bluuebunny/crossref_metadata_2025 huggingface dataset:
EVAUATION OF SANITARY HYGIENIC PRACTICES IN THE PRODUCTION OF AÇAÍ IN THE BOWL: DIAGNOSIS AND INTERVENTION
Authors: OLIVEIRA TATIANNE , Gomes Rosa de Moura Eveline , Cristina de Oliveira Thaynara , Ayumi Amemiya Daniela , Fernandes Nobre Carolina , Troncoso Chaves Moreno Raquel , Hidalgo Campos Raquel , Jayme Borges Liana , Dantas Porfírio Borges André Maria Cláudia
Published: September 2020

The aim of this work was to evaluate the nutritional and microbiological quality of ready-to-eat açai, the physical and functional conditions of establishments that market this product and to verify the presence of microorganisms at handlers’ hands and nostrils. Twenty-three establishments in the city of Goiânia–Goiás were evaluated and açaí samples were obtained in two steps: before and after the training of handlers about good manufacturing practices. A decrease in the counts of total coliforms (from 26.08% to 8.7% of samples), coagulase positive staphylococci (from 78.26% to 65.2% of samples) and aerobic mesophiles (from 100% to 73.91% of samples) was observed between steps. The presence of microorganisms at handlers’ hands and nostrils did not present statistical difference between the two steps. According to the applied checklist, six items showed reduced compliance. After the training of handlers, the microbiological contamination of açaí decreased, and the presence of E coli in handlers’ nostrils was no longer observed, which highlights the importance of training about the implementation Good Manufacturing Practices to ensure food sanitary quality.
RESOLUÇÃO DO PROBLEMA DO CAIXEIRO VIAJANTE NO SETOR VAREJISTA USANDO HEURÍSTICA COM PREVISÃO DE TRAJETÓRIA
Authors: Gonçalves Wellington , Canal Hilson Henrique Massucatti , Canal Mauro Henrique Massucatti
Published: September 2020

A entrega rápida e econômica em domicílio de mercadorias encomendadas é um desafio logístico. E, devido a isso, diversas empresas estão procurando novas formas de serem mais ágeis para com seus clientes. Em nossos cenários, a duração necessária para prestar serviço a qualquer cliente não é fixa, mas, definida como uma função do horário de início da atividade. Assim, este trabalho realizou uma simulação de rotas para reduzir distâncias percorridas em serviços de entrega, empregando a heurística Traveling Salesman Problem (TSP). O modelo proposto pode lidar com vários tipos de funções de tempo de serviço e, condicionantes e características locais. Além disso, aplicamos nosso modelo a várias instâncias reais com diferentes características e tamanhos de percurso. Os experimentos sugerem que são possíveis economias substanciais com esse modelo em comparação com a entrega baseada somente na expertise. A modelagem realizada e os resultados numéricos obtidos com a implementação do TSP em várias instâncias de teste são apresentados. Esses resultados permitiram identificar rotas otimizadas, as quais obtiveram uma redução média de 6,1% das distâncias percorridas, e ainda, possibilidades da aplicação desta metodologia como uma ferramenta de gestão e minimização de custos.
Scalable Steam Additives for Enhancing In-Situ Bitumen Recovery in SAGD Process
Authors: Hassanzadeh Armin , Castellanos Diaz Orlando , Chung Cheng , Crosley Matt , Kardenetz Phillip
Published: September 2020

Chemical additives for co-injection with steam at low dosages were evaluated for enhancement of SAGD operations. The additives were selected based on their commercial scalability, water solubility and transportability inside the SAGD chamber (volatility). A custom-designed oil-recovery experiment, mimicking actual mechanisms of a SAGD chamber edge, was utilized for additive evaluation in the laboratory. The apparatus is a steam-soaking system composed of a synthetically prepared oil sand core suspended above an additive solution. The core was internally cooled to drive steam condensation and create co-current oil/water drainage inside the core. The additive effect on the recovery rate was quantified by comparison with a steam-only baseline. Amongst 20 additives tested, Additives A and B showed the most promising performance. Additive A improved the rate of oil recovery by 18% at a dosage of 5000 ppm. When the dosage was doubled (1 wt %), improvement in the rate of recovery increased favorably by 5 times (93% over baseline). Additive B showed significantly higher oil recovery of 240% over the baseline at 5000 ppm.

The transport behaviors of Additives A and B inside the steam chamber were also evaluated with reservoir modeling for potential field implementation. A homogeneous reservoir model was used to predict the transport behavior of the additives in a growing chamber and evaluate multiple injection scenarios. Compared with Additive A, Additive B was less volatile and required longer travel time from the injector to the chamber edge. Hence, Additive B can be injected in a younger (smaller) steam chamber, where the chamber edge is more accessible by the additive. Additive A, on the other hand, can target regions away from the injector in a more developed steam chamber. Additives A and B could also be co-injected or alternatively injected regardless of chamber size to simultaneously enhance oil production from different regions of the chamber.
Simulation of Non-Condensable Gases Co-Injection in Steam Assisted Gravity Drainage: State of the Art and Important Mechanisms
Authors: Mendoza Ana Maria , Kantzas Apostolos
Published: September 2020

When non condensable gases (NCGs) are co-injected with steam in SAGD, the steam oil ratio is reduced without negative effects in the oil production rates. But most simulation studies show the opposite effect. In this work, a critical literature review is conducted to understand the mechanisms affecting the response of NCG in numerical simulations of SAGD, and a simulation study is performed to investigate the parameters affecting the NCG co-injection process.

