bluuebunny/crossref_metadata_2025 huggingface dataset:
Strategy Analysis of Network Information Technology in College English Micro-lesson Teaching
Authors: Wang Xiuli
Published: December 2020

Modern network information technology has not only changed people's life, but also changed the pattern of education. With the help of network information technology, micro class, a new teaching mode in college English teaching, has been widely used. This paper mainly focuses on the following aspects: an overview of the connotation of micro class, the analysis of the relationship between network information technology and micro class teaching, and the strategy exploration of network information technology in college English micro class teaching, hoping to bring some new inspiration to the majority of college English educators and further improve the quality of college English teaching in China.
Divide among the Millennial Generation: Historical and Empirical Justifications. (Part two)
Authors: Radaev Vadim
Published: December 2020

In this concluding part of the paper, we continue an empirical analysis based on dividing the generation of millennials into two age cohorts. Special attention is drawn to a group of millennials designated as “3S” (“smartphones”, “social media”, “decline of the economy”). This younger generation began entering the period of adulthood since the year 2008, which has been marked by a continuous economic recession and broad dissemination of the technologies and digital consumer services. Data were collected from the annual Russian Longitudinal Monitoring Survey (RLMS–HSE) in 1994–2018. The results obtained show a divide in the millennial generation measured by a multiplicity of social indicators along with the preservation of many inter-generational differences. In the second part of the paper, we show that the younger generation of “3S” millennials demonstrates a decline in alcohol consumption and smoking, while being more involved in sports. “3S” millennials watch TV less frequently and are more engaged in reading and cultural activities. They reveal lower religious affiliations and are more optimistic in regards to their material status and life prospects. Many intra- and intergenerational differences are significant and robust over the time of observation when controlling for age and other standard variables. In conclusion, four types of inter-relations between intra- and intergenerational differences are delineated.
A Model Based on Clusters of Similar Color and NIR to Estimate Oil Content of Single Olives
Authors: Fredes Claudio , Valero Constantino , Diezma Belen , Mora Marco , Naranjo-Torres José , Wilson Manuel , Delgadillo Gabriel
Published: December 2020

The color and NIR spectrum are key to build an oil estimation model, thus it requires individual olives clustering before the Sohlext oil extraction method can be applied. The objective was to analyze an OC estimation model of individual olives, based on cluster of similar color and NIR spectrum in different combination of the first and/or the second season. This study was performed with Chilean Arbequina olives in 2016 and 2017. The descriptor of the cluster consisted of the 3 color channels of c1, c2, c3 color model plus 11 reflectance points between 1710 and 1735 nm of each olive, normalized with the Z-score index. Clusters of similar color and NIR spectrum were formed with the k-means++ algorithm, leaving a sufficient amount of olives to be able to perform the Sohlext analysis of OC, as reference value. The estimation models were based on the Support Vector Machine. The test was carried out with the Leave One-Out Cross Validation in different training-testing combinations. The best model predicted the OC with 6% and 13%deviation respect to the real value in one season by itself and when one season tested with another season, respectively. The use of clustering in estimation model is discussed.
Personalized Biometrics of Physical Pain Agree with Its Psychological Perception by Participants with Sensory Over Responsivity
Authors: Ryu Jihye , Bar-Shalita Tami , Granovsky Yelena , Weissman-Fogel Irit , Torres Elizabeth B.
Published: December 2020

The study of pain requires a balance between subjective methods that rely on self-reports and complementary objective biometrics that ascertain physical signals associated with subjective accounts. There are at present no objective scales that enable the personalized assessment of pain, as most work involving electrophysiology rely on summary statistics from a priori theoretical population assumptions. Along these lines, recent work has provided evidence of differences in pain sensations between participants with Sensory Over Responsivity (SOR) and controls. While these analyses are useful to understand pain across groups, there remains a need to quantify individual differences more precisely in a personalized manner. Here we offer new methods to characterize pain using the moment-by-moment standardized fluctuations in EEG brain activity centrally reflecting the person’s experiencing temperature-based stimulation at the periphery. This type of gross data is often disregarded as noise, yet here we show its utility to characterize the lingering sensation of discomfort raising to the level of pain, individually, for each participant. We show fundamental differences between the SOR group in relation to controls and provide an objective account of pain congruent with the subjective self-reported data. This offers the potential to build a standardized scale useful to profile pain levels in a personalized manner across the general population.
Additive manufacturing and technical strategies for improving outcomes in breast reconstructive surgery
Authors: Rocco Nicola , Papallo Ida , Nava Maurizio Bruno , Catanuto Giuseppe , Accurso Antonello , Onofrio Ilaria , Oliviero Olimpia , Improta Giovanni , Speranza Domenico , Domingos Marco , Russo Teresa , De Santis Roberto , Martorelli Massimo , Gloria Antonio
Published: December 2020

