bluuebunny/crossref_metadata_2025 huggingface dataset:
¿Mejora el Programa de Alimentación Escolar (PAE) el desempeño académico de los estudiantes en Ibagué?
Authors: Ariza John Fredy , Rojas Shirley Lorena
Published: December 2020

El presente trabajo estima el efecto causal del Programa de Alimentación Escolar (PAE) sobre el rendimiento académico de los estudiantes del sector oficial, de grado once, del municipio de Ibagué en el 2018, utilizando la información del Simat y la base de datos de las pruebas Saber 11 del Icfes. Metodológicamente se utiliza un modelo econométrico de evaluación de impacto que se basa en la técnica de propensity score matching PSM para identificar el efecto causal. Los resultados sugieren que el programa no tuvo ningún impacto sobre el desempeño académico de los estudiantes. Los problemas asociados a la asignación del operador y a la gestión del programa parecen haber influido de forma significativa sobre la efectividad del programa.
A formação de professores para a inclusão de crianças com transtorno do espectro autista: um estudo qualitativo
Authors: Sousa Simone França de , Menezes Ronny Diogenes de
Published: December 2020

Este trabalho é fruto de uma pesquisa realizada no curso de pós-graduação em Educação Profissional e Tecnológica Inclusiva, do Instituto Federal do Triângulo Mineiro, voltada para profissionais que atuam com alunos com necessidades especiais na Educação Básica. Nosso objetivo, neste trabalho, foi observar a formação de professores para atuar na inclusão de crianças com necessidades especiais, dando ênfase para as portadoras do Transtorno do Espectro Autista (TAE). Dessa forma para alcançarmos tal objetivo quantificamos as publicações realizadas no intervalo 2004 a 2019 que abordam a formação de professores para atuar com crianças portadoras do TAE na Educação Infantil; Analisamos os resultados encontrados em teses e dissertações que abordam a formação de professores para a inclusão de pessoas com TAE, utilizando como metodologia a pesquisa bibliográfica. Após a realização do presente artigo, foi possível concluir que os estudos que abordam a inclusão de crianças com TEA em salas regulares ainda são poucos, apesar de termos uma legislação há mais de três décadas em vigor. Ressaltamos que houve avanços neste período, no entanto, poderíamos termos atualmente uma conscientização maior dos cidadãos, se houvesse um investimento maior na educação de maneira mais sólida, tanto nas redes básicas, como o fomento na formação docente.
As reverberações da história e a elaboração estética da personagem no romance Predadores
Authors: Pinto Jesuino Arvelino , Cardoso João Batista
Published: December 2020

O propósito deste trabalho consiste em analisar o romance Predadores, de Pepetela, buscando apreender as formas de representação da condição itinerante que muitos grupos sociais se submetem em função das consequências de revoltas e guerras, modos de governo autoritários e mesmo de acidentes naturais. Mais especificamente, nossa proposta visa à reflexão acerca da reestruturação das memórias na formação da identidade de um povo, tendo a personagem central, Vladimiro Caposso, como elemento catalisador da trama demarcada pelo período de 1974 a 2004, compreendendo trinta anos, a partir das lutas finais pela Independência de Angola. A literatura pode servir como ferramenta de registro e manutenção dos costumes e tradições dominantes, uma vez que o discurso se materializa na oralidade e na escrita, que perpassam a História da evolução do homem como ser social. O suporte teórico deste trabalho constitui-se em estudos que permeiam a relação Literatura, História, Política e Sociedade, perpassando pelas acepções de memória e identidade, como: Mata (1993), Candido (1976, 1989), Barthes (1988), Carvalho (2010), Hall (2006), Ricoeur (2007), Lukács (2000) dentre outros. No que tange à formação da identidade cultural, a literatura traduz peculiaridades locais, manifestando os traços do momento histórico e da realidade social nela abordados.
O calor estranho na narrativa da velhice em Clarice Lispector
Authors: Scorsolini-Comin Fabio
Published: December 2020

A partir da análise dos contos A procura de uma dignidade e A partida do trem, presentes na coletânea Onde estivestes de noite, de Clarice Lispector, publicada originalmente em 1974, o objetivo deste estudo é refletir sobre como a mulher idosa é retratada pela autora na tentativa não de balizar uma imagem universal associada ao envelhecimento, mas do lugar autorizado à mulher nessa etapa do ciclo vital. Entre os sentidos que circulam nesses contos encontramos imagens acerca da sexualidade feminina, da passividade, da constituição do feminino a partir da oposição ao sexo masculino e também de discussões sobre família, tempo, casamento e desejo. A partir de uma leitura acerca dos universos intrapsíquicos de duas personagens idosas presentes nesses contos, Clarice problematiza a condição de ser mulher e idosa em uma sociedade sustentada na assimetria de gênero e na invisibilidade do desejo feminino na velhice. Endereçamentos sobre a identificação da autora com os itinerários dessas personagens e os diálogos entre essa leitura e a Psicologia do Desenvolvimento são realizados no presente estudo.
Prólogo
Authors: Aguerre Natalia , Trindade Denise , Chagastelles Gianne
Published: December 2020

El presente volumen aborda la dimensión política de las manifestaciones estéticas, para reflexionar sobre los modos de representación que dichas prácticas expresan en articulación con las temáticas relacionadas con las identidades, el campo popular, los cuerpos, el espacio público, con las formas de activismo político y de producción económica e investigación científica.
Basic Income as a Response to New Economic Challenges
Authors: Kvashnin Y.
Published: December 2020