The simulation tests were run in a two-dimensional homogeneous model based on available data of Surmont reservoir using CMG STARS. According to previous simulation studies, the time of co-injection, solubility data, ex-solution rate, injection pressure and amount of NCG co-injected are important mechanisms affecting the simulation of NCG in SAGD. These parameters were evaluated independently in the simulation study. In addition, the diffusion of methane in the gas phase and gas-liquid relative permeability curves were evaluated to study the flow of the gas in the steam chamber.

As observed in previous studies, we also found that the time of co-injection, the amount of NCG co-injected and the injection pressure are critical for the design and optimization of an NCG co-injection process in SAGD. However, we found that the gas-liquid relative permeabilities are the parameter that most affects the simulation results. There are not congruent gas-liquid relative permeability curves in the literature for the SAGD reservoir simulation, and if the proper gas-liquid relative permeability curves are not considered, the design of the process using numerical simulators may not represent the real field behaviour. The liquid production rates and ex-solution rate of the gas are also important mechanisms affecting the simulation of NCG in SAGD. Contrary to what was expected, there was not a significant effect in the simulation when the diffusion and solubility of gases in the liquid were evaluated.
Validation of the French translation of the Dutch Residency Educational Climate Test
Authors: Majbar Anass Mohammed , Majbar Yassin , Benkabbou Amine , Amrani Laila , Bougtab Abdeslam , Mohsine Raouf , Souadka Amine
Published: September 2020

Background The learning environment is one of the most influential factors in training of medical residents. The Dutch Residency Educational Climate Test (D-RECT) is one of the strongest instruments for measuring the learning environment. However, it has not been translated in French. The objective of this study is the psychometric validation of the DRECT French version.Material and methods After translation of the D-RECT questionnaire into French, residents of five Moroccan hospitals were invited to complete the questionnaire between July and September 2018. Confirmatory factor analysis was used to evaluate the validity of the construct using the standardized root mean square residual (SRMR), the root mean square error approximation (RMSEA), the Comparative Fit Index (CFI) and the Tucker- Lewis Index (TLI). Reliability analysis was analysed using Internal consistency and Test-retest.Results During the study period, 211 residents completed the questionnaire. Confirmatory factor analysis showed an adequate model fit with the following indicators: SRMR = 0.058 / RMSEA = 0.07 / CFI = 0.88 / TLI = 0.87. The French translation had a good internal consistency (Cronbach alpha score > 0.7 for all subscales) and a good temporal stability (correlation score between two measurements = 0.89). Conclusion This French version has an acceptable validity of the construct, a good internal consistency and good temporal reliability, and may be used to evaluate the learning climate. Additional research is necessary in other French-speaking contexts, in order to confirm these results.
Malaria in children and women of childbearing age: infection prevalence, knowledge and use of malaria prevention tools in the province of Nyanga, Gabon
Authors: IMBOUMY-LIMOUKOU Roméo Karl , MAGHENDJI-NZONDO Sydney , SIR-ONDO-ENGUIER Pater Noster , DE CARVALHO Julie NIEMCZURA , TEGOMO Nathalie Pernelle TSAFACK , Buekens Julie , OKOUGA Alain Prince , ONDEME Augustin MOUINGA , NOLNA Sylvie KWEDY , LEKANA-DOUKI Jean Bernard
Published: September 2020

Background There is little information on the social perception of malaria and the use of preventative measures in Gabon, especially in rural areas. Adequate knowledge of malaria prevention and control can help in reducing the burden of malaria among vulnerable groups, particularly pregnant women and children under five years old living in malaria-endemic settings. This study was designed to assess the prevalence of malaria and the knowledge and attitude towards this disease in households in Nyanga Province. Methods A cross-sectional study was conducted to assess malaria knowledge, prevention practices and prevalence of the malaria infection in five departments of Nyanga Province. Plasmodial infection was diagnosed in children ≤5 years of age and women aged 15-49 years using rapid diagnostic tests. A questionnaire was administered randomly to women aged 15-49 years and to the parents or guardians of children aged ≤5 years in 535 households during a 2-week period in March 2018. Overall, the respondents’ socio-demographic characteristics, knowledge of malaria, malaria prevention practices and malaria prevalence were evaluated and compared across the five departments.Results Data from a total of 1,307 participants were included in this study, including 631 women of childbearing age (61 of them pregnant) and 676 children. Practically the entire (97.7%) interviewed population had heard about malaria and attributed the cause of malaria to a mosquito bite (95.7%). This survey revealed that the reported rate of reported bed-net use was 73.3%. The study observed an average malaria parasite prevalence of 13.9%. All departmental capitals of Nyanga Province had a significant level of malaria infection except for Mayumba where no plasmodial infection was foundConclusion High malaria prevalence is found in the departmental capital cities of Nyanga Province. This study reveals that respondents have a high knowledge of the malaria symptoms, its mode of transmission and preventive measures. Despite this high level of knowledge of the disease and its preventive measures, the incidence of malaria remains relatively high in this rural community highlighting the need for other types of interventions.
“…we were like tourists in the theatre, the interns assisted almost all procedures…” Challenges facing the training of Assistant Medical Officers in Tanzania
Authors: Sirili Nathanael , Anaeli Amani , Mselle Lilian , Nyongole Obadia Venance , Massawe Siriel
Published: September 2020

