bluuebunny/crossref_metadata_2025 huggingface dataset:
In vitro antimicrobial susceptibility of clinical respiratory isolates to ceftazidime-avibactam and comparators (2016–2018)
Authors: Piérard D. , Stone G. G.
Published: June 2021

Background

This antimicrobial surveillance study reports in vitro antimicrobial activity and susceptibility data for a panel of agents against respiratory isolates of Enterobacterales and Pseudomonas aeruginosa.

Methods

Isolates from respiratory specimens were collected in Africa/Middle East, Asia/South Pacific, Europe and Latin America between 2016 and 2018, as part of the Antimicrobial Testing Leadership and Surveillance (ATLAS) program. Broth microdilution methodology was used to quantify minimum inhibitory concentrations, from which rates of susceptibility were determined using EUCAST breakpoints (version 10). Rates of subsets with genes encoding β-lactamases (extended-spectrum β-lactamases [ESBLs], serine carbapenemases and metallo-β-lactamases [MBLs]) were also determined, as well as rates of multidrug-resistant (MDR) P. aeruginosa.

Results

Among all respiratory Enterobacterales isolates, susceptibility to ceftazidime-avibactam, meropenem, colistin and amikacin was ≥94.4% in each region. For Enterobacterales isolates that were ESBL-positive or carbapenemase-positive/MBL-negative, ceftazidime-avibactam susceptibility was 93.6 and 98.9%, respectively. Fewer than 42.7% of MBL-positive Enterobacterales isolates were susceptible to any agents, except colistin (89.0% susceptible). Tigecycline susceptibility was ≥90.0% among Citrobacter koseri and Escherichia coli isolates, including all β-lactamase-positive subsets. ESBL-positive Enterobacterales were more commonly identified in each region than isolates that were ESBL/carbapenemase-positive; carbapenemase-positive/MBL-negative; or MBL-positive. Among all respiratory P. aeruginosa isolates, the combined susceptibility rates (susceptible at standard dosing regimen plus susceptible at increased exposure) were highest to ceftazidime-avibactam, colistin and amikacin (≥82.4% in each region). Susceptibility to colistin was ≥98.1% for all β-lactamase-positive subsets of P. aeruginosa. The lowest rates of antimicrobial susceptibility were observed among MBL-positive isolates of P. aeruginosa (≤56.6%), with the exception of colistin (100% susceptible). MDR P. aeruginosa were most frequently identified in each region (18.7–28.7%), compared with the subsets of ESBL-positive; carbapenemase-positive/MBL-negative; or MBL-positive isolates.

Conclusions

Rates of susceptibility among the collections of respiratory Enterobacterales and P. aeruginosa isolates were highest to ceftazidime-avibactam, colistin and amikacin in each region. Tigecycline was active against all subsets of C. koseri and E. coli, and colistin was active against all subsets of P. aeruginosa. The findings of this study indicate the need for continued antimicrobial surveillance among respiratory Gram-negative pathogens, in particular those with genes encoding MBLs.
Predictors of aetiology and outcomes of acute gastrointestinal illness in returning travellers: a retrospective cohort analysis
Authors: Lever Robert A. , Tapper Louis , Skarbek Sophie , Chiodini Peter L. , Armstrong Margaret , Bailey Robin L.
Published: June 2021

Background

Gastrointestinal illness is a major cause of morbidity in travellers and is a common reason for presentation to healthcare services on return. Whilst the aetiology of imported gastrointestinal disease is predominantly infectious, outcomes are variable due to a range of phenomena such as post-infectious irritable bowel syndrome, drug resistance and occult pathology (both infectious and non-infectious). Previous studies have focussed on predictors of aetiology of gastrointestinal disease in travellers; we present a retrospective study combining both aetiological and early outcome data in a large cohort of returned travellers.

Method

We identified 1450 patients who attended our post-travel walk-in clinic with gastrointestinal symptoms between 2010 and 2016. Demographic, travel, clinical and laboratory data was collected through case note review. Logistic regression analysis to examine correlates of aetiology and outcome were performed in R (CRAN Project 2017).

Results

Of 1450 patients in our cohort 153 reported bloody diarrhoea and 1081 (74.6%) reported non-bloody diarrhoea. A definitive microbiological diagnosis was made in 310 (20.8%) of which 137 (9.4%) had a parasite identified and 111 (7.7%) had a bacterial cause identified. Factors associated with a parasitological diagnosis included history of travel to South Asia (aOR = 2.55; 95%CI 1.75–3.70, p < 0.0001) and absence of bloody diarrhoea (aOR = 0.22; 95%CI 0.066–0.53, p < 0.005). Factors associated with a bacteriological diagnosis included male gender (aOR = 1.69; 95%CI 1.10–2.62, p < 0.05), an age < 37 years on presentation (aOR = 2.04; 95%CI 1.25–3.43, p < 0.01), white cells on stool microscopy (aOR = 3.52; 95%CI 2.09–5.86, p < 0.0001) and a C-reactive protein level of >5iu/dL (aOR = 4.68; 95%CI 2.91–7.72, p < 0.0001). The majority (1235/1450, 82.6%) reported full symptomatic resolution by the first follow up visit; factors associated with lack of symptomatic resolution included female gender (aOR = 1.45 95%CI 1.06–1.99, p < 0.05), dysenteric diarrhoea (aOR = 2.14 (95%CI 1.38–3.25, p < 0.0005) and elevated peripheral leukocyte count (aOR = 1.58 95%CI 1.02–2.40, p < 0.05).

