bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting the Amount of Lost Circulation While Drilling Using Artificial Neural Networks: An Example of Southern Iraq Oil Fields
Authors: Abbas Ahmed K. , Hamed Hussain M. , Al-Bazzaz Waleed , Abbas Hayder
Published: October 2019

Lost circulation is a serious problem that imposes some extra costs to petroleum and gas exploration operations. Substantial technical and economic benefits can be accomplished if the severity and frequency of mud loss are considered during the well planning procedure. This will lead to preventing the occurrence of losses by using treatments/solutions that are applied before entering lost circulation zones. In the present work, new models were developed to predict the amount of lost circulation using artificial neural networks (ANNs). This model was implemented to obtain a deeper understanding of the relations between the losses rate and the controllable drilling variables (i.e., rate of penetration [ROP], flow rate [FR], circulation pressure [CP], weight on bit [WOB], and rotation per minute [RPM]). The losses rate was found to be sensitive to high ROP, FR, and CP, such that increasing these parameters continuously increase the amount of lost circulation. While a slight rise in the losses rate was observed at high WOB and RPM. The proposed ANNs model was used to predict the losses rate for two wells, and comparison plot (actual amount of lost circulation versus predicted) was introduced as a function of depth. An accurate and early prediction of lost circulation has been of great importance to avoid the risks associated with this problem's occurrence.
TIMP-2 secreted by monocytes is a potent suppressor of invadopodia formation in pancreatic cancer cells
Authors: Benzing Christian , Lam Hoyin , Tsang Chi Man , Rimmer Alexander , Arroyo-Berdugo Yoana , Calle-Patino Yolanda , Wells Claire
Published: October 2019

Background Monocytes are a major component of the tumor microenvironment (TME) in pancreatic ductal adenocarcinoma (PDAC). However, the complex interactions between tumor cells and monocytes and their role in tumor invasion have not been fully established. Methods In this in vitro study, to specifically test the impact of interaction on invasive potential, two PDAC cell lines PaTu8902 and CFPAC-1 were selected on their ability to form invasive adhesions, otherwise known as invadopodia. Co-culture experiments were performed using undifferentiated THP1 monocytes. Results When the PDAC cells were co-cultured with undifferentiated THP1 monocytes invadopodia formation was significantly suppressed. Moreover, conditioned media of THP1 cells (CM) was also able to suppress invadopodia formation. Further investigation revealed that both tissue inhibitor of metalloproteinase (TIMP) 1 and 2 were present in the CM. However, suppression of invadopodia formation was found that was specific to TIMP2 activity. Conclusions Our findings indicate that TIMP2 levels in the tumour microenvironment may have prognostic value in patients with PDAC. Furthermore, activation of TIMP2 expressing monocytes in the primary tumour could present a potential therapeutic opportunity to suppress cell invasion in PDAC.
Comparison between Ultrasound-guided TIVAD via the right innominate vein and the right internal jugular vein approach
Authors: Sun Xingwei , Bai Xuming , Shen Jiaofeng , Yu Ziyang , Zhuang Zhixiang , Jin Yong
Published: October 2019

Purpose: To compare the efficacy and safety of right internal jugular vein (IJV) approach and right innominate vein (INV) approach for US-guided totally implantable venous access devices (TIVADs), and to explore the advantages and disadvantages of the two approaches. Methods: Six hundred and nineteen adult patients had long-term infusion and chemotherapy needs and inconvenience of peripheral venous infusion. Right INV approach was used to implant 339 cases of TIVADs, and right IJV approach was used to implant 280 cases of TIVADs. The success rate of one-time catheterization and the incidence of complications in the two groups were retrospectively analyzed. Results: All patients were successfully implanted in TIVAD. The success rates of one-time puncture in INV group and IJV approach group were 98.53% (334/339) and 95.36% (267/280), respectively. There was significant difference between the two groups (P=0.020). The incidence of perioperative complications was 1.18% (4/339) and the long-term complications was 3.54% (12/339) in the right INV group. The incidence of perioperative complications was 1.43% (4/280) and the long-term complications was 3.93% (11/280) in the right INV group. There was no significant difference in the incidence of complications between the two groups (P=0.785，P=0.799, respectively). Conclusions: US-guided TIVADs via the right INV approach and the right IJV approach are both safe and reliable. The right INV approach improves the one-time puncture success rate, as long as the technique is properly operated, serious complications rarely occur.
Interpreter proxy versus healthcare interpreter for administration of patient surveys following arthroplasty: a pilot study.
Authors: Xue Daniel , Churches Timothy , Armstrong Elizabeth , Mittal Rajat , Naylor Justine M. , Harris Ian A.
Published: October 2019