Background: Training of mid-level providers is a task sharing strategy that has gained popularity in the recent past for addressing critical shortage of health workforce. In Tanzania, training of mid-level providers has existed for over five decades, however, concerns are upon the quality of the mid-level cadres amidst the growing number of medical universities. This study sought to explore the challenges facing the training of the Assistant Medical Offices in Tanzania.Methods: An exploratory qualitative case study was carried out in four regions to include one rural district in each of the selected regions and two AMOs Training Colleges in Tanzania. A semi-structured interview guide was used to interview 29 Key informants from the district hospitals, district management, regional management, AMOs training college and one retired AMO. In addition, four focus group discussions were conducted with 35 AMO trainees.Results: Training of AMOs in Tanzania faces many challenges. The challenges include; use of outdated and static curriculum, inadequate tutors (lack of teaching skills and experience of teaching adults), Inadequate teaching infrastructure in existence of many other trainees to include interns, and limited or lack of scholarships and sponsorship for the AMO trainees. Conclusions: The findings of this study underscore that the challenges facing AMO training have the potentials to negatively impact the quality of care rendered by this cadre. Holistic approach is needed in addressing these challenges. The solutions should focus on reviewing the curriculum, deploying qualified tutors and improving the competencies of the available tutors through continued medical education programmes. Furthermore, the government in collaboration with other stakeholders should work together to address the challenges on teaching infrastructure and financial support to this cadre that has continued to be the backbone of the primary health care in Tanzania. Long term solution should consider to deploy the medical officers at the primary facilities and phase out the AMOs. Finally, challenges facing mid-level providers in Tanzania and similar settings are similar, thus these findings can be used as a starting pointing in addressing them.
Racial disparities in pedestrian-related injury hospitalizations in the United States
Authors: Hamann Cara , Peek-Asa Corinne , Butcher Brandon
Published: September 2020

BackgroundRacial/ethnic disparity has been documented in a wide variety of health outcomes, and environmental components are contributors. For example, food deserts have been tied to obesity rates. Pedestrian injuries are strongly tied to environmental factors, yet no studies have examined racial disparity in pedestrian injury rates. We examine a nationally-representative sample of pedestrian-related hospitalizations in the United States to identify differences in incidence, severity, and cost by race/ethnicity.MethodsPatients with ICD diagnosis E-codes for pedestrian injuries were drawn from the United States Nationwide Inpatient Sample (2009-2016). Rates were calculated using the United States Census. Descriptive statistics and generalized linear regression were used to examine characteristics (age, sex, severity of illness, mortality rates, hospital admissions, length of stay, total costs) associated with hospitalizations for pedestrian injuries.ResultsThe burden of injury from pedestrian-related hospitalizations was higher among Black, Hispanic, and Multiracial/Other groups in terms of admission rates, costs per capita, proportion of children injured, and length of stay compared to Whites and Asian or Pacific Islander race/ethnicities. Compared to Whites, hospital admission rates were 1.92 (95% CI: 1.89-1.94) and 1.20 (95% CI: 1.19-1.21) times higher for Multiracial/Other and Blacks, respectively. Costs per capita ($USD) were $6.30, $4.14, and $3.22 for Multiracial/Others, Blacks, and Hispanics, compared to $2.88 and $2.32 for Whites and Asian or Pacific Islanders. Proportion of lengths of stay exceeding one week were larger for Blacks (26.4%), Hispanics (22.6%), Asian or Pacific Islanders (23.1%), and Multiracial/Other (24.1%), compared to Whites (18.6%). Extreme and major loss of function proportions were also highest among Black (34.5%) and lowest among Whites (30.2%).ConclusionsResults from this study show racial disparities in pedestrian injury hospitalization rates and outcomes, particularly among Black, Hispanic, and Multiracial/Other race/ethnicity groups and support population and system-level approaches to prevention. Access to transportation is an indicator for health disparity, and these results indicate that access to safe transportation also shows inequity by race/ethnicity.
Virtual Reality Experience In Long Term Care Resident Older Adults With Dementia: A Case Series 
Authors: Sultana Munira , Campbell Karen , Jennings Morgan , Montero-Odasso Manuel , Orange Joseph. B. , Knowlton Jill , George Armin St. , Bryant Dianne
Published: September 2020

BACKGROUND: Behavioural and Psychological Symptoms of Dementia (BPSD) worsens as dementia progresses, intensifies caregiver distress and consequent institutionalization. We wanted to evaluate feasibility of Virtual Reality (VR) as non-pharmacologic intervention for BPSD in a long-term care home. METHODS: A single site (Henley Place at London, Ontario) case series with a convenience sample (24 older adult residents with moderate to severe dementia). Intervention was 30 minutes of VR experience with Broomx©, five days a week for two weeks. RESULTS: Implementing VR experience was possible at Henley Place (recruitment rate=40%, the adherence rate=21%, and the attrition=0%) and participants could tolerate it. No adverse events and one-to-one staff use were recorded during the intervention period. CONCLUSION: VR experience can be implemented in a care home. TRIAL REGISTRATION: The study was not registered as clinical trial. We obtained ethics approval from ADVARRA Canada Ethics Board before recruiting participants for the study.
Using the drug repositioning approach to develop a novel therapy, tipepidine hibenzate sustained-release tablet (TS-141), for children and adolescents with Attention-Deficit/Hyperactivity Disorder
Authors: Saito Takuya , Yamashita Yushiro , Tomoda Akemi , Okada Takashi , Umeuchi Hideo , Iwamori Saki , Shinoda Satoru , Mizuno-Yasuhira Akiko , Urano Hidetoshi , Nishino Izumi , Saito Kazuhiko
Published: September 2020

