree of pollen limitation, which indicates that plants might undergo more severe pollen limitation in relatively high places.

Conclusions

This paper is the first to address the severe pollen limitation of the flowering plants growing in East Himalaya-Hengduan Mountains region. Moreover, we reveal the positive correlation between elevation and the degree of pollen limitation.
Assessment of antidiabetic potential and phytochemical profiling of Rhazya stricta root extracts
Authors: Mahmood Rashid , Kayani Waqas Khan , Ahmed Tanveer , Malik Farnaz , Hussain Shahzad , Ashfaq Muhammad , Ali Hussain , Rubnawaz Samina , Green Brian D. , Calderwood Danielle , Kenny Owen , Rivera Gerardo A. , Mirza Bushra , Rasheed Faiza
Published: September 2020

Background

Diabetes mellitus is a chronic disease characterized by hyperglycemia that may occur due to genetic, environmental or lifestyle factors. Natural remedies have been used to treat diabetes since long and many antidiabetic compounds of varied efficacies have been isolated from medicinal plants.Rhazya strictahas been used for decades for the treatment of diabetes mellitus and associated ailments. Considering the folkloric use ofR. strictaagainst diabetes, it was aimed to investigate the effectiveness of its root extracts against diabetes through in vitro assays and in vivo studies using animal model along with phytochemical profiling through GCMS.

Methods

Various fractions ofRhazya strictaobtained through column chromatography were evaluated for a variety of assays including α-glucosidase, Dipeptidyl peptidase-IV (DPP-IV), β-secretase and Glucagon-like peptide-1 (GLP-1) secretion studies. For the in vivo studies the alloxan-induced diabetic mice were treated with root extracts and blood glucose levels, HbA1C, and other biochemical markers along with the histological study of the liver were done. The phytochemical identification was performed using an Agilent 7890B GC coupled to a 7010 Triple Quadrupole (MS/MS) system. GraphPad Prism software version 5.01 was used for statistical analysis.

Results

Majority of the extract fractions showed excellent results against diabetes by inhibiting enzymes DPP-IV (Up to 61%) and β-secretase (Up to 83%) with IC50s979 μg/ml and 169 μg/ml respectively with increase in the GLP1 secretion. The results of in vivo studies indicated a marked reduction in blood glucose and HbA1c levels along with positive effects on other parameters like lipid profile, liver functions and renal functions of extract-treated mice as compared to control. The histological examination of the liver demonstrated hepatoprotective effects against diabetes led changes and various classes of phytochemicals were also identified through GCMS in different fractions.

Conclusion

The results revealed strong antidiabetic activity ofR. strictaroot with the potential to protect body organs against diabetic changes. Moreover, a variety of phytochemicals has also been identified through GCMS that might be responsible for the antidiabetic potential ofRhazya strictaroot.

Graphical abstract
Motivations of assessment item writers in medical programs: a qualitative study
Authors: Karthikeyan Sowmiya , O’Connor Elizabeth , Hu Wendy
Published: September 2020

Background

The challenge of generating sufficient quality items for medical student examinations is a common experience for medical program coordinators. Faculty development strategies are commonly used, but there is little research on the factors influencing medical educators to engage in item writing. To assist with designing evidence-based strategies to improve engagement, we conducted an interview study informed by self-determination theory (SDT) to understand educators’ motivations to write items.

Methods

We conducted 11 semi-structured interviews with educators in an established medical program. Interviews were transcribed verbatim and underwent open coding and thematic analysis.

Results

Major themes included; responsibility for item writing and item writer motivations, barriers and enablers; perceptions of the level of content expertise required to write items; and differences in the writing process between clinicians and non-clinicians.