It has been widely reported that breast reconstruction improves the quality of life of women who undergo mastectomy for breast cancer.
This approach provides many psychological advantages. Today, different techniques are available for the breast oncoplastic surgeon
that involve the use of breast implants and autologous tissues, also offering interesting results in terms of aesthetic and patient-reported
outcomes. On the other hand, advanced technologies and design strategies (i.e. design for additive manufacturing, reverse engineering)
may allow the development of customised porous structures with tailored morphological, mechanical, biological, and mass transport
properties. For this reason, the current study deals with the challenges, principles, and methods of developing 3D additive manufactured
structures in breast reconstructive surgery. Specifically, the aim was to design 3D additive manufactured poly(ε-caprolactone) scaffolds
with different architectures (i.e. lay-down patterns). Preliminary mechanical and biological analyses have shown the effect of the lay-
down pattern on the performances of the manufactured structures.
RiskScape: A Data Visualization and Aggregation Platform for Public Health Surveillance Using Routine Electronic Health Record Data
Authors: Cocoros Noelle M. , Kirby Chaim , Zambarano Bob , Ochoa Aileen , Eberhardt Karen , Rocchio, SB Catherine , Ursprung W. Sanouri , Nielsen Victoria M. , Durham Natalie Nguyen , Menchaca John T. , Josephson Mark , Erani Diana , Hafer Ellen , Weiss Michelle , Herrick Brian , Callahan Myfanwy , Isaac Thomas , Klompas Michael
Published: December 2020

Automated analysis of electronic health record (EHR) data is a complementary tool for public health surveillance. Analyzing and presenting these data, however, demands new methods of data communication optimized to the detail, flexibility, and timeliness of EHR data.

RiskScape is an open-source, interactive, Web-based, user-friendly data aggregation and visualization platform for public health surveillance using EHR data. RiskScape displays near-real-time surveillance data and enables clinical practices and health departments to review, analyze, map, and trend aggregate data on chronic conditions and infectious diseases. Data presentations include heat maps of prevalence by zip code, time series with statistics for trends, and care cascades for conditions such as HIV and HCV. The platform’s flexibility enables it to be modified to incorporate new conditions quickly—such as COVID-19.

The Massachusetts Department of Public Health (MDPH) uses RiskScape to monitor conditions of interest using data that are updated monthly from clinical practice groups that cover approximately 20% of the state population. RiskScape serves an essential role in demonstrating need and burden for MDPH’s applications for funding, particularly through the identification of inequitably burdened populations.
Do Exposures to Green Space Reduce the Risk of Hypertension?
Authors: Jiang Jie , Chen Gongbo , Li Baojing , Lu Yuanan , Guo Yuming , Li Shanshan , Wang Chongjian , Xiang Hao
Published: December 2020

Background: Few epidemiological research examined the effects of greenness on cardiovascular diseases in developing countries. We aimed to explore the relationships between green space and hypertension and blood pressure in China.Methods: This cross-sectional study recruited 39, 259 adults from five counties in central China. Blood pressure measurements were performed according to a standardized protocol. Normalized diﬀerence vegetation index (NDVI) and enhanced vegetation index (EVI) was used to assess the exposure to greenness. We used mixed linear models to test greenspace-cardiovascular disease outcome pathways.Results: Higher green space was related to decreased hypertension prevalence and blood pressure. After fully adjusting the covariates, each interquartile range increase in NDVI500m and EVI500m were related to an 8% decrease in odds of hypertension. The changes in SBP and DBP (95% CI) were - 0.88 mm Hg (- 1.17, - 0.58) and - 0.64 mm Hg (- 0.82, - 0.46) for NDVI, and - 0.79 mm Hg (- 1.14, - 0.45) and - 0.67 mm Hg (- 0.87, - 0.46) for EVI, respectively. Subgroup analyses showed that the effects of green space were more pronounced in males, smokers, and drinkers.Conclusions: The effects of green space may reduce the risk of hypertension. Also, behavioral factors may affect this potential pathway.
Exploring the role and nature of trust in institutional capacity building in low- and middle-income countries: a systematic review
Authors: Manoj Malvikha , Brough Richard , Kalbarczyk Anna
Published: December 2020