Conclusions

In a cohort of returned travellers, we were able to identify multiple factors that are correlated with both aetiology and outcome of imported gastrointestinal syndromes. We predict these data will be valuable in the development of diagnostic and therapeutic pathways for patients with imported gastrointestinal infections.
The INTREST registry: protocol of a multicenter prospective cohort study of predictors of women’s response to integrative breast cancer treatment
Authors: Haller Heidemarie , Voiß Petra , Cramer Holger , Paul Anna , Reinisch Mattea , Appelbaum Sebastian , Dobos Gustav , Sauer Georg , Kümmel Sherko , Ostermann Thomas
Published: June 2021

Background

Cancer registries usually assess data of conventional treatments and/or patient survival. Beyond that, little is known about the influence of other predictors of treatment response related to the use of complementary therapies (CM) and lifestyle factors affecting patients’ quality and quantity of life.

Methods

INTREST is a prospective cohort study collecting register data at multiple German certified cancer centers, which provide individualized, integrative, in- and outpatient breast cancer care. Patient-reported outcomes and clinical cancer data of anticipatedN = 715 women with pTNM stage I-III breast cancer are collected using standardized case report forms at the time of diagnosis, after completing neo−/adjuvant chemotherapy, after completing adjuvant therapy (with the exception of endocrine therapy) as well as 1, 2, 5, and 10 years after baseline. Endpoints for multivariable prediction models are quality of life, fatigue, treatment adherence, and progression-based outcomes/survival. Predictors include the study center, sociodemographic characteristics, histologic cancer and comorbidity data, performance status, stress perception, depression, anxiety, sleep quality, spirituality, social support, physical activity, diet behavior, type of conventional treatments, use of and belief in CM treatments, and participation in a clinical trial. Safety is recorded following the Common Terminology Criteria for Adverse Events.

Discussion

This trial is currently recruiting participants. Future analyses will allow to identify predictors of short- and long-term response to integrative breast cancer treatment in women, which, in turn, may improve cancer care as well as quality and quantity of life with cancer.

Trial registration

German Clinical Trial RegisterDRKS00014852. Retrospectively registered at July 4th, 2018.
A systematic review and meta-analysis of group peer support interventions for people experiencing mental health conditions
Authors: Lyons Natasha , Cooper Chris , Lloyd-Evans Brynmor
Published: June 2021

Background

Peer support is being integrated within mental health services to further the development of a recovery approach. However, the most effective models and formats of intervention delivery are unknown. We conducted this systematic review and meta-analysis to determine the effectiveness of peer support for improving outcomes for people with lived experience of mental health conditions, when delivered as group interventions.

Methods

Studies reporting randomised controlled trials of group peer support interventions for people experiencing mental health conditions were identified by searching MEDLINE, PsycINFO, Embase and Cochrane CENTRAL, from inception until July 12th 2019 and undertaking supplementary searches. Included studies were assessed for risk of bias and meta-analyses were conducted if three or more trials provided usable data.

Results

Eight trials met eligibility criteria, providing data from 2131 participants. Six trials had either high or unclear risk of bias. Interventions were categorised as mutual support groups, or peer support groups, sub-categorised as anti-stigma or self-management interventions.

Meta-analyses were only possible for peer support groups and five outcomes. We found evidence that group peer support may make small improvements to overall recovery but not hope or empowerment individually, or to clinical symptoms. Evidence for effectiveness for outcomes which could not be meta-analysed was mixed.

Conclusions

Findings from the few eligible trials suggest group peer support interventions may be specifically effective for supporting personal recovery and have a limited impact on other outcomes, though there were some risks of bias to study findings. Interventions were heterogeneous and most social outcomes were absent in the literature, highlighting further limitations to the current evidence-base. There is insufficient evidence available from trials of group peer support torecommend the routine implementation of these interventions across mainstream mental health services at present. More high-quality trials of peer-developed, group peer support interventions are needed in order tomake firm conclusions about intervention effectiveness.
Racial and ethnic disparities in subjective cognitive decline: a closer look, United States, 2015–2018
Authors: Gupta Sangeeta
Published: June 2021

Background

Subjective cognitive decline (SCD), characterized by self-experience of deterioration in cognitive performance may be a precursor to Alzheimer’s disease (AD). Given the association of AD with dependence and disability for a long duration, earlier the detection, the sooner people and their families can receive information regarding better management. It is critical to explore disparities amongst racial and ethnic populations with SCD in order to facilitate targeted interventions. The primary objective was to identify disparities in prevalence of SCD amongst Whites, Blacks and Hispanics by select sociodemographic characteristics and functional limitations in a U.S. population-based sample of non-institutionalized adults aged 45 and older. The secondary objective was to assess the association between SCD and select chronic conditions (angina, heart attack, stroke, diabetes, high blood pressure and high cholesterol) by race/ethnicity.