Background: Clinical quality registries and other systems that conduct routine post-discharge surveillance of patient outcomes following surgery may have difficulty surveying patients who have limited proficiency in the language of the healthcare provider. Interpreter proxies (family and carers) are often used due to limited access to certified healthcare interpreters (due to cost or availability). The aim of this study was to assess the reliability of engaging interpreter proxies compared with certified healthcare interpreters for the administration of patient-reported health-related surveys for people with limited English proficiency (LEP).
Methods: People with LEP and due for a routine 6-month telephone follow-up post knee or hip arthroplasty were invited to participate. Participants were randomly allocated to having their first interview with an interpreter proxy or a certified healthcare interpreter followed by the second (crossover) interview within 2 weeks (range: 4 to 12 days) after the first interview using the alternative method. Agreement between the two methods was assessed using quadratic weighted Cohen's kappa, intraclass correlation and concordance correlation co-efficient where appropriate for EQ-5D health domains, total Oxford hip and knee scores, patient satisfaction, operation success, readmission, reoperation, and post-surgical complication responses. The mean of the differences between the same data items collected by each of the two methods was also calculated.
Results: 85 participants (96%) completed the study. There was substantial to excellent inter-rater agreement (kappa=0.69-0.87 and ICCs above 0.74) for all but one measure. The mean differences between family proxy and healthcare interpreter scores for each participant were small, ranging from 0.01 (score range of 1-5) to 0.72 (score range of 0-100).
Conclusion: These results suggest that using interpreter proxies is a reliable alternative to certified healthcare interpreters in conducting patient-reported health surveys, potentially making this process easier and cost effective for researchers and registries.
Genome-wide association mapping revealed syntenic loci QFhb-4AL and QFhb-5DL for Fusarium head blight resistance in common wheat (Triticum aestivum L.)
Authors: Author) Wenjing Hu(Former Corresponding , Gao Derong , Wu Hongya , Liu Jian , Zhang Chunmei , Wang Junchan , Jiang Zhengning , Liu Yeyu , Li Dongsheng , Zhang Yong , Author) Chenbin Lu(New Corresponding
Published: October 2019

Background: Fusarium head blight (FHB), primarily caused by Fusarium graminearum, is a major threat to wheat production and food security worldwide. Breeding stably and durably resistant cultivars is the most effective approach for managing and controlling the disease. The success of FHB resistance breeding relies on identification of effective resistant germplasm. We performed a genome-wide association study (GWAS) using the high-density wheat 90K single nucleotide polymorphism (SNP) assays to better understand the genetic basis of FHB resistance in natural population and identify associated molecular markers.
Results: The resistance to FHB fungal spread along the rachis (Type II resistance) was evaluated on 171 wheat cultivars in the 2016-2017 (abbr. as 2017) and 2017-2018 (abbr. as 2018) growing seasons. Using Illumina Infinum iSelect 90K SNP genotyping data, a genome-wide association study (GWAS) identified 26 loci（88 marker-trait associations）, which explained 6.65-14.18% of the phenotypic variances. The associated loci distributed across all chromosomes except 2D, 6A, 6D and 7D, with those on chromosomes 1B, 4A, 5D and 7A being detected in both years. New loci for Type II resistance were found on syntenic genomic regions of chromsome 4AL ( QFhb-4AL , 621.85 Mb - 622.24 Mb) and chromosome 5DL ( QFhb-5DL , 546.09 Mb - 547.27 Mb) which showed highly collinearity in gene content and order. SNP markers wsnp_JD_c4438_5568170 and wsnp_CAP11_c209_198467 of 5D, reported previously linked to a soil-borne wheat mosaic virus (SBWMV) resistance gene, were also associated with FHB resistance in this study.
Conclusion: The syntenic FHB resistant loci and associated SNP markers identified in this study are valuable for FHB resistance breeding via marker-assisted selection.
Old subjects with sepsis: trend analysis of case fatality rate in the Emergency Department
Authors: Fabbri Andrea , Marchesini Giulio , Benazzi Barbara , Morelli Alice , Montesi Danilo , Bini Cesare , Rizzo Stefano Giovanni
Published: October 2019

Background: The burden of sepsis represents a global health care problem. We aimed to assess the case fatality rate (CFR) and its predictors in subjects with sepsis admitted to a general Italian hospital from 2009 to 2016, stratified by risk score.Methods: We performed a retrospective analysis of all sepsis-related hospitalizations after Emergency Department (ED) visit in a public Italian hospital in an 8-year period. A risk score to predict CFR was computed by logistic regression analysis of selected variables in a training set (2009-2012), and then confirmed in the whole study population. A trend analysis of CFR during the study period was performed dividing patient as high-risk (upper tertile of risk score) or low-risk . Results: 2,492 subjects were included. Over time the incidental admission rate (no. of sepsis-related admissions per 100 total admissions) increased from 4.1% (2009-2010) to 5.4% (2015-2016); P<0.001, accompanied by a reduced CFR (from 38.0% to 18.4%; P<0.001). A group of 10 variables (admission in intensive care unit, cardio-vascular dysfunction, HIV infection, diabetes, age ≥80 years, respiratory diseases, number of organ dysfunction, digestive diseases, dementia and cancer) were selected by the logistic model to predict CFR with good accuracy: AUC 0.873 [0.009]. Along the years CFR decreased from 31.8% (2009-2010) to 25.0% (2015-2016); P = 0.007. The relative proportion of subjects ≥80 years (overall, 52.9% of cases) and classified as high-risk did not change along the years. CFR decreased only in low-risk subjects (from 13.3% to 5.2%; P<0.001), and particularly in those aged ≥80 (from 18.2% to 6.6%; P=0.003), but not in high-risk individuals (from 69.9% to 64.2%; P=0.713).
Conclusion: Between 2009 and 2016 the incidence of sepsis-related hospitalization increased in a general Italian hospital, with a downward trend in CFR, only limited to low-risk patients and particularly to subjects ≥80 years.
Colchicine causes prenatal cell toxicity and increases tetraploid risk
Authors: Wang Ding , Xie Yingjun , Yan Minyi , Pan Qianying , Liang Yi , sun xiaofang
Published: October 2019