Background Global concern with strengthening institutions is evident and has been underscored in the wake of the COVID-19 pandemic. Trusted or trustworthy institutions are vital in addressing institutional capacity strengthening, but there is limited research on institutional trust and how to build it. A preliminary approach entitled, Trusted Institutions (TI), identifies six essential elements of trust including: team culture, autonomy, scale and longevity, commitment to quality and ethics, sustainability, and good fit with local context and culture. We aimed to explore capacity building initiatives and the notion of ‘trust’ within non-government health institutions in low- and middle-income countries (LMICs) and validate these essential elements of trust through a systematic review.Methods We searched the published literature in PubMed and EMBASE in March 2020 and employed a three-concept search that included “health-related institutions”; “capacity building”; and “LMICs”. The study team used PRISMA reporting guidelines to conduct title and full-text reviews and conduct data extraction and analysis.Results The search yielded 342 unique articles. Seventy-seven references met initial inclusion criteria and underwent full-text extraction; 31 studies were included in the final analysis. Capacity building activities ranged from individual-level skills to institutional systems and structures. All articles addressed at least one element of trust with over half of articles describing sustainability (n = 18; 58%) and good fit with local context and culture (n = 18; 58%). Only 14 (45%) of articles explicitly mentioned the concept of trust either within an institution (intra-institutional) or between two or more institutions (interinstitutional). Four additional themes emerged as relevant to institutional trust including collaboration, communication, extent of institutional networks, and intersectionality.Conclusions This review validates essential elements of trust in the TI approach and documents the importance of building trust both within and between institutions. The TI approach can be used by public health institutions in LMICs to enhance their abilities to achieve institutional missions and meet global targets.
RETRACTED: “From Hell to Healed” – A Qualitative Study on Women’s Experience of Recovery, Relationships and Sexuality after Severe Obstetric Perineal Injury
Authors: Huber Malin , Tunon Katarina , Lindqvist Maria
Published: December 2020

The authors have requested that this preprint be removed from Research Square.
Low Engagement in HIV Services and Progress through the Treatment Cascade among Key Populations Living with HIV in Mozambique: Alarming Gaps in Knowledge of Status
Authors: Boothe Makini , Sathane Isabel , Baltazar Cynthia Semá , Chicuecue Noela , Horth Roberta , Fazito Erika , Raymond Henry Fisher
Published: December 2020

Background. Mozambique has a generalized HIV epidemic of 13.5% among the general population. Early modeling exercises in Mozambique estimate that key populations (KP), defined as men who have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID), along with their partners account for about one third of all new infections. There is limited data describing the engagement of KP living with HIV in testing, care and treatment services. Methods. We conducted a secondary data analysis of HIV-positive participants in the first Bio-behavioral Surveillance (BBS) surveys in Mozambique conducted 2011-2014 in order to assess service uptake and progress though the HIV treatment cascade among MSM, FSW, and PWID. Unweighted pooled estimates were calculated for each key population group.Results. Among HIV-positive MSM, 63.2% of participants had ever received an HIV test, 8.8% were aware of their status, 6.1% reported having been linked to care, while 3.5% initiated ART and were currently on treatment. Of the HIV-infected FSW participants, 76.5% reported a previous HIV test and 22.4% were previously aware of their status. Linkage to care was reported by 20.1%, while 12.7% reported having initiated ART and 11.8% reported being on treatment at the time of the survey. Among HIV-infected PWID participants, 79.9% had previously received an HIV test, 63.2% were aware of their HIV status, and 49.0% reported being linked to care for their HIV infection. ART initiation was reported by 42.7% of participants, while 29.4% were on ART at the time of the survey. Conclusion. Among the three high risk populations in Mozambique, losses occurred throughout critical areas of service uptake with the most alarming breakpoint occurring at knowledge of HIV status. Special attention should be given to increasing HIV testing and linkage to ART treatment. Future surveys will provide the opportunity to monitor improvements across the cascade in line with global targets and should include viral load testing to guarantee a more complete picture of the treatment cascade.
A Cross-Sectional Survey Of Fertility Knowledge In Obstetrics And Gynecology Residents
Authors: Roberts Leah May , Kudesia Rashmi , Zhao Huaqing , Dolan Shaliz , Rose Marisa
Published: December 2020

BACKGROUND: To evaluate fertility knowledge among current Obstetrics and Gynecology (OB-GYN) residents using a recently published validated instrument, the Fertility and Infertility Treatment Knowledge Score (FIT-KS).METHODS: OB-GYN residents in the United States were recruited through an email to all residency coordinators nationwide. They were asked to voluntarily respond to a short questionnaire including demographic information and the FIT-KS instrument, through an online survey platform. Of approximately 5,000 OB-GYN residents in the country, 177 responded. RESULTS: The sample was 91% female, with 69% between the ages of 26 and 30. Participants evenly represented all four years of training. Mean FIT-KS score was 21.2 (73% correct; range 17-26). No statistically significant differences were noted across the level of training. Several knowledge gaps were noted. Residents could define the common assisted reproductive technologies; however overestimated their success rates per cycle. CONCLUSIONS: Substantial gaps exist in fertility knowledge among OB-GYN residents, with understanding of male fertility and success rates of Assisted Reproductive Technologies (ART) being particularly limited. Knowledge of fertility does not change throughout residency training, demonstrating consistent gaps in fertility knowledge. Knowledge during post graduate year (PGY)-1 year is consistent with mean scores found in prior research in Internal Medicine residents (65%), as well as a cohort of female medical students and obstetrics and gynecology residents and fellows (64.9%)(1, 2).
Effectiveness of Hospital Emergency Department Regionalization and Categorization Policy on Appropriate Patient Emergency Care Use: A Nationwide Observational Study in Taiwan
Authors: Lin Chih-Yuan , Lee Yue-Chune
Published: December 2020