The article reviews the current debates on universal basic income and assesses the prospects for its implementation. In 2020, the idea of unconditional cash payments gained a significant number of new supporters. This was partly due to the vibrant political campaign of Andrew Yang, who took part in U.S. Democratic primaries, advocating the introduction of the so-called freedom dividend for all Americans, regardless of their income level or labor status. However, a real surge in interest occurred against the backdrop of a global recession caused by the coronavirus pandemic, which forced national governments to respond quickly to new social and economic challenges. In a number of East Asian countries, the authorities provided a one-time emergency assistance to the entire population. Compared to other types of direct payments (“helicopter money”), emergency basic income has shown several advantages. Due to its universal nature, it covers all citizens, including those who are completely or partially excluded from existing social protection systems. Moreover, in organizational terms, it is much easier to directly transfer an equal sum of money to everyone, especially in conditions of self-isolation. In Western countries, however, the probability of transition to basic income, even in its emergency form, is still rather low. Preference will be given to traditional measures aimed at supporting the unemployed and other vulnerable groups. At the same time, the current crisis has already revived discussions about the effectiveness of existing social protection systems, which will play into the hands of political forces offering new approaches to welfare reform.
Triaging of Culture Conditions for Enhanced Secondary Metabolite Diversity from Different Bacteria
Authors: Schwarz Jenny , Lütz Stephan
Published: December 2020

Over the past decade, the One Strain Many Compounds (OSMAC) approach has been established for silent gene cluster activation and elicitation of secondary metabolite production, but so far the full secondary metabolome of a biosynthetically promising bacterium has not been elucidated yet. Here, we investigate the ability of seven categories of OSMAC conditions to enhance the diversity of new mass features from bacterial strains with little literature coverage but high biosynthetic potential. The strains Bacillus. amyloliquefaciens DSM7, Corallococcus. coralloides DSM2259, Pyxidicoccus. fallax HKI727, Rhodococcus. jostii DSM44719, and Streptomyces. griseochromogenes DSM40499 were selected after genome mining with antiSMASH. After cultivation under OSMAC conditions, the generated extracts were subjected to LC-MS and MZmine analysis to determine new mass features and evaluate the tested culture conditions. 4 predicted compounds, bacillibactin, desferrioxamine B, myxochelin A, and surfactin, were identified and up to 147 new mass features were detected in the generated extracts, which greatly surpasses the number of predicted gene clusters. Among the new mass features are bioactive compounds that were so far unreported for the strains such as cyclo-(Tyr-Pro) from DSM7 and nocardamin from DSM2259. Furthermore, the tested culture conditions were evaluated regarding their suitability for the generation of new mass features from the selected strains and promising new starting points for further screenings are postulated. Especially culture conditions with little prior literature coverage are responsible for the activation of predicted gene clusters
Chromosome Instability in Fanconi Anemia: From Breaks to Phenotypic Consequences
Authors: García-de-Teresa Benilde , Rodríguez Alfredo , Frias Sara
Published: December 2020

Abstract: Fanconi anemia (FA), a chromosomal instability syndrome, is caused by inherited pathogenic variants in any of 22 FANC genes, that cooperate in the FA/BRCA pathway. This pathway regulates the repair of DNA interstrand crosslinks (ICLs) through homologous recombination. In FA proper repair of ICLs is impaired, and accumulation of toxic DNA double strand breaks occurs. In order to repair this type of DNA damage, FA cells activate alternative error-prone DNA repair pathways, that may lead to the formation of gross structural chromosome aberrations of which radial figures are the hallmark of FA and their segregation during cell division are the origin of subsequent aberrations like translocations, dicentrics and acentric fragments. The deficiency in DNA repair has pleiotropic consequences in the phenotype of patients with FA, including developmental alterations, bone marrow failure and an extreme risk to develop cancer. The mechanisms leading to the physical abnormalities during embryonic development have not been clearly elucidated, however FA has features of premature aging with chronic inflammation mediated by pro-inflammatory cytokines, that results in tissue attrition, selection of malignant clones and cancer onset. Moreover, the effect of the FA/BRCA pathway in germinal cells, evidenced by infertility in patients with FA attests of chromosomal instability and cell death also occurring in the germinal compartment.
Hif-Prolyl Hydroxylase Domain Proteins (Phds) in Cancer – Potential Targets for Anti-Tumor Therapy?
Authors: Gaete Diana , Rodriguez Diego , Watts Deepika , Sormendi Sundary , Chavakis Triantafyllos , Wielockx Ben
Published: December 2020

Solid tumors are typically associated with unbridled proliferation of malignant cells, accompanied by an immature and dysfunctional tumor-associated vascular network. Consequent impairment in transport of nutrients and oxygen eventually leads to a hypoxic environment wherein cells must adapt to survive and overcome these stresses. Hypoxia inducible factors (HIFs) are central transcription factors in the hypoxia response and drive the expression of a vast number of survival genes in cancer cells and in cells in the tumor microenvironment. HIFs are tightly controlled by a class of oxygen sensors, the HIF-prolyl hydroxylase domain proteins (PHDs), which hydroxylate HIFs, thereby marking them for proteasomal degradation. Remarkable and intense research during the past decade has revealed that, contrary to expectations, PHDs are often overexpressed in many tumor types and that inhibition of PHDs can lead to decreased tumor growth, impaired metastasis and diminished tumor-associated immune-tolerance. Therefore, PHDs represent an attractive therapeutic target in cancer research. Multiple PHD inhibitors have been developed that have either been recently accepted in China as erythropoiesis stimulating agents (ESA) or are currently in phase III trials. We review here the function of HIFs and PHDs in cancer and related therapeutic opportunities.
An Update on the Chemistry, Pharmacology and Dose Calculations of Mepivacaine Hydrochloride for Podiatrists in the United Kingdom
Authors: Reilly Ian , Burt Nicola , Reilly Rebecca , Swami Ajay
Published: December 2020

