bluuebunny/crossref_metadata_2025 huggingface dataset:
Interplay between Mediterranean Diet and Gut Microbiota in the Interface of Autoimmunity: An Overview
Authors: Tsigalou Christina , Tsolou Avgi , Konstantinidis Theoharis , Zafiriou Efterpi , Efthimios Dardiotis , Tsirogianni Alexandra , Bogdanos Dimitrios
Published: January 2020

The nutritional habits regulate the gut microbiota and may provoke and/or prevent autoimmune disease. Western diet is rich in sugars, meat and poly-unsaturated fatty acids, which lead to dysbiosis of intestinal microbiota, disruption of gut epithelial barrier and chronic mucosal inflammation. On the other hand, Mediterranean Diet (MedDiet) is rich in ω3 fatty acids, fruits and vegetables and has anti-inflammatory properties, which can restore gut eubiosis. The effect of MedDiet and its components in health and disease states have been thoroughly analyzed in several studies. Moreover, several studies have specifically investigated the association between MedDiet, microbiota and risk for autoimmune diseases. Furthermore, the MedDiet has been associated with lower risk of cardiovascular diseases, which plays a critical role in reducing mortality in patients suffering from autoimmune diseases with comorbidities. The aim of the present review is to specifically highlight current knowledge regarding possible interactions of MedDiet with the patterns of intestinal microbiota focusing on autoimmunity and a blueprint through dietary modulations for the prevention and management of diseases’s activity and progression.
Smart Assistant Guided Flowback Data Analysis
Authors: Miertschin Emma , Rasdi Faisal , Gupta Sidd , Anderson Seth , Jeyachandra Benin Chelinsky
Published: January 2020

The Oilfield is a cash flow dependent business, making the speed of decision-making very important. Our industry collects an incredible amount of data, but the volume of this data, coupled with inefficient oilfield software, slows down analysis and decision making. Critical decisions are delayed, and decision quality is affected.

Smart Assistants like Siri and Alexa have become extraordinarily popular lately due to their ability to perform routine tasks and make information readily accessible. Considering the oil industry's drive towards enhanced speed and efficiency, there is a considerable upside in applying the concept of a Smart Assistant to oil and gas applications. This Smart Assistant for Oil and Gas would consolidate massive amounts of data, derive knowledge from it, automate workflows, and provide faster and consistent insights.

This paper will look closely at a specific application of this Smart Assistant: analyzing flowback data from newly drilled wells. Engineers at Equinor have recently leveraged learnings from this Smart Assistant to increase efficiency in day-to-day tasks and realize results.
Developing Upscaling Approach for Swarming Hydraulic Fractures Observed at Hydraulic Fracturing Test Site Through Multiscale Simulations
Authors: Fu Wei , Morris Joseph , Fu Pengcheng , Huang Jixiang , Sherman Christopher , Settgast Randolph , Wu Hui , Ryerson Frederick
Published: January 2020

This work aims to address a challenge posed by recent observations of tightly-spaced hydraulic fractures in core samples from the Hydraulic Fracturing Test Site (HFTS). Many fractures in retrieved cores have sub-foot spacing, which is at odds with conventional models where usually one fracture is initiated per cluster. Since it is unrealistic to explicitly model all densely-spaced fractures, we develop a new upscaling law that enables existing simulation tools to predict reservoir responses to fracture swarms. The upscaling law is derived based on an energy argument and validated through multiscale simulations using a high-fidelity code, GEOS. The swarming fractures are first modeled with a spacing that is much smaller than the cluster spacing; these fractures are then approximated by an upscaled, single fracture based on the proposed upscaling law. The upscaled fracture is shown to successfully match the energy input rate and produce the total fracture aperture and average propagation length of the explicitly simulated swarm. Afterwards, the upscaling approach is further implemented in 3D field-scale simulations and validated against the HFTS microseismic data of a horizontal well in the Middle Wolfcamp Formation. Our results show that hydraulic fracture swarming can significantly affect fracture propagation behaviors compared with the propagation of single fractures as assumed by conventional modeling approaches. Under the considered situations, the conventional case entails fast propagation speed that far exceeds that indicated by the microseismic data. We also illustrate this discrepancy can be reduced readily through the implementation of the upscaling law. Our results demonstrate the importance of accounting for the fracture swarming effect in field-scale simulations and the efficacy of this approach to enable realistic predictions of reservoir responses to fracture swarms, without explicit modeling all tightly-spaced fractures observed in the field.
Proppant Distribution Observations from 20,000+ Perforation Erosion Measurements
Authors: Roberts Glyn , Whittaker Jeff , McDonald Joe , Paxson Tanner
Published: January 2020

Recent step changes in downhole video technology and image analysis have coincided with a growing understanding of how perforation erosion can be used to measure the effectiveness of limited entry hydraulic fracturing. This has led to rapid growth in video-based perforation imaging and produced a substantial database of measured and statistically analysed perforations. A review of recurring patterns and common trends identified in the database provides useful insights on proppant placement and distribution.

An analysis was undertaken on a dataset that includes detailed individual perforation dimensions from more than 6,000 clusters and 600 stages. With a focus on understanding the uniformity of proppant distribution, the initial phase was to identify significant recurring patterns in cluster level proppant placement derived from perforation erosion measurements. Multiple treatment design parameters were then analysed to understand their influence on proppant distribution. Among those considered were stage length, number and spacing of clusters per stage, the number of perforations shot per cluster, perforation charge type and phasing.