Conclusions

Our findings suggest that flexible item writing training, strengthening of peer review processes and institutional improvements such as improved communication of expectations, allocation of time for item writing and pairing new writers with experienced writers for mentorship could enhance writer engagement.
Opportunities and challenges to integrating mental health into HIV programs in a low- and middle-income country: insights from the Nigeria implementation science Alliance
Authors: Ezeanolue Echezona E. , Iheanacho Theddeus , Adedeji Isaac A. , Itanyi Ijeoma Uchenna , Olakunde Babayemi , Patel Dina , Dakum Patrick , Okonkwo Prosper , Akinmurele Timothy , Obiefune Michael , Khamofu Hadiza , Oyeledun Bolanle , Aina Muyiwa , Eyo Andy , Oleribe Obinna , Oko John , Olutola Ayodotun , Gobir Ibrahim , Aliyu Muktar H. , Aliyu Gambo , Woelk Godfrey , Aarons Gregory , Siberry George , Sturke Rachel ,   Nigeria Implementation Science Alliance
Published: September 2020

Background

In Nigeria, there is an estimated 1.9 million people living with HIV (PLHIV), 53% of whom utilize HIV care and services. With decreasing HIV-related deaths and increasing new infections, HIV with its associated comorbidities continue to be a key public health challenge in Nigeria. Untreated, comorbid mental disorders are a critical but potentially modifiable determinant of optimal HIV treatment outcomes.

This study aimed to identify the challenges and opportunities related to integrating mental health care into existing HIV programs in Nigeria.

Method

Attendees at the Nigeria Implementation Science Alliance (NISA)‘s 2019 conference participated in nominal group technique (NGT) exercise informed by the “Exploration, Preparation, Implementation, and Sustainment (EPIS)” framework. The NGT process was conducted among the nominal groups in two major sessions of 30-min phases followed by a 30-min plenary session. Data analysis proceeded in four steps: transcription, collation, theming and content analysis.

Results

The two major theoretical themes from the study were – opportunities and challenges of integrating mental health treatment into HIV services. Three sub-themes emerged on opportunities: building on health care facilities for HIV services (screening, counseling, task-sharing monitoring and evaluation frameworks), utilizing existing human resources or workforce in HIV programs (in-service training and including mental health in education curriculum) and the role of social and cultural structures (leveraging existing community, traditional and faith-based infrastructures). Four sub-themes emerged for challenges: double burden of stigma and the problems of early detection (HIV and mental health stigma, lack of awareness), existing policy gaps and structural challenges (fragmented health system), limited human resources for mental health care in Nigeria (knowledge gap and burnout) and dearth of data/evidence for planning and action (research gaps).

Conclusions

Potential for integrating treatments for mental disorders into HIV programs and services exist in Nigeria. These include opportunities for clinicians’ training and capacity building as well as community partnerships. Multiple barriers and challenges such as stigma, policy and research gaps would need to be addressed to leverage these opportunities. Our findings serve as a useful guide for government agencies, policy makers and research organizations to address co-morbid mental disorders among PLHIV in Nigeria.
Retargeting azithromycin analogues to have dual-modality antimalarial activity
Authors: Burns Amy L. , Sleebs Brad E. , Siddiqui Ghizal , De Paoli Amanda E. , Anderson Dovile , Liffner Benjamin , Harvey Richard , Beeson James G. , Creek Darren J. , Goodman Christopher D. , McFadden Geoffrey I. , Wilson Danny W.
Published: September 2020

Background

Resistance to front-line antimalarials (artemisinin combination therapies) is spreading, and development of new drug treatment strategies to rapidly kill Plasmodium spp. malaria parasites is urgently needed. Azithromycin is a clinically used macrolide antibiotic proposed as a partner drug for combination therapy in malaria, which has also been tested as monotherapy. However, its slow-killing ‘delayed-death’ activity against the parasite’s apicoplast organelle and suboptimal activity as monotherapy limit its application as a potential malaria treatment. Here, we explore a panel of azithromycin analogues and demonstrate that chemical modifications can be used to greatly improve the speed and potency of antimalarial action.

Results

Investigation of 84 azithromycin analogues revealed nanomolar quick-killing potency directed against the very earliest stage of parasite development within red blood cells. Indeed, the best analogue exhibited 1600-fold higher potency than azithromycin with less than 48 hrs treatment in vitro. Analogues were effective against zoonotic Plasmodium knowlesi malaria parasites and against both multi-drug and artemisinin-resistant Plasmodium falciparum lines. Metabolomic profiles of azithromycin analogue-treated parasites suggested activity in the parasite food vacuole and mitochondria were disrupted. Moreover, unlike the food vacuole-targeting drug chloroquine, azithromycin and analogues were active across blood-stage development, including merozoite invasion, suggesting that these macrolides have a multi-factorial mechanism of quick-killing activity. The positioning of functional groups added to azithromycin and its quick-killing analogues altered their activity against bacterial-like ribosomes but had minimal change on ‘quick-killing’ activity. Apicoplast minus parasites remained susceptible to both azithromycin and its analogues, further demonstrating that quick-killing is independent of apicoplast-targeting, delayed-death activity.