Local anaesthetic agents suppress action potentials in excitable tissues by blocking voltage-gated sodium channels. In doing so they inhibit the depolarisation of nociceptive nerve fibres and so prevent the transmission of pain impulses. UK legislation allows HCPC-registered Podiatrists with POM-A annotation access to six local anaesthetic drugs and two of these with the addition of adrenaline. The use of local anaesthetia has transformed the treatment of nail pathology by Podiatrists. In the UK, the drug of choice in podiatric practice is 3% mepivacaine hydrochloride: it is a good choice of drug for digital anaesthesia. This paper will review the chemistry, pharmacology and dose calculation of mepivacaine, and challenge some of the orthodoxy over the rigid calculation of maximum safe dosages.
Revision of the Atmospheric Modeling for SNR Observations in Ground-Based GNSS Reflectometry
Authors: Reinking Jörg
Published: December 2020

The application of signal-to-noise (SNR) observations from ground-based GNSS Reflectometry is becoming an operational tool for coastal sea-level altimetry. As in all data analyses, systematic influences must be reduced here too, to achieve reliable results. A prominent influence results from atmospheric refraction. Different approaches exist to describe or to correct for this influence. In our contribution we will revise the latest developments and suggest a simple atmospheric interferometric delay model that takes into account ray bending as well as along-path propagation delay. The findings are double-checked by numerical experiments based on a step-by-step raytracing procedure.
Development of a Technology of Isothermal Annealing With the Use of the Forging Heat for Chromium-Molybdenum Steel
Authors: Barełkowski Artur , Kuziak Roman
Published: December 2020

The article discusses the results of investigations performed during a thermo-mechanical treatment of forgings made of chromium-molybdenum 42CrMo4 grade steel. The treatment was realized during a regular series production. The forging process was combined with a heat treatment carried out directly after forging on a specially adapted station. Such a production technology will make it possible to eliminate the step of repeated heating of the forgings. On the example of an element of a steering gear, it was demonstrated how it is possible to perform an isothermal annealing process starting from the temperature at which the trimming of the forgings ends. During the cooling of the forgings, it is enough to maintain the temperature at the proper level in order for the exothermal phase transformation of austenite into pearlite to take place. With an appropriate design of the processing line, the heat released during the transformation could be used to maintain the applied temperature, thus limiting the consumption of energy needed to power the devices. The test results show that, with the properly selected temperature of isothermal annealing, it is possible to obtain an equilibrial ferritic-pearlitic structure in the required hardness scope. Introducing such a solution into the industrial practice would allow significant savings of the energy used for the heat treatment.
Liquid-based 3D Cultured Tumoroids Modeling Resistance to Cisplatin and Imatinib in Metastatic Colorectal Cancer
Authors: Sogawa Chiharu , Eguchi Takanori , Namba Yuri , Aoyama Eriko , Ohyama Kazumi , Okamoto Kuniaki
Published: December 2020

Researchers have developed and used several three-dimensional (3D) culture systems, including spheroids, organoids, and tumoroids. Drug resistance is a crucial issue involving recurrence in cancer patients. Many studies on anticancer drugs have been done in 2D culture systems, where-as 3D cultured tumoroids have many advantages for assessing drug sensitivity and resistance. Here, we aim to investigate whether Cisplatin (a DNA crosslinker), Imatinib (a multiple tyro-sine kinase inhibitor), and 5-Fluorouracil (5-FU: an antimetabolite) alter tumoroid growth of metastatic colorectal cancer (mCRC). To establish a liquid-based 3D multiplexing reporter assay system, LuM1 (a murine mCRC cell line) was stably transfected with the Mmp9 promoter-driven ZsGreen reporter gene, which was designated as LuM1/m9 cells and cultured in NanoCulture Plate (NCP), a 3D culture device. The larger tumoroids were not sensitive to Cisplatin and ex-pressed ABCG2 (a marker of cancer stem cells, a.k.a. a drug efflux transporter), whereas smaller cell-aggregates were more sensitive to Cisplatin. Both Imatinib and Cisplatin significantly in-creased tumoroid growth (larger than 300 μm2) and Mmp9 promoter activity and were not cytotoxic to the mCRC tumoroids. On the other hand, 5-FU was cytotoxic to the tumoroids and significantly inhibited tumoroid growth, although not completely. Thus, platinum resistance and imatinib resistance in mCRC were modeled using the liquid-based 3D cultured tumoroid system. The tumoroid culture is useful and easily accessible for the assessment of drug sensitivity and resistance.
Comparative Analysis of Disaster Risk Management Policies in the Region of South-East Europe
Authors: Cvetković Vladimir M. , Todorović Saša
Published: December 2020