While every well produces a unique set of results, several recurring trends were identified across the database. These often indicated sub-optimal proppant placement with undesirable consequences for production and ultimate recovery. Results demonstrate thatProppant placement is often significantly non-uniform across a stageA strong tendency for greater heel-side perforation erosion is typically observed for ‘geometric’ stage and cluster designsA similar strong preference for proppant to be placed in perforations located towards the low-side of the wellbore is also apparentMore uniform proppant distribution can be obtained using an engineered design approachAlthough they are often inter-related several treatment parameters can be engineered with relative ease to produce more uniform proppant placement

Analysis methods, results, treatment parameter considerations, primary conclusions and other relevant findings will be discussed in detail.

The majority of research on treatment design parameters that influence proppant placement has mainly used CFD-DEM models. The approach presented in this paper, however has used empirical, in-situ data. The size of the dataset and the frequency at which certain tendencies are observed provide some confidence that the approach and results are valid and can help improve treatment design. It is hoped that the results of the study will provide hydraulic fracture specialists with further evidence-based guidelines that ultimately help increase production and enhance ultimate recovery.
A New Mechanism for the Formation of Hydraulic Fracture Swarms
Authors: Manchanda Ripudaman , Shrivastava Kaustubh , Zheng Shuang , Sharma Mukul
Published: January 2020

Mine-back experiments, lab experiments, and cores taken through fractured rock show that hydraulic fracturing treatments can create swarms of fractures. Subcritical crack growth, microcracking ahead of the fracture tip and failure of weak planes in the rock are mechanisms that have helped explain fracture swarming observed in both natural and hydraulic fractures. In this work, we show that fracture swarms can also form in homogeneous rocks by complex stress fields induced in the reservoir by propagating hydraulic fractures or by other geologic events.

A 3-D fracturing simulator based on the Displacement Discontinuity Method (DDM) and a 3-D fracturing-reservoir simulator based on the Finite Volume Method (FVM) were used to simulate hydraulic fracture propagation. These models can accurately account for stress shadow effects and simulate fracture turning during propagation with the direction of propagation calculated using the maximum tangential stress criterion. Simultaneous propagation of multiple fractures is simulated to exhibit multi-stranded fracture propagation behavior in the absence of natural fractures in the reservoir. Additionally, we assess the impact of natural fractures in the reservoir on the created fracture swarms.

The stress shadow around a single fracture is spatially variable. Simulation of the propagation of multiple fractures shows that parts of the fractures propagating in lower stress contrast regions turn more readily than the parts of the fractures propagating in higher stress contrast regions. The smaller width of the fracture in the high-stress layers induces a smaller stress shadow while the larger width of the fracture surface in the low-stress layers induces a larger stress shadow. Higher stress interference in certain layers causes fracture turning in those layers and induces splitting of the fracture tip resulting in swarms of fractures. The FVM simulations clearly show this effect. Fracture branching and tip splitting are only evident when these simulations are run in 3-D. The fracture branching results obtained from the simulators show good agreement with field core-through observations from the Eagle Ford and the Permian basins. This work shows that the stress field created by propagating fractures can result in the creation of fracture swarms. It is shown that this branching can happen in the absence of material flaws and weaknesses. This new mechanism of fracture branching to create fracture swarms is quantified through both DDM and finite volume simulations.
Developing Methodology for DFIT Design and Pressure Interpretation by Coupled Reservoir Geomechanics Flow Simulation
Authors: Mohamed Mohamed , Thaker Tirth , Ibrahim Mazher , Ozkan Erdal
Published: January 2020

A numerical, coupled reservoir flow and geomechanics model has been built using a black-oil simulator and evaluated for diagnostic fracture injection test (DFITs) in unconventional reservoirs. DFITs have evolved into a commonly used technique to generate direct estimates of some key unconventional reservoir characteristics. Challenges, however, arise due to the complexity of the unconventional reservoir characteristics, long shut-in times to reach the closure pressure, and the long test durations to obtain realistic reservoir parameters from pseudoradial flow. One way to improve the analysis of minifrac tests in unconventional reservoirs is to use a coupled geomechanics and flow simulator, which is capable of representing the interactions between the reservoir fractures and minifrac developed during minifrac tests.

The numerical model used in this work is based on coupling the geomechanical rock properties with the reservoir flow model. The geomechanical model simulates the growth and subsequent closure of the hydraulic and secondary fractures by modeling the change in the reservoir stresses. Furthermore, the model simulates the minifrac pressure response before fracture-closure as well as during the after-closure falloff period. The pressure response during the falloff period is then analyzed to evaluate the reservoir properties using Nolte pre-closure and after-closure analysis techniques.

The coupled geomechanics and flow simulation of minifrac provides the capability of modeling the fracture breakdown and fracture closure and estimating the fracture dimensions. The traditional fracture design tools provide similar information focusing only on the geomechanics of the rock and ignoring the effect of the reservoir flow. An additional advantage of the simulator used in this work is to provide estimates of fracture stiffness, fracture closure permeability, residual permeability, and permeability of the matrix.