Background Colchicine is a clinical medicine used for relief from gout and familial Mediterranean fever. Because of its toxic effects, intravenous injection of colchicine has been banned, but it is still widely administered orally. We assayed the toxic effects of colchicine in cultured primary chorionic villus cells and amniotic fluid cells to interpret its influence on the placenta and foetus. Methods Bright field record and cell count kit 8 were used to value cell viability. Flow cytometer was used to identify cells markers, cell cycle and cell apoptosis. G-banding was used for karyotype analysis for sample genetic and drug effect evaluation. Results Chorionic villus cells and amniotic fluid cells were characterized as mesenchymal cells that share most cell surface markers and have a similar response to colchicine. Colchicine did not induce a decline in cell viability at low concentrations but suppressed cell proliferation by arresting the cell cycle in the G2/M phase and increased the risk of tetraploid generation in a small subset of cases. Conclusions Our study revealed the results of a colchicine-induced toxicity test in prenatal cells and determined the anti-mitotic biologically functional dose and manner of administration that might reduce the risk of tetraploid generation.
Predictions of Indigenous Chicken Phenotypes from Genotypes: Comparison Between Machine Learning and conventional Linear Models
Authors: SUMUKWO CHESANG , Muasya Thomas K. , Ngeno Kiplangat.
Published: October 2019

Genomic selection is a new breeding strategy which is rapidly becoming the method of choice of selection. It is useful in predicting the phenotypes of quantitative traits based on genome-wide markers of genotypes using conventional predictive models such as ridge regression BLUP. However, these conventional predictive models are faced with a statistical challenge related to the high dimensionality of marker data, inter and intra-allelic interactions and typically make strong assumptions. Machine learning models can be used as an alternative in the prediction of phenotypes due to their ability to address this challenges. Therefore, the aim of this study was to compare the predictive ability of machine learning using deep convolutional neural network (DeepGS), conventional neural network (Artificial neural network), conventional statistical predictive model ridge regression best linear unbiased (RR-BLUP) model and combination of DeepGS and RR-BLUP(Ensemble model) in predicting body weight (BW) of indigenous chicken based on genome-wide markers. The pearson correlation coefficient (PCC) results from this study for the four models were 0.891,0.889, 0.892 and 0.812 for DeepGS, RR-BLUP, Ensemble and ANN. This showed that DeepGS did not yield significant difference (p>0.05) from the other models, therefore, it can be used in complement to the commonly used conventional models. For individuals with higher phenotypic values, the PCC results showed a drastic decrease in the performance of DeepGS, rrBLUP, Ensemble and ANN from 0.891, 0.889, 0.892, 0.845 to 0.315, 0.466, 0.342, 0.518 respectively. Therefore, more effort should be put on individuals with higher phenotypic values.
Profiling of inflammatory mediators in the synovial fluid related to pain in knee osteoarthritis
Authors: Li Li , Li Zhenxing , Li Yuyan , Hu Xi , Zhang Yu , Fan Pei
Published: October 2019

Background: Inflammatory mediators in the synovial fluid (SF) play critical roles in the initiation and development of pain in knee osteoarthritis (KOA). However, the expression of inflammatory mediators is controversial and the role of SF inflammatory mediators in neuropathic pain is not clear. Therefore, the aim of this study is to identify the SF inflammatory mediators associated with nociceptive and neuropathic pain in KOA. Methods: The levels of IL-1β, IL-6, TNF-α, macrophage colony-stimulating factor, MMP-3, MMP-13, metalloproteinase with thrombospondin motifs 5, calcitonin gene-related peptide, neuropeptide Y, substance P and bradykinin were measured in 86 patients using enzyme-linked immunosorbent assays. Nociceptive pain was measured using the numeric rating scale (NRS), visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC ) pain score. Neuropathic pain was measured using the PainDETECT questionnaire. Moreover, knee function was evaluated by the WOMAC score and range of motion (ROM) assessments. Radiological grade was defined using the Kellgren-Lawrence (K-L) grading scale. Results: Pain scores measured using different methods were highly correlated to each other. The worse the pain, the worse the K-L grade and knee function were. The expression of IL-1β and IL-6 was increased in the early stage compared with the late stage. The NRS was positively correlated to age, K-L grade, and the WOMAC score and negatively correlated to ROM and TNF-α expression. The VAS was positively correlated to age, K-L grade, and the WOMAC score but negatively correlated to ROM and the levels of IL-1β, IL-6 and TNF-α. The WOMAC pain score was not correlated to any of the measured inflammatory mediators; it correlated to only ROM. The PainDETECT score correlated to only the WOMAC score. The expression of other inflammatory mediators was not correlated to any of the pain scores. Conclusions: IL-1β, IL-6 and TNF-α exhibit higher expression in early stage of KOA than the late stage of KOA and correlated to pain. The measured catabolic enzymes and neuropeptides are not correlated to nociceptive and neuropathic pain. New biomarkers related to pain in the late stage need to be further investigated.
Myocardial Characterization in Pre-Dialysis Chronic Kidney Disease: A Study of Prevalence, Patterns and Outcomes
Authors: Price Anna M , Hayer Manvir K , Vijapurapu Ravi , Fyyaz Saad A , Moody William E , Ferro Charles J , Townend Jonathan N , Steeds Richard P , Edwards Nicola C
Published: October 2019

