bluuebunny/crossref_metadata_2025 huggingface dataset:
Satisfaction of Healthcare Professionals and People With Diabetes With an Insulin Bolus Calculator Mobile Application
Authors: Katz Laurence B. , Hurrell Graham , Venugopal Usha , Cameron Hilary , Shearer David M.
Published: May 2020

People with diabetes (PWD) who need to take mealtime insulin to help control their blood sugar often have difficulty correctly calculating their dose due to consideration of many factors such as current blood glucose, carbohydrate consumption, active insulin duration, insulin-to-carb ratio, and insulin sensitivity. The Insulin Mentor, a bolus calculator tool in the OneTouch Reveal diabetes management app, uses an algorithm to automate many of these calculations and contains a link to a food diary to help estimate carbohydrate intake. In the current study, healthcare professionals and PWD from United States and Germany responded favorably to simulations of this calculator tool and compared it positively with other apps on the market. The Insulin Mentor may simplify the difficult process of correctly calculating mealtime insulin doses for PWD.
Smoking is Associated With Increased Risk of Not Achieving Glycemic Target, Increased Glycemic Variability, and Increased Risk of Hypoglycemia for People With Type 1 Diabetes
Authors: Jensen Morten Hasselstrøm , Cichosz Simon Lebech , Hirsch Irl B. , Vestergaard Peter , Hejlesen Ole , Seto Edmund
Published: May 2020

Background:

The prevalence of smoking and diabetes is increasing in many developing countries. The aim of this study was to investigate the association of smoking with inadequate glycemic control and glycemic variability with continuous glucose monitoring (CGM) data in people with type 1 diabetes.

Methods:

Forty-nine smokers and 320 nonsmokers were obtained from the Novo Nordisk Onset 5 trial. After 16 weeks of treatment with continuous subcutaneous insulin infusion, risk of not achieving glycemic target and glycemic variability from six CGM measures was investigated. Analyzes were carried out with logistic regression models (glycemic target) and general linear models (glycemic variability). Finally, CGM median profiles were examined for the identification of daily glucose excursions.

Results:

A 4.7-fold (95% confidence interval: 1.5-15.4) increased risk of not achieving glycemic target was observed for smokers compared with nonsmokers. Increased time in hyperglycemia, decreased time in range, increased time in hypoglycemia (very low interstitial glucose), and increased fluctuation were observed for smokers compared with nonsmokers from CGM measures. CGM measures of coefficient of variation and time in hypoglycemia were not statistically significantly different. Examination of CGM median profiles revealed that risk of morning hypoglycemia is increased for smokers.

Conclusions:

In conclusion, smoking is associated with inadequate glycemic control and increased glycemic variability for people with type 1 diabetes with especially risk of morning hypoglycemia. It is important for clinicians to know that if the patient has type 1 diabetes and is smoking, a preemptive action to treat high glycated hemoglobin levels should not necessarily be treatment intensification due to the risk of hypoglycemia.
Properties of Cartilage–Subchondral Bone Junctions: A Narrative Review with Specific Focus on the Growth Plate
Authors: Kazemi Masumeh , Williams John Leicester
Published: May 2020

Objective

The purpose of this narrative review is to summarize what is currently known about the structural, chemical, and mechanical properties of cartilage-bone interfaces, which provide tissue integrity across a bimaterial interface of 2 very different structural materials. Maintaining these mechanical interfaces is a key factor for normal bone growth and articular cartilage function and maintenance.

Materials and Methods

A comprehensive search was conducted using Google Scholar and PubMed/Medline with a specific focus on the growth plate cartilage–subchondral bone interface. All original articles, reviews in journals, and book chapters were considered. Following a review of the overall structural and functional characteristics of the physis, the literature on histological studies of both articular and growth plate chondro-osseous junctions is briefly reviewed. Next the literature on biochemical properties of these interfaces is reviewed, specifically the literature on elemental analyses across the cartilage–subchondral bone junctions. The literature on biomechanical studies of these junctions at the articular and physeal interfaces is also reviewed and compared.

Results

Unlike the interface between articular cartilage and bone, growth plate cartilage has 2 chondro-osseous junctions. The reserve zone of the mature growth plate is intimately connected to a plate of subchondral bone on the epiphyseal side. This interface resembles that between the subchondral bone and articular cartilage, although much less is known about its makeup and formation.

Conclusion

There is a notably paucity of information available on the structural and mechanical properties of reserve zone–subchondral epiphyseal bone interface. This review reveals that further studies are needed on the microstructural and mechanical properties of chondro-osseous junction with the reserve zone.
Cognitive Issues in Bible Translation: The Biblical Text in the Context of Human Experience
Authors: Shaw R. Daniel , DeLoach Danny , Grimes Jonathan , Luchivia John O. , Silzer Sheryl , West Amy
Published: May 2020

Cognitive studies affect all disciplines that reflect the connection between the mind–brain and human behavior. To state the obvious, Bible translation is a multidisciplinary task influenced by cognitive processes. What, then, do Bible translators need to know about the intended communication of a biblical text on one hand and a people’s context-based inferences on the other? Can these disparate, but necessarily interactive, environments blend to reflect a totality of knowledge from the content of the biblical text? Together, the coauthors explore a variety of cognitive processes that reflect on the relationship between translation and human behavior. Our objective is to show how translated biblical text interfaces with human cognition to affect behavior in specific contexts.
The Role of Religiosity on Fashion Store Patronage Intention of Muslim Consumers in Indonesia
Authors: Kusumawati Andriani , Listyorini Sari , Suharyono  , Yulianto Edy
Published: May 2020