The simulator allows pressure matching and successfully simulates the reservoir flow for extended shut-in periods. The simulator allows designing DFITs with different injection volumes, rates, and shut-in periods and thus helps provide the optimum parameters for the test. The after-shut-in flow regimes generated by the simulation model agree with the DFIT theory.
A Rapid Injection Flow-Back Test RIFT to Estimate In-Situ Stress and Pore Pressure in a Single Test
Authors: Wang HanYi , Sharma Mukul
Published: January 2020

Quantifying in-situ stress and pore pressure has significant applications in earth sciences and subsurface engineering, such as fault zone studies, underground CO2 sequestration, oil and gas reservoir development, injection into deep wells, and geothermal energy exploitation. The extended leak-off test (XLOT)/ pump-in and flow-back test (PIFB) have been the industry-standard for stress determination during drilling for some time, where drilling mud is injected to create a small fracture in an vertical open-hole below a newly cemented casing. This is followed by a shut-in phase and/or flow-back phase. However, there is still no consensus as regards to which methods should be used to pick closure stress from XLOT/PIFB data, and the influence of drilling mud and near wellbore hoop stress can further complicate the interpretation process. In addition, the risks of formation damage and wellbore integrity issues are also major concerns when executing XLOT/PIFB during high-cost drilling operations.

Diagnostic Fracture Injection Tests (DFIT) is another standard method for estimating in-situ stress and other important reservoir/fracture parameters such as pore pressure and permeability. Such tests can be executed in either open-hole or cased-hole, and even carried out in horizontal wells. In very low permeability reservoirs, it may take several days for fracture closure and weeks to observe the after-closure flow regime. The required shut-in time for DFITs can be extremely long in unconventional reservoirs (weeks or months). In some circumstances, if the reservoir is naturally fractured and its effective permeability is strongly pressure-sensitive during the before-closure period, picking the closure stress in the DFIT data becomes ambiguous.

In this study, we present a new approach to estimate in-situ stress and pore pressure using a Rapid Injection Flow-Back Test (RIFT) in low permeability formations, where the fracture closure process is facilitated via controlled flow-back that is followed by a shut-in period. This significantly shortens the time required to conduct a test that allows us to estimate the in-situ stress and the pore pressure. The time-convolution solution for RIFT is derived by preserving the physics of unsteady-state reservoir flow, elastic fracture mechanics, material balance, and progressive fracture closure. Our new approach not only provides an unambiguous way to estimate in-situ stress (even in naturally fractured formations), but also allows us to estimate pore pressure with data from a test that lasts only a few hours. It also provides to estimate effective fracture volume. Both numerical simulations and field cases are presented to demonstrate the advantages of RFIT, along with a discussion of cautions and the potential pitfalls when designing and executing RIFT.
Distributed Acoustic and Temperature Sensing Applications for Hydraulic Fracture Diagnostics
Authors: Li Xinyang , Zhang Jimmy , Grubert Marcel , Laing Carson , Chavarria Andres , Cole Steve , Oukaci Yassine
Published: January 2020

Hydraulic fracturing operations in unconventional reservoirs are increasingly being monitored with fiber-optic (FO) Distributed Acoustic and Temperature Sensing (DAS/DTS). In this paper, we discuss how a single well equipped with fiber optics and DAS can be used as a diagnostic tool to better understand the completions program of three offset wells and the fiber instrumented well.

Strain measurements were initially conducted for seismic studies, then followed by measurements of fluid injections from monitoring wells to better understand placement along the lateral section of the wellbore for programs such as hydraulic fracturing, water flooding, and steam injection. The broadband DAS signals have shown of value for the monitoring of microseismic, as well as thermal and mechanical strain of the fiber over the entire well-pad's completion process. During well stimulation, as a fracture propagates to an offset wellbore with fiber deployed, the DAS measurements can be used to monitor very small changes of strain on the fiber. Analysis of the Cross-Well Communication (CWC) strain measurements provide information about possible fracture numbers and locations, as well as the fracture propagating rate based on known well distance. Changes in the strain measurements are coupled with microseismic events that can be simultaneously monitored using the same interrogator unit and fiber optic cable.

Here we present various diagnostic tools for DAS that help to better understand the completions program. A variety of physical effects, such as temperature, strain and micro seismicity are measured and correlated with the treatment program to aid in the analysis. Two of the offset wells were zipper-fractured first, then the fiber installed well was zipper-fractured with the third offset well. By monitoring CWC strain measurements we show that DAS can assess the treatment and performance of neighboring wells that are not instrumented with fiber optic cable. Low frequency strain events from neighboring wells provide direct measurements of the fracture density and possible fracture network post fiber well completion. CWC measurements can provide strain levels that can be analyzed in the context of the various completion parameters including stage length, clusters, and well spacing, etc. We also discuss the fluid and proppant allocations measurements that can be performed on the well with fiber installation. We show how DAS can be used as a tool for investigating cluster efficiency, diverter effectiveness, and for determining completions problems like screen-outs and stage communication.