Background: Emergency department (ED) overcrowding is a health services issue worldwide. Modern health policy emphasizes appropriate health services utilization. However, the relationship between accessibility, capability, and appropriateness of ED use is unknown. Thus, this study aimed to examine the effect of hospital ED regionalization policy and categorization of hospital emergency capability policy (categorization policy) on patient-appropriate ED use.Methods: Taiwan implemented a nationwide three-tiered hospital ED regionalization and categorization of hospital emergency capability policies in 2007 and 2009, respectively. We conducted a retrospective observational study on the effect of emergency care policy intervention on patient visit. Between 2005 and 2011, the Taiwan National Health Insurance Research Database recorded 1,835,860 ED visits from one million random samples. ED visits were categorized using the Yang-Ming modified New York University-ED algorithm. A time series analysis was performed to examine the change in appropriate ED use rate after policy implementation.Results: From 2005 to 2011, total ED visits increased by 10.7%. After policy implementation, the average appropriate ED visit rate was 66.9%. The intervention had no significant effect on the trend of appropriate ED visit rate.Conclusions: Although regionalization and categorization policies did increase emergency care accessibility, it had no significant effect on patient-appropriate ED use. Further research is required to improve data-driven policymaking.
Comparing Charlson and Elixhauser comorbidity indices with different weightings to predict in-hospital mortality: an analysis of national inpatient data
Authors: Sharma Narayan , Schwendimann René , Endrich Olga , Ausserhofer Dietmar , Simon Michael
Published: December 2020

Background: Understanding how comorbidity measures contribute to patient mortality is essential both to describe patient health status and to adjust for risks and potential confounding. The Charlson and Elixhauser comorbidity indices are well-established for risk adjustment and mortality prediction. Still, a different set of comorbidity weights might improve the prediction of in-hospital mortality. The present study, therefore, aimed to derive a set of new Swiss Elixhauser comorbidity weightings, to validate and compare them against those of the Charlson and Elixhauser-based van Walraven weights in an adult in-patient population-based cohort of general hospitals. Methods: Retrospective analysis was conducted with routine data of 102 Swiss general hospitals (2012–2017) for 6.09 million inpatient cases. To derive the Swiss weightings for the Elixhauser comorbidity index, we randomly halved the inpatient data and validated the results of part 1 alongside the established weighting systems in part 2, to predict in-hospital mortality. Charlson and van Walraven weights were applied to Charlson and Elixhauser comorbidity indices. Derivation and validation of weightings were conducted with generalized additive models adjusted for age, gender and hospital types. Results: Overall, the Elixhauser indices, c-statistic with Swiss weights (0.867, 95% CI: 0.865–0.868) and van Walraven’s weights (0.863, 95% CI: 0.862-0.864) had substantial advantage over Charlson’s weights (0.850, 95% CI: 0.849–0.851) and in the derivation and validation groups. The net reclassification improvement of new Swiss weights improved the predictive performance by 1.6% on the Elixhauser-van Walraven and 4.9% on the Charlson weights.Conclusions: All weightings confirmed previous results with the national dataset. The new Swiss weightings model improved slightly the prediction of in-hospital mortality in Swiss hospitals. The newly derive weights support patient population-based analysis of in-hospital mortality and seek country or specific cohort-based weightings.
Assessment of chronic disease self-management in patients with chronic heart failure based on the MCID of patient-reported outcomes by the multilevel model 
Authors: Tian Jing , Zhao Jinghua , Zhang Qing , Ren Jia , Han Linai , Li Jing , Zhang Yanbo , Han Qinghua
Published: December 2020