Conclusion

We show that azithromycin and analogues can rapidly kill malaria parasite asexual blood stages via a fast action mechanism. Development of azithromycin and analogues as antimalarials offers the possibility of targeting parasites through both a quick-killing and delayed-death mechanism of action in a single, multifactorial chemotype.
Comprehensive analysis of angiogenesis-related genes and pathways in early diabetic retinopathy
Authors: Gu Chufeng , Lhamo Thashi , Zou Chen , Zhou Chuandi , Su Tong , Draga Deji , Luo Dawei , Zheng Zhi , Yin Lili , Qiu Qinghua
Published: September 2020

Background

Angiogenesis is an important parameter in the development of diabetic retinopathy (DR), and it is indicative of an early stage evolving into a late phase. Therefore, examining the role of angiogenic factors in early DR is crucial to understanding the mechanism of neovascularization.

Methods

The present study identified hub genes and pathways associated with angiogenesis in early DR using bioinformatics analysis. Genes from published literature and Gene Expression Omnibus (GEO) were collected and analysed.

Results

We collected 73 genes from 70 published studies in PubMed, which were referred to as DR-related gene set 1 (DRgset1). The gene expression profile of GSE12610 was downloaded, and 578 differentially expressed genes (DEGs) between diabetic and normal samples were identified. DEGs and DRgset1 were further combined to create DR-related gene set 2 (DRgset2). After an enrichment analysis, we identified 12 GO terms and 2 pathways associated with neovascularization in DRgset1, and 8 GO terms and 2 pathways in DRgset2. We found 39 new genes associated with angiogenesis and verified 8 candidate angiogenesis-related genes in DR cells using real-time PCR: PIK3CB, ALDH3A1, ITGA7, FGF23, THBS1, COL1A1, MAPK13, and AIF1. We identified 10 hub genes associated with neovascularization by constructing a protein-protein interaction (PPI) network: TNF, VEGFA, PIK3CB, TGFB1, EDN1, MMP9, TLR4, PDGFB, MMP2, and THBS1.

Conclusions

The present study analysed angiogenesis-related genes and pathways in early DR in a comprehensive and systematic manner. PIK3CB, ALDH3A1, ITGA7, FGF23, THBS1, COL1A1, MAPK13, and AIF1 may be the candidate genes to further explore the mechanisms of angiogenesis in early DR. TNF, PIK3CB, TGFB1, EDN1, MMP9, TLR4, PDGFB, MMP2, and THBS1 may be new targets for early neovascularization therapy in the future.
Association of diurnal temperature range with daily hospitalization for exacerbation of chronic respiratory diseases in 21 cities, China
Authors: Wang Zihui , Zhou Yumin , Luo Ming , Yang Huajing , Xiao Shan , Huang Xiaoliang , Ou Yubo , Zhang Yongbo , Duan Xianzhong , Hu Wei , Liao Chenghao , Zheng Yijia , Wang Long , Xie Min , Tang Longhui , Zheng Jinzhen , Liu Sha , Wu Fan , Deng Zhishan , Tian Heshen , Peng Jieqi , Wang Xinwang , Zhong Nanshan , Ran Pixin
Published: September 2020

Background

The association between diurnal temperature range (DTR) and hospitalization for exacerbation of chronic respiratory diseases (CRD) was rarely reported.

Objectives

To examine the association between DTR and daily hospital admissions for exacerbation of CRD and find out the potential effect of modifications on this association.

Method

Data on daily hospitalization for exacerbation of chronic obstructive pulmonary disease (COPD), asthma and bronchiectasis and meteorology measures from 2013 through 2017 were obtained from 21 cities in South China. After controlling the effects of daily mean temperature, relative humidity (RH), particulate matter < 2.5 μm diameter (PM2.5) and other confounding factors, a standard generalized additive model (GAM) with a quasi-Poisson distribution was performed to evaluate the relationships between DTR and daily hospital admissions of CRD in a two-stage strategy. Subgroup analysis was performed to find potential modifications, including seasonality and population characteristics.