Religiosity covers all aspects of human life values. Consumer decision-making in Muslim product purchase needs to involve religiosity. Muslim fashion is increasingly popular and becomes a potential business for fashion entrepreneurs in Indonesia. This condition evokes a dilemma for the consumers as Muslim fashion users on whether they have to conform to the religious sharia or follow the trend. The purpose of this article is to identify the role of religiosity as a factor affecting Muslim consumers to revisit Muslim fashion stores. This research involved 243 Muslim consumers of several Muslim fashion stores. The results showed that religiosity of Muslim consumers had a direct effect on patronage intention and indirect effect on patronage intention of Muslim fashion stores through Customer Satisfaction. The research findings are directed to managerial implications for Muslim fashion entrepreneurs in relation to consumer religiosity and marketing of Indonesian Muslim fashion products.
Contextual Prejudice: How Occupational Context and Stereotypes Shape Bias against Gay and Lesbian Employees
Authors: Mishel Emma
Published: May 2020

While much research provides evidence that gay men and lesbians are discriminated against in the U.S. labor force, the contexts in which such bias is enhanced or reduced, or the mechanisms behind it, are harder to pinpoint. This article puts forth that occupational context—and specifically, the stereotypes about gay men and lesbians evoked by certain occupational contexts—plays an important role in shaping bias against gay men and lesbians in the labor force. I argue that people are implicitly guided by cultural stereotypes about gay men and lesbians, which affects perceptions about whether they are suitable for specific occupations. This leads to penalties for being openly gay or lesbian in some occupational scenarios, but may lead to less or no penalties in others. This theory is tested empirically using a list experiment, a methodological technique designed to reduce or eliminate social desirability bias in responses. Results suggest that bias against gay men and lesbians is not standard across all occupations or subgroups of gay employees, but rather, is shaped by important contextual factors that can activate certain stereotypes about gay and lesbian individuals.
A to Z of Zika Virus: A Comprehensive Review for Clinicians
Authors: Arora Harbir Singh
Published: May 2020

Since its first outbreak in 2007 in the Pacific (Yap islands and Federal States of Micronesia), Zika virus has gradually and recently spread to the Americas in 2015. The neurotropic character of the virus was first noted during this outbreak in Brazil in 2015. Increasing number of infants born with microcephaly and other congenital deformities were identified through studies that have highlighted the importance of prevention of transmission of Zika virus in pregnant women. Long-term outcomes in infants born with this infection are now better understood than at the time of onset of this outbreak. Topics covered in this review include the history, modes of transmission, diagnosis of suspected cases, pathophysiology, complications, and prevention of Zika virus infection.
How Do Subjective Health Literacy Measures Work in Young Adults? Specifying “Online” or “Paper-Based” Forms Impacts Results
Authors: Politi Mary C. , Goodwin Courtney M. , Kaphingst Kimberly A. , Wang Xuechen , Fagerlin Angela , Fuzzell Lindsay N. , Philpott-Streiff Sydney E.
Published: May 2020

Purpose. There is no gold-standard health literacy measure. The Single Item Literacy Screener (SILS) and Subjective Literacy Screener (SLS) ask people to self-report ability to understand health information. They were developed in older adults, before common use of electronic health information. This study explored whether the SILS and SLS related to objective literacy, numeracy, and comprehension among young adults, and whether specifying “online” or “paper-based” wording affected these relationships. Methods. Eligible individuals (18–35 years of age, English-speaking, US residents) from an online survey company were randomized to 1) original measures; 2) measures adding “paper-based” to describe health information/forms; or 3) measures adding “online” to describe health information/forms. We examined how each measure related to e-Health Literacy (eHEALS), subjective numeracy (SNS), objective numeracy (ONS), and comprehension of a short passage. Results. A total of 848/1342 respondents correctly answered attention-checks and were analyzed. The validated SILS related to comprehension ( P = 0.003), eHEALS ( P = 0.04), and ONS ( P < 0.001) but not SNS ( P = 0.44). When adding “paper-based,” SILS related to eHEALS ( P < 0.001) and ONS ( P = 0.003) but did not relate to comprehension ( P = 0.25) or SNS ( P = 0.35). When adding “online,” SILS related to comprehension ( P < 0.001), eHEALS ( P < 0.001), ONS ( P = 0.005), and SNS ( P = 0.03). The validated SLS related to comprehension ( P < 0.001), eHEALS ( P < 0.001), ONS ( P < 0.001), and SNS ( P < 0.001). When adding “paper-based,” the SLS only related to eHEALS ( P = <0.001) and comprehension ( P = 0.03) but did not relate to ONS ( P = 0.13) or SNS ( P = 0.33). When adding “online,” the SLS related to comprehension ( P < 0.001), eHEALS ( P < 0.001), and SNS ( P = 0.03) but not ONS ( P = 0.06). Conclusions. Young adults might interpret subjective health literacy measures differently when prompted to think about electronic or paper-based information. Researchers should consider clearer instructions or modified wording when using these measures in this population.
Correlation of spectral acceleration values of vertical and horizontal ground motion pairs
Authors: Kohrangi Mohsen , Papadopoulos Athanasios N , Bazzurro Paolo , Vamvatsikos Dimitrios
Published: May 2020