Background Asverin® (tipepidine hibenzate) has been used as an antitussive for >50 years in Japan. Studies revealed that tipepidine modulates monoamine levels, by inhibiting G-protein-activated inwardly rectifying potassium (GIRK) channels, expecting the potential therapeutic effects of tipepidine for attention-deficit/hyperactivity disorder (ADHD) in recent years. In this study, TS-141, a sustained-release tablet of tipepidine, was developed for the treatment of ADHD through a drug repositioning approach.Methods The sustained-release profile of TS-141 in healthy adults was investigated, and tipepidine exposure in the plasma after the TS-141 administration was compared to that of Asverin in the phase I study. Phase II study was conducted to examine the effects of TS-141 30 (once a day), 60 (once a day), 120 mg (60 mg twice a day), or placebo, that is within the exposure in the maximum dosage of Asverin, in children and adolescents with ADHD, and was designed as an 8-week treatment, randomized, parallel group, double-blind, placebo-controlled trial recruiting 6–17-year-old children and adolescents diagnosed with ADHD. A total of 216 patients were randomized according to the CYP2D6 phenotype. The primary end-point was ADHD Rating Scale IV-J changes. Furthermore, effects of CYP2D6 phenotype on the efficacy in the subgroup analysis were investigated. Results TS-141 had the sustained-release profile, and the CYP2D6 phenotype had effects on the plasma exposure of tipepidine. ADHD RS-IV-J scores in all TS-141 dosages decreased from their baseline scores; however, no significant difference was observed in ADHD RS-IV-J score changes between the placebo and TS-141-administered groups. In patients with intermediate metabolizer CYP2D6, ADHD RS-IV-J score changes in the 120 mg group tended to be larger than that in the placebo group.Conclusions ADHD RS-IV-J changes on TS-141 may depend on the interaction between the TS-141 dose and CYP2D6 phenotype, suggesting that further clinical trials should be conducted with careful consideration of polymorphism. Drug repositioning approach of TS-141 was attempted at the same dose as that of antitussive; however, dose setting according to the indication was necessary.Trial RegistrationPhase I study: JapicCTI-205235 (Registered 25 March 2020), Phase II study: JapicCTI-163244 (Registered 9 May 2016), https://www.clinicaltrials.jp/cti-user/trial/Show.jsp
Does high dose intravenous acetaminophen affect liver function for PDA closure in premature neonate?
Authors: Bahrami Reza , Ezzatabadi Aida , Mehdizadegan Nima , Mohammadi Hamid , Amoozgar Hamid , Edraki Mohammad Reza
Published: September 2020

Objectives: The aim of this study was to collect consistent data on the efficacy and safety and evaluation hepatotoxicity of intravenous acetaminophen for the treatment of PDA in preterm infants.Methods: This is an observational longitudinal prospective study on 46 preterm infants with PDA who treated with high dose of acetaminophen and evaluated with echocardiography and serum liver enzymes at Hafez and Zeinabiyeh hospitals from January 2016 to December 2019.Result: Forty-six preterm infants with PDA treated with intravenous acetaminophen. Rate of closure of PDA was 82.6. There was no significant difference after treatment regarding AST, ALT, Albumin, total and direct bilirubin (P value >0.05) and no adverse side effects were observed in association with intravenous acetaminophen. Conclusion: High dose of acetaminophen is an effective and safe therapeutic option without hepatotoxic side effect for PDA closure.
Assessment of burnout in medical students using the Maslach Burnout Inventory-Student Survey: A cross-sectional data analysis
Authors: Obregon Michael , Luo Jessica , Shelton Jarod , Blevins Terri , MacDowell Martin
Published: September 2020

Background: Medical student burnout can cause emotional and physical exhaustion and detachment. The objectives of this study were to evaluate burnout using the Maslach Burnout Inventory-Student Survey (MBI-SS), identify factors that may predict burnout, and assess wellness initiatives effectiveness at reducing burnout. Methods: The MBI-SS was administered to all medical students (Classes 2019 to 2022) at the University of Illinois College of Medicine (UICOM) from February to May 2019. Factor analysis and internal consistency of the MBI-SS were assessed. Mean MSBI-SS subscale scores for burnout were calculated for cynicism (CY), emotional exhaustion (EE), and academic efficacy (AE). Multiple regression analysis was used to identify student factors that may predict burnout.Results: A total of 273 (21.6%) UICOM students completed the survey and 110 (40.3%) respondents reported self-perceived burnout. MBI-SS subscale scores were significantly higher for CY and EE, and significantly lower for AE in students who reported suffering from burnout versus students who did not report burnout. Mean ± SD subscale scores for CY, EE, and AE in burnout students were 14.44 ± 5.59, 23.23 ± 4.74, and 24.81 ± 5.35, respectively. In comparison, mean ± SD subscale scores for CY, EE, and AE in non-burnout students were 7.59 ± 5.16, 14.96 ± 5.71, and 28.74 ± 3.21, respectively. Regression analysis denoted significant associations between burnout and being out-of-phase in the curriculum, the effectiveness of wellness initiatives, and strength of motivation for medical school (SMMS) in both the two- and three-dimensional MBI-SS models. Gender was significantly associated with burnout in only the two-dimensional model.Conclusions: Self-reported burnout in medical students at UICOM was validated using the MBI-SS. Being out-of-phase in the curriculum, being female, rating wellness initiatives as less effective, and demonstrating lower motivation for continued medical school education may be used as predictors of medical student burnout. This investigation may act as a guide for measuring burnout in medical student populations and how the implementation of wellness initiatives may ameliorate burnout.
Spatiotemporal and Source Analysis of Ultrafine Particulates (PM1) over Bengaluru, Karnataka, India
Authors: S Manjunatha A , E Ganesh K
Published: September 2020