The analysis of the DAS data demonstrates that current fiber-optic technology can provide enough sensitivity to detect a significant number of frac events that can be used for an improved reservoir description and as an assessment of the completions program.
Mixing Equations in Various Geometries
Authors: Brigham William E.
Published: January 2020

Often, in flow through porous media, the mixing characteristics of the flowing fluids are defined by the diffusivity equation. Solutions of this equation are available for linear flow and close approximations are available for radial flow. In this paper, one of the radial flow approximation methods has been generalized to a variety of geometries. The solution is assumed to be in the form of an error function; and equations are derived for the standard deviation, i.e., the argument of the error function. By breaking the flow system into segments and by repeated use of these solutions, mixing can be calculated in a large variety of flow systems. For example, equations can be used to calculate tracer flow behavior in reservoirs and mixing in vertical miscible displacement.

INTRODUCTION

In the absence of viscous fingering, the equations defining mixing in a linear miscible displacement are well known.
Association between peripheral blood/bronchoalveolar lavage eosinophilia and significant oxygen requirements in patients with acute eosinophilic pneumonia
Authors: Choi Joon Young , Lim Jeong Uk , Jeong Ho Jung , Lee Ji Eun , Rhee Chin Kook
Published: January 2020

Background We investigated the association between a combination of two markers, peripheral (PEC) and bronchoalveolar lavage (BAL) eosinophil percentage (BEP), and oxygen requirements in patients with acute eosinophilic pneumonia (AEP). Methods We retrospectively reviewed the medical records of patients with AEP treated at the Armed Forces Capital Hospital between May 2012 and May 2017. We used correlation analyses to assess the association between PEC/BEP and clinical outcomes in AEP patients. Receiver operating characteristic (ROC) curve analyses were used to calculate the cut-off value for BEP that categorised patients requiring a significant oxygen supply. The BAL/blood eosinophil (BBE) score was introduced to stratify patients with peripheral eosinophilia and elevated BEP. Clinical characteristics and outcomes were compared between the different groups. Multiple logistic regression was performed for significant oxygen requirements using two different models using age, C-reactive protein (CRP), smoking duration, and BBE score (model 1) and age, CRP, BEP, and PEC (model 2). Results Among the 338 patients, 99.7% were male, and their mean age was 20.4 ± 1.4 years. Only 0.6% of patients were never smokers and the mean number of smoking days was 26.2 ± 25.4. Correlation analyses revealed that both the PaO2/FiO2 ratio and duration of oxygen supply were associated with BEP. ROC curve analyses indicated a cut-off level of 41.5%. Patients with a high BBE score had favourable outcomes in terms of hypoxemia, hospital days, intensive care unit admission, oxygen supply days, and steroid treatment days. Multiple logistic regression revealed that BEP and BBE score tended to be associated with significant oxygen requirements. Conclusions In this study, we revealed that both peripheral and BAL eosinophilia is associated with favourable outcomes in AEP patients.
Case Identification of Mental Health and Related Problems in Children and Young People using the New Zealand Integrated Data Infrastructure
Authors: Bowden Nicholas , Gibb Sheree , Thabrew Hiran , Kokaua Jesse , Audas Richard , Merry Sally , Taylor Barry , Hetrick Sarah
Published: January 2020

Background In a novel endeavour we aimed to develop a clinically relevant case identification method for use in research about the mental health of children and young people in New Zealand using the Integrated Data Infrastructure (IDI). The IDI is a linked individual-level database containing New Zealand government and survey microdata. Methods We drew on diagnostic and pharmaceutical information contained within five secondary care service use and medication dispensing datasets to identify probable cases of mental health and related problems. A systematic classification and refinement of codes, including restrictions by age, was undertaken to assign cases into 13 different mental health problem categories. This process was carried out by a panel of eight specialists covering a diverse range of mental health disciplines (a clinical psychologist, four child and adolescent psychiatrists and three academic researchers in child and adolescent mental health). The case identification method was applied to the New Zealand youth estimated resident population for the 2014/15 fiscal year. Results Over 82,000 unique individuals aged 0-24 with at least one specified mental health or related problem were identified using the case identification method for the 2014/15 fiscal year. The most prevalent mental health problem subgroups were emotional problems (31,266 individuals), substance problems (16,314), and disruptive behaviours (13,758). Overall, the pharmaceutical collection was the largest source of case identification data (59,862). Conclusion This study demonstrates the value of utilising IDI data for mental health research, moving beyond incidence rates based on single data sources, and providing directions for future use and validation, including further linkage of data to the IDI.
Usage of Cloud Storage Facilities by Medical students in a low-middle income country, Sri Lanka: A cross sectional study
Authors: Hettige Samankumara , Dasanayaka Eshani , Ediriweera Dileepa Senajith
Published: January 2020