We present correlation coefficient estimates between a number of ground motion intensity measures ( IMs), as measured from the NGA-West2 database, with focus on the correlation of vertical–vertical and vertical–horizontal ground motion components. The IMs considered include spectral accelerations with periods from 0.01 to 10 s, peak ground acceleration, peak ground velocity, and significant duration (for 5%–75% and 5%–95% definitions). To facilitate their use, parametric equations are also fitted to the correlation models. Finally, the dependence of the obtained correlation coefficients to magnitude, distance, and Vs30 is evaluated.
Comparative transcriptome analysis between inbred and hybrids reveals molecular insights into yield heterosis of upland cotton
Authors: Shahzad Kashif , Zhang Xuexian , Guo Liping , Qi Tingxiang , Bao Lisheng , Zhang Meng , Zhang Bingbing , Wang Hailin , Tang Huini , Qiao Xiuqin , Feng Juanjuan , Wu Jianyong , Xing Chaozhu
Published: May 2020

Background

Utilization of heterosis has greatly improved the productivity of many crops worldwide. Understanding the potential molecular mechanism about how hybridization produces superior yield in upland cotton is critical for efficient breeding programs.

Results

In this study, high, medium, and low hybrids varying in the level of yield heterosis were screened based on field experimentation of different years and locations. Phenotypically, high hybrid produced a mean of 14% more seed cotton yield than its better parent. Whole-genome RNA sequencing of these hybrids and their four inbred parents was performed using different tissues of the squaring stage. Comparative transcriptomic differences in each hybrid parent triad revealed a higher percentage of differentially expressed genes (DEGs) in each tissue. Expression level dominance analysis identified majority of hybrids DEGs were biased towards parent like expressions. An array of DEGs involved in ATP and protein binding, membrane, cell wall, mitochondrion, and protein phosphorylation had more functional annotations in hybrids. Sugar metabolic and plant hormone signal transduction pathways were most enriched in each hybrid. Further, these two pathways had most mapped DEGs on known seed cotton yield QTLs. Integration of transcriptome, QTLs, and gene co-expression network analysis discovered genes Gh_A03G1024, Gh_D08G1440, Gh_A08G2210, Gh_A12G2183, Gh_D07G1312, Gh_D08G1467, Gh_A03G0889, Gh_A08G2199, and Gh_D05G0202 displayed a complex regulatory network of many interconnected genes. qRT-PCR of these DEGs was performed to ensure the accuracy of RNA-Seq data.

Conclusions

Through genome-wide comparative transcriptome analysis, the current study identified nine key genes and pathways associated with biological process of yield heterosis in upland cotton. Our results and data resources provide novel insights and will be useful for dissecting the molecular mechanism of yield heterosis in cotton.
Comparative transcriptome profiling reveals cold stress responsiveness in two contrasting Chinese jujube cultivars
Authors: Zhou Heying , He Ying , Zhu Yongsheng , Li Meiyu , Song Shuang , Bo Wenhao , Li Yingyue , Pang Xiaoming
Published: May 2020

Background

Low temperature is a major factor influencing the growth and development of Chinese jujube (Ziziphus jujubaMill.) in cold winter and spring. Little is known about the molecular mechanisms enabling jujube to cope with different freezing stress conditions. To elucidate the freezing-related molecular mechanism, we conducted comparative transcriptome analysis between ‘Dongzao’ (low freezing tolerance cultivar) and ‘Jinsixiaozao’ (high freezing tolerance cultivar) using RNA-Seq.

Results

More than 20,000 genes were detected at chilling (4 °C) and freezing (− 10 °C, − 20 °C, − 30 °C and − 40 °C) stress between the two cultivars. The numbers of differentially expressed genes (DEGs) between the two cultivars were 1831, 2030, 1993, 1845 and 2137 under the five treatments. Functional enrichment analysis suggested that the metabolic pathway, response to stimulus and catalytic activity were significantly enriched under stronger freezing stress. Among the DEGs, nine participated in the Ca2+signal pathway, thirty-two were identified to participate in sucrose metabolism, and others were identified to participate in the regulation of ROS, plant hormones and antifreeze proteins. In addition, important transcription factors (WRKY,AP2/ERF,NACandbZIP) participating in freezing stress were activated under different degrees of freezing stress.

Conclusions

Our research first provides a more comprehensive understanding of DEGs involved in freezing stress at the transcriptome level in twoZ. jujubacultivars with different freezing tolerances. These results may help to elucidate the molecular mechanism of freezing tolerance in jujube and also provides new insights and candidate genes for genetically enhancing freezing stress tolerance.
Cryptococcus meningitis mimicking cerebral septic emboli, a case report series demonstrating injection drug use as a risk factor for development of disseminated disease
Authors: Polk Christopher , Meredith Jacqueline , Kuprenas Alyssa , Leonard Michael
Published: May 2020

Background

Clinicians may be less inclined to consider a diagnosis of cryptococcal meningitis in people without HIV infection or transplant-related immunosuppression. This may lead to a delay in diagnosis particularly if disseminated cryptococcal disease mimics cerebral septic emboli in injection drug use (IDU) leading to a search for endocarditis or other infectious sources. Though, IDU has been described as a potential risk for disseminated cryptococcal disease.