Result

Elevated risk of hospitalization for exacerbation of CRD (RR = 1.09 [95%CI: 1.08 to 1.11]) was associated with the increase in DTR (the 75th percentile versus the 25th percentile of DTR at lag0–6). The effects of DTR on hospital admissions for CRD were strong at low DTR in the hot season and high DTR in the cold season. The RR (the 75th percentile versus the 25th percentile of DTR at lag0–6) of hospitalization was 1.11 (95%CI: 1.08 to 1.12) for exacerbations of COPD and 1.09 (95%CI: 1.05 to 1.13) for asthma. The adverse effect of DTR on hospitalization for bronchiectasis was only observed in female patients (RR = 1.06 [95%CI: 1.03 to 1.10]).

Conclusion

Our study provided additional evidence for the association between DTR and daily hospitalization for exacerbation of CRD, and these associations are especially stronger in COPD patients and in the cold season than the hot season. Preventive measures to reduce the adverse impacts of DTR were needed for CRD patients.
SOX4 promotes the growth and metastasis of breast cancer
Authors: Zhang Jing , Xiao Chunhua , Feng Zhenbo , Gong Yun , Sun Baohua , Li Zhongqi , Lu Yimin , Fei Xiaojie , Wu Weizhu , Sun Xiaoping , Teng Lisong
Published: September 2020

Purpose

Increasing evidence has shown that the transcription factor SOX4 is closely associated with the development and progression of many malignant tumors. However, the effect of SOX4 on breast cancer is unclear. In this study, we purposed to investigate the role of SOX4 in the growth and metastasis in breast cancer and the underlying mechanism. Moreover, the effect of SOX4 on cancer cell resistance to chemotherapeutic agents was also evaluated in vitro and in vivo.

Methods

We used lentivirus technique to ectopically express SOX4 in MDA-MB-231 and SUM149 cells or knockdown SOX4 in BT474 cells, and examined the effect of these changes on various cellular functions. MTT assay was used to determine the cell viability as well as resistance to chemotherapeutic agents. The regulation of SOX4 on epithelial-mesenchymal transition (EMT)-related genes was analyzed using qRT-PCR. The binding of SOX4 to the CXCR7 gene was demonstrated using chromatin immunoprecipitation assay and dual-luciferase reporter activity assay. The effect of SOX4/CXCR7 axis on metastasis was examined using Transwell migration and Matrigel invasion assays. The expression of SOX4/CXCR7 in primary tumors and metastatic foci in lymph nodes was assessed using immunohistochemistry. Cellular morphology was investigated under phase contrast microscope and transmission electron microscopy. Moreover, the effect of SOX4 on tumor growth, metastasis, and resistance to chemotherapy was also studied in vivo by using bioluminescent imaging.

Results

SOX4 increased breast cancer cell viability, migration, and invasion in vitro and enhanced tumor growth and metastasis in vivo. It regulated EMT-related genes and bound to CXCR7 promoter to upregulate CXCR7 transcription. Both SOX4 and CXCR7 were highly expressed in human primary tumors and metastatic foci in lymph nodes. Treatment of breast cancer cells with the CXCR7 inhibitor CCX771 reversed the SOX4 effect on cell migration and invasion. Ectopic expression of SOX4 increased the susceptibility of cells to paclitaxel.

Conclusions

SOX4 plays an important role in the growth and metastasis of breast cancer. SOX4/CXCR7 may serve as potential therapeutic targets for the treatment. Paclitaxel may be a good therapeutic option if the expression level of SOX4 is high.
Association between obesity-associated markers and semen quality parameters and serum reproductive hormones in Chinese infertile men
Authors: Ma Jian-Xiong , Wang Bin , Li Hai-Song , Jiang Xue-Juan , Yu Jia , Ding Cai-Fei , Chen Wang-Qiang
Published: September 2020

Background

The current evidence on the association between obesity-associated markers and semen quality, serum reproductive hormones and lipids remains inconsistent. In this study, we tested the hypothesis that, in infertile Chinese men, body mass index (BMI) negatively correlates with sperm concentration, serum total testosterone (TT), and high-density lipoprotein cholesterol (HDL-C). The relationship between other obesity-associated markers and semen quality parameters, serum reproductive hormones, lipids and leptin were also investigated.