Background:
Cloud storage facilities (CSF) has become popular among the internet users. There is limited data on CSF usage among university students in low middle-income countries including Sri Lanka. In this study we present the CSF usage among medical students at the Faculty of Medicine, University of Kelaniya.
Methods:
We undertook a cross sectional study at the Faculty of Medicine, University of Kelaniya, Sri Lanka. Stratified random sampling was used to recruit students representing all the batches. A self-administrated questionnaire was given.
Results:
Of 261 (90.9%) respondents, 181 (69.3%) were females. CSF awareness was 56.5% (95%CI: 50.3% - 62.6%) and CSF usage was 50.8% (95%CI: 44.4 - 57.2%). Awareness was higher in males (P=0.003) and was low in senior students. Of CSF aware students, 85% knew about Google Drive and 70.6% used it. 73.6% and 42.1% knew about Dropbox and OneDrive. 50.0% and 22.0% used them respectively. There was no association between CSF awareness and pre-university entrance or undergraduate examination performance. Inadequate knowledge, time, accessibility, security and privacy concerns limited CSF usage. 69.8% indicated that they would like to undergo training on CSF as an effective tool for education.
Conclusion:
CSF awareness and usage among the students were 56.5% and 50.8%. Google drive is the most popular CSF. Lack of knowledge, accessibility, concerns on security and privacy limited CSF usage among students. Majority were interested to undergo training on CSF and undergraduate Information Communication Technology (ICT) curricula should introduce CSF as effective educational tools.
Implementation of a new program of gestational diabetes screening and management in Morocco: A qualitative exploration of health workers’ perceptions
Authors: Utz Bettina , Assarag Bouchra , Lekhal Touria , Damme Wim Van , De Brouwere Vincent
Published: January 2020

Background: Gestational diabetes mellitus (GDM) is associated with an increased risk for a future type 2 diabetes mellitus in women and their children. As linkage between maternal health and non-communicable diseases, antenatal care plays a key role in the primary and secondary prevention of GDM associated adverse outcomes. While implementing a locally adapted GDM screening and management approach through antenatal care services at the primary level of care, we assessed its acceptability by the implementing health care providers. Methods : As part of a larger implementation effectiveness study assessing a decentralized gestational diabetes screening and management approach in the prefecture of Marrakech and the rural district of Al Haouz in Morocco, we conducted four focus group discussions with 29 primary health care providers and seven in-depth interviews with national and regional key informants. After transcription of data, we thematically analysed the data using a combined deductive and inductive approach. Results: The intervention of screening and managing women with gestational diabetes added value to existing antenatal care services but presented an additional workload for first line health care providers. An existing lack of knowledge about gestational diabetes in the community and among private health care physicians required of public providers to spend more time on counselling women. Nurses had to adapt recommendation on diet to the socio-economic context of patients. Despite the additional task, especially nurses and midwives felt motivated by their gained capacity to detect and manage gestational diabetes, and to take decisions on treatment and follow-up. Conclusions : Detection and initial management of gestational diabetes is an acceptable strategy to extend the antenatal care service offer in Morocco and to facilitate service access for affected pregnant women. Despite its additional workload, gestational diabetes management can contribute to the professional motivation of primary level health care providers.
Treating periodontitis-A systematic review and meta-analysis comparing ultrasonic and manual subgingival scaling at different probing pocket depths.
Authors: Zhang Xin , Hu Zixuan , Zhu Xuesong , Li Wenjie , Chen Jun
Published: January 2020

Background: Mechanical plaque removal has been commonly accepted to be the basis for periodontal treatment. This study aims to compare the effectiveness of ultrasonic and manual subgingival scaling at different initial probing pocket depths (PPD) in periodontal treatment. Methods: English-language databases (PubMed, Cochrane Central Register of Controlled Trials, EMBASE, Medline, and ClinicalTrials.gov, by January, 2019) were searched. Weighted mean differences in primary outcomes, PPD and clinical attachment loss (CAL) reduction, were estimated by random effects model. Secondary outcomes, bleeding on probing (BOP), gingival recession (GR), and post-scaling residual dental calculus, were analyzed by comparing the results of each study. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. The GRADE approach was used to assess quality of evidence. Results: Ten randomized controlled trials were included out of 1,434 identified. Initial PPD and follow-up periods formed subgroups. For 3-months follow-up: (1) too few shallow initial pocket studies available to draw a conclusion; (2) the heterogeneity of medium depth studies was so high that could not be merged to draw a conclusion; (3) deep pocket studies showed no statistical differences in PPD and CAL reduction between ultrasonic and manual groups. For 6-months follow-up: (1) too few shallow initial PPD studies to draw a conclusion; (2) at medium pocket depth, PPD reduction showed manual subgingival scaling better than ultrasound. No statistical differences were observed in CAL reduction between the two approaches; (3) for deep initial PPD studies, both PPD and CAL reduction showed manual subgingival scaling better. GR results indicated no statistical differences at medium and deep initial pocket studies between the two methods. BOP results showed more reduction at deep pocket depths with manual subgingival scaling. No conclusion could be drawn about residual dental calculus. Conclusion: When initial PPD was 4-6mm, PPD reduction proved manual subgingival scaling was superior, but CAL results showed no statistical differences between the two means. When initial PPD was ≥6mm, PPD and CAL reductions suggested that manual subgingival scaling was superior.
Intensive psychotherapy and case management for Karen refugees with Major Depression in primary care: a pragmatic randomized control trial
Authors: Northwood Andrea , Vukovich Maria M , Beckman Alison , Walter Jeffrey P , Josiah Novia , Hudak Leora , Burrows Kathleen O’Donnell , Letts James P , Danner Christine C
Published: January 2020