Case presentations

We present two cases of cryptococcal meningitis in IDU without HIV or other obvious immune deficits. Both patients presented with at least 2 weeks of headache and blurred vision. They developed central nervous system (CNS) vasculitis, one of which mimicked septic cerebral emboli, but both resulted with poor neurologic outcomes.

Conclusions

IDU likely induces an underappreciated immune deficit and is a risk factor for developing cryptococcal meningitis. This diagnosis, which can mimic cerebral septic emboli through involvement of a CNS vasculitis, should be considered in the setting of IDU.
Moving a neodymium magnet promotes the migration of a magnetic tracer and increases the monitoring counts on the skin surface of sentinel lymph nodes in breast cancer
Authors: Makita Masujiro , Manabe Eriko , Kurita Tomoko , Takei Hiroyuki , Nakamura Seigo , Kuwahata Akihiro , Sekino Masaki , Kusakabe Moriaki , Ohashi Yasuo
Published: May 2020

Background

We suspected that moving a small neodymium magnet would promote migration of the magnetic tracer to the sentinel lymph node (SLN). Higher monitoring counts on the skin surface before making an incision help us detect SLNs easily and successfully. The present study evaluated the enhancement of the monitoring count on the skin surface in SLN detection based on the magnet movement in a sentinel lymph node biopsy (SNB) using superparamagnetic iron oxide (SPIO) nanoparticles.

Methods

After induction of general anesthesia, superparamagnetic iron oxide nanoparticles were injected sub-dermally into the subareolar area or peritumorally. The neodymium magnet was moved over the skin from the injection site to the axilla to promote migration of the magnetic tracer without massage. A total of 62 patients were enrolled from February 2018 to November 2018: 13 cases were subjected to magnet movement 20 times (Group A), 8 were subjected to 1-min magnet movement (Group B), 26 were given a short (about 5 min) interval from injection to 1-min magnet movement (Group C), and 15 were given a long (about 25 min) interval before 1-min magnet movement using the magnetometer’s head (Group D). In all cases, an SNB was conducted using both the radioisotope (RI) and SPIO methods. The monitoring counts on the skin surface were measured by a handheld magnetometer and compared among the four groups. Changes in the monitoring count by the interval and magnet movement were evaluated.

Results

The identification rates of the SPIO and RI methods were 100 and 95.2%, respectively. The mean monitoring counts of Group A, B, C, and D were 2.39 μT, 2.73 μT, 3.15 μT, and 3.92 μT, respectively (p < 0.0001; Kruskal-Wallis test). The monitoring counts were higher with longer magnet movement and with the insertion of an interval. Although there were no relationships between the monitoring count on the skin surface and clinicopathologic factors, magnet movement strongly influenced the monitoring count on the skin surface.

Conclusion

Moving a small neodymium magnet is effective for promoting migration of a magnetic tracer and increasing monitoring counts on the skin surface.

Trial registration

UMIN, UMIN000029475. Registered 9 October 2017
A novel COMP mutation in a Chinese family with multiple epiphyseal dysplasia
Authors:   Deciphering Disorders Involving Scoliosis and COmorbidities (DISCO) study, Shao Jiashen , Zhao Sen , Yan Zihui , Wang Lianlei , Zhang Yuanqiang , Lin Mao , Yu Chenxi , Wang Shengru , Niu Yuchen , Li Xiaoxin , Qiu Guixing , Zhang Jianguo , Wu Zhihong , Wu Nan
Published: May 2020

Background

Multiple epiphyseal dysplasia (MED) is a skeletal disorder characterized by delayed and irregular ossification of the epiphyses and early-onset osteoarthritis. At least 66% of the reported autosomal dominant MED (AD-MED) cases are caused byCOMPmutations.

Methods

We recruited a four-generation Chinese family with early-onset hip osteoarthritis, flatfoot, brachydactyly, and mild short stature. An assessment of the family history, detailed physical examinations, and radiographic evaluations were performed on the proband and other family members, followed by the performance of whole-exome sequencing (WES). The pathogenicity of the candidate mutation was also analyzed.

Results

An AD-MED family with 10 affected members and 17 unaffected members was recruited. The main radiographic findings were symmetrical changes in the dysplastic acetabulum and femoral heads, irregular contours of the epiphyses, a shortened femoral neck, and flatfoot. Lower bone density was also observed in the ankle joints, wrist joints, and knees, as well as irregular vertebral end plates. In the proband, we identified the missense mutation c.1153G > T (p. Asp385Tyr), located in exon 11 of theCOMPgene. This mutation was assessed as 'pathogenic' because of its low allele frequency and its high likelihood of co-segregation with disease in the reported family. Sanger sequencing validated the novel heterozygous mutation c.1153G > T (p. Asp385Tyr) in exon 11 ofCOMPin all affected individuals in the family.