Measurement and analysis of Particulate Matter (PM1) of aerodynamic diameter less than 1µm (PM1) has been carried out using indigenously built air sampler APM 577 from IIT-K for the period July 2018 - July 2019. Bengaluru being one of the megacities of India requires constant follow up of air quality. Following locations of Bengaluru city have been selected for the study: Basavanagudi (BAS), Domlur (DOM), Hosur road (HOS) and DC Halli (DCH). The mass concentrations of collected PM1 samples have been observed to vary from 20.16 to 68.64 µg m-3 during the study period. The highest mass concentration of 68.64 µg m-3 was observed for the location BAS and the lowest mass concentration of 20.16 µg m-3 was observed for the location DOM. The seasonal average mass concentration of PM1 around Bengaluru for winter, summer, monsoon & post monsoon season during the entire study period is observed to be 47.60, 40.24, 30.85 and 38.76 µg m-3 respectively. The average 24 h mass concentrations of PM1 in winter season that is in December month at BAS location is found to be higher than National Ambient Air Quality Standard limit of 60 µg m-3 for PM2.5 however in January and February months mass concentration is found to be less than the standard limit. The Scanning Electron Microscope-Energy Dispersive Analysis X-ray techniques were used to understand the morphology and elemental composition of PM1. Scanning electron microscope images confirms the presence of particulates both from anthropogenic (primary) and natural (secondary) activities. Also, some of the collected samples showed the presence of microorganisms and biological particles such as Bacillus. Elemental composition analysis showed the presence of non-metals such as Carbon, Oxygen, Nitrogen, Sulphur and traces of metals such as Sodium, Aluminium, Calcium and Potassium. A detailed study along with the possible conclusion is the subject matter of this paper.
Micronized sacchachitin promotes satellite cell proliferation through TAK1-JNK-AP-1 signaling pathway predominantly by TLR2 activation
Authors: Wu Meng-Huang , Lin Chuang-Yu , Hou Chun-Yin , Sheu Ming-Thau , Chang Hsi
Published: September 2020

​ Background: Ganoderma sp., such as Ganoderma tsugae (GT), play an important role in traditional Chinese medicine. Ganoderma sp. contains several constituents, including Sacacchin, which has recently drawn attention because it can not only enhance the repair of muscle damagebut also strengthen themuscle enforcement. Although Ganoderma sp. have a therapeutic effect for neuromuscular disorders, the underlying mechanism remains unclear. This study investigated the effect and underlying molecular mechanism of micronized sacchachitin(mSC) on satellite cells (SCs), which are known as the muscle stem cells. Methods: The myogenic cells, included SCs (Pax7 +) were isolated from tibialis anterior muscles of a healthy rat and were cultured in growth media with different mSC concentrations. For the evaluation of SC proliferation, these cultivated cells were immunostained with Pax7 and bromodeoxyuridineassessed simultaneously. The molecular signal pathway was further investigated by using Western blotting and signal pathway inhibitors. Results: Our results revealed that 200 µg/mL mSC had an optimal capability to significantly enhance the SC proliferation. Furthermore, this enhancement of SC proliferation was verified to be involved with activation of TAK1-JNK-AP-1 signaling pathway through TLR2, whose expression on SC surface was confirmed for the first time here. Conclusion: Micronized sacchachitinextracted fromGT was capable of promoting the proliferation of SC under a correct concentration.
New Onset Diabetes Mellitus and Cardiovascular Events in Korean Patients with Acute Myocardial Infarction Receiving High-Intensity Statins
Authors: Choi Jah Yeon , Choi Cheol Ung , Choi Byoung Geol , Park Yoonjee , Kang Dong Oh , Jang Won Young , Kim Woohyeun , Na Jin Oh , Kim Jin Won , Kim Eung Ju , Rha Seung-Woon , Park Chang Gyu , Seo Hong Seog , Jeong Myung Ho , Chae Sung-Chull , Seong In-Whan , Yoon Chang-Hwan , Cha Kwang Soo , Oh Seok Kyu
Published: September 2020