Background

Late gadolinium enhancement (LGE) using cardiac magnetic resonance (CMR) characterizes myocardial disease and predicts an adverse cardiovascular (CV) prognosis. Myocardial abnormalities, are present in early chronic kidney disease (CKD). To date there are no data defining prevalence, pattern and clinical implications of LGE-CMR in CKD.Methods

Patients with pre-dialysis CKD (stage 2-5) attending specialist renal clinics at University Hospital Birmingham (UK) who underwent gadolinium enhanced CMR (1.5T) between 2005 and 2017 were included. The patterns and presence (LGEpos) / absence (LGEneg) of LGE were assessed by two blinded observers. Association between LGE and CV outcomes were assessed.Results

In total, 159 patients received gadolinium (male 61%, mean age 55 years, mean left ventricular ejection fraction 69%, left ventricular hypertrophy 5%) with a median follow up period of 3.8 years [1.04-11.59]. LGEpos was present in 55 (34%) subjects; the patterns were: right ventricular insertion point n=28 (51%), mid wall n=18 (33%), sub-endocardial n=5 (9%) and sub-epicardial n=4 (7%). There were no differences in left ventricular structural or functional parameters with LGEpos. There were 12 adverse CV outcomes over follow up; 7 of 55 with LGEpos and 5 of 104 LGEneg. LGEpos was not predicted by age, gender, glomerular filtration rate or electrocardiographic abnormalities.Conclusions

In a selected cohort of subjects with moderate CKD but low CV risk, LGE was present in approximately a third of patients. LGE was not associated with adverse CV outcomes. Further studies in high risk CKD cohorts are required to assess the role of LGE with multiplicative risk factors.
Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis
Authors: Shen Yu , Lin Xiaoqin , Zhang Luyi , Wu Miaoqin
Published: October 2019

Background: The purpose of this study was to compare the anatomical and visual outcomes of inverted internal limiting membrane (ILM) flap technique and internal limiting membrane peeling in large macular holes (MH).
Methods: Related studies were reviewed by searching electronic databases of Pubmed, Embase, Cochrane Library. We searched for articles that compared inverted ILM flap technique with ILM peeling for large MH (> 400 μm). Double-arm meta-analysis was performed for the primary end point that was the rate of MH closure, and the secondary end point was postoperative visual acuity (VA). Heterogeneity, publication bias, sensitivity analysis and subgroup analysis were conducted to guarantee the statistical power.
Results: This review included eight studies involving 593 eyes, 4 randomized control trials and 4 retrospective studies. After sensitivity analysis for eliminating the heterogeneity of primary outcome, the pooled data showed the rate of MH closure with inverted ILM flap technique group was statistically significantly higher than ILM peeling group (odds ratio (OR) = 3.95, 95% confidence interval (CI) = 1.89 to 8.27; P = 0.0003). At the follow-up duration of 3 months, postoperative VA was significantly better in the group of inverted ILM flap than ILM peeling (mean difference (MD) = -0.16, 95% CI = -0.23 to 0.09; P ＜ 0.00001). However, there was no difference in visual outcomes between the two groups of different surgical treatments at relatively long-term follow-up over 6 months (MD = 0.01, 95% CI = -0.12 to 0.15; P = 0.86).
Conclusion: Vitrectomy with inverted ILM flap technique had a better anatomical outcome than ILM peeling. Flap technique also had a signifcant visual gain in the short term, but the limitations in visual recovery at a longer follow-up was found.
Keywords: Inverted internal limiting membrane flap technique, Internal limiting membrane peeling, Large macular hole, Meta-analysis
Factors associated with unintended pregnancy in Ethiopia; further analysis of the 2016 Ethiopian demographic health survey data.
Authors: Bekele Yibeltal Alemu , Fekadu Gedefaw Abeje
Published: October 2019

Background

Unintended pregnancy is an important public health problem in Ethiopia. It causes adverse physical, mental, social and economic outcomes. Identifying factors associated with unintended pregnancy may help to reduce unintended pregnancy and hence adverse outcomes. There are few studies about the prevalence and associated factors of unintended pregnancy in Ethiopia. But these studies were based on few sample size and fragmented. Therefore, this analysis was done to identify factors associated with unintended pregnancy in Ethiopia based on nationally representative data.Methods

The study used the 2016 Ethiopian demographic and health survey data. The data was downloaded from The DHS program with permission. A total of 1135 women were included in the final model. Data was weighted to consider disproportionate sampling and non-response. Multivariable logistic regression was used to identify factors associated with unintended pregnancy among women.Result

About 30% (95% CI: 25.33 -34.39) pregnancies were unintended. Married women (AOR; 0.034; 95% CI: 0.01- 0.14), woman living in developing regions (AOR; 0.14; 95% CI: 0.07- 0.27) and women who reported distance not a big problem to get medical care (AOR 0.59; 95% CI: 0.36 - 0.99) had lower odds of unintended pregnancy. On the other hand, multi-para (AOR; 3.77; 95% CI: 1.71 - 8.33), grand multi-para (AOR; 6.72; 95% CI: 2.74 - 16.49) women and women who ever used contraceptives (AOR; 1.86 95% CI: 1.06 - 3.26) had higher odds of unintended pregnancy.Conclusion