Methods

Combined data (2015–2018) were obtained from the Behavioral Risk Factor Surveillance System (BRFSS) to conduct a population -based study. Analyses included 179,852 respondents aged 45 years or older who answered the SCD screening question as “yes” (n = 19,276) or “no” (n = 160,576). Descriptive statistics examined sociodemographic characteristics including functional limitations amongst racial/ethnic groups with SCD. Association of SCD with chronic conditions by race/ethnicity was also calculated.

Results

Overall, 10.8% (CI: 10.6–11.1) of adults aged 45 years or older reported SCD.10.7% Whites, 12.3% Blacks and 9.9% Hispanics experienced SCD. Blacks and Hispanics with SCD were more likely to be in the younger age group (45–54 years), less educated, low income, without access to health care, living alone and with functional limitations. Only half had discussed cognitive decline with a health care professional. Prevalence of selected chronic conditions was significantly higher in all racial/ethnic groups with SCD.

Conclusions

Demographic trends predict a larger proportion of Hispanics and Blacks with SCD in the coming years. This information can lead to identification of opportunities for addressing negative SCD outcomes in minorities affected by inequitable conditions.
Social determinants of multimorbidity in Jamaica: application of latent class analysis in a cross-sectional study
Authors: Craig Leslie S. , Cunningham-Myrie Colette A. , Hotchkiss David R. , Hernandez Julie H. , Gustat Jeanette , Theall Katherine P.
Published: June 2021

Background

Non-communicable disease (NCD) multimorbidity is associated with impaired functioning, lower quality of life and higher mortality. Susceptibility to accumulation of multiple NCDs is rooted in social, economic and cultural contexts, with important differences in the burden, patterns, and determinants of multimorbidity across settings. Despite high prevalence of individual NCDs within the Caribbean region, exploration of the social epidemiology of multimorbidity remains sparse. This study aimed to examine the social determinants of NCD multimorbidity in Jamaica, to better inform prevention and intervention strategies.

Methods

Latent class analysis (LCA) was used to examine social determinants of identified multimorbidity patterns in a sample of 2551 respondents aged 15–74 years, from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008. Multimorbidity measurement was based on self-reported presence/absence of 11 chronic conditions. Selection of social determinants of health (SDH) was informed by the World Health Organization’s Commission on SDH framework. Multinomial logistic regression models were used to estimate the association between individual-level SDH and class membership.

Results

Approximately one-quarter of the sample (24.05%) were multimorbid. LCA revealed four distinct profiles: a Relatively Healthy class (52.70%), with a single or no morbidity; and three additional classes, characterized by varying degrees and patterns of multimorbidity, labelled Metabolic (30.88%), Vascular-Inflammatory (12.21%), and Respiratory (4.20%). Upon controlling for all SDH (Model 3), advancing age and recent healthcare visits remained significant predictors of all three multimorbidity patterns (p < 0.001). Private insurance coverage (relative risk ratio, RRR = 0.63; p < 0.01) and higher educational attainment (RRR = 0.73; p < 0.05) were associated with lower relative risk of belonging to the Metabolic class while being female was a significant independent predictor of Vascular-Inflammatory class membership (RRR = 2.54; p < 0.001). Material circumstances, namely housing conditions and features of the physical and neighbourhood environment, were not significant predictors of any multimorbidity class.

Conclusion

This study provides a nuanced understanding of the social patterning of multimorbidity in Jamaica, identifying biological, health system, and structural determinants as key factors associated with specific multimorbidity profiles. Future research using longitudinal designs would aid understanding of disease trajectories and clarify the role of SDH in mitigating risk of accumulation of diseases.
Sequential non-invasive following short-term invasive mechanical ventilation in the treatment of tuberculosis with respiratory failure: a randomized controlled study
Authors: Kang Nai-Min , Zhang Nan , Luo Bao-Jian , Wu En-Dong , Shi Jian-Quan , Li Liang , Jiang Li
Published: June 2021

Background

Invasive and non-invasive mechanical ventilation (MV) have been combined as sequential MV in the treatment of respiratory failure. However, the effectiveness remains unclear. Here, we performed a randomized controlled study to assess the efficacy and safety of sequential MV in the treatment of tuberculosis with respiratory failure.

Methods

Forty-four tuberculosis patients diagnosed with respiratory failure were randomly divided into sequential MV group (n = 24) and conventional MV group (n = 20). Initially, the patients in both groups received invasive positive pressure ventilation. When the patients' conditions were relieved, the ventilation modality in sequential MV group was switched to oronasal face mask continuous positive airway pressure until weaning.

Results

After treatment, the patients in sequential MV group had similar respiratory rate, heart rate, oxygenation index, alveolo-arterial oxygen partial pressure difference (A-aDO2), blood pH, PaCO2 to those in conventional MV group (all P value > 0.05). There was no significant difference in ventilation time and ICU stay between the two groups (P > 0.05), but sequential MV group significantly reduced the time of invasive ventilation (mean difference (MD): − 36.2 h, 95% confidence interval (CI) − 53.6, − 18.8 h, P < 0.001). Sequential MV group also reduced the incidence of ventilator-associated pneumonia (VAP; relative risk (RR): 0.44, 95% CI 0.24, 0.83, P = 0.006) and atelectasis (RR:0.49, 95% CI 0.24,1.00, P = 0.040).

Conclusions

Sequential MV was effective in treating tuberculosis with respiratory failure. It showed advantages in reducing invasive ventilation time and ventilator-associated adverse events.