Background: High-intensity statin therapy is typically used in patients with acute myocardial infarction (AMI) for secondary prevention. However, there have been consistent concerns regarding its association with diabetes mellitus. We investigated the effect of high-intensity atorvastatin and rosuvastatin on new-onset diabetes mellitus (NODM) and cardiovascular outcomes over a 3-year follow-up period.Methods: Data from the Korea Acute Myocardial Infarction Registry were collected from November 2011 to October 2015, and 13,104 patients with AMI were enrolled from major cardiovascular centers. Among them, 2,221 patients without diabetes who had been administered with high-intensity atorvastatin (40–80 mg) and rosuvastatin (20 mg) were investigated. The atorvastatin and rosuvastatin groups were evaluated for the incidence of NODM and major adverse cardiac events (MACE) including death, myocardial infarction, and revascularization cases in the following 3 years.Results: Baseline characteristics were comparable between the two groups. Event-free survival rate of NODM and MACE was not significantly different between the atorvastatin and rosuvastatin groups (92.5% vs. 90.8%, respectively; Log-rank P-value = 0.550). The event-free survival rate of MACE was also not significantly different between atorvastatin and rosuvastatin groups (89.0% vs. 89.6%, respectively; Log rank P-value = 0.662). Multivariate Cox analysis revealed that statin type was not a prognostic factor in the development of NODM and MACE.Conclusions: Administering high-intensity atorvastatin and rosuvastatin in patients with AMI produced comparable effects on NODM and clinical outcomes, suggesting their clinical equivalence in secondary prevention.
The Impact of Dementia and Language on Hospitalizations. A Retrospective Cohort of Long-Term Care Residents.
Authors: Riad Karine , Webber Colleen , Batista Ricardo , Reaume Michael , Rhodes Emily , Knight Braden , Prud’homme Denis , Tanuseputro Peter
Published: September 2020

Background: Hospitalizations carry considerable risks for frail, elderly patients; this is especially true for patients with dementia, who are more likely to experience delirium, falls, functional decline, iatrogenic complications, and infections when compared to their peers without dementia. Since up to two thirds of patients in long-term care (LTC) facilities have dementia, there is interest in identifying factors associated with transitions from LTC facilities to hospitals. The purpose of this study was to investigate the association between dementia status and incidence of hospitalization among residents in LTC facilities in Ontario, Canada, and to determine whether this association is modified by linguistic factors. Methods: We used linked administrative databases to establish a prevalent cohort of 81,188 residents in 628 LTC facilities from April 1st 2014 to March 31, 2017. Diagnoses of dementia were identified with a previously validated algorithm; all other patient characteristics were obtained from in-person assessments. Residents’ primary language was coded as English or French; facility language (English or French) was determined using language designation status according to the French Language Services Act. We identified all hospitalizations within 3 months of the first assessment performed after April 1st 2014. We performed multivariate logistic regression analyses to determine the impact of dementia and resident language on the incidence of hospitalization; we also considered interactions between dementia and both resident language and resident-facility language discordance. Results: The odds of hospitalization were 39% lower for residents with dementia compared to residents without dementia (OR 0.61, 95% CI 0.57–0.65). Francophones had lower odds of hospitalization than Anglophones, but this difference was not statistically significant (OR 0.91, 95% CI 0.81 – 1.03). However, Francophones without dementia were significantly less likely to be hospitalized compared to Anglophones without dementia (OR 0.71, 95% CI 0.53 – 0.94). Resident-facility language discordance did not significantly affect hospitalizations. Conclusions: Residents in LTC facilities were generally less likely to be hospitalized if they had dementia, or if their primary language was French and they did not have dementia. These findings could be explained by differences in end-of-life care goals; however, they could also be the result of poor patient-provider communication.
Everolimus-eluting bioresorbable scaffolds and metallic stents in diabetic patients: a patient-level pooled analysis of the prospective ABSORB DM Benelux Study, TWENTE and DUTCH PEERS
Authors: Hommels T. M. , Hermanides R. S. , Berta B. , Fabris E. , De Luca G. , Ploumen E. H. , von Birgelen C. , Kedhi E.
Published: September 2020

Background

Several studies compared everolimus-eluting bioresorbable scaffolds (EE-BRS) with everolimus-eluting stents (EES), but only few assessed these devices in patients with diabetes mellitus.

Aim

To evaluate the safety and efficacy outcomes of all-comer patients with diabetes up to 2 years after treatment with EE-BRS or EES.

Methods

We performed a post-hoc pooled analysis of patient-level data in diabetic patients who were treated with EE-BRS or EES in 3 prospective clinical trials: The ABSORB DM Benelux Study (NTR5447), TWENTE (NTR1256/NCT01066650) and DUTCH PEERS (NTR2413/NCT01331707). Primary endpoint of the analysis was target lesion failure (TLF): a composite of cardiac death, target vessel myocardial infarction or clinically driven target lesion revascularization. Secondary endpoints included major adverse cardiac events (MACE): a composite of all-cause death, any myocardial infarction or clinically driven target vessel revascularization, as well as definite or probable device thrombosis (ST).

Results

A total of 499 diabetic patients were assessed, of whom 150 received EE-BRS and 249 received EES. Total available follow-up was 222.6 patient years (PY) in EE-BRS and 464.9 PY in EES. The adverse events rates were similar in both treatment groups for TLF (7.2 vs. 5.2 events per 100 PY, p=0.39; adjusted hazard ratio (HR)=1.48 (95% confidence interval (CI): 0.77-2.87), p=0.24), MACE (9.1 vs. 8.3 per 100 PY, p=0.83; adjusted HR=1.23 (95% CI: 0.70-2.17), p=0.47), and ST (0.9 vs. 0.6 per 100 PY, p>0.99).