Conclusions

Our results underlined a key role of the Asp385 amino acid in the protein function of COMP and confirmed the pathogenicity of theCOMP(c.1153G > T; p. Asp385Tyr) mutation in AD-MED disease. We have therefore expanded the known mutational spectrum ofCOMPand revealed new phenotypic information for AD-MED.
The quadrivalent HPV vaccine is protective against genital warts: a meta-analysis
Authors: Lukács Anita , Máté Zsuzsanna , Farkas Nelli , Mikó Alexandra , Tenk Judit , Hegyi Péter , Németh Balázs , Czumbel László Márk , Wuttapon Sadaeng , Kiss István , Gyöngyi Zoltán , Varga Gábor , Rumbus Zoltán , Szabó Andrea
Published: May 2020

Background

The quadrivalent human papillomavirus (HPV) vaccine has been assumed to give protection against genital warts (GW) as well as cervical cancer. Our main question was whether HPV vaccine has any effects on the prevention of GW reported in randomised controlled clinical trials (RCTs) and time-trend analyses.

Methods

This meta-analysis was performed according to the PRISMA guidelines using the PICO format. We searched in three electronic databases (PubMed, Embase, Cochrane Trials), and assessed heterogeneity using the Q-test and I-squared statistics, meta-regression was also performed. Odds ratios (OR) and their confidence intervals (CI) were calculated. The sensitivity was tested by leave-one-out method. We evaluated the presence of publication bias using the funnel plot graph and the Copas selection model. The strength of evidence was assessed using the GRADE approach.

Results

Eight RCTs (per-protocol populations) and eight time-trend ecological studies were included in this meta-analysis. A significant reduction (pooled OR = 0.03, 95% CI: 0.01–0.09; I-squared = 53.6%) of GW in young women was recorded in RCTs, and in time-trend analyses both in young women (pooled OR = 0.36, CI 95% = 0.26–0.51; I-squared = 98.2%), and in young men (pooled OR = 0.69, 95% CI = 0.61–0.78; I-squared = 92.7%). In subgroup analysis, a significant reduction of the number of GW events was observed especially in women under 21 years (pooled OR = 0.33, 95% CI = 0.17–0.63). Leave-one-out analysis showed that similar results could be obtained after excluding one study, meta-regression did not show significant difference.

Conclusions

Prophylactic, quadrivalent HPV vaccination can prevent GW in healthy women and men, therefore, it should be included in routine immunization programme.
The speed of adoption of new drugs and prescription volume after the amendments in reimbursement coverage: the case of non-vitamin K antagonist oral anticoagulants in South Korea
Authors: Son Kyung-Bok
Published: May 2020

Background

The speed of adoption of new drugs and frequencies of substitutions leads to changes in health care expenditures as well as patient outcomes. In this study, we aim to understand the speed of adoption of new drugs and their prescription volume in health care institutions and evaluate the impact of policy options to manage pharmaceutical expenditure.

Methods

We conducted a retrospective cohort study of health care institutions prescribing NOACs, including Apixaban, Dabigatran, and Rivaroxaban, to address the speed of adoption and their substitution from October 1, 2010, through December 31, 2015, using the National Health Insurance Service-National Sample Cohort. Two threshold time points, including the extension of reimbursement with the need for the letter of opinion and the withdrawal of the letter of opinion, were noted in this study. Then, we applied a survival analysis to elucidate factors that affected the speed of adoption of NOACs, and interrupted time series analysis to estimate the effect of amendments in reimbursement coverage in prescription volume.

Results

Among 934 health care institutions in a study population, 334 institutions (36%) had prescribed NOACs at least one time during the study period, indicating that health care institutions were conservative in adopting new drugs. However, the speed of adoption was related to the characteristics of health care institution. We also found that prescriptions of NOACs before the withdrawal of the need for the letter of opinion were marginal, and the prescription volume of NOACs was significantly increased after the withdrawal of a letter of opinion.

Conclusions

Health care institutions were conservative in adopting new drugs, and the speed of adoption is not closely related to an increased prescription volume in the short run. Thus, policies that are centered on managing pharmaceutical expenditure should be devised with considering the impact of introducing new drugs in the long run. A letter of opinion, which was devised to manage prescriptions of NOACs, was effective in managing pharmaceutical expenditures in health care institutions, particularly for tertiary institutions. Conversely, the withdrawal of the need for the letter of opinion should be implemented with caution.
Can cluster analyses of linked healthcare data identify unique population segments in a general practice-registered population?
Authors: Nnoaham Kelechi Ebere , Cann Kimberley Frances
Published: May 2020

Background

Population segmentation is useful for understanding the health needs of populations. Expert-driven segmentation is a traditional approach which involves subjective decisions on how to segment data, with no agreed best practice. The limitations of this approach are theoretically overcome by more data-driven approaches such as utilisation-based cluster analysis. Previous explorations of using utilisation-based cluster analysis for segmentation have demonstrated feasibility but were limited in potential usefulness for local service planning. This study explores the potential for practical application of using utilisation-based cluster analyses to segment a local General Practice-registered population in the South Wales Valleys.

Methods

Primary and secondary care datasets were linked to create a database of 79,607 patients including socio-demographic variables, morbidities, care utilisation, cost and risk factor information. We undertook utilisation-based cluster analysis, using k-means methodology to group the population into segments with distinct healthcare utilisation patterns based on seven utilisation variables: elective inpatient admissions, non-elective inpatient admissions, outpatient first & follow-up attendances, Emergency Department visits, GP practice visits and prescriptions. We analysed segments post-hoc to understand their morbidity, risk and demographic profiles.

Results

Ten population segments were identified which had distinct profiles of healthcare use, morbidity, demographic characteristics and risk attributes. Although half of the study population were in segments characterised as ‘low need’ populations, there was heterogeneity in this group with respect to variables relevant to service planning – e.g. settings in which care was mostly consumed. Significant and complex healthcare need was a feature across age groups and was driven more by deprivation and behavioural risk factors than by age and functional limitation.