Registration number for clinical trial

Chinese Clinical Trial Registry ChiCTR2000032311, April 21st, 2020
Evidence on the economic value of end-of-life and palliative care interventions: a narrative review of reviews
Authors: Luta Xhyljeta , Ottino Baptiste , Hall Peter , Bowden Joanna , Wee Bee , Droney Joanne , Riley Julia , Marti Joachim
Published: June 2021

Background

As the demand for palliative care increases, more information is needed on how efficient different types of palliative care models are for providing care to dying patients and their caregivers. Evidence on the economic value of treatments and interventions is key to informing resource allocation and ultimately improving the quality and efficiency of healthcare delivery. We assessed the available evidence on the economic value of palliative and end-of-life care interventions across various settings.

Methods

Reviews published between 2000 and 2019 were included. We included reviews that focused on cost-effectiveness, intervention costs and/or healthcare resource use. Two reviewers extracted data independently and in duplicate from the included studies. Data on the key characteristics of the studies were extracted, including the aim of the study, design, population, type of intervention and comparator, (cost-) effectiveness resource use, main findings and conclusions.

Results

A total of 43 reviews were included in the analysis. Overall, most evidence on cost-effectiveness relates to home-based interventions and suggests that they offer substantial savings to the health system, including a decrease in total healthcare costs, resource use and improvement in patient and caregivers’ outcomes. The evidence of interventions delivered across other settings was generally inconsistent.

Conclusions

Some palliative care models may contribute to dual improvement in quality of care via lower rates of aggressive medicalization in the last phase of life accompanied by a reduction in costs. Hospital-based palliative care interventions may improve patient outcomes, healthcare utilization and costs. There is a need for greater consistency in reporting outcome measures, the informal costs of caring, and costs associated with hospice.
Sense of coherence and strategies for coping with stress among nurses
Authors: Betke Katarzyna , Basińska Małgorzata Anna , Andruszkiewicz Anna
Published: June 2021

Background

The nursing profession is associated with constant presence of difficult situations and stress, which arise from responsibility for the highest values – human life and health. With demographic changes in the society, the demand for nursing care increases. Looking after the health of nursing staff becomes a non-material investment in employees. One of the most important health potentials described in literature is the sense of coherence. It can significantly contribute to maintaining good health, modify one’s functioning in a stressful working environment and influence the choice of strategies for coping with stress.

Aim

The aim of the study was to describe the specific relationship between the sense of coherence and strategies for coping with stress in a group of professionally active nurses.

Methodology and methods

The study involved 91 nurses in central Poland, aged 22–52. The group was diversified in terms of: education, work system, marital status and place of residence. The study was conducted with the use of: Sense of Coherence Questionnaire SOC-29 and Inventory to Measure Coping Strategies with Stress - Mini-COPE. The study was conducted in accordance with the principles of scientific research set out in the Helsinki Declaration.

Results

The sense of coherence value in the test group was M = 134.24 (SD = 19.55). In stressful situations nurses most often used active strategies to cope with stress: Planning M = 2.10 (SD = 0.54), Seeking Emotional Social Support M = 1.95 (SD = 0.68) and Seeking Instrumental Social Support M = 1.95 (SD = 0.69), and the least frequently: Alcohol/Drug Use M = 0.28 (SD = 0.48). The level of the sense of coherence and its components differentiated the strategies of coping with stress used in the examined group of nurses.

Conclusions

The research confirmed that the sense of coherence serves as a health potential in a stressful working environment - a high sense of coherence translate into better mental health, correct functioning in the working environment, and using adaptive strategies of coping with stress. Nurses with a stronger sense of coherence used more adaptive strategies to deal with stress than those with average or low levels.
Adherence to international dietary recommendations in association with all-cause mortality and fatal and non-fatal cardiovascular disease risk: a prospective analysis of UK Biobank participants
Authors: Kebbe Maryam , Gao Min , Perez-Cornago Aurora , Jebb Susan A. , Piernas Carmen
Published: June 2021

Background

International dietary guidelines aim to reduce risks of all-cause mortality, cardiovascular disease (CVD), and fatal CVD often associated with poor dietary habits. However, most studies have examined associations with individual nutrients, foods, or dietary patterns, as opposed to quantifying the pooled health effects of adherence to international dietary recommendations. We investigated associations between total adherence to the World Health Organization (WHO) dietary recommendations for saturated fats, free sugars, fibre, and fruits and vegetables and all-cause mortality and fatal and non-fatal CVD.

Methods

We included participants from the UK Biobank cohort recruited in 2006–2010, which provided at least two valid 24-h dietary assessments. We defined adherence to dietary recommendations as ≤ 10% saturated fats, ≤ 10% free sugars, ≥ 25 g/day fibre, and ≥ 5 servings of fruits and vegetables/day. Multivariable Cox-proportional hazards models were used to investigate prospective associations with all-cause mortality and fatal and non-fatal CVD. In cross-sectional analyses, multivariable linear regression was used to examine associations with cardiometabolic risk factors.