Methods

181 Chinese infertile men were recruited from September 2018 to September 2019. Their obesity-associated markers, semen parameters, and serum reproductive hormones, lipids and leptin were detected. Statistical analysis was performed to assess the relationship between obesity-associated markers and semen quality, serum reproductive hormones, lipids and leptin.

Result(s)

Statistically negative correlation was found between other obesity-associated markers (e.g. waist-to-hip ratio and waist-to-height ratio) and semen parameters (e.g. sperm concentration, ratio of progressive motility and ratio of non-progressive motility), while no significant correlation was found between BMI and semen quality, serum reproductive hormones, lipids and leptin. Ratio of morphologically normal sperm was negatively correlated with serum lipids including total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), leptin and seminal superoxide dismutase. Ratio of progressive sperm, sperm concentration and ratio of morphologically normal sperm exhibited significantly lower values in overweight group than normal group. Estradiol (E2) and E2/TT were significantly higher in obese group than normal group, while TT level was significantly lower in obese group than normal group. Univariate and multivariate analysis indicated that TC was significantly associated with BMI. Serum leptin concentration was positively correlated with seminal leptin concentration in overweight and obese groups.

Conclusion(s)

No significant correlation was found between BMI and sperm concentration, serum TT and HDL-C, while other obesity-associated markers were found to negatively correlate with sperm concentration, ratio of progressive motility and ratio of non-progressive motility. Statistically significant correlations between serum reproductive hormones, lipids and leptin also existed in Chinese infertile men.
Differences in adolescent activity and dietary behaviors across home, school, and other locations warrant location-specific intervention approaches
Authors: Ortega Adrian , Bejarano Carolina M. , Cushing Christopher C. , Staggs Vincent S. , Papa Amy E. , Steel Chelsea , Shook Robin P. , Sullivan Debra K. , Couch Sarah C. , Conway Terry L. , Saelens Brian E. , Glanz Karen , Frank Lawrence D. , Cain Kelli L. , Kerr Jacqueline , Schipperijn Jasper , Sallis James F. , Carlson Jordan A.
Published: September 2020

Background

Investigation of physical activity and dietary behaviors across locations can inform “setting-specific” health behavior interventions and improve understanding of contextual vulnerabilities to poor health. This study examined how physical activity, sedentary time, and dietary behaviors differed across home, school, and other locations in young adolescents.

Methods

Participants were adolescents aged 12–16 years from the Baltimore-Washington, DC and the Seattle areas from a larger cross-sectional study. Participants (n = 472) wore an accelerometer and Global Positioning Systems (GPS) tracker (Mean days = 5.12, SD = 1.62) to collect location-based physical activity and sedentary data. Participants (n = 789) completed 24-h dietary recalls to assess dietary behaviors and eating locations. Spatial analyses were performed to classify daily physical activity, sedentary time patterns, and dietary behaviors by location, categorized as home, school, and “other” locations.

Results

Adolescents were least physically active at home (2.5 min/hour of wear time) and school (2.9 min/hour of wear time) compared to “other” locations (5.9 min/hour of wear time). Participants spent a slightly greater proportion of wear time in sedentary time when at school (41 min/hour of wear time) than at home (39 min/hour of wear time), and time in bouts lasting ≥30 min (10 min/hour of wear time) and mean sedentary bout duration (5 min) were highest at school. About 61% of daily energy intake occurred at home, 25% at school, and 14% at “other” locations. Proportionately to energy intake, daily added sugar intake (5 g/100 kcal), fruits and vegetables (0.16 servings/100 kcal), high calorie beverages (0.09 beverages/100 kcal), whole grains (0.04 servings/100 kcal), grams of fiber (0.65 g/100 kcal), and calories of fat (33 kcal/100 kcal) and saturated fat (12 kcal/100 kcal) consumed were nutritionally least favorable at “other” locations. Daily sweet and savory snacks consumed was highest at school (0.14 snacks/100 kcal).