Purpose: The minimal clinically important difference (MCID) of a patient-reported outcome (PRO) represents the threshold value of the change in the score for that PRO. It is deemed to have an important implication in clinical management. This study was performed to evaluate the clinical significance of chronic disease self-management (CDSM) for patients with chronic heart failure based on the MCID of the chronic heart failure - PRO measure (CHF-PROM).Methods: A multicenter, prospective cohort study of 555 patients with heart failure were enrolled from July 2018. Advice of CDSM was provided in written form at discharge to all patients. Information regarding CHF-PROM and CDSM were collected during follow-up. Multilevel models were applied to dynamically evaluate the effects of CDSM for CHF-PROM scores, as well as its physical and psychological domains. MCID changes of the PRO were introduced and compared with β values of CDSM obtained from the multi-level models to further evaluate the clinical significance.Results: Scores for CHF-PROM improved significantly after discharge. The multilevel models showed that a regular schedule, avoidance of over-eating, a low-sodium diet and exercise increased scores on CHF-PROM. Compared with the MCID, avoidance of over-eating (12.39 vs. 9.75) and maintenance of a regular schedule often (10.98 vs. 9.75), and exercise almost every day (11.36 vs. 9.75) reached clinical significance for the overall summary. Avoidance of over-eating (5.88 vs. 4.79) and a regular schedule almost every day (4.96 vs. 4.79) reached clinical significance for the physical scores. Avoidance of over-eating half of the time (5.26 vs. 4.87) and a regular schedule almost every day (5.84 vs. 4.87) demonstrated clinical significance for the psychological scores.Conclusions: This study observed an association of avoidance of over-eating and maintenance of a regular schedule with the improvement of CHF-PROM. It provides further evidence for management of heart failure.
Generating Real-world Evidence from Unstructured Clinical Notes to Examine Clinical Utility of Genetic Tests: Use Case in BRCAness
Authors: ZHAO Yiqing , Weroha Saravut J , Goode Ellen , Liu Hongfang , Wang Chen
Published: December 2020

Background: Next-generation sequencing provides comprehensive information about individuals’ genetic makeup and is commonplace in oncology clinical practice. However, the utility of genetic information in clinical decision-making process has not been examined extensively from a real-world, data-driven perspective. Through mining real-world data (RWD) from clinical notes, we could extract patients’ genetic information and further associate treatment decisions with genetic information.Methods: We proposed a real-world evidence (RWE) study framework that incorporates context-based natural language processing (NLP) methods and data quality examination before final association analysis. The framework was demonstrated in a Foundation-tested women cancer cohort (N=196). Upon retrieval of patients’ genetic information using NLP system, we assessed the completeness of genetic data captured in unstructured clinical notes according to a genetic data-model. We examined the distribution of different topics regarding BRCA1/2 throughout patients’ treatment process, and then analyzed the association between BRCA1/2 mutation status and the discussion/prescription of targeted therapy. Results: We identified seven topics in clinical context of genetic mentions including: Information, Evaluation, Insurance, Order, Negative, Positive, and Variants of unknown significance (VUS). Our rule-based system achieved a precision of 0.87, recall of 0.93 and F-measure of 0.91. Our machine learning system achieved a precision of 0.901, recall of 0.899 and F-measure of 0.9 for four-topic classification and a precision of 0.833, recall of 0.823 and F-measure of 0.82 for seven-topic classification. We found in result-containing sentences, capture of BRCA1/2 mutation information was 75%, but detailed variant information (e.g. variant types) is largely missing. Using cleaned RWD, significant associations were found between BRCA1/2 positive mutation and targeted therapies.Conclusions: In conclusion, we demonstrated a framework to generate RWE using RWD from different clinical sources. Rule-based NLP system achieved the best performance for resolving contextual variability when extracting RWD from unstructured clinical notes. Data quality issues such as incompleteness and discrepancies exist thus manual data cleaning is needed before further analysis can be performed. Finally, we were able to use cleaned RWD to evaluate real-world utility of genetic information to initiate a prescription of targeted therapy.
Personal Social Capital and Self-Rated Health among Middle-Aged and Older Adults: A Cross-sectional Study Exploring the Roles of Leisure-Time Physical Activity and Socioeconomic Status
Authors: Kim Youngdeok , Schneider Tim , Faß Eric , Lochbaum Marc
Published: December 2020

Background: Personal social capital, which refers to the scope and quality of an individual’s social networks within a community, has received increasing attention as a potential sociological factor associated with better individual health; yet, the mechanism relating social capital to health is still not fully understood. This study examined the associations between social capital and self-rated health while exploring the roles of leisure-time physical activity (LTPA) and socioeconomic status (SES) among middle-aged and older adults. Methods: Cross-sectional data were collected from 662 middle-aged and older adults (Mean age: 58.11±10.59 years old) using the Qualtrics survey panel. Personal Social Capital Scale was used to measure bonding and bridging social capital and the International Physical Activity Questionnaire was used to assess LTPA levels. SES was assessed by education and household income levels. Self-rated health was assessed using a single item, by which the participants were categorized into the two groups, having ‘good’ vs. ‘not good’ self-rated health. A series of univariate and multivariate logistic regression models were established to examine the independent and adjusted associations of social capital with self-rated health and to test mediating and moderating roles of LTPA and SES, respectively.Results: Bonding and bridging social capital were positively associated with self-rated health (Odds ratios = 1.11 and 1.09; P’s <.05, respectively), independent of LTPA that was also significantly associated with greater self-rated health (P-for-linear trends = .007). After adjusting SES, the associations of social capital were significantly attenuated and there was a significant interaction effect by household income (P-for-interaction = .012). Follow-up analyses stratified by household income showed that beneficial associations of social capital with self-rated health were more apparent among the people with low and high levels of household income; yet, LTPA was the stronger predictor of self-rated health among those in the middle class of household income. Conclusions: Findings suggest that both social capital and LTPA are associated with better self-rated health; yet, these associations vary by SES. The health policymakers should address both social capital and LTPA for enhancing perceived health among aging populations but may need to consider varying SES backgrounds.
The preventive efficacy of vitamin B supplement on the cognitive decline of elderly adults: a systematic review and meta-analysis
Authors: Li Shufeng , Guo Yuchen , Men Jie , Fu Hanlin , Xu Ting
Published: December 2020