Although high,the magnitude of unintended pregnancy in Ethiopia was lower compared to the global level. Marital status, region, perceived distance to seek medical care, parity and history of contraceptive use were found significant predictors of unintended pregnancy in Ethiopia.
Qualitative exploration of the acceptability of a postnatal pelvic floor muscle training intervention to prevent urinary incontinence
Authors: Grant Aileen , Currie Sinead
Published: October 2019

Background Childbirth is a major risk factor for urinary incontinence (UI). As a result, pelvic floor muscle training (PFMT) is commonly recommended during and after pregnancy to prevent the onset of UI. PFMT is often classed as a physical activity (PA) behaviour, hence PA guidelines for postnatal women encourage PFMT alongside aerobic activities. However, postnatal lifestyle interventions tend to overlook PFMT which can be detrimental to women’s health and future health risks, including urinary incontinence. This study aimed to explore perceptions and acceptability of a postnatal physical activity and PFMT intervention with postnatal women in Scotland.Methods We recruited women who had given birth within the last five years by displaying posters in health centres and community centres in Stirling and through Facebook. Data was gathered via online and face-to-face focus groups, which were audio recorded and transcribed verbatim. Analytic themes were initially organised under related concepts derived from the topic guide and thematic analysis conducted. Subsequent analysis was by the Framework technique.Results A total of seven online and face-to-face focus group discussions with 31 women identified there was a clear intention behaviour gap for engagement in PA with both psychological and logistical barriers identified such as motivation and childcare. This was distinct from PFMT where there was a feeling of helplessness around not knowing how to perform a correct PFMT contraction subsequently resulting in women not adhering to PFMT guidance. Women felt there was no accessible PFMT advice available through the NHS. Some participants had received PFMT advice after childbirth and spoke of the Squeezee app being useful in adhering to a PFMT regimen but they did require additional teaching on how to do correct contractions. There was need for clarity and practical support for PFMT in the postnatal period with an approved intervention incorporating an accessible app being suggested by participants.Conclusions Women would like to be trained on postnatal PFMT but face barriers to accessing adequate information and education on how to do a PFMT contraction. An intervention combining PFMT training and an app would be the most useful for their needs and circumstances.
How the resource allocation and inpatient behavior affect the expenditures of terminal malignant tumor patients?
Authors: Li Fen , Zhu Bifan , Sang Peimin , JIN Chunlin
Published: October 2019

Background: The inappropriate use of medical resources and escalating health expenditures of severe diseases patients has been a great concern in China’s health system especially among terminal stage. This study aims to analyze how the resource allocation and hospitalization behavior affect the expenditures of terminal malignant tumor patients, and provide evidences on resource allocation and utilization. Methods: An analysis framework of influencing factors of medical expenses was built according to Andersen’s Behavioral Model. Hospitalization expenditures of malignant tumor patients who died in medical institutions were tracked in Shanghai in 2016. We use path analysis to analyze the influencing factors of hospitalization expenditures at terminal stage. Results: Results demonstrated that hospital services and expenditures during the terminal stage were primarily in tertiary hospitals. The top three influencing factors were length of stay, number of admissions and level of medical institutions. While the influence of demographic characteristics (age, gender, type of medical insurance, etc.) was relatively low. Conclusions: Data suggest that hospitalization expenditures and patients’ economic burden can be reduced through adjusting allocation of medical resources and service utilization, as well as reducing unnecessary hospitalization days.
HIV-exposed infant follow-up in Mozambique: Formative research findings for the design of a cluster randomized controlled trial to improve testing and ART initiation
Authors: Vieira Lúcia Da Costa , Mahumane Arlete Miloque , Napua Manuel , Chale Falume Azamo , Manuel João , Cowan Jessica , Sherr Kenneth , Chapman Rachel , Pfeiffer James
Published: October 2019

Background HIV-exposed infant diagnosis (EID) and initiation of HIV-positive infants on anti-retroviral therapy (ART) requires a well-coordinated cascade of care. Loss-to-follow-up (LTFU) can occur at multiple steps and effective EID is impeded by human resource constraints, difficulty with patient tracking, and long waiting periods. The objective of this research was to conduct formative research to guide the development of an intervention to improve the pediatric HIV care cascade in central Mozambique. The study was conducted in Manica and Sofala Provinces where the adult HIV burden is higher than the national average. The research focused on 3 large clinics in each province, along the highly populated Beira corridor.Methods The research was initiated in 2014 over 3 months at six facilities and consisted of 1) patient flow mapping and collection of health systems data from postpartum, child-at-risk, and ART service registries, 2) measurement of patient waiting times, and 3) patient and health worker focus groups.Results HIV testing and ART initiation coverage for mothers tends to be high, but EID and pediatric ART initiation are hampered by lack of patient tracking, long waiting times, and inadequate counseling to navigate the care cascade. About 76% of HIV+ infants were LTFU and did not initiate ART.Conclusions Effective interventions to reduce LTFU in EID and improve pediatric ART initiation should focus on patient tracking, active follow-up of defaulting patients, reduction in waiting times for PCR results, and initiation of ART by nurses in child-at-risk services.
Decomposing the educational inequalities in the risk factors of severe acute malnutrition among under-five children in low and middle-income countries
Authors: Fagbamigbe Adeniyi Francis , Kandala Ngianga- Bakwin , Uthman Olalekan
Published: October 2019