Conclusions

Adolescents’ health behaviors differed based on the location/environment they were in. Although dietary behaviors were generally more favorable in the home and school locations, physical activity was generally low and sedentary time was higher in these locations. Health behavior interventions that address the multiple locations in which adolescents spend time and use location-specific behavior change strategies should be explored to optimize health behaviors in each location.
Credible practice of modeling and simulation in healthcare: ten rules from a multidisciplinary perspective
Authors: Erdemir Ahmet , Mulugeta Lealem , Ku Joy P. , Drach Andrew , Horner Marc , Morrison Tina M. , Peng Grace C. Y. , Vadigepalli Rajanikanth , Lytton William W. , Myers Jerry G.
Published: September 2020

The complexities of modern biomedicine are rapidly increasing. Thus, modeling and simulation have become increasingly important as a strategy to understand and predict the trajectory of pathophysiology, disease genesis, and disease spread in support of clinical and policy decisions. In such cases, inappropriate or ill-placed trust in the model and simulation outcomes may result in negative outcomes, and hence illustrate the need to formalize the execution and communication of modeling and simulation practices. Although verification and validation have been generally accepted as significant components of a model’s credibility, they cannot be assumed to equate to a holistic credible practice, which includes activities that can impact comprehension and in-depth examination inherent in the development and reuse of the models. For the past several years, the Committee on Credible Practice of Modeling and Simulation in Healthcare, an interdisciplinary group seeded from a U.S. interagency initiative, has worked to codify best practices. Here, we provide Ten Rules for credible practice of modeling and simulation in healthcare developed from a comparative analysis by the Committee’s multidisciplinary membership, followed by a large stakeholder community survey. These rules establish a unified conceptual framework for modeling and simulation design, implementation, evaluation, dissemination and usage across the modeling and simulation life-cycle. While biomedical science and clinical care domains have somewhat different requirements and expectations for credible practice, our study converged on rules that would be useful across a broad swath of model types. In brief, the rules are: (1) Define context clearly. (2) Use contextually appropriate data. (3) Evaluate within context. (4) List limitations explicitly. (5) Use version control. (6) Document appropriately. (7) Disseminate broadly. (8) Get independent reviews. (9) Test competing implementations. (10) Conform to standards. Although some of these are common sense guidelines, we have found that many are often missed or misconstrued, even by seasoned practitioners. Computational models are already widely used in basic science to generate new biomedical knowledge. As they penetrate clinical care and healthcare policy, contributing to personalized and precision medicine, clinical safety will require established guidelines for the credible practice of modeling and simulation in healthcare.
The incidence of obesity, venous sinus stenosis and cerebral hyperaemia in children referred for MRI to rule out idiopathic intracranial hypertension at a tertiary referral hospital: a 10 year review
Authors: Bateman Grant Alexander , Subramanian Gopinath Musuwadi , Yap Swee Leong , Bateman Alexander Robert
Published: September 2020

Background

Children referred to a tertiary hospital for the indication, “rule out idiopathic intracranial hypertension (IIH)” may have an increased risk of raised venous sinus pressure. An increase in sinus pressure could be due to obesity, venous outflow stenosis or cerebral hyperemia. The purpose of this paper is to define the incidence of each of these variables in these children.

Methods

Following a data base review, 42 children between the ages of 3 and 15 years were found to have been referred over a 10 year period. The body mass index was assessed. The cross sectional areas and circumferences of the venous sinuses were measured at 4 levels to calculate the hydraulic and effective diameters. The arterial inflow, sagittal and straight sinus outflows were measured. Automatic cerebral volumetry allowed the brain volume and cerebral blood flow (CBF) to be calculated. The optic nerve sheath diameter was used as a surrogate marker of raised intracranial pressure (ICP). The sagittal sinus percentage venous return was used as a surrogate marker of elevated venous pressure. Age and sex matched control groups were used for comparison.

Results

Compared to controls, the obesity rates were not significantly different in this cohort. Compared to controls, those at risk for IIH had a 17% reduction in transverse sinus and 14% reduction in sigmoid sinus effective cross sectional area (p = 0.005 and 0.0009). Compared to controls, the patients at risk for IIH had an arterial inflow increased by 34% (p < 0.0001) with a 9% larger brain volume (p = 0.02) giving an increase in CBF of 22% (p = 0.005). The sagittal and straight sinus venous return were reduced by 11% and 4% respectively (p < 0.0001 and 0.0009) suggesting raised venous sinus pressure. Forty five percent of the patients were classified as hyperemic and these had optic nerve sheath diameters 17% larger than controls (p < 0.0002) suggesting raised ICP.