Background: Despite an unparalleled global refugee crisis, there are almost no studies in primary care addressing real-world conditions and longer courses of treatment that are typical when resettled refugees present to their physician with critical psychosocial needs and complex symptoms. We studied the effects of a year of psychotherapy and case management in a primary care setting on common symptoms and functioning for Karen refugees (a newly arrived population in St Paul, Minnesota) with depression. Methods: A pragmatic parallel-group randomized control trial was conducted at two primary care clinics with large resettled Karen refugee patient populations, with simple random allocation to one year of either: (1) intensive psychotherapy and case management (IPCM), or (2) care-as-usual (CAU). Eligibility criteria included Major Depression diagnosis determined by structured diagnostic clinical interview, Karen refugee, ages 18-65. IPCM (n=112) received a year of psychotherapy and case management coordinated onsite between the case manager, psychotherapist, and primary care providers; CAU (n=102) received care-as-usual from their primary care clinic, including behavioral health referrals and/or brief onsite interventions. Blinded assessors collected outcomes of mean changes in depression and anxiety symptoms (measured by Hopkins Symptom Checklist-25), PTSD symptoms (Posttraumatic Diagnostic Scale), pain (internally developed 5-item Pain Scale), and social functioning (internally developed 37-item instrument standardized on refugees) at baseline, 3, 6 and 12 months. After propensity score matching, data were analyzed with the intention-to-treat principle using repeated measures ANOVA with partial eta-squared estimates of effect size. Results: Of 214 participants, 193 completed a baseline and follow up assessment (90.2%). IPCM patients showed significant improvements in depression, PTSD, anxiety, and pain symptoms and in social functioning at all time points, with magnitude of improvement increasing over time. CAU patients did not show significant improvements. The largest mean differences observed between groups were in depression (difference, 5.5, 95% CI, 3.9 to 7.1, P <.001) and basic needs/safety (difference, 5.4, 95% CI, 3.8 to 7.0, P <.001). Conclusions: Adult Karen refugees with depression benefited from intensive psychotherapy and case management coordinated and delivered under usual conditions in primary care. Intervention effects strengthened at each interval, suggesting robust recovery is possible.
Antimicrobial resistance and novel mutations detected in the gyrA and parC genes of Pseudomonas aeruginosa strains isolated from companion dogs
Authors: Park Youjin , Oh Jaeyoung , Park Sowon , Sum Samuth , Song Wonkeun , Chae Jongchan , Park Hee-Myung
Published: January 2020

Background: Fluoroquinolone agents, such as enrofloxacin and marbofloxacin, are commonly used in for pseudomonal infection in veterinary medicine. However, the rate of resistance rate to fluoroquinolone s is rapidly increasing , according to multiple studies in various countries. The p P oint mutation s in the quinolone resistance - determining region (QRDR) is are closely related to the increased fluoroquinolone resistance of Pseudomonas aeruginosa . The aim of this study was to investigate current antimicrobial susceptibility and fluoroquinolone resistance in P. aeruginosa strains isolated from dogs. The presence of the point mutations in the QRDR was confirmed by gyrA and parC polymerase chain reaction and nucleotide sequencing analysis. Results: A total of 84 nonduplicated P. aeruginosa strains were obtained from 228 healthy dogs (healthy group) and 260 dogs with clinical signs (infected group). From Of Among these isolates , 38 strains from the healthy group were detected in several sample type s, whereas 46 strains from the infected group were mostly obtained mostly from dogs’ ears with otitis externa (41/260, 15.8%). All strains were resistant to nalidixic acid, while some were also resistant to enrofloxacin (23/84, 27.4%), marbofloxacin (17/84, 20.2%), levofloxacin (12/84, 14.3%), or ciprofloxacin (11/84, 13.1%). Enrofloxacin resistance was significantly higher in strains from the infected group than in th ose at of from the healthy group ( p <0.05). Among the 23 fluoroquinolone-resistant strains, 8 and 4 different mutations were detected in the gyrA and parC genes, respectively. Mutations in gyrA were significantly common in the infected group ( p <0.05). Hotspots for the gyrA and parC mutations were Thr83 (34.8%, 8/23) and Pro116 (91.3%, 21/23), respectively. Double and triple mutations were also found in 5 of the strains. Conclusion: Novel mutations in the gyrA and parC genes were first found in P. aeruginosa isolated from companion dogs in South Korea. These findings suggest that it is important to alert encourage the prudent use of fluoroquinolone antibiotics in canine pseudomona l s infection treatment.
The Relationship Between Dental Caries and YKL-40 Levels in Saliva
Authors: Duruk Gülsüm , Laloglu Esra
Published: January 2020

Objective : YKL-40, a new biomarker of localized inflammation, is secreted by macrophages and regulates inflammation and immune responses. The aim of this study was to investigate YKL-40 levels in saliva and compare the level of this mediator in healthy and unhealthy oral cavity. Methods: 85 children (46 girls, 39 boys), aged 6-15 (mean±SD: 9.15±2.16) were included in this study. The children were divided into three groups: Group-I (control, n=25, DMFT/dmft=0), Group-II (n=30, exist of localized dental caries) and Group-III (n=30, exist of localized advanced dental caries). Gingival index (GI), plaque index (PI), DMFT/dmft, DMFS/dmfs, and the number of advanced dental caries according to the ICDAS II and PUFA/pufa index were recorded. Saliva was collected and YKL-40 concentrations were measured. One-way ANOVA with Tukey post hoc, Kruskal-Wallis, multiple regression analysis, and Sperman’s correlation tests were used for statistical analysis. Results: The highest level of YKL-40 was obtained in group III , followed by groups II and I , respectively (p<0.01). In Group II, DMFT/dmft scores and the number of caries (DT/dt) were higher than in group III (p<0.01). In group III, there was a statistically significant correlation between YKL-40 levels in saliva and the number of advanced dental caries. In addition, there was no statistically significant difference in terms of age and gender (p>0.05). Conclusion: Advanced dental caries, rather than DMFT/dmft score, may play an important role in the increasing levels of YKL-40 in saliva.
Comparing Empathy in Medical Students of two Portuguese Medicine Schools
Authors: Santiago Luiz Miguel , Silva Inês Rosendo , Coutinho Mona Lisa , Maurício Kati , Neto Isabel , Simões José Augusto
Published: January 2020