Background Low- and Middle-income countries (LMIC) are still plagued with the burden of severe acute malnutrition (SAM). While studies have identified factors that influence SAM, efforts have not been made to decompose the educational inequalities across the individual, neighbourhood and national levels in LMIC. This study aims to decompose educational-related inequalities in the prevalence of SAM across LMIC.Methods We pooled successive secondary data from the Demographic and Health Survey (DHS) conducted between 2010 and 2018 in 51 LMIC. We analysed data of 532,680 under-five children nested within 55,823 neighbourhoods. Severe acute malnutrition was the outcome variable while the literacy status of mothers (literate vs illiterate) was the main exposure variable. The explanatory variables cut across the individual-, household and neighbourhood-level factors of the mothers-children pair. Oaxaca-Blinder decomposition method was used to analyse the educational gap in the factors associated with SAM.Results Mothers with no formal education ranged from 0.1% in Armenia and Kyrgyz to as much as 86.1% in Niger. The overall prevalence of SAM in the group of children whose mothers had no education was 5.8% compared with 4.2% among those whose mothers were educated. Thirteen countries had statistically significant pro-illiterate inequality (i.e. SAM concentrated among uneducated mothers) while none of the countries showed statistically significant pro-literate inequality. There were variations in the important factors responsible for the educational inequalities across the countries. On average, neighbourhood socioeconomic status disadvantage, location of residence were the most important factors in most countries. Other contributors to the explanation of educational inequalities are birth weight, maternal age and toilet type.Conclusions We identified that SAM is prevalent in most LMIC with wide educational inequalities. The occurrence of SAM was explained by the individual, household and community-level factor. A potential strategy to reduce the burden of SAM to reduce educational inequalities among mothers in the low- and middle-income countries through the promotion of women education.
Anthropometrical measurements and maternal visceral fat during first half of pregnancy: a cross-sectional survey
Authors: Kretzer Daniela Cortez , Matos Salete , Von Diemen Lisia , Magalhães José Antônio de Azevedo , Rocha Alexandre da Silva , Bernardi Juliana Rombaldi
Published: October 2019

Background Prenatal care is fundamental for achieving good results in the outcome of pregnancy, however, the coverage in Brazil is still low. In the impossibility of pre-gestational weight measure and subsequent body mass index (BMI) values, the others anthropometric measurements are useful and may be ideal for measuring the nutritional status of pregnant women, especially in low- and middle-income countries. The aim of this study was to assess the anthropometrical measurements during pregnancy and compared it to maternal ultrasound visceral adipose tissue.Methods A cross-sectional study was conducted with pregnant women from the city of Porto Alegre (city), capital of Rio Grande do Sul (state), southern Brazil, from October 2016 until January 2018. Anthropometrical variables (weight, height, mid-upper arm circumference (MUAC), circumferences of calf and neck and triceps skin folds – TSF and subscapular skin folds – SBSF), and ultrasound variables (visceral adipose tissue – VAT and total adipose tissue – TAT) were collected. To verify the correlation of anthropometric and ultrasound measurements, non-adjusted and adjusted Spearman correlation was used. The study was approved by the ethics committees.Results Among the 149 pregnant women, 54.8% (n=80) were white race. The age median was 25 years [21 - 31], pre-pregnancy BMI was 26.22kg/m 2 [22.16 – 31.21] and gestational age was 16.2 weeks [13.05 – 18.10]. The best measurements correlated with VAT and TAT were MUAC and SBSF, being anthropometric measurements with a higher correlation than pre-pregnancy BMI.Conclusion It is possible to provide a practical and reliable estimate of VAT and TAT from anthropometric evaluation (MUAC or SBSF) that is low cost, efficient and replicable in outpatient clinic environment, especially in low- and middle-income countries.
Prioritising pathogens for the management of severe febrile patients to improve clinical care in low- and middle-income countries
Authors: Osborn Jennifer , Roberts Teri , Guillen Ethan , Bernal Oscar , Roddy Paul , Ongarello Stefano , Sprecher Armand , Page Anne-Laure , Ribeiro Isabela , Piriou Erwan , Tamrat Abiy , Tour Roberto de la , Rao V. Bhargavi , Flevaud Laurence , Jensen Tomas , McIver Lachlan , Kelly Cassandra , Dittrich Sabine
Published: October 2019