Conclusion

In children with the chronic headache/ IIH spectrum, the highest associations were with cerebral hyperemia and mild venous sinus stenosis. Obesity was not significantly different in this cohort. There is evidence to suggest hyperemia increases the venous sinus pressure and ICP.
Systematic review of early abortion services in low- and middle-income country primary care: potential for reverse innovation and application in the UK context
Authors: Zhou Jacy , Blaylock Rebecca , Harris Matthew
Published: September 2020

Background

In the UK, according to the 1967 Abortion Act, all abortions must be approved by two doctors, reported to the Department of Health and Social Care (DHSC), and be performed by doctors within licensed premises. Removing abortion from the criminal framework could permit new service delivery models. We explore service delivery models in primary care settings that can improve accessibility without negatively impacting the safety and efficiency of abortion services. Novel service delivery models are common in low-and-middle income countries (LMICs) due to resource constraints, and services are sometimes provided by trained, mid-level providers via “task-shifting”. The aim of this study is to explore the quality of early abortion services provided in primary care of LMICs and explore the potential benefits of extending their application to the UK context.

Methods

We searched MEDLINE, EMBASE, Global Health, Maternity and Infant Care, CINAHL, and HMIC for studies published from September 1994 to February 2020, with search terms “nurses”, “midwives”, “general physicians”, “early medical/surgical abortion”. We included studies that examined the quality of abortion care in primary care settings of low-and-middle-income countries (LMICs), and excluded studies in countries where abortion is illegal, and those of services provided by independent NGOs. We conducted a thematic analysis and narrative synthesis to identify indicators of quality care at structural, process and outcome levels of the Donabedian model.

Results

A total of 21 indicators under 8 subthemes were identified to examine the quality of service provision: law and policy, infrastructure, technical competency, information provision, client-provider interactions, ancillary services, complete abortions, client satisfaction. Our analysis suggests that structural, process and outcome indicators follow a mediation pathway of the Donabedian model. This review showed that providing early medical abortion in primary care services is safe and feasible and “task-shifting” to mid-level providers can effectively replace doctors in providing abortion.

Conclusion

The way services are organised in LMICs, using a task-shifted and decentralised model, results in high quality services that should be considered for adoption in the UK. Collaboration with professional medical bodies and governmental departments is necessary to expand services from secondary to primary care.
An automatic method for counting wheat tiller number in the field with terrestrial LiDAR
Authors: Fang Yuan , Qiu Xiaolei , Guo Tai , Wang Yongqing , Cheng Tao , Zhu Yan , Chen Qi , Cao Weixing , Yao Xia , Niu Qingsong , Hu Yongqiang , Gui Lijuan
Published: September 2020

Background

The tiller number per unit area is one of the main agronomic components in determining yield. A real-time assessment of this trait could contribute to monitoring the growth of wheat populations or as a primary phenotyping indicator for the screening of cultivars for crop breeding. However, determining tiller number has been conventionally dependent on tedious and labor-intensive manual counting. In this study, an automatic tiller-counting algorithm was developed to estimate the tiller density under field conditions based on terrestrial laser scanning (TLS) data. The novel algorithm, which is named ALHC, involves two steps: (1) the use of an adaptive layering (AL) algorithm for cluster segmentation and (2) the use of a hierarchical clustering (HC) algorithm for tiller detection among the clusters. Three field trials during the 2016–2018 wheat seasons were conducted to validate the algorithm with twenty different wheat cultivars, three nitrogen levels, and two planting densities at two ecological sites (Rugao & Xuzhou) in Jiangsu Province, China.

Result

The results demonstrated that the algorithm was promising across different cultivars, years, growth stages, planting densities, and ecological sites. The tests from Rugao and Xuzhou in 2016–2017 and Rugao in 2017–2018 showed that the algorithm estimated the tiller number of the wheat with regression coefficient (R2) values of 0.61, 0.56 and 0.65, respectively. In short, tiller counting with the ALHC generally underestimated the tiller number and performed better for the data with lower plant densities, compact plant types and the jointing stage, which were associated with overlap and noise between plants and inside the dense canopy.