Results

Among 115,051 participants (39–72 years), only 29.7%, 38.5%, 22.3%, and 9.5% met 0, 1, 2, or 3–4 recommendations, respectively. There was a lower risk of all-cause mortality among participants meeting more dietary recommendations (Ptrend < 0.001), with a significantly lower risk among participants meeting 2: HR 0.91 (95% confidence interval [CI] 0.85–0.97) and 3–4: HR 0.79 (95% CI 0.71–0.88) recommendations. There was no trend with CVD risk, but a significantly lower risk of fatal CVD with 3–4 recommendations: HR 0.78 (95% CI 0.61–0.98). Meeting more recommendations resulted in significant cross-sectional trends (Ptrend < 0.001) towards lower body fat, waist circumference, LDL cholesterol, apolipoprotein B, triglycerides, alkaline phosphatase, gamma glutammyltransferase, and hs-CRP, but higher glucose and aspartate aminotransferase.

Conclusions

Meeting dietary recommendations is associated with additive reductions in premature mortality. Motivating and supporting people to adhere to dietary guidelines may help extend years of healthy life expectancy.
Real-life evidence of low-dose mepolizumab efficacy in EGPA: a case series
Authors: Detoraki Aikaterini , Tremante Eugenio , Poto Remo , Morelli Emanuela , Quaremba Giuseppe , Granata Francescopaolo , Romano Antonio , Mormile Ilaria , Rossi Francesca Wanda , de Paulis Amato , Spadaro Giuseppe
Published: June 2021

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, small vessel, necrotizing vasculitis. The disease is mainly characterized by hypereosinophilia and asthma with frequent sinonasal involvement, although multiple organs can be affected, including the heart, lungs, skin, gastrointestinal tract, kidneys, and nervous system. IL-5 production is pathogenetically central for the development of the disease by promoting proliferation, transvascular migration and functional activation of eosinophils. The degree of blood and tissue eosinophilia appears to be associated with disease pathogenesis and eosinophil depletion represents a promising treatment approach for EGPA. We prospectively evaluated the efficacy and safety of a low dose (100 mg q4w), 12-month course of mepolizumab, an anti-IL-5 monoclonal antibody, in eight patients with severe asthma and active EGPA. Patients were recruited by the tertiary care center of Clinical Immunology and Allergy, University of Naples Federico II. The following outcomes were assessed before (T0), and after 6 (T6) and 12 months (T12) of mepolizumab treatment: Birmingham Vasculitis Activity Score (BVAS), prednisone intake, Sino-Nasal Outcome Test (SNOT-22), Total Endoscopic Polyp Score (TENPS), Asthma Control Test (ACT), Forced Expiratory Volume one second (FEV1)%, blood eosinophilia. BVAS score significantly decreased showing a sharp reduction in disease activity score. Clinical improvements in terms of sinonasal scores and asthma symptoms were observed, in parallel with a drastic drop in eosinophil blood count. Prednisone intake was significantly reduced. In two patients, asthma exacerbations led to discontinuation in mepolizumab therapy after 6 and 12 months despite BVAS reduction. Mepolizumab treatment was well tolerated, and no severe adverse drug effects were registered. In conclusion, our 12-month real-life study suggests that mepolizumab may be beneficial and safe in active EGPA patients by improving disease activity score, sinonasal and asthma outcomes while reducing the burden of prednisone intake.
Gender disparities in opioid treatment progress in methadone versus counseling
Authors: Guerrero Erick , Amaro Hortensia , Kong Yinfei , Khachikian Tenie , Marsh Jeanne C.
Published: June 2021

Background

In the United States, the high dropout rate (75%) in opioid use disorder (OUD) treatment among women and racial/ethnic minorities calls for understanding factors that contribute to making progress in treatment. Whereas counseling and medication for OUD (MOUD, e.g. methadone, buprenorphine, naltrexone) is considered the gold standard of care in substance use disorder (SUD) treatment, many individuals with OUD receive either counseling or methadone-only services. This study evaluates gender disparities in treatment plan progress in methadone- compared to counseling-based programs in one of the largest SUD treatment systems in the United States.

Methods

Multi-year and multi-level (treatment program and client-level) data were analyzed using the Integrated Substance Abuse Treatment to Eliminate Disparities (iSATed) dataset collected in Los Angeles County, California. The sample consisted of 4 waves: 2011 (66 SUD programs, 1035 clients), 2013 (77 SUD programs, 3686 clients), 2015 (75 SUD programs, 4626 clients), and 2017 (69 SUD programs, 4106 clients). We conducted two multi-level negative binomial regressions, one per each outcome (1) making progress towards completing treatment plan, and (2) completing treatment plan. We included outpatient clients discharged on each of the years of the study (over 95% of all clients) and accounted for demographics, wave, homelessness and prior treatment episodes, as well as clients clustered within programs.

Results

We detected gender differences in two treatment outcomes (progress and completion) considering two outpatient program service types (MOUD-methadone vs. counseling). Clients who received methadone vs. counseling had lower odds of completing their treatment plan (OR = 0.366; 95% CI = 0.163, 0.821). Female clients receiving methadone had lower odds of both making progress (OR = 0.668; 95% CI = 0.481, 0.929) and completing their treatment plan (OR = 0.666; 95% CI = 0.485, 0.916) compared to male clients and receiving counseling. Latina clients had lower odds of completing their treatment plan (OR = 0.617; 95% CI = 0.408, 0.934) compared with non-Latina clients.