Conclusions

This analysis shows that utilisation-based cluster analysis of linked primary and secondary healthcare use data for a local GP-registered population can segment the population into distinct groups with unique health and care needs, providing useful intelligence to inform local population health service planning and care delivery. This segmentation approach can offer a detailed understanding of the health and care priorities of population groups, potentially supporting the integration of health and care, reducing fragmentation of healthcare and reducing healthcare costs in the population.
Prognostic value of systemic inflammatory factors NLR, LMR, PLR and LDH in penile cancer
Authors: Hu Chen , Bai Yu , Li Jun , Zhang Guoyin , Yang Libo , Bi Chengwei , Zhao Bin , Yang Yong , Li Ruiqian , Wu Hongyi , Wang Qilin , Qin Yang
Published: May 2020

Background

Penile squamous cell carcinoma (PSCC) represents an important public health problem for developing countries. The major prognostic factors in PSCC are pathological subtype, perineural invasion, lymphovascular invasion, depth of invasion and grade, which are hard to obtain precisely before the operation. Besides, micro-metastases will be detected in about 30% of intermediate-risk patients with clinically non-palpable inguinal lymph nodes after inguinal lymph node dissection (ILND). It means approximately 70% of patients are unable to benefit from ILND who might suffered from the complications of surgery. We hope some biomarkers could be found which are able to predict the outcome before surgery and reflect the inguinal lymph nodes metastasis.

Methods

A total of 349 consecutive patients of penile cancer in Yunnan cancer hospital in China between October 2002 and December2017. Two hundred twenty-five was succeed to follow-up. The association between NLR, LMR, PLR, LDH and Overall survival (OS), progression free survival (PFS), inguinal lymph node (N stage) was analyzed with K-M analysis, univariable, multivariable logistic regression and Kendall’s tau-b correlation coefficient.

Results

Multivariable analysis reveal that only PLR was significant independent factor which is associated with inferior OS and PFS; Age and LDH was associated with inferior OS; Lymph node and metastatic status remained significant for OS and PFS as NCCN and EAU Guidelines indicated; the tumor type, initial treatment and NLR LMR were not significant in predicting both OS and PFS. NLR, LMR and PLR were corresponded to N stage, while LDH was not associated with the N stage based on logistic regression model analysis. NLR, LMR and PLR were found weakly related to N stage through an application of Kendall’s tau-b correlation coefficient.

Conclusions

PLR was significant independent factors for OS and PFS, Age and LDH was significant independent factors for OS. NLR, LMR, PLR was corresponded to N stage.
Protocol for the economic evaluation of the InTENSE program for rehabilitation of chronic upper limb spasticity
Authors: Milte Rachel , Ratcliffe Julie , Ada Louise , English Coralie , Crotty Maria , Lannin Natasha A.
Published: May 2020

Background

Assessment of the costs of care associated with chronic upper-limb spasticity following stroke in Australia and the potential benefits of adding intensive upper limb rehabilitation to botulinum toxin-A are key objectives of the InTENSE randomised controlled trial.

Methods

Recruitment for the trial has been completed. A total of 139 participants from 6 stroke units across 3 Australian states are participating in the trial. A cost utility analysis will be undertaken to compare resource use and costs over 12 months with health-related quality of life outcomes associated with the intervention relative to a usual care comparator. A cost effectiveness analysis with the main clinical measure of outcome, Goal Attainment Scaling, will also be undertaken. The primary outcome measure for the cost utility analysis will be the incremental cost effectiveness ratio (ICER) generated from the incremental cost of the intervention as compared to the incremental benefit, as measured in quality adjusted life years (QALYs) gained. The utility scores generated from the EQ-5D three level instrument (EQ-5D-3 L) measured at baseline, 3 months and 12 months will be utilised to calculate the incremental Quality Adjusted Life Year (QALY) gains for the intervention relative to usual care using area-under the curve methods.

Discussion

The results of the economic evaluation will provide evidence of the total costs of care for patients with chronic upper limb spasticity following stroke. It will also provide evidence for the cost-effectiveness of adding evidence-based movement therapy to botulinum toxin-A as a treatment, providing important information for health system decision makers tasked with the planning and provision of services.
Is Nigeria prepared and ready to respond to the COVID-19 pandemic in its conflict-affected northeastern states?
Authors: Tijjani Salman Jidda , Ma Le
Published: May 2020

Northeastern Nigeria has over the decade suffered from the Boko Haram insurgency and is still in the process of recovery from the complex humanitarian crisis that has displaced and subjected millions of vulnerable children, women and elderly population to poverty, disease outbreaks, hunger and malnutrition. Yet, the conflict-affected states in Northeastern Nigeria is not far away from being the worse-hit by the COVID-19 pandemic if urgent public health preventive measures are not taken to contain the spread of the deadly and highly infectious virus. The question arises, “what is Nigeria doing to tackle the burden of a COVID-19 spread and an ongoing humanitarian crisis?
Effects of cardiopulmonary bypass with low-priming volume on clinical outcomes in children undergoing congenital heart disease surgery
Authors: Wang Lei , Chen Qiang , Qiu Yong Qiang , Ye Jian Xi , Du Jian Zhi , Lv Xiao Chai , Hou Yan Ting , Chen Liang Wan
Published: May 2020

Background

Cardiopulmonary bypass (CPB) with high-priming volume can significantly activate the inflammatory response and increse the usage of packed red blood cells (PRBCs). As risks and complications related to transfusions are increasing, many cardiac centers are focusing on reducing the priming volume of CPB. In our center, efforts have also been made to reduce the priming volume, and the effects of CPB with low-priming volume on clinical outcomes in children undergoing congenital heart disease (CHD) surgery were investigated in this study to provide referential experiences for pediatric CPB.