Background: Severe febrile illness without a known source (SFWS) is a challenge for clinicians when deciding how to manage a patient, particularly given the wide spectrum of potential aetiologies that contribute to fever. These infections are difficult to distinguish clinically, and accurate diagnosis requires a plethora of diagnostics including blood cultures, imaging techniques, molecular or serological tests, and more. When laboratory services are available, a limited test menu hinders clinical decision-making and antimicrobial stewardship, leading to empiric treatment and suboptimal patient outcomes. To specifically address SFWS, this work aimed to identify priority pathogens for a globally applicable panel for fever causing pathogens. Method: A pragmatic two-pronged approach combining currently available scientific data in an analytical hierarchy process and systematically gathered expert input, was designed to address the lack of comprehensive global aetiology data. The expert re-ranked list was then further adapted for a specific use case to focus on community acquired infections in whole blood specimens. The resulting list was further analysed to address different geographical regions (Asia, Africa, and Latin America), and Cohen kappa scores of agreement were calculated. Results: The expert ranked prioritized pathogen list generated as part of this two-pronged approach included typhoidal Salmonella , Plasmodium species and Mycobacterium tuberculosis as the top 3 pathogens. This pathogen list was then further adapted for the SFWS use case to develop a final pathogen list to inform product development. Subsequent analysis comparing the relevance of the SFWS pathogen list to multiple populations and geographical regions showed that the SFWS prioritized list had considerable utility across Africa and Asia, but less so for Latin America. In addition, the list showed high levels of agreement across different patient sub-populations, but lower relevance for neonates and symptomatic HIV patients. Conclusion: This work highlighted once again the challenges of prioritising in global health, but it also shows that taking a two-pronged approach, including the actionability, can result in a broadly applicable priority list. This broad utility is particularly important in the context of product development, where a sufficient market size is essential to achieve a sustainable commercialized diagnostic product to address SFWS.
Application of the adenosine triphosphate sensitivity assay in infantile vascular anomalies
Authors: Li Li , Yang Bin , Wei Li , Zhang Bin , Han Xiao-feng , Xu Zi-gang , Ma Lin
Published: October 2019

BACKGROUND: The term vascular anomalies include various vascular tumors and vascular malformations, among them infantile hemangiomas and capillary malformations are the most well-known associated diseases in early ages. Multiple drugs have been introduced for intervention, but susceptibility test in vitro were scarcely reported.OBJECTIVE: To evaluate the inhibition effect of adenosine triphosphate sensitivity assay in vitro before the treatment of infantile hemangiomas and capillary malformations. METHODS: Specimens were selected from 5 cases of infantile hemangiomas and 11 cases of capillary malformations. Propranolol, rapamycin, sildenafil and itraconazole were tested for their growth inhibition effect by using the adenosine triphosphate sensitivity assay. RESULTS: Propranolol demonstrated inhibitory effects on infantile hemangiomas cells. Rapamycin and itraconazole both showed inhibitory effects on infantile hemangiomas cells and capillary malformations cells. Sildenafil has no growth inhibitory effect on infantile hemangiomas cells or capillary malformations cells. CONCLUSION: Adenosine triphosphate sensitivity assay is a sensitive and useful testing method before the management of vascular anomalies, and individualized medication suggestions for the choice of therapeutic drugs were offered based on the testing result and together with a comprehensive evaluation of each infant.
Treatment of Distal Clavicle Fractures using a Scorpion Plate and Influence of Timing on Surgical Outcomes: A Retrospective Cohort Study of 105 Cases
Authors: Furuhata Ryogo , Takahashi Masaaki , Hayashi Teppei , Inagawa Miyu , Kono Aki , Matsumura Noboru , Kiyota Yasuhiro , Kamata Yusaku , Yoshiyama Akira , Arino Hiroshi , Morioka Hideo
Published: October 2019

Background Plate fixation is the established method of treating unstable distal clavicle fractures. However, the appropriate timing of surgery for acute distal clavicle fractures remains unclear. The present study aimed to evaluate the clinical outcomes of osteosynthesis using a Scorpion plate and to assess the influence of surgery timing on the surgical outcomes for acute unstable distal clavicle fractures. Methods We retrospectively reviewed 105 patients who underwent fixation for acute unstable distal clavicle fractures (Neer type II and V) using the Scorpion plate between 2008 and 2018. Patients were divided into early (45 patients) and delayed (60 patients) treatment groups based on the timing of the surgical intervention (within or after seven days). The outcomes were postoperative complications (delayed union, peri-implant fracture, plate loosening, plate-related pain, and stiffness). We evaluated the outcomes from X-ray radiographs and clinical notes.Results Among the 105 patients, delayed union, plate loosening, plate-related pain, and stiffness were observed in six patients (5.7%), four patients (3.8%), seven patients (6.7%), and one (1.0%) patient, respectively. The delayed union rate was significantly higher in the delayed treatment group than that in the early treatment group (P=0.036). Although the difference was not significant, plate loosening and stiffness were only observed in the delayed treatment group. Conclusion Our results demonstrated that osteosynthesis using Scorpion plates achieved satisfactory surgical outcomes for unstable distal clavicle fractures . In addition, this study suggested that performing surgery within six days after injury is recommended to reduce postoperative complications .
Using Intervention Mapping to Develop a Motivational Interviewing Training and Support Program for HIV Lay Counsellors to Improve ART Uptake in The Primary Health Care Setting in Gauteng, South Africa
Authors: Mokhele Idah , Sineke Tembeka , Vuyovic Marnie Vuyovic , Fox Matthew A , Ruiter Robert AC , Onoya Dorina
Published: October 2019