Conclusion

In this patient-level pooled analysis of patients with diabetes mellitus from 3 clinical trials, EE-BRS showed clinical outcomes that were quite similar to EES.
Maternal near miss and potentially life-threatening condition determinants in patients with type 1 Diabetes Mellitus in a university hospital in Sao Paulo, Brazil: a retrospective study.
Authors: MORAIS LUIZA RUSSO , PATZ BEATRIZ , CAMPANHARO FELIPE FAVORETTE , DUALIB PATRICIA , Sun Sue , MATTAR ROSIANE
Published: September 2020

Background: To date, the rates of potentially life-threatening condition (PTLC), maternal near miss (MNM) and maternal deaths in pregnant patients with type 1 diabetes mellitus (T1DM) and variables associated to it have not been studied. Methods: This study was as a cross-sectional retrospective study conducted at São Paulo Hospital of Universidade Federal de São Paulo, a tertiary hospital that provides public medical care through the Brazilian unified health system to high-risk pregnancies. Inclusion criteria were T1DM pregnant women who delivered from January 2005 to December 2015. Three groups were established by the World Heath Organization criteria and associations were assessed using the chi-square test in between MNM and no morbidity or PLTC and no morbidity. A P value < 0.05 was considered statistically significant. Results: The final sample included 137 patients, 8 MNM cases (5.84%), 51 PLTC (37.23%), no cases of maternal deaths and 78 patients (56.93%) did not present any complication. Moreover, there were 122 live births, resulting in a near miss rate of 65.5 per 1.000 live births in patients with T1DM. Two of the MNM cases were for clinical criteria (uncontrollable fit in both) and laboratory criteria for the other six: one patient with severe acute azotemia (creatinine >300 μmol/ml), one patient with severe hypoperfusion (lactate >5 mmol/L) and four of them with loss of consciousness and the presence of glucose and ketoacids in urine. PLTC criteria were studied in MNM and PLTC cases. Prolonged hospital stay was the most prevalent PLTC criteria in both groups (100% of MNM cases and 96% of PLTC), followed by renal failure in 50% of MNM cases and severe preeclampsia in 22% of PLTC cases. This study could not find any association between prenatal factors or sociodemographic characteristics with maternal morbidity. Conclusions: MNM rate in T1DM was extremely high, and determined by complications of the primary disease or hypertensive disorders. No sociodemographic variables studied were related to maternal morbidity; therefore, we could not predict what increases MNM and PLTC in this specific population.
Fabrication of Polylactic Acid/Paclitaxel Nano Fibers by Electrospinning for Cancer Therapeutics
Authors: Yu C. H. , Chan Vincent , Li Chuan , Hsieh J. H. , Lin P. H. , Tsai Ya-Hui , Chen Yun
Published: September 2020

Polylactic acid (PLA) is a thermoplastic and biodegradable polyester, largely derived from renewable resources such as corn starch, cassava starch and sugarcane. However, PLA is only soluble in a narrow range of solvents such as tetrahydrofuran, dioxane, chlorinated solvents and heated benzene. The limited choices of solvent for PLA dissolution have imposed singificant challenges in the development of specifically engineered PLA nanofibers with electrospinning techniques. Generally, the electrospun polymeric materials have been rendered with unique properties such as high porosity and complex geometry while maintaining its biodegradability and biocompatibility for emerging biomedical applications. In this study, a new anticancer drug delivery system composed of PLA nanofibers with encapsulated paclitaxel was developed by the electrospinning of the respective nanofibers on top of a spin-coated thin film with the same chemical compositions. Our unique approach is meant for promoting strong bonding between PLA-based nanofibers and their respective films in order to improve the prolonged release properties and composite film stability within a fluctuative phyiochemical environment during cell culture. PLA/paclitaxel nanofiber supported on respective polymeric films were probed by scanning electronic microscope, Fourier transform infrared spectrometer and water contact measurement for determining their surface morphologies, fibers’ diameters, molecular vibrational modes, and wettability, respectively. Moreover, PLA/paclitaxel nanofibers supported on respective spin-coated films at different loadings of paclitaxel were evaluated for their abilities in killing human colorectal carcinoma cells (HCT-116). More importantly, MTT assays showed that regardless of the concentrations of paclitaxel, the growth of HCT-116 was effectively inhibited by the prolonged release of paclitaxel from PLA/paclitaxel nanofibers. An effective prolonged delivery system of paclitaxel based on PLA nanofiber-based film has demonstrated exciting potentials for emerging applications as implantable drug delivery patch in post-surgical cancer eradication.
The intrinsically disordered region of GCE protein adopts a more fixed structure by interacting with the LBD of the nuclear receptor FTZ-F1
Authors: Kolonko Marta , Bystranowska Dominika , Taube Michał , Kozak Maciej , Bostock Mark , Popowicz Grzegorz , Ożyhar Andrzej , Greb-Markiewicz Beata
Published: September 2020

The Drosophila melanogaster Germ cell-expressed protein (GCE) is a paralog of the juvenile hormone (JH) receptor - Methoprene tolerant protein (MET). Both proteins mediate JH function, preventing precocious differentiation during D. melanogaster development. Despite that GCE and MET are often referred to as equivalent JH receptors, their functions are not fully redundant and show tissue specificity. Both proteins belong to the family of bHLH-PAS transcription factors. The similarity of their primary structure is limited to defined bHLH and PAS domains, while their long C-terminal fragments (GCEC, METC) show significant differences and are expected to determine differences in GCE and MET protein activities. In this paper we present the structural characterization of GCEC as a coil-like intrinsically disordered protein (IDP) with highly elongated and asymmetric conformation. In comparison to previously characterized METC, GCEC is less compacted, contains more molecular recognition elements (MoREs) and exhibits a higher propensity for induced folding. The NMR shifts perturbation experiment and pull-down assay clearly demonstrated that the GCEC fragment is sufficient to form an interaction interface with the ligand binding domain (LBD) of the nuclear receptor Fushi Tarazu factor-1 (FTZ-F1). Significantly, these interactions can force GCEC to adopt more fixed structure that can modulate the activity, structure and functions of the full-length receptor. The discussed relation of protein functionality with the structural data of inherently disordered GCEC fragment is a novel look at this protein and contributes to a better understanding of the molecular basis of the functions of the C-terminal fragments of the bHLH-PAS family.
Investigating the associations between intimate partner violence and nutritional status of women in Zimbabwe
Authors: Mukamana Jeanette , Machakanja Pamela , Zeeb Hajo , Yaya Sanni , Adjei Nicholas Kofi
Published: September 2020