Objectives To evaluate differences in empathy between the Integrated Master’s degree in Medicine (MIM) students from the Faculty of Medicine - University of Coimbra (FMUC) and the Faculty of Health Sciences - University of Beira Interior (FCS-UBI).Methodology Cross-sectional observational study with the Jefferson Scale of Physician Empathy – students’ Portuguese version (JSPE – spv) to 1st, 3rd and 6th year students of the 2017/2018 academic year with descriptive and inferential statistical analysis (p<0.05).Results Size representative sample of 795 students. Higher total empathy score (TES) (p=0.008) and "Perspective taking" (p=0.001) in FCS-UBI were found. JSPE-TES was higher in FCS-UBI, 3rd year (p=0.038). Higher FCS-UBI "Perspective taking" in the 1st year (p=0.030) and 6th year (p=0.044), for "Compassionate care" in the 3rd (p=0.019) and for "Standing in the patient’s shoes" in the 1st year (p=0.018) and in FMUC for "Compassionate care" in the 1st year (p=0.037) and the "Standing in the patient’s shoes" in the 3rd year (p=0.002) were found. Higher levels of empathy were found in FCS-UBI female students, for JSPE-TES (p=0.045) and "Perspective taking" (p=0.001).Conclusion Higher e mpathy levels in FCS-UBI were found, with different results in the third year suggesting influence of the medical course teaching characteristics.
Prevalence and factors associated with double and triple burden of malnutrition among mothers and children in Nepal: evidence from 2016 Nepal Demographic and Health Survey
Authors: Sunuwar Dev Ram , Singh Devendra Raj , Pradhan Pranil Man Singh
Published: January 2020

Background: Malnutrition among mothers and children is a major public health challenge in developing countries like Nepal. Although undernutrition among children has been gradually decreasing, the coexistence of various forms of malnutrition among mothers and children has continued to rise globally. There is a gap in knowledge of the coexistence of such multiple burdens of malnutrition in the Nepalese context. The aims of this study were to explore the coexistence of various forms of malnutrition and associated factors among the mother-child pairs in the same household. Methods: A total sample of 2,261 mother-child pairs from the Nepal Demographic and Health Survey (NDHS) 2016 were included in the study. Anthropometric measurements and hemoglobin levels of the children and anthropometric measurements of their mothers were taken. The bivariate and multivariable logistic regression were performed to assess the factors associated with the double burden of malnutrition (DBM) and the triple burden of malnutrition (TBM). Results: Prevalence of DBM and TBM was 6.60(5.13-8.84) % and 7(5.42-8.99) % respectively in the same household. In the adjusted multivariable logistic regression, mothers with short stature compared to normal height (AOR=4.18, 95% CI: 2.04-8.52), from the richest wealth status compared to poor wealth status (AOR=2.46, 95% CI= 1.17-5.15), from age group of above 35 years compared to 15-24 years (AOR=3.08, 95% CI:1.20-7.86), and those who had attended at least a secondary level of education compared to no education (AOR=2.05, 95% CI: 1.03-4.07) were more likely to suffer from the DBM. Similarly, mothers with short stature compared to normal height (AOR=5.01, 95% CI:2.45-10.24), from the richest wealth status compared to poor wealth status (AOR=2.66, 95% CI=1.28-5.54), age groups of above 35 years compared to 15-24 years (AOR=3.41, 95% CI:1.26-9.17), and those who had attended at least a secondary level of education compared to no education (AOR=2.05, 95% CI: 1.00-4.18) were more likely to suffer from the TBM. Conclusions: There is a low prevalence of double and triple burden of malnutrition among mother-child pairs in Nepal. Older mothers with short stature and from richer wealth status were more likely to suffer from double and triple burden of malnutrition.
Predicting the microbial cause of community-acquired pneumonia: can physicians or a data-driven method differentiate viral from bacterial pneumonia at patient presentation?
Authors: LHOMMET Claire , GAROT Denis , GRAMMATICO-GUILLON Leslie , JOURDANNAUD Cassandra , ASFAR Pierre , FAISY Christophe , MULLER Grégoire , BARKER Kimberly A. , MERCIER Emmanuelle , ROBERT Sylvie , LANOTTE Philippe , GOUDEAU Alain , BLASCO Helene , Guillon Antoine
Published: January 2020