Using measures for sustainable development and reducing the risk of disasters in order to protect the population, goods and the environment, is the duty of every state in the fight against the security challenges that disasters bring. Disaster risk reduction is a multidisciplinary policy designed to implement various measures to strengthen community resilience and preparedness for disasters. The region of Southeast Europe is recognized as extremely endangered by natural disasters. The countries of the region, especially their national risk management policies, continue to be based in part on solutions from earlier times. The subject of the research is focused on the analysis of disaster risk management policies in the countries of Southeast Europe, their comparison and review of similarities and differences. The countries of this region base their policies on similar solutions aimed at reducing the risk of disasters. There are shortcomings in the full implementation of the adopted international frameworks in the national risk management policies and normative-legal frameworks in certain countries of this region.
The Ambiguities of ‘Sustainable’ Berlin
Authors: Kalandides Ares , Grésillon Boris
Published: December 2020

City Marketing has a strong tradition in Berlin, with two organisations, Berlin Partner and Visit Berlin, responsible for designing and implementing relevant strategies. Sustainability has been on and off the city marketing agenda, almost exclusively in its environmental dimension. In this article we examine the current representations of Berlin as a “sustainable city” in the official City Marketing strategies. We look at how sustainability is used and instrumentalized to create a specific city profile, and also to attract particular target groups in tourism. We propose an analysis of sustainable planning in Berlin since reunification, to show how it has moved into different directions over time and how this has (or has not) been followed by City Marketing. In this endeavour we move between the existing, and as we argue deeper and more sophisticated, environmental planning of the city on the one hand, and the reductions and simplifications of City Marketing representations on the other. Finally, we argue that there are inherent contradictions in marketing a sustainable city, where both in terms of tourism and economic development, the concept of growth seems to be reaching environmental limits.
New Pharmaceutical Salts of Trazodone
Authors: Jaśkowska Jolanta , Zaręba Przemysław , Drabczyk Anna , Kozak Agnieszka , Madura Izabela , Majka Zbigniew , Pindelska Edyta
Published: December 2020

New pharmaceutically acceptable salts of trazodone for the treatment of central nervous system disorders are synthesized and described. Each salt (trazodone hydrogen bromide and trazodone 1-hydroxy-2-naphthoate) was obtained by two or three different methods leading to the same crystalline form. Although trazodone salts are poorly crystalline, single-crystal X-ray diffraction data for trazodone 1-hydroxy-2-naphthoate were collected and analyzed as well as compared to the previously described crystal structure of commercially available trazodone hydrochloride. The powder samples of all new salts were characterized by Fourier transform infrared spectroscopy and 13C solid-state nuclear magnetic resonance spectroscopy. Spectroscopic studies were supported by gauge including projector augmented wave (GIPAW) calculations of carbon chemical shielding constants. The main goal of our research was to find salts with better physicochemical properties and to make an attempt to associate them with both the anion structure and the most prominent interactions exhibited by the protonated trazodone cation. The dissolution profiles of trazodone from tablets prepared from various salts with lactose monohydrate were investigated. The studies revealed that salts with simple anions show a fast release of the drug while the presence of more complex anion, more strongly interacting with the cation, effects a slow-release profile of the active substance and can be used for the preparation of the tables with a delay or prolonged mode of action.
A metodologia WebQuest no ensino de História: uma experiência com estudantes da educação básica
Authors: Nascimento Éder Dias Do , Hahn Fábio André
Published: December 2020

Integrar as tecnologias à prática docente tem sido um grande desafio para o sistema educacional brasileiro nestas primeiras décadas do século XXI, principalmente no que diz respeito ao uso da internet nas diferentes disciplinas. O presente artigo apresenta um estudo sobre as contribuições da metodologia de navegação orientada WebQuest para o ensino de História aplicada em uma escola pública. Seus resultados evidenciaram que, além da necessidade da constante reflexão sobre os elementos formais da metodologia WebQuest, é relevante pensar sobre ela considerando o protagonismo dos estudantes e a forma específica de como eles se apropriam das tecnologias.
Nonoperative Treatment of Anterior Glenoid Rim Fractures After First-Time Traumatic Anterior Shoulder Dislocation
Authors: Wieser Karl , Waltenspül Manuel , Ernstbrunner Lukas , Ammann Elias , Nieuwland Arend , Eid Karim , Gerber Christian
Published: December 2020

Background:

Primary traumatic anterior shoulder dislocations can be associated with displaced anterior glenoid rim fractures. Nonoperative treatment of such fractures has been shown to have excellent results in a small cohort of patients; as such, we have been treating these fractures nonoperatively, regardless of fragment size and degree of displacement, provided that post-reduction computed tomography scans revealed an anteroposteriorly centered humeral head. The aim of this study was to analyze the medium- to long-term results of nonoperative treatment of displaced anterior glenoid rim fractures, assessing in particular the residual instability and development of osteoarthritis.

Methods:

In a 2-center study, 30 patients with a mean age of 48 years (range, 29 to 67 years) were evaluated clinically with use of the Subjective Shoulder Value, Constant score, American Shoulder and Elbow Surgeons score, and Western Ontario Shoulder Instability index, as well as radiographically with use of radiographs and computed tomography scans at a mean follow-up of 9 years (range, 5 to 14 years).