Conclusions

Clients receiving methadone, the most common and highly effective MOUD in reducing opioid use, were less likely to make progress towards or complete their treatment plan than those receiving counseling. Women, and in particular those identified as Latinas, were least likely to benefit from methadone-based programs. These findings have implications for health policy and program design that consider the need for comprehensive and culturally responsive services in methadone-based programs to improve outpatient treatment outcomes among women.
Preoperative risk factors for postoperative blood transfusion after hip fracture surgery: establishment of a nomogram
Authors: Bian Fu Cheng , Cheng Xiao Kang , An Yong Sheng
Published: June 2021

Background

This study aimed to explore the preoperative risk factors related to blood transfusion after hip fracture operations and to establish a nomogram prediction model. The application of this model will likely reduce unnecessary transfusions and avoid wasting blood products.

Methods

This was a retrospective analysis of all patients undergoing hip fracture surgery from January 2013 to January 2020. Univariate and multivariate logistic regression analyses were used to evaluate the association between preoperative risk factors and blood transfusion after hip fracture operations. Finally, the risk factors obtained from the multivariate regression analysis were used to establish the nomogram model. The validation of the nomogram was assessed by the concordance index (C-index), the receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and calibration curves.

Results

A total of 820 patients were included in the present study for evaluation. Multivariate logistic regression analysis demonstrated that low preoperative hemoglobin (Hb), general anesthesia (GA), non-use of tranexamic acid (TXA), and older age were independent risk factors for blood transfusion after hip fracture operation. The C-index of this model was 0.86 (95% CI, 0.83–0.89). Internal validation proved the nomogram model’s adequacy and accuracy, and the results showed that the predicted value agreed well with the actual values.

Conclusions

A nomogram model was developed based on independent risk factors for blood transfusion after hip fracture surgery. Preoperative intervention can effectively reduce the incidence of blood transfusion after hip fracture operations.
Understanding the effects of different residual lignin fractions in acid-pretreated bamboo residues on its enzymatic digestibility
Authors: Lin Wenqian , Yang Jinlai , Zheng Yayue , Huang Caoxing , Yong Qiang
Published: June 2021

Background

During the dilute acid pretreatment process, the resulting pseudo-lignin and lignin droplets deposited on the surface of lignocellulose and inhibit the enzymatic digestibility of cellulose in lignocellulose. However, how these lignins interact with cellulase enzymes and then affect enzymatic hydrolysis is still unknown. In this work, different fractions of surface lignin (SL) obtained from dilute acid-pretreated bamboo residues (DAP-BR) were extracted by various organic reagents and the residual lignin in extracted DAP-BR was obtained by the milled wood lignin (MWL) method. All of the lignin fractions obtained from DAP-BR were used to investigate the mechanism for interaction between lignin and cellulase using surface plasmon resonance (SPR) technology to understand how they affect enzymatic hydrolysis

Results

The results showed that removing surface lignin significantly decreased the yield for enzymatic hydrolysis DAP-BR from 36.5% to 18.6%. The addition of MWL samples to Avicel inhibited its enzymatic hydrolysis, while different SL samples showed slight increases in enzymatic digestibility. Due to the higher molecular weight and hydrophobicity of MWL samples versus SL samples, a stronger affinity for MWL (KD = 6.8–24.7 nM) was found versus that of SL (KD = 39.4–52.6 nM) by SPR analysis. The affinity constants of all tested lignins exhibited good correlations (r > 0.6) with the effects on enzymatic digestibility of extracted DAP-BR and Avicel.

Conclusions

This work revealed that the surface lignin on DAP-BR is necessary for maintaining enzyme digestibility levels, and its removal has a negative impact on substrate digestibility.
Imaging findings of human hepatic fascioliasis: a case report and review of the literature
Authors: Salahshour Faeze , Tajmalzai Abasin
Published: June 2021

Background

Fascioliasis is a food-borne hepatobiliary zoonosis caused by Fasciola hepatica and Fasciola gigantica. Human infestations are predominantly seen in developing countries where the disease is endemic, but, due to the increase in international travel rates, hepatic fascioliasis is also appearing in nonendemic areas including Europe and the USA. The clinical and laboratory findings are usually nonspecific. Cross-sectional imaging can be very helpful in the diagnosis of fascioliasis as well as to differentiate it from other liver diseases with a very similar clinical picture. The objectives of this case report are to discuss imaging findings of hepatic fascioliasis and to review the literature.

Case presentation

We report the case of a 35-year-old Iranian patient who presented with right upper quadrant pain, low-grade fever, fatigue, and anorexia. The patient had a history of recent travel to the Gilan Province of Iran, almost a month before the onset of symptoms, which is an endemic area of fascioliasis in the country. Laboratory examinations revealed eosinophilia, elevated hepatic enzymes, and slightly raised C-reactive protein. Contrast-enhanced computed tomography of the patient shows clusters of focal ill-defined hypodense lesions with mild peripheral enhancement in the right liver lobe and subcapsular regions. Magnetic resonance imaging of the liver revealed multiple ill-defined lesions of low signal intensity on the T1-weighted image and high signal intensity on the T2-weighted image, extending from the liver capsule into deeper parenchyma toward periportal regions, which shows mild peripheral enhancement on post-contrast images. Imaging-based diagnosis of fascioliasis was made depending on the characteristic distribution of subcapsular tracts/lesions on the above-mentioned imaging, which was then confirmed by serologic tests using enzyme-linked immunosorbent assay. The patient was treated with triclabendazole, showing great clinical improvement, and was eventually discharged in good health condition.