Background: The irreversibility of cognitive impairment of Alzheimer’s disease (AD) prompts that preventing or delaying the onset of AD should be a public health priority. Vitamin B supplement can lower the serum homocysteine (Hcy) level, but whether it can prevent cognitive decline or not remains unclear. We aimed to evaluate the preventive efficacy of vitamin B supplement on the cognitive decline of elderly adults.Methods: We searched PubMed, Embase, The Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, Science Direct, PsycINFO from inception to December 1, 2019, and then updated the retrieved results on June 1, 2020. The randomized controlled trials (RCTs) which evaluated the efficacy of vitamin B in mild cognitive impairment (MCI) patients or elderly adults without cognitive impairment were selected. Standardized mean difference (SMD) or mean difference (MD) as well as their 95% confidence interval (CI) were calculated by performing random effects models or fixed effects models.Results: A total of 21 RCTs involving 7571 participants were included for meta-analysis. The forest plots showed that there is significant effect in global cognitive function (15 RCTs, SMD: 0.36; 95% CI: 0.18 to 0.54, P < 0.01) and Hcy (11 RCTs, MD: -4.59; 95%CI: -5.51 to -3.67, P < 0.01), but there is no effect in information processing speed (10 RCTs, SMD: 0.06; 95% CI: -0.12 to 0.25, P = 0.49), episodic memory (15 RCTs, SMD: 0.10; 95% CI: -0.04 to 0.25, P = 0.16), executive function (11 RCTs, SMD: -0.21; 95% CI: -0.49 to 0.06, P = 0.13). The value of effect size and heterogeneity did not vary apparently when excluding the low-quality studies, so we could believe that the results of meta-analysis were robust.Conclusions: Vitamin B supplement might delay or maintain the cognitive decline of elderly adults. We can recommend that the vitamin B supplement should be considered as a preventive medication to MCI patients or elderly adults without cognitive impairment. More well-designed RCTs with large sample sizes were required to clarify the preventive efficacy in the future.
Developing a scoring tool to estimate the risk of deterioration for normotensive patients with acute pulmonary embolism on admission
Authors: Gao Yizhuo , Ji Chao , Zhao Hongyu , Han Jun , Shen Haitao , Jia Dong
Published: December 2020

Background: It is important to identify deterioration in normotensive patients with acute pulmonary embolism (PE). This study aimed to develop a tool for predicting deterioration among normotensive patients with acute PE on admission.Methods: Clinical, laboratory, and computed tomography parameters were retrospectively collected for normotensive patients with acute PE who were treated at a Chinese center from January 2011 to May 2020 on admission into the hospital. The endpoint of the deterioration was any adverse outcome within 30 days. Eligible patients were randomized 2:1 to derivation and validation cohorts, and a nomogram was developed and validated by the aforementioned cohorts, respectively. The areas under the curves (AUCs) with 95% confidence intervals (CIs) were calculated. A risk-scoring tool for predicting deterioration was applied as a web-based calculator.Results: The 845 eligible patients (420 men, 425 women) had an average age of 60.05±15.43 years. Adverse outcomes were identified for 81 patients (9.6%). The nomogram for adverse outcomes included heart rate, systolic pressure, N-terminal-pro brain natriuretic peptide, and ventricle/atrial diameter ratios at 4-chamber view, which provided AUC values of 0.925 in the derivation cohort (95% CI: 0.900–0.946, p<0.001) and 0.900 in the validation cohort (95% CI: 0.883–0.948, p<0.001). A risk-scoring tool was published as a web-based calculator (https://gaoyzcmu.shinyapps.io/APE9AD/).Conclusions: We developed a web-based scoring tool that may help predict deterioration in normotensive patients with acute PE.
Maximum chest CT score is associated with progression to severe illness in patients with COVID-19: A retrospective study from Wuhan, China
Authors: Xiao Jianwei , Li Xiang , Xie Yuanliang , Huang Zengfa , Ding Yi , Zhao Shengchao , Yang Pei , Du Dan , Liu Bin , Wang Xiang
Published: December 2020