Results:

Fracture-healing was documented in all patients. Seven patients (23%) had post-fracture onset of osteoarthritis (5 with Samilson grade I and 2 with Samilson grade IV). Of these, 1 patient had recurrent instability that was successfully treated with hemiarthroplasty 9 years after the index injury (relative Constant score, 101%), and was excluded from further analysis. No other patient had a recurrent redislocation, subluxation, or positive apprehension. The other 6 patients with new-onset radiographic osteoarthritis were pain-free (mean Constant score pain scale, 15 points) with good shoulder function (relative Constant score, 84% to 108%). A total of 26 patients (90%) rated their functional outcome as good or very good, and 3 patients (10%) rated it as fair. The mean relative Constant score was 97% (range, 61% to 108%), the mean American Shoulder and Elbow Surgeons score was 92 points (range, 56 to 100 points), and the mean Western Ontario Shoulder Instability index score was 126 points (range, 0 to 660 points). All patients returned to full-time work.

Conclusions:

Nonoperative treatment of anterior glenoid rim fractures following primary traumatic anterior shoulder dislocation results in excellent clinical outcomes with a very low rate of residual instability and, thus, treatment failure. Asymptomatic radiographic osteoarthritis occurred in roughly 1 of 4 patients.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Vertebrobasilar Artery Geometry and Bisilar Artery Plaques: A High-Resolution Magnetic Resonance Imaging Stydy
Authors: Zheng Jinmei , Sun Bin , Lin Ruolan , Teng Yongqi , Zhao Xihai , Xue Yunjing
Published: December 2020

Background Atherosclerotic plaques are often present in regions with complicated flow patterns. Vascular morphology plays a role in hemodynamics. In this study, we investigate the relationship between the geometry of the vertebrobasilar artery system and the basilar artery (BA) plaque prevalence.Methods We enrolled 290 patients with posterior circulation ischemic stroke. We distinguished four configurations of the vertebrobasilar artery: Walking, Tuning Fork, Lambda, and No Confluence. The diameter of the vertebral artery (VA) and the number of bends in the intracranial VA segment was assessed using three-dimensional time-of-flight magnetic resonance angiography. We differentiated between multi-bending (≥ 3 bends) and oligo-bending (< 3 bends) VAs. High-resolution magnetic resonance imaging was used to evaluate BA plaques. Logistic regression models examined the relationship between the geometry type and BA plaque prevalence.Results After adjusting for sex, age, body mass index ≥ 28, hypertension, and diabetes mellitus, the Walking, Lambda, and No Confluence geometries were associated with the presence of BA plaque. Patients with multi-bending VAs in both the Walking (71.43%, P = 0.003) and Lambda group (40.43%, P = 0.018) had more plaques compared to patients with oligo-bending VAs in these groups. In the Lambda group, the diameter difference between the VAs was larger in patients with BA plaques than that in patients without BA plaques (1.4 mm vs. 0.9 mm, P < 0.001).Conclusions The Walking, Lambda, and No Confluence geometry, ≥ 3 bends in the VAs, and a large diameter difference between the VAs were associated with the presence of BA plaque.
A contact tracing prospective cohort retrieving epidemiological facts on SARS-CoV-2 transmission aspects; a serological analysis
Authors: Vazirinejad Reza , Khalili Parvin , Jafarzadeh Abdollah , Shabani Ziba , Jamalizadeh Ahmad , Rezaei Batool , Ahmadnia Hassan , Rezayati Mohammad-taghi , Ebrahimian Mohammad , Mehralinasab Gholamreza , Bagherizadeh Azam , Bazaz Shima , Vazirinejad Erfan
Published: December 2020

Introduction Novel coronavirus spread seems mysterious enough for convincing us to double check the indices being used to predict its transmission. Serological analysis was applied for assessing some metric epidemiological aspects of the infection and its transmissibility among people who were in contact with SARA-CoV-2 patients. Methods In this contact tracing prospective cohort study, 453 contact cases of forty COVID 19 patients were followed for three months. SARS-CoV-2 patients were diagnosed by real time polymerase chain reaction testing of nasopharyngeal samples. The history of infectiousness was detected by serological testing of IgG and IgM. Trained expert team completed two questionnaires and blood samples were taken by experts in laboratory. Data were analyzed using SPSS (Ver.21) and R software. Some important epidemiological characteristics of the infection were calculated. Results Mean age of SARS-CoV-2 patients and contact cases were 53.0±18.2 and 30.8±19.3 years, respectively. Overall R0 of the infection was 2.56. Household and non-household secondary attack rates (SAR) were 20% (95%CI; 12.7 – 27.3) and 11.3% (95%CI; 6.1-16.5), respectively. Transmission probability in each contact was 0.0205 and the serial interval was 6.4±4.6 (95% CI; 5.2–7.6) days. SAR among contact cases who exposed asymptomatic primary cases (28%, 95%CI; 10-46%) was higher than that (13.8%, 95%CI;9.4-18.2) among contact cases exposing to symptomatic patients. Conclusions We concluded a herd immunity between 60 and 65% is needed in human communities. Findings demonstrated how much reduction in infection R0 is predicted based on both clinical and public health interventions.
Herpes Simplex Virus 1 and the Risk of Dementia: A Population-Based Study
Authors: Murphy Meghan , Fani Lana , Ikram Kamran , Ghanbari Mohsen , Ikram Arfan
Published: December 2020