Background. Severe community-acquired pneumonia (sCAP) requires urgent and specific antimicrobial therapy. However, the causal pathogen is typically unknown at the point when anti-infective therapeutics must be initiated. Physicians synthesize information from diverse data streams to make appropriate decisions. Artificial intelligence (AI) excels at finding complex relationships in large volumes of data. We aimed to evaluate the abilities of experienced physicians and AI to answer this question at patient admission: is it a viral or a bacterial pneumonia? Methods. We included patients hospitalized for sCAP and recorded all data available in the first 3-hour period of care (clinical, biological and radiological information). For this proof-of-concept investigation, we decided to study only CAP caused by a singular and identified pathogen. We built a machine learning model prediction using all collected data. Finally, an independent validation set of samples was used to test the pathogen prediction performance of: (i) a panel of three experts and (ii) the AI algorithm. Both were blinded regarding the final microbial diagnosis. Positive likelihood ratio (LR) values >10 and negative LR values <0.1 were considered clinically relevant. Results. We included 153 patients with sCAP (70.6% men; 62 [51-73] years old; mean SAPSII, 37 [27-47]), 37% had viral pneumonia, 24% had bacterial pneumonia, 20% had a co-infection and 19% had no identified respiratory pathogen. We performed the analysis on 93 patients as co-pathogen and no-pathogen cases were excluded. The discriminant abilities of the AI approach were low to moderate (LR+ = 2.12 for viral and 6.29 for bacterial pneumonia), and the discriminant abilities of the experts were very low to low (LR+ = 3.81 for viral and 1.89 for bacterial pneumonia).Conclusion. Neither experts nor an AI algorithm can predict the microbial etiology of sCAP within the first hours of hospitalization when there is an urgent need to define the anti-infective therapeutic strategy.
Cyclosporine-A Attenuates Retinal Inflammation by Inhibiting HMGB-1 Formation in Rats with Type 2 Diabetes Mellitus
Authors: Wang Peng , Chen Fei , Zhang Xuedong
Published: January 2020

Background:Cyclosporine-A has been regarded as an immunoregulatory and anti-inflammatory drug for the treatment of various immune inflammatory diseases. However, the effect of Cyclosporine-A on the retina of type 2 diabetic rats and the underlying mechanism remains to be elucidated. The objective of the present study was to investigate the effect and mechanism of Cyclosporine-A on diabetic retinopathy. Methods:Male Sprague-Dawley rats were established to type 2 diabetic model.After 6 weeks, diabetic rats and normal controls were intravitreally injected with Cs-A (42 ng/2 μL) to the left eye, and 2μL DMSO to the right eye for the control. Another part of normal wild-type rats was subjected to intravitreal injections into the left eyes with 5 μL PBS or HMGB-1 (5 ng/5 μL) or HMGB-1(5 ng/5 μL) plus Cs-A (42 ng/2 μL), respectively. Retinal morphological changes were observed with hematoxylin–eosin staining. Expressions of HMGB-1, IL-1β and TNF-α were detected by immunohistochemistry, ELISA or western blot. Results:Retinal expression levels of IL-1β and TNF-α were upregulated in type 2 diabetic rats and in normal rats with intravitreal injection of HMGB-1, which were attenuated by intravitreal Cs-A. Moreover, Cs-A decreased HMGB-1 expression in diabetic retina and relieved the retinopathy in type 2 diabetic rats. Conclusions:Intravitreal administration of Cs-A showed a protective effect on retina of diabetic rats, possibly by downregulating retinal expressions of IL-1β and TNF-α via the suppression of HMGB-1.
Silencing of microRNA-210 inhibits the progression of liver cancer and Hepatitis B virus-associated liver cancer via targeting EGR3
Authors: Li Xiaojie , Yuan Mei , Song Lu , Wang Yan
Published: January 2020

Background: This study was aimed to investigate the regulatory role of microRNA-210 (miRNA-210) on the progression of liver cancer and Hepatitis B virus (HBV)-associated liver cancer. Methods: The expression of miRNA-210 was detected in liver tissues of HBV-associated cirrhosis and liver cancer, and in HepG2 and HepG2.2.15 cells by qRT-PCR. MiRNA-210 was silenced in HepG2 and HepG2.2.15 cells by the transfection of miRNA-210 inhibitor. The cell viability and apoptosis was detected by MTT assay and Annexin V-fluorescein isothiocyanate/propidium iodide staining, respectively. The protein expression of EGR3 was detected by Western blot. The regulatory relationship between EGR3 and miRNA-210 was predicted by TargetScan and identified by Dual luciferase reporter gene assay.Results: MiRNA-210 was overexpressed in the liver tissues of HBV-associated cirrhosis and liver cancer, and in HepG2 and HepG2.2.15 cells (P < 0.05). Silencing of miRNA-210 inhibited the viability and promoted the apoptosis of HepG2 and HepG2.2.15 cells (P < 0.05). EGR3 was a target of miRNA-210, which was down-regulated in the liver tissues of HBV-associated cirrhosis and liver cancer, and in HepG2 and HepG2.2.15 cells (P < 0.05). Silencing of miRNA-210 increased the mRNA and protein expression of EGR3 (P < 0.05). Silencing of EGR3 reversed the anti-tumor effect of miRNA-210 inhibitor on HepG2 and HepG2.2.15 cells (P < 0.05).Conclusions: Silencing of miRNA-210 inhibits the progression of liver cancer and HBV-associated liver cancer via up-regulating EGR3.