Conclusions

Differing from the previous methods, the ALHC proposed in this paper made full use of 3D crop information and developed an automatic tiller counting method that is suitable for the field environment.
Hip pain and its correlation with cam morphology in young skiers—a minimum of 5 years follow-up
Authors: Abrahamson Josefin , Jónasson Pall , Sansone Mikael , Aminoff Anna Swärd , Todd Carl , Karlsson Jón , Baranto Adad
Published: September 2020

Background

There is conflicting evidence regarding the association between cam morphological changes and hip pain, and it remains unclear who with cam morphology will develop hip pain and who will not. This study aimed to investigate the correlation between cam morphology, hip pain, and activity level at a 5-year follow-up in young Alpine and Mogul skiers.

Method

All students (n = 76) at Åre Ski National Sports High School were invited and accepted participation in this prospective study at baseline. Magnetic resonance imaging (MRI) of both hips was conducted to evaluate the presence of cam morphology (α-angle ≥ 55°) and its size alongside the reporting of hip pain, type, and frequency of training by the Back and hip questionnaire, at baseline. After 5 years, the skiers were invited to complete a shortened version of the same questionnaire.

Results

A total of 60 skiers (80%) completed the follow-up questionnaire, of which 53 had concomitant MRI data. Cam morphology was present in 25 skiers (47.2%, 39 hips). Hip pain at baseline and at follow-up was reported in 17 (28.3%) and 22 (36.7%) skiers, respectively. No correlations were found between the activity level, the frequency, and the size of cam morphology and hip pain, except for the right hip α-angle at 1 o’clock and hip pain in skiers with cam morphology at baseline (rs = 0.49; P = 0.03) and at follow-up (rs = 0.47; P = 0.04). A total of 73.3% skiers had retired, of which 48% reported this was due to injuries.

Conclusion

Hip pain was not shown to be correlated, or had a low correlation, with activity level and the presence and size of cam morphology in young skiers on a 5-year follow-up. Based on these results, cam morphology or activity level did not affect hip pain to develop during 5 years of follow-up in young skiers. Furthermore, this study highlights that almost 75% of young elite skiers had retired from their elite career with almost 50% reporting that this was due to injuries sustained from skiing.
Assessment of the risks of a myasthenic crisis after thymectomy in patients with myasthenia gravis: a systematic review and meta-analysis of 25 studies
Authors: Liu Chaoying , Liu Peng , Zhang Xiao jing , Li Wen qian , Qi Guoyan
Published: September 2020

Background

Despite the burgeoning literature describing preoperative and postoperative risks of a myasthenic crisis after thymectomy (MCAT) in patients with myasthenia gravis, substantial differences exist in the risk factors identified by previous studies. We conducted a meta-analysis to assess the reported risk factors and MCAT risk.

Methods

We collected relevant studies on the risk factors for MCAT by searching the PubMed, Embase, The Cochrane Library, China Biology Medicine (CBM), WanFang Data, VIP and CNKI databases. The search period ranged from the establishment of the database to November 2019.

Results

Twenty-five of the 458 identified studies were eligible for the meta-analysis. Seven retrospective cohort studies and 18 case-control studies were included, and 14 risk factors for MCAT were extracted. Meta-analyses of the association between MCAT and risk factors related to the patient’s preoperative condition included a preoperative history of MC, preoperative bulbar symptoms, IIa + IIb + III + VI, IIb + III + VI, VI + V, dosage of pyridostigmine bromide prior to the operation, a preoperative AchR-Ab level > 100 (nm/L), preoperative pulmonary function, preoperative complications, and preoperative disease course. Meta-analyses of the association between MCAT and surgery-related risk factors included intraoperative blood loss > 1000 mL and the mode of operation. Meta-analyses of the association between MCAT and postoperative risk factors included postoperative lung infection, thymoma and the WHO classification. The operation time was not an independent risk factor for MCAT.

Conclusions

The independent risk factors for MCAT were a preoperative history of MC, preoperative bulbar symptoms, preoperative MG Osserman stage, preoperative dosage of pyridostigmine bromide, preoperative serum AchR-Ab level, lung function, major postoperative complications, disease duration before thymectomy, blood loss, thoracotomy, postoperative lung infection, thymoma, and WHO classification.