IntroductionHerpes Simplex Virus 1 (HSV1) is a neuroinvasive virus capable of entering the brain which makes it a candidate pathogen for increasing risk of dementia. Previous studies are inconsistent in their findings regarding the link between HSV1 and dementia, therefore, we investigated how HSV1 relates to cognitive decline and dementia risk using data from a population-based study. MethodsWe measured HSV1 immunoglobulin (IgG) antibodies in serum collected between 2002 and 2005 from participants of the Rotterdam Study. We used linear regression to determine HSV1 in relation to change in cognitive performance during 2 consecutive examination rounds on average 6,5 years apart. Next, we determined the association of HSV1 with risk of dementia (until 2016) using a Cox regression model. We repeated analyses for Alzheimer’s disease. All models were adjusted for age, sex, cardiovascular risk factors, and apolipoprotein E genotype. Results Of 1,915 non-demented participants (mean age 71.3 years, 56.7% women), with an average follow-up time of 9.1 years, 244 participants developed dementia (of whom 203 Alzheimer’s disease). HSV1 seropositivity was associated with decline in global cognition (mean difference per standard deviation -0.16; 95% confidence interval (95%CI), -0.26; -0.07), as well as separate cognitive domains, namely memory, information processing, and executive function, but not motor function. Finally, HSV1 seropositivity was not associated with risk of dementia (adjusted hazard ratio, 1.18, 95%CI, 0.83; 1.68), similar for Alzheimer’s disease. DiscussionHSV1 is associated with cognitive decline but not with incident dementia in the general population. These data suggest HSV1 to be associated only with subtle cognitive disturbances but not with greater cognitive disorders that result in dementia.
The Effectiveness of Syndromic Surveillance for the Early Detection of Waterborne Outbreaks: A Systematic Review
Authors: Hyllestad Susanne , Amato Ettore , Nygård Karin , Line Vold , Aavitsland Preben
Published: December 2020

Background: Waterborne outbreaks are still a risk in high-income countries, and their early detection is crucial to limit their societal consequences. Although syndromic surveillance is widely used for the purpose of detecting outbreaks days earlier than traditional surveillance systems, evidence of the effectiveness of such systems is lacking. Thus, our objective was to conduct a systematic review of the effectiveness of syndromic surveillance to detect waterborne outbreaks. Method: We searched the Cochrane Library, Medline/PubMed, EMBASE, Scopus, and Web of Science for relevant published articles using a combination of the keywords ‘drinking water’, ‘surveillance’, and ‘waterborne disease’ for the period of 1990 to 2018. The references lists of the identified articles for full-text record assessment were screened, and random searches using the same key words were conducted. We assessed the risk of bias in the included articles using the ROBINS-I tool and PRECEPT for the cumulative body of evidence. Results: From the 1,955 articles identified, we reviewed 52 articles, of which 16 met the eligibility criteria. Ten were retrospective studies, whereas six were simulation studies. There is no clear evidence for syndromic surveillance in terms of the ability to detect waterborne outbreaks (low sensitivity and high specificity). However, one simulation study implied that multiple sources of signals combined with spatial information may increase the timeliness in detecting a waterborne outbreak and reduce false alarms. Conclusion: This review demonstrates that there is no conclusive evidence on the effectiveness of syndromic surveillance for the detection of waterborne outbreaks, thus suggesting the need to focus on primary prevention measures to reduce the risk of waterborne outbreaks. Future studies should investigate methods for combining health and environmental data with an assessment of needed financial and human resources for implementing such surveillance systems.
A Case of Thyrotoxicosis-induced Anemia After the Onset of Painless Thyroiditis in a Patient With Pancreatic Diabetes Mellitus: Profile of Hemoglobin, Thyroid Hormones, Soluble IL-2 Receptor, LDL-C, HDL-C and Liver Function.
Authors: Komiya Ichiro , Yagi Noriharu , Tomoyose Takeaki , Ouchi Gen , Wakugami Tamio
Published: December 2020

Background: There have been several reports of secondary anemia associated with Graves' disease. There are no reports of secondary anemia resulting from thyrotoxicosis due to painless thyroiditis (silent thyroiditis). We report the case of a patient with pancreatic diabetes who developed normocytic anemia caused by thyrotoxicosis due to painless thyroiditis.Case presentation: The patient was a 37-year-old man who visited the hospital complaining of fatigue, palpitations, and dyspnea. His hemoglobin was 110 g/l, and mean corpuscular volume was 81.5 fl. His free thyroxine (FT4) was high, at 1.004 pmol/l, the free triiodothyronine (FT3) was high, at 27.49 pmol/l, TSH was <0.01 mIU/l, and TSH receptor antibody was negative. Soluble IL-2 receptor (sIL-2R) was high, at 1,340 U/ml, low-density lipoprotein cholesterol (LDL-C) was 0.78 mmol/l, and high-density lipoprotein cholesterol (HDL-C) was 0.75 mmol/l. Propranolol was prescribed and followed up. Thyroid hormones, sIL-2R, LDL-C, and HDL-C had almost normalized by 8 weeks after onset. Anemia completely disappeared by 12 weeks after disease onset. Slight increases in liver enzyme levels and a decrease in serum albumin were observed, and recovered later than normalization of thyroid function and cholesterol levels. He developed mild hypothyroidism and was treated with L-thyroxine at 24 weeks.Conclusions: This is the first case report of transient secondary anemia associated with thyrotoxicosis due to painless thyroiditis. Changes in sIL-2R, HDL-C, LDL-C and liver function were also observed during the clinical course of thyrotoxicosis and anemia, suggesting the autoimmune processes in thyroid gland, bone marrow and liver.
Physical Restraint of Dementia Patients in Acute-Care Hospitals During the COVID-19 Pandemic: A Cohort Analysis in Japan
Authors: Okuno Takuya , Shin Jung-ho , Takada Daisuke , Morishita Tetsuji , Kunisawa Susumu , Imanaka Yuichi
Published: December 2020