Background Worldwide, countries are striving to achieve universal antiretroviral treatment (ART) coverage. In South Africa, given the shortage of specialist health care professionals in the public sector, lay HIV counsellors are at the forefront of many HIV related behavioural interventions. They have limited formal counselling training and little ongoing in-service support, leading to considerable variability in skills, knowledge, and approaches to counselling. We aimed to use the Intervention Mapping approach to develop a motivational interviewing counselling training and support program for lay HIV counsellors practising in primary health care (PHC) clinics in Gauteng, South Africa. Methods We applied the steps of Intervention Mapping. This included the analysis of key informant data collected among clinic managers and counsellors (target group), in-depth literature reviews on determinants of critical elements of target behaviours and approaches for influencing these. Extensive consultations with an expert team led to two program objectives: 1) improved general HIV counselling skills among lay HIV counsellors; and 2) sustained motivational interviewing skills for ART and HIV care demand creation. Matrices of change objectives were produced specifying performance and change objectives as well as evidence and theory-based training methods to achieve these. Result We developed a motivational interviewing counselling training and support program titled “Thusa-Thuso - helping you help”. For objective one, we partnered with a seasoned psychologist and counselling trainers to recap and strengthen essential counselling skills and resilience. For objective two, we adapted the Boston University Brief Negotiated Interviewing motivational interviewing counselling training. Adaptations include adjusting the English readability level of training materials; translating materials to spoken Zulu and Sotho; anchoring the training around interactive sessions; producing contextually-relevant modelling videos, in-training role plays and on-site (clinic) mentoring using the Motivational Interviewing Treatment Integrity coding system (MITI) as a training and self-correction tool. The planned support component comprises of quarterly support and mentoring sessions over 12-months. Conclusion The “Thusa-Thuso” motivational interviewing counselling training and support program is a contextually relevant, locally-produced, scalable training and support program designed to impart sustained motivational interviewing counselling skills in lay HIV counsellors for improved ART uptake in the UTT era.
Selectivity of herbicides in the post-emergence sugarcane seedlings in primary selection fields
Authors: Silva Tácio Peres , Moura Amanda Mendes de , Melo Bruno Manoel Rezende de , Castro Douglas Goulart , Tomé Laís Moretti , Félix Marco Renan , Botelho Flávia Barbosa Silva
Published: October 2019

The hypothesis here proposed is that, in primary fields of mass selection (F1) of sugarcane, herbicides exert a selective action when applied in the early post-emergence of seedlings (POST-i) and supplemented after their establishment phase (POST-l) even in sandy soils. To verify such hypothesis, the selectivity of herbicides was studied on seedlings of three sugarcane families, after their application both at early and late post-emergence in primary selection fields (F1). The field had a randomized blocks design, with five replications, and the subdivided plots scheme was used. Twelve herbicide treatments were allocated in the plots (27 m-2), whereas the sub-plots (9 m-2) contained three families of seedlings. Each sub-plot consisted of a transplanted row (0.5 x 1.50 m) with 12 individuals of the same family. Six treatments were employed, namely, T1: tebuthiuron (1200 g ha-1) post-i + ametryn (3000 g ha-1) post-l; T2: diuron (1404 g ha-1) + hexazinone (396 g ha-1) post-i + ametryn (3000 g ha-1) post-l; T3: sulfentrazone (800 g ha-1) post-i + ametryn (3000 g ha-1) post-l; T4: diuron (1404 g ha-1) + hexazinone (396 g ha-1) post-i + metribuzin (1920 g ha-1) post-l; T5: sulfentrazone (800 g ha-1) post-i + metribuzin (1920 g ha-1) post-l, and T6: weeded plot. The sugarcane families were: F400 (♀IAC086155 x ♂unknown), F43 (♀IACBIO264 × ♂IAC911099), and F14 (♀IACSP991305 × ♂GlagaH). We concluded that the herbicides tebuthiuron (1200 g ha-1), diuron (104 g ha-1) + hexazinone (396 g ha-1), or sulfentrazone (800 g ha-1), when applied in the early post-emergence and supplemented with ametryn (3000 g ha-1) or metribuzin (1920 g ha-1) in late post-emergence (60 days from planting) of the sugarcane families studied, were selective to the seedlings. That is, no toxicity symptoms with a potential to impede the final selection of seedlings occurred.
Soil fertility under different tillage systems in sugarcane expansion area
Authors: Moraes Emmerson Rodrigues de , Mageste José Geraldo , Peixoto Joicy Vitória Miranda , Domingues Luis Augusto da Silva , Lana Regina Maria Quintão , Lemes Ernane Miranda
Published: October 2019

In sugarcane expansion areas where soil fertility restrictions regularly occur, soil preparing ameliorates soil physical and chemical properties to improve conditions for sugarcane crop development. Therefore, the aim of this study was to evaluate soil chemical attributes under different soil preparation methods for sugarcane cultivation at the first and second year of expansion area in the Cerrado biome. The experiment was conducted in an area previously used as pasture land for more than 10 years with Brachiaria decumbens without any soil correction. CTC-2 sugarcane variety was planted. The experiment was set up as a randomized block design with six treatments and four replications. The treatments were: desiccation-liming-plowing-harrowing; liming-plowing-harrowing; liming-harrowing-plowing-harrowing; desiccation-liming-direct planting; desiccation-liming-subsoiling, and harrowing-liming-plowing-harrowing. Soil attributes: organic matter, water pH, H++Al3+, Al3+, m, V, H2PO4-, K+, Ca2+, Mg2+, and S-SO4-2 were evaluated at 0-0.2, 0.2-0.4 and 0.4-0.6 m soil depth. The variables were submitted ANOVA, joint analysis and Tukey’s test (p < 0.05). The treatments including liming followed by harrowing, plowing and harrowing, and harrowing followed by liming, plowing and harrowing, resulted in the largest gains in soil fertility. In the first year of sugarcane cultivation, the no-tillage system proved to be sustainable and appropriate for sugarcane cultivation economically viable.