Conclusion

The imaging findings in this case report highlight the importance of cross-sectional imaging for further evaluation of suspected cases of fluke-induced liver disease. The hypothesis of hepatic fascioliasis should be always considered when consistent radiological findings are observed. Clusters of tortuous subcapsular lesions with peripheral contrast enhancement extending into deeper liver parenchyma are characteristic imaging findings that strongly suggest hepatic fascioliasis.
Damage to intestinal barrier integrity in piglets caused by porcine reproductive and respiratory syndrome virus infection
Authors: Zhao Jin , Wan Shuangxiu , Sun Na , Sun Panpan , Sun Yaogui , Khan Ajab , Guo Jianhua , Zheng Xiaozhong , Fan Kuohai , Yin Wei , Li Hongquan
Published: June 2021

Porcine reproductive and respiratory syndrome (PRRS) induces respiratory disease and reproductive failure accompanied by gastroenteritis-like symptoms. The mechanism of intestinal barrier injury caused by PRRSV infection in piglets has yet to be investigated. An in vivo PRRSV-induced model was established in 30-day-old piglets by the intramuscular injection of 2 mL of 104 TCID50/mL PRRSV for 15 days. Observations of PRRSV replication and histology were conducted in the lungs and intestine, and goblet cell counts, relative MUC2 mRNA expression, and tight junction protein, proinflammatory cytokine, TLR4, MyD88, IκB and p-IκB expression were measured. PRRSV replicated in the lungs and small intestine, as demonstrated by absolute RT-qPCR quantification, and the PRRSV N protein was detected in the lung interstitium and jejunal mucosa. PRRSV infection induced both lung and gut injury, markedly decreased villus height and the villus to crypt ratio in the small intestine, and obviously increased the number of goblet cells and the relative expression of MUC2 mRNA in the jejunum. PRRSV infection aggravated the morphological depletion of tight junction proteins and increased IL-1β, IL-6, IL-8 and TNF-α expression by activating the NF-κB signalling pathway in the jejunum. PRRSV infection impaired intestinal integrity by damaging physical and immune barriers in the intestine by inducing inflammation, which may be related to the regulation of the gut-lung axis. This study also provides a new hypothesis regarding the pathogenesis of PRRSV-induced diarrhoea.
Use of health care services by people with substance use disorders in Belgium: a register-based cohort study
Authors: Van Baelen Luk , Plettinckx Els , Antoine Jérôme , De Ridder Karin , Devleesschauwer Brecht , Gremeaux Lies
Published: June 2021

Background

The objective of the study was to describe the frequencies of health-care utilization by people with substance use disorder (SUD), including contacts with general practitioners (GP), psychiatrists, emergency departments (ED) and hospital admissions and to compare this frequency to the general population.

Methods

Data from the national register of people who were in treatment for SUD between 2011 and 2014 was linked to health care data from the Belgian health insurance (N = 30,905). Four comparators were matched on age, sex and place of residence to each subject in treatment for SUD (N = 123,620). Cases were further divided in five mutually exclusive categories based on the main SUD (opiates, crack/cocaine, stimulants, cannabis and alcohol). We calculated the average number of contacts with GP, psychiatrists and ED, and hospital admissions per person over a ten year period (2008–2017), computed descriptive statistics for each of the SUD and used negative binomial regression models to compare cases and comparators.

Results

Over the ten-year period, people in treatment for SUD overall had on average 60 GP contacts, 3.9 psychiatrist contacts, 7.8 visits to the ED, and 16 hospital admissions. Rate ratios, comparing cases and corresponding comparators, showed that people in treatment for SUD had on average 1.9 more contacts with a GP (95 % CI 1.9-2.0), 7.4 more contacts with a psychiatrist (95 % CI 7.0-7.7), 4.2 more ED visits (95 % CI 4.2–4.3), and 6.4 more hospital admissions (95 % CI 6.3–6.5).

Conclusions

The use of health services for people with SUD is between almost two (GP) and seven times (psychiatrist) higher than for comparators. People in treatment for alcohol use disorders use health care services more frequently than people in treatment for other SUD. The use of health services remained stable in the five years before and after the moment people with SUD entered into treatment for SUD. The higher use of primary health care services by people with SUD might indicate that they have higher health care needs than comparators.
Antiquities in a time of conflict: a crime script analysis of antiquities trafficking during the Syrian Civil War and implications for conflict antiquities
Authors: Weirich Christine A.
Published: June 2021

The Syrian Civil War created an opportunity for increased trafficking of antiquities and has resulted in a renewed awareness on the part of a global audience. The persistence of criminal and organisational networks which facilitate antiquities trafficking networks (ATNs) has been recognised as significant, leading to increased interest in the development of new and improved methods of understanding such networks. While this field of research has traditionally been dominated by relevant areas such as archaeology, law, art and museum studies, there is a noticeable gap in crime prevention research. This paper presents a crime script of Syrian antiquities trafficking networks during the Syrian Civil War which has been generated from open source journalistic data. In creating a broad crime script for such a prevalent issue, this paper aims to demonstrate the need for further crime script analysis and specifically crime prevention research more generally within the study of antiquities trafficking.
Regulatory VCAN polymorphism is associated with shoulder pain and disability in breast cancer survivors
Authors: Mafu Trevor S. , September Alison V. , Shamley Delva
Published: June 2021

Background and purpose

Shoulder morbidity following breast cancer treatment is multifactorial. Despite several treatment- and patient-related factors being implicated, unexplained inter-individual variability exists in the development of such morbidity. Given the paucity of relavant genetic studies, we investigate the role of polymorphisms in candidate proteoglycan genes.