Background: The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for medical staff worldwide, especially for those working in hospitals in which COVID-19-positive or -suspected patients are being treated. The announcement of COVID-19 hospital restrictions by the Japanese government has led to several limitations in hospital care, including an increased use of physical restraints, that could affect the care of elderly dementia patients. However, few studies have empirically validated the impact of physical restraint use during the COVID-19 pandemic. We aimed to evaluate the impact of regulatory changes, consequent to the pandemic, on physical restraint use among elderly dementia patients in acute care hospitals.Methods: In this retrospective cohort study, we extracted the data of elderly patients (age >65 years) who received dementia care in acute care hospitals to which COVID-19-positive or -suspected patients were admitted between July 1, 2018 and June 30, 2020. We calculated descriptive statistics to compare the year-on-year trend in 2-week intervals and conducted an interrupted time-series analysis to validate the changes in the use of physical restraint.Results: The year-on-year trend in the number of patients who were physically restrained per 1,000 hospital admissions increased after the government’s announcement of COVID-19 restrictions, with a maximum incidence of 111.4% between the 47th and 48th week after the announcement. Additionally, a significant increase in the use of physical restraints in elderly dementia patients was noted (p=.002).Conclusions: Elderly dementia patients who required personal care experienced an obvious and significant increase in the use of physical restraints during the COVID-19 pandemic. Understanding the causes and mechanisms underlying an increased use of physical restraints in dementia patients can help design more effective care protocols for similar future situations.
The Associations of Psoas and Masseter Muscles With Sarcopenia and Related Adverse Outcomes in Older Trauma Patients- A Retrospective Study
Authors: Varma Surabhi , Wilson Michael SJ , Naik Mitesh , Sandhu Amandeep , Ota Helen Chidera Uchenna , Aylwin Christopher , Fertleman Michael , Peck George
Published: December 2020

Background: There is an emerging role for the radiological evaluation of the psoas muscle as a marker of sarcopenia, and as a prognostic discriminant in elderly patients with traumatic injuries. Older trauma patients are more likely to undergo cranial than abdomino-pelvic imaging. Identifying sarcopenia using masseter cross sectional area (M-CSA) has shown correlation with mortality. We sought to determine the correlation between psoas: lumbar vertebral index (PLVI) and the M-CSA, and their association with health outcomes. Methods: Patients aged 65 or above, who presented as a trauma call over a 1 year period were included if they underwent cranial or abdominal CT imaging. Images were retrospectively analyzed to obtain PLVI and mean M-CSA measurements. Electronic records were abstracted for demographics and outcomes. Logistic regression methods, log scale analyses, Cox regression model and Kaplan-Meier plots were used to determine association of sarcopenia with outcomes. Results: There were 155 eligible patients in the M-CSA group and 204 patients in the PLVI group. Sarcopenia was defined as the lowest quartile in each group. Both PLVI and M-CSA measurements were available in 142 patients. Pearson’s correlation indicated a weakly positive linear relationship (r=0.35, p<0.001) between these. There was no statistical association between M-CSA sarcopenia status and any measured outcomes. Those with PLVI sarcopenia were more likely to die in hospital (adjusted OR 3.38, 95% CI 1.47-9.73, p=0.006) and at 2-years (adjusted HR 1.90, 95% CI 1.11-3.25, p=0.02). Only 29% patients with PLVI sarcopenia were discharged home, compared with 58% without sarcopenia (p=0.001).Conclusion: Sarcopenia, defined by PLVI, is predictive of increased in-patient and 2- year mortality. Our study did not support prognostic relevance of M-CSA. Further research should be directed at improving the validity of masseter measurements or identifying alternative radiological determinants of sarcopenia on cranial imaging.
WITHDRAWN: The Correlation Between Early Net Fluid Balance and The Clinical Outcomes of Patients Receiving Extracorporeal Cardiopulmonary Resuscitation
Authors: Li Wei , Lv Jinru , Hu Deliang , Sun Feng , He Fengpu , Chen Xufeng , Mei Yong
Published: December 2020

Background: Large amounts of fluid administration are often needed during the extracorporeal cardiopulmonary resuscitation (ECPR) course. Finally, fluid overload is often present.Methods: Adult patients on ECPR admitted to our center from May 2015 to December 2020 were included. Net fluid balance for consecutive 4 days after ECPR was recorded. The primary outcome was to intensive care unit(ICU) survival . We used multivariable logistic regression to assess the association between fluid status and clinical outcome.Results: A total of 72 patients were enrolled and divided into two groups: the survivor group and the non-survivor group. The overall rate of ICU survival was 44.4%. Daily fluid balance(DFB) in the survivor group was lower than that in the non-survivor group at day 4 (-11.47[-19.74,8.7] vs -5.08[-12.94,13.9]ml/kg, P=0.046), as was CFB over the first 4 days (-36.03[-51.45,19.03] vs -7.22[-32.79,21.02] ml/kg, P=0.009). Both continuous renal replacement therapy(CRRT) and CFB from days 1-4 were significantly correlated with ICU survival(OR=14.617[95%CI:1.344,48.847], P=0.028; OR=1.261[95%CI1.091,1.375], P=0.003, respectively). CFB from day 1-4 was determined to have a roughly linear association with the log odds of ICU survival.Conclusions: Early negative fluid balance maybe associated with ICU survival in patients receiving ECPR.
Learning From the 'Tail End' of De-implementation: The Case of Chemical Castration for Localized Prostate Cancer
Authors: Skolarus Ted A. , Forman Jane , Sparks Jordan B. , Metreger Tabitha , Hawley Sarah T. , Caram Megan , Dossett Lesly , Paniagua-Cruz Alan , Makarov Danil , Leppert John T. , Shelton Jeremy B. , Stensland Kristian , Hollenbeck Brent K. , Shahinian Vahakn , Sales Anne E. , Wittmann Daniela A.
Published: December 2020