Background: The Coronavirus Disease 2019 (COVID-19) pandemic is a world-wide health crisis. Limited information is available regarding which patients will experience more severe disease symptoms. We evaluated hospitalized patients who were initially diagnosed with moderate COVID-19 for clinical parameters and radiological feature that showed an association with progression to severe/critical symptoms.Methods: This study, a retrospective single-center study at the Central Hospital of Wuhan, enrolled 243 patients with confirmed COVID­19 pneumonia. Forty of these patients progressed from moderate to severe/critical symptoms during follow up. Demographic, clinical, laboratory, and radiological data were extracted from electronic medical records and compared between moderate- and severe/critical-type symptoms. Univariable and multivariable logistic regressions were used to identify the risk factors associated with symptom progression.Results: Patients with severe/critical symptoms were older (p<0.001) and more often male (p=0.046). A combination of chronic obstructive pulmonary disease (COPD) and high maximum chest computed tomography (CT) score was associated with disease progression. Maximum CT score (>11) had the greatest predictive value for disease progression. The area under the receiver operating characteristic curve was 0.861 (95% confidence interval: 0.811-0.902).Conclusions: Maximum CT score and COPD were associated with patient deterioration. Maximum CT score (>11) was associated with severe illness.
SARS-CoV-2 serology increases diagnostic accuracy in CT-suspected, PCR-negative COVID-19 patients during pandemic
Authors: Schneider Jochen , Mijocevic Hrvoje , Ulm Kurt , Ulm Bernhardt , Weidlich Simon , Wuerstle Silvia , Rothe Kathrin , Treiber Matthias , Iakoubov Roman , Mayr Ulrich , Lahmer Tobias , Rasch Sebastian , Herner Alexander , Burian Egon , Lohöfer Fabian , Braren Rickmer , Makowski Marcus , Schmid Roland , Protzer Ulrike , Spinner Christoph , Geisler Fabian
Published: December 2020

Background:In the absence of PCR detection of SARS-CoV-2 RNA, accurate diagnosis of COVID-19 is challenging. Low-dose computed tomography (CT) detects pulmonary infiltrates with high sensitivity, but findings may be non-specific. This study assesses the diagnostic value of SARS-CoV-2 serology for patients with distinct CT features but negative PCR.Methods:IgM/IgG chemiluminescent immunoassay was performed for 107 patients with confirmed (group A: PCR+; CT±) and 46 patients with suspected (group B: repetitive PCR-; CT+) COVID-19, admitted to a German university hospital during the pandemic’s first wave. A standardized, in-house CT classification of radiological signs of a viral pneumonia was used to assess the probability of COVID-19.Results:Seroconversion rates (SR) determined on day 5, 10, 15, 20 and 25 after symptom onset (SO) were 8%, 25%, 65%, 76% and 91% for group A, and 0%, 10%, 19%, 37% and 46% for group B, respectively; (p<0.01). Compared to hospitalized patients with a non-complicated course, seroconversion tended to occur at lower frequency and delayed in patients on intensive care units. SR of patients with CT findings classified as high certainty for COVID-19 were 8%, 22%, 68%, 79% and 93% in group A, compared with 0%, 15%, 28%, 50% and 50% in group B (p<0.01). SARS-CoV-2 serology established a definite diagnosis in 12/46 group B patients. In 88% (8/9) of patients with negative serology >14 days after symptom onset (group B), clinico-radiological consensus reassessment revealed probable diagnoses other than COVID-19. Sensitivity of SARS-CoV-2 serology was superior to PCR >17d after symptom onset.Conclusions:Approximately one-third of patients with distinct COVID-19 CT findings are tested negative for SARS-CoV-2 RNA by PCR rendering correct diagnosis difficult. Implementation of SARS-CoV-2 serology testing alongside current CT/PCR-based diagnostic algorithms improves discrimination between COVID-19-related and non-related pulmonary infiltrates in PCR negative patients. However, sensitivity of SARS-CoV-2 serology strongly depends on the time of testing and becomes superior to PCR after the 2nd week following symptom onset.
Novel and traditional anthropometric indices for identifying metabolic syndrome in non-overweight/obese adults
Authors: Wu Lihong , Zhu WenHua , Qiao Qiaohua , Huang Lijuan , Li Yiqi , Chen Liying
Published: December 2020