Patients and methods

We conducted a cross-sectional study on 254 South African breast cancer survivors, to evaluate associations between shoulder pain/disability and ten single nucleotide polymorphisms (SNPs) within four proteoglycan genes: ACAN (rs1126823 G>A, rs1516797 G>T, rs2882676 A>C); BGN (rs1042103 G>A, rs743641 A>T, rs743642 G>T); DCN rs516115 C>T; and VCAN (rs11726 A>G, rs2287926 G>A, rs309559). Participants were grouped into no–low and moderate–high shoulder pain/disability based on total pain/disability scores: < 30 and ≥ 30, respectively using the Shoulder Pain and Disability Index (SPADI).

Results

The GG genotype of VCAN rs11726 was independently associated with an increased risk of being in the moderate-to-high shoulder pain (P = 0.005, OR = 2.326, 95% CI = 1.259–4.348) or disability (P = 0.011, OR = 2.439, 95% CI = 1.235–4.762) categories, after adjusting for participants’ age. In addition, the T-T-G inferred allele combination of BGN (rs74364–rs743642)–VCAN rs11726 was associated with an increased risk of being in the moderate-to-high shoulder disability category (0 = 0.002, OR = 2.347, 95% CI = 1.215–4.534).

Conclusion

Our study is first to report that VCAN rs11726, independently or interacting with BGN polymorphisms, is associated with shoulder pain or disability in breast cancer survivors. Whereas our findings suggest an involvement of proteoglycans in the etiology of shoulder pain/disability, further studies are recommended.
Development of the Paranormal and Supernatural Beliefs Scale using classical and modern test theory
Authors: Dean Charlotte E. , Akhtar Shazia , Gale Tim M. , Irvine Karen , Wiseman Richard , Laws Keith R.
Published: June 2021

Background

This study describes the construction and validation of a new scale for measuring belief in paranormal phenomena. The work aims to address psychometric and conceptual shortcomings associated with existing measures of paranormal belief. The study also compares the use of classic test theory and modern test theory as methods for scale development.

Method

We combined novel items and amended items taken from existing scales, to produce an initial corpus of 29 items. Two hundred and thirty-one adult participants rated their level of agreement with each item using a seven-point Likert scale.

Results

Classical test theory methods (including exploratory factor analysis and principal components analysis) reduced the scale to 14 items and one overarching factor:Supernatural Beliefs. The factor demonstrated high internal reliability, with an excellent test–retest reliability for the total scale. Modern test theory methods (Rasch analysis using a rating scale model) reduced the scale to 13 items with a four-point response format. The Rasch scale was found to be most effective at differentiating between individuals with moderate-high levels of paranormal beliefs, and differential item functioning analysis indicated that the Rasch scale represents a valid measure of belief in paranormal phenomena.

Conclusions

The scale developed using modern test theory is identified as the final scale as this model allowed for in-depth analyses and refinement of the scale that was not possible using classical test theory. Results support the psychometric reliability of this new scale for assessing belief in paranormal phenomena, particularly when differentiating between individuals with higher levels of belief.
CT-based multi-phase Radiomic models for differentiating clear cell renal cell carcinoma
Authors: Chen Menglin , Yin Fu , Yu Yuanmeng , Zhang Haijie , Wen Ge
Published: June 2021

Background

The aim of the study is to compare the diagnostic value of models that based on a set of CT texture and non-texture features for differentiating clear cell renal cell carcinomas(ccRCCs) from non-clear cell renal cell carcinomas(non-ccRCCs).

Methods

A total of 197 pathologically proven renal tumors were divided into ccRCC(n = 143) and non-ccRCC (n = 54) groups. The 43 non-texture features and 296 texture features that extracted from the 3D volume tumor tissue were assessed for each tumor at both Non-contrast Phase, NCP; Corticomedullary Phase, CMP; Nephrographic Phase, NP and Excretory Phase, EP. Texture-score were calculated by the Least Absolute Shrinkage and Selection Operator (LASSO) to screen the most valuable texture features. Model 1 contains the three most distinctive non-texture features with p < 0.001, Model 2 contains texture scores, and Model 3 contains the above two types of features.

Results

The three models shown good discrimination of the ccRCC from non-ccRCC in NCP, CMP, NP, and EP. The area under receiver operating characteristic curve (AUC)values of the Model 1, Model 2, and Model 3 in differentiating the two groups were 0.748–0.823, 0.776–0.887 and 0.864–0.900, respectively. The difference in AUC between every two of the three Models was statistically significant (p < 0.001).

Conclusions

The predictive efficacy of ccRCC was significantly improved by combining non-texture features and texture features to construct a combined diagnostic model, which could provide a reliable basis for clinical treatment options.