Methods

The clinical case data of 158 children undergoing CHD surgery with CPB were collected. The children were divided into the low-priming-volume group (group A,n = 79) and the traditional group (group B,n = 79) according to the priming volume. The amount of PRBCs transfused, the postoperative hematological test results and the clinical outcomes of the two groups were compared by the independent samplet-test or the chi-square test.

Results

The amount of PRBCs transfused during CPB and during the whole operation were significantly lower in group A than in group B (p < 0.01), but the hemoglobin (Hb) concentration was higher in group A on the first day after surgery (p < 0.01) and before hospital discharge. However, the latter showed no statistical significant difference. The lowest postoperative platelet count was higher in group A than in group B (p < 0.05). There was no statistical difference in the postoperative inflammatory markers and the main clinical outcomes between the two groups.

Conclusions

The usage of PRBCs in CPB with low-priming volume decreased significantly, but the postoperative Hb concentration and platelet count could still be maintained at a high level, improving the use efficiency of PRBCs. CPB with low-priming volume did not affect the postoperative recovery of patients, so it is worthy of continuous promotion and optimization.
Reproductive options for families at risk of Osteogenesis Imperfecta: a review
Authors: Zhytnik Lidiia , Simm Kadri , Salumets Andres , Peters Maire , Märtson Aare , Maasalu Katre
Published: May 2020

Background

Osteogenesis Imperfecta (OI) is a rare genetic disorder involving bone fragility. OI patients typically suffer from numerous fractures, skeletal deformities, shortness of stature and hearing loss. The disorder is characterised by genetic and clinical heterogeneity. Pathogenic variants in more than 20 different genes can lead to OI, and phenotypes can range from mild to lethal forms. As a genetic disorder which undoubtedly affects quality of life, OI significantly alters the reproductive confidence of families at risk. The current review describes a selection of the latest reproductive approaches which may be suitable for prospective parents faced with a risk of OI. The aim of the review is to alleviate suffering in relation to family planning around OI, by enabling prospective parents to make informed and independent decisions.

Main body

The current review provides a comprehensive overview of possible reproductive options for people with OI and for unaffected carriers of OI pathogenic genetic variants. The review considers reproductive options across all phases of family planning, including pre-pregnancy, fertilisation, pregnancy, and post-pregnancy. Special attention is given to the more modern techniques of assisted reproduction, such as preconception carrier screening, preimplantation genetic testing for monogenic diseases and non-invasive prenatal testing. The review outlines the methodologies of the different reproductive approaches available to OI families and highlights their advantages and disadvantages. These are presented as a decision tree, which takes into account the autosomal dominant and autosomal recessive nature of the OI variants, and the OI-related risks of people without OI.

The complex process of decision-making around OI reproductive options is also discussed from an ethical perspective.

Conclusion

The rapid development of molecular techniques has led to the availability of a wide variety of reproductive options for prospective parents faced with a risk of OI. However, such options may raise ethical concerns in terms of methodologies, choice management and good clinical practice in reproductive care, which are yet to be fully addressed.
Modeling the natural history of ductal carcinoma in situ based on population data
Authors: Chootipongchaivat Sarocha , van Ravesteyn Nicolien T. , Li Xiaoxue , Huang Hui , Weedon-Fekjær Harald , Ryser Marc D. , Weaver Donald L. , Burnside Elizabeth S. , Heckman-Stoddard Brandy M. , de Koning Harry J. , Lee Sandra J.
Published: May 2020

Background

The incidence of ductal carcinoma in situ (DCIS) has increased substantially since the introduction of mammography screening. Nevertheless, little is known about the natural history of preclinical DCIS in the absence of biopsy or complete excision.

Methods

Two well-established population models evaluated six possible DCIS natural history submodels. The submodels assumed 30%, 50%, or 80% of breast lesions progress from undetectable DCIS to preclinical screen-detectable DCIS; each model additionally allowed or prohibited DCIS regression. Preclinical screen-detectable DCIS could also progress to clinical DCIS or invasive breast cancer (IBC). Applying US population screening dissemination patterns, the models projected age-specific DCIS and IBC incidence that were compared to Surveillance, Epidemiology, and End Results data. Models estimated mean sojourn time (MST) in the preclinical screen-detectable DCIS state, overdiagnosis, and the risk of progression from preclinical screen-detectable DCIS.

Results

Without biopsy and surgical excision, the majority of DCIS (64–100%) in the preclinical screen-detectable state progressed to IBC in submodels assuming no DCIS regression (36–100% in submodels allowing for DCIS regression). DCIS overdiagnosis differed substantially between models and submodels, 3.1–65.8%. IBC overdiagnosis ranged 1.3–2.4%. Submodels assuming DCIS regression resulted in a higher DCIS overdiagnosis than submodels without DCIS regression. MST for progressive DCIS varied between 0.2 and 2.5 years.