Background: Men with prostate cancer are often treated with the suppression of testosterone through long-acting injectable drugs termed chemical castration or androgen deprivation therapy (ADT). In most cases, ADT is not an appropriate treatment for localized prostate cancer, indicating low-value care. Guided by the Theoretical Domains Framework (TDF) and the Behavior Change Wheel’s Capability, Opportunity, Motivation Model (COM-B), we conducted a qualitative study to identify behavioral determinants of low-value ADT use to manage localized prostate cancer, and theory-based opportunities for de-implementation strategy development.Methods: We used national cancer registry and administrative data from 2016-2017 to examine variation in low-value ADT use across Veterans Health Administration facilities. Using purposive sampling, we selected high and low performing sites to conduct 20 urology provider interviews regarding low-value ADT. We coded transcripts into TDF domains and mapped content to the COM-B Model to generate a conceptual framework for addressing low-value ADT practices.Results: Our interview findings reflected provider perspectives on prescribing ADT as low-value localized prostate cancer treatment. We characterized providers as belonging in 1 of 3 categories with respect to low-value ADT use: 1) never prescribe, 2) willing, under some circumstances, to prescribe, and 3) prescribe as an acceptable treatment option. Provider Capability to prescribe low-value ADT depended on their knowledge of localized prostate cancer treatment options (knowledge) coupled with interpersonal skills to engage patients in educational discussion (skills). Provider Opportunity to prescribe low-value ADT centered on the environmental resources to inform ADT decisions (e.g., multi-disciplinary review), perceived guideline availability, and social influences regarding ADT practices, such as prior training. Provider Motivation involved goals of ADT use, including patient preferences, beliefs in capabilities/professional confidence and beliefs about the consequences of prescribing or not prescribing ADT. Conclusions: Use of the TDF domains and the COM-B model enabled us to conceptualize provider behavior with respect to low-value ADT use and clarify possible areas for intervention to effect de-implementation of low-value ADT prescribing in localized prostate cancer.
A systematic review and meta-analysis of nab-paclitaxel mono-chemotherapy for metastatic breast cancer
Authors: Lu Haili , Zha Siluo , Zhang Wei , Wang Qiang , Jiang Daozhen , Xu Xinyun , Zheng Xiangmin , Qiu Ming , Shan Chengxiang
Published: December 2020

Background
Various clinical trials and real-life studies have tried to explore the value of nab-paclitaxel mono-chemotherapy for metastatic breast cancer (MBC). The safety and efficacy of nab-paclitaxel needs to be systematically evaluated.
Methods
Electronic searches for prospective clinical trials containing nab-paclitaxel monotherapy for MBC were performed. Requisite data were extracted, integrated and analyzed from the included studies according to different purposes using systematic review and meta-analysis.
Results
22 studies with 3287 MBC patients were included. 1685 MBC patients received nab-paclitaxel as first-line therapy, 640 patients as further-line therapy, and 962 patients as mixed-line therapy. 1966 MBC patients (60.40%) received nab-paclitaxel weekly, while 1190 patients (36.56%) received nab-paclitaxel triweekly and 99 patients (3.04%) biweekly. The overall incidence of all grades neutropenia, leukopenia, peripheral sensory neuropathy, and fatigue was 52% (95% CI, 38%-66%), 58% (95% CI, 43%-73%), 58% (95% CI, 48%-68%), and 49% (95% CI, 41%-56%) respectively. The overall response rate (ORR) was 40% (95% CI, 35%-45%) and the clinical benefit rate (CBR) was 66% (95% CI, 59%-73%) following nab-paclitaxel monotherapy. The median progression free survival (PFS) was 7.64 months (95% CI, 6.89–8.40 months) and the median overall survival (OS) was 24.51 months (95% CI, 21.25–27.78 months). According to the meta-regression analysis, grade 3/4 neutropenia occurred less frequently in Her-2 negative patients compared with all population (P = 0.046). Patients who received first-line nab-paclitaxel monotherapy showed higher ORR (P = 0.006) and longer PFS (P = 0.045). Patients who received further-line therapy was demonstrated to have shorter median OS versus first- and mixed-line therapy. Efficacy outcomes were not affected by the administration schedule. However, patients appeared to have more superior ORR (P = 0.044) and longer PFS (P = 0.03) along with the increasing dosage of nab-paclitaxel under the same schedule.
Conclusions
Both weekly and triweekly nab-paclitaxel mono-chemotherapy were proved to be effective for MBC with generally reasonable toxicity profiles. Higher ORR, longer PFS and OS would be achieved in patients treated with nab-paclitaxel as first line. Increasing nab-paclitaxel dosage would result in better tumor control (higher ORR and PFS). Changing nab-paclitaxel schedule had no benefit on ameliorating the overall survival.