Background: Intimate partner violence (IPV) against women and poor nutritional status are growing health problems in low and middle-income countries (LMICs). Moreover, violence against women has been shown to be associated with poor nutrition. This study investigated the relationship between IPV and nutritional status (i.e., underweight, overweight, and obesity) among women of reproductive age (15-49 years) in Zimbabwe. Methods: Pooled data from the 2005/2006, 2010/2011, and 2015 Zimbabwe Demographic Health Surveys (ZDHS) on 13,008 married/cohabiting women were analysed. Multinomial logistic regression models were used to examine the associations between the various forms of IPV and the nutritional status of women. We further estimated the prevalence of BMI ≥ 25.0 kg/m2 (overweight and obesity) by intimate partner violence type.Results: The mean BMI of women was 24.3 kg/m2, more than one-fifth (24%) were overweight and about 12% were obese. Forty-three percent (43%) of women reported to have ever experienced at least one form of intimate partner violence. More than one-third (35%) of women who reported to have ever experienced at least one form of intimate partner violence had a BMI ≥ 25.0 kg/m2 (p< 0.01). Relative to normal weight, women who had ever experienced at least one form of IPV (i.e., physical, emotional, or sexual) were more likely to be obese (aOR = 2.59; 95% CI = 1.05–6.39). Women’s exposure to any form of intimate partner violence was not significantly associated with the likelihood of being underweight or overweight relative to normal weight.Conclusions: The study findings showed that women of reproductive age in Zimbabwe are at high risk of both IPV and excess weight. Moreover, we found a positive relationship between IPV and obesity. Public health interventions that target the well-being, empowerment, and development of women are needed to address the complex issue of IPV and adverse health outcomes, including obesity.
A Clinical Decision Support System is Associated with Reduced Loss to Follow-Up Among Patients Receiving HIV Treatment in Kenya: A Cluster Randomised Trial
Authors: Oluoch Tom , Katana Abraham , Cornet Ronald , Muthusi Jacques , Kimanga Davies , Kwaro Daniel , Okeyo Nicky , Abu-Hanna Ameen , de Keizer Nicolette
Published: September 2020

Background Loss to follow-up (LFTU) among HIV patients continues to be a major obstacle to achieving treatment goals with the risk of failure to achieve viral suppression and thereby increased HIV transmission. Although use of clinical decision support systems (CDSSs) has been shown to improve adherence to HIV clinical guidance, this is the first study ever conducted to show its effect on LTFU in low-resource settings. Methods We analyzed data from a cluster-randomized trial conducted at 20 HIV clinics in western Kenya to assess the effects of a CDSS implemented as alerts on an electronic health records (EHR) system on: (1) the proportion of patients that were LTFU, (2) LTFU patients traced and successfully referred back to treatment, and (3) the time from enrollment on treatment to LTFU. Results Among eligible 5,901 patients receiving ART, 40.6% (n=2,396) were LTFU at any time during the study period. Lack of a CDSS was associated with higher LTFU among the ART patients (Adjusted Odds Ratio - aOR=1.45, 95% CI: 1.35-1.55). The proportions of patients linked back to treatment were 29.1% (95% CI: 27.6– 0.6) and 34.1 % (95% CI: 32.1–36.2) in EHR only and EHR with CDSS sites respectively. There was no statistically significant association between the use of a CDSS and time to LTFU.Conclusion A CDSS can potentially improve quality of care through reduction of LTFU among HIV patients in a resource-limited country. CDSS is only part of the solution to LTFU and would be most effective if implemented together with other interventions.
Factors Hindering the Effective Application of User Knowledge in the Designing of New Home Healthcare Devices: Investigating Thirty-Eight Devices and Their Manufacturers
Authors: Yang Fan , Mahmud Abdullah Al
Published: September 2020

Background: This study explored the factors hindering the effective application of user knowledge in the designing of new Home Healthcare Device (HHCD), along with the interrelationships between the factors. The demand for HHCDs arises, however many HHCDs on the market are not designed to reflect the needs and features of the end-users. Methods: We first analysed the project documents of thirty-eight carefully selected HHCDs produced by five manufacturers. Then we interviewed in a total of thirty stakeholders who were involved in the development of these devices.Results: The use of insufficient user insights in HHCD development were mainly attributed to the four factors: (i) the user insights utilised in formulating project strategies and the designing of new devices; (ii) the sources of user information; (iii) the execution of user research; and (iv) the formulation of the manufacturers’ principal NPD processes.Conclusions: The users’ characteristics and needs were not sufficiently reflected within the device development processes, as the manufactures were in short of commitment and motivation in deploying formal user research. One root cause was that most of the projects were initiated following the requests from the public sector (the clients). In contrast, the end-users were perceived by the manufacturers as having little impact on the success of the devices. Actual or potential applications of this study include the facilitation of the appropriate application of human factors methods in the development of new HHCDs, and the improvement of the user performance of the end-devices.