Conclusions

Our findings suggest that the majority of screen-detectable but unbiopsied preclinical DCIS lesions progress to IBC and that the MST is relatively short. Nevertheless, due to the heterogeneity of DCIS, more research is needed to understand the progression of DCIS by grades and molecular subtypes.
COVID-19 in breast cancer patients: a cohort at the Institut Curie hospitals in the Paris area
Authors:   Institut Curie Breast Cancer and COVID Group, Vuagnat Perrine , Frelaut Maxime , Ramtohul Toulsie , Basse Clémence , Diakite Sarah , Noret Aurélien , Bellesoeur Audrey , Servois Vincent , Hequet Delphine , Laas Enora , Kirova Youlia , Cabel Luc , Pierga Jean-Yves , Bozec Laurence , Paoletti Xavier , Cottu Paul , Bidard François-Clément
Published: May 2020

Background

Cancer patients have been reported to be at higher risk of COVID-19 complications and deaths. We report the characteristics and outcome of patients diagnosed with COVID-19 during breast cancer treatment at Institut Curie hospitals (ICH, Paris area, France).

Methods

An IRB-approved prospective registry was set up at ICH on March 13, 2020, for all breast cancer patients with COVID-19 symptoms or radiologic signs. Registered data included patient history, tumor characteristics and treatments, COVID-19 symptoms, radiological features, and outcome. Data extraction was done on April 25, 2020. COVID-19 patients were defined as those with either a positive RNA test or typical, newly appeared lung CT scan abnormalities.

Results

Among 15,600 patients actively treated for early or metastatic breast cancer during the last 4 months at ICH, 76 patients with suspected COVID-19 infection were included in the registry and followed. Fifty-nine of these patients were diagnosed with COVID-19 based on viral RNA testing (N = 41) or typical radiologic signs: 37/59 (63%) COVID-19 patients were treated for metastatic breast cancer, and 13/59 (22%) of them were taking corticosteroids daily. Common clinical features mostly consisted of fever and/or cough, while ground-glass opacities were the most common radiologic sign at diagnosis. We found no association between prior radiation therapy fields or extent of radiation therapy sequelae and extent of COVID-19 lung lesions. Twenty-eight of these 59 patients (47%) were hospitalized, and 6 (10%) were transferred to an intensive care unit. At the time of analysis, 45/59 (76%) patients were recovering or had been cured, 10/59 (17%) were still followed, and 4/59 (7%) had died from COVID-19. All 4 patients who died had significant non-cancer comorbidities. In univariate analysis, hypertension and age (> 70) were the two factors associated with a higher risk of intensive care unit admission and/or death.

Conclusions

This prospective registry analysis suggests that the COVID-19 mortality rate in breast cancer patients depends more on comorbidities than prior radiation therapy or current anti-cancer treatment. Special attention must be paid to comorbidities when estimating the risk of severe COVID-19 in breast cancer patients.
APOE ε4 genotype-dependent cerebrospinal fluid proteomic signatures in Alzheimer’s disease
Authors: Konijnenberg Elles , Tijms Betty M. , Gobom Johan , Dobricic Valerija , Bos Isabelle , Vos Stephanie , Tsolaki Magda , Verhey Frans , Popp Julius , Martinez-Lage Pablo , Vandenberghe Rik , Lleó Alberto , Frölich Lutz , Lovestone Simon , Streffer Johannes , Bertram Lars , Blennow Kaj , Teunissen Charlotte E. , Veerhuis Robert , Smit August B. , Scheltens Philip , Zetterberg Henrik , Visser Pieter Jelle
Published: May 2020

Background

Aggregation of amyloid β into plaques in the brain is one of the earliest pathological events in Alzheimer’s disease (AD). The exact pathophysiology leading to dementia is still uncertain, but the apolipoprotein E (APOE) ε4 genotype plays a major role. We aimed to identify the molecular pathways associated with amyloid β aggregation using cerebrospinal fluid (CSF) proteomics and to study the potential modifying effects of APOE ε4 genotype.

Methods

We tested 243 proteins and protein fragments in CSF comparing 193 subjects with AD across the cognitive spectrum (65% APOE ε4 carriers, average age 75 ± 7 years) against 60 controls with normal CSF amyloid β, normal cognition, and no APOE ε4 allele (average age 75 ± 6 years).

Results

One hundred twenty-nine proteins (53%) were associated with aggregated amyloid β. APOE ε4 carriers with AD showed altered concentrations of proteins involved in the complement pathway and glycolysis when cognition was normal and lower concentrations of proteins involved in synapse structure and function when cognitive impairment was moderately severe. APOE ε4 non-carriers with AD showed lower expression of proteins involved in synapse structure and function when cognition was normal and lower concentrations of proteins that were associated with complement and other inflammatory processes when cognitive impairment was mild. Repeating analyses for 114 proteins that were available in an independent EMIF-AD MBD dataset (n = 275) showed that 80% of the proteins showed group differences in a similar direction, but overall, 28% effects reached statistical significance (ranging between 6 and 87% depending on the disease stage and genotype), suggesting variable reproducibility.

Conclusions

These results imply that AD pathophysiology depends on APOE genotype and that treatment for AD may need to be tailored according to APOE genotype and severity of the cognitive impairment.