Background: Metabolic syndrome (MetS) in non-overweight/obese people is insidiously associated with cardiovascular disease (CVD). Novel anthropometric indices can reflect central obesity better than the traditional anthropometric indices. Therefore, we hypothesize that these newly developed anthropometric indices can better identify MetS in non-overweight/obese people than conventional indices. Methods: Cross-sectional data of sociodemographic, biochemical and anthropometric indices were collected from 2916 non-overweight/obese Chinese people. A body shape index (ABSI), body roundness index (BRI), waist-to-height ratio (WHtR), weight-adjusted-waist index (WWI) and abdominal volume index (AVI) were calculated. Partial correlation analysis was used to clarify the correlation between anthropometric indices and MetS variables. Binary logistic regression analysis was applied to assess the association between anthropometric indices and MetS and its components. Receiver-operating characteristic (ROC) curve was used to identify the diagnostic ability of anthropometric indices for MetS and its components. The area under curve (AUC) difference between WHtR and each new anthropometric index was compared in pairs.Results: After adjusting for covariates, AVI had the optimal ability of identifying MetS (AUC: 0.743 for male, 0.819 for female) and the strongest correlation with high-density lipoprotein cholesterol (HDL-C) (coe: -0.227 for male, -0.207 for female) and the highest odds rations (OR) with low HDL-C group (male: OR=1.37, female: OR=1.55). The WHtR was comparable to BRI in assessing MetS (AUC: 0.739 for male, 0.817 for female). WHtR or BRI could also well identify hypertension (AUC: 0.602 for male, 0.688 for female) and dysglycemia (AUC: 0.669 for male, 0.713 for female) and female's high triglyceride level (AUC 0.712). The recognition ability of the two was equivalent. The ability of ABSI and WWI to identify MetS was weak.Conclusions: AVI is the optimal anthropometric indices to identify MetS in non-overweight/obese Chinese adults. BRI and WHtR can also be considered as discriminators, while ABSI and WWI are weak discriminators. WHtR is easy to measure. So, it is recommended as an early preliminary screening method for the MetS in non-overweight/obese people.
Evaluating performance of health care facilities at meeting HIV-indicator reporting requirements in Kenya: An application of K-means clustering algorithm
Authors: Gesicho Milka , Were Martin , Babic Ankica
Published: December 2020

BackgroundThe ability to report complete, accurate and timely data by HIV care providers and other entities is a key aspect in monitoring trends in HIV prevention, treatment and care, hence contributing to its eradication. In many low-middle-income-countries (LMICs), aggregate HIV data reporting is done through the District Health Information Software 2 (DHIS2). Nevertheless, despite a long-standing requirement to report HIV-indicator data to DHIS2 in LMICs, few rigorous evaluations exist to evaluate adequacy of health facility reporting at meeting completeness and timeliness requirements over time. The aim of this study is to conduct a comprehensive assessment of the reporting status for HIV-indicators, from the time of DHIS2 implementation, using Kenya as a case study.MethodsA retrospective observational study was conducted to assess reporting performance of health facilities providing any of the HIV services in all 47 counties in Kenya between 2011 to 2018. Using data extracted from DHIS2, K-means clustering algorithm was used to identify homogeneous groups of health facilities based on their performance in meeting timeliness and completeness facility reporting requirements for each of the six programmatic areas. Average silhouette coefficient was used in measuring the quality of the selected clusters.ResultsBased on percentage average facility reporting completeness and timeliness, four homogeneous groups of facilities were identified namely: best performers, average performers, poor performers and outlier performers. Apart from blood safety reports, a distinct pattern was observed in five of the remaining reports, with the proportion of best performing facilities increasing and the proportion of poor performing facilities decreasing over time. However, between 2016 and 2018, the proportion of best performers declined in some of the programmatic areas. Over the study period, no distinct pattern or trend in proportion changes was observed among facilities in the average and outlier groups.ConclusionsThe identified clusters revealed general improvements in reporting performance in the various reporting areas over time, but with noticeable decrease in some areas between 2016 and 2018. This signifies the need for continuous performance monitoring with possible integration of machine learning and visualization approaches into national HIV reporting systems.
Predicting Polish transport industry equilibrium characteristics as an inverse problem: An Entropy Econometrics Model
Authors: Bwanakare Second , Cierpiał-Wolan Marek
Published: December 2020

The business environment dynamics is governed by a high degree of uncertainty and risk; consequently, in a majority of cases investors face serious difficulties when making business decisions. Additionally, when detailed statistical information relating to industry is missing, any decisions may become a matter of highly risky conjectures.

The present article proposes a simultaneous equation model based on the entropy econometrics estimator for recovering some key industrial subsector long-term equilibrium characteristics in the situation where only sparse, insufficient statistical information is available (e.g. only aggregated data on the whole industry).

The model is applied to the transportation equipment manufacturing industry in Poland, which is composed of eight sub-sectors. As a result of the above procedure, an observation has been made that all firms from different sub-sectors have to increase their steady-state concentration ratios, while the highest concentration corresponds to the lowest increase in profitability. The model outputs conform to the market tendency in this sector and should lead to further applications of the NCEE methodology in business activity on a worldwide scale.
Anti-EGFR-mAb and 5-Fluorouracil Conjugated Polymeric Nanoparticles for Colorectal Cancer
Authors: Bhattacharya Sankha
Published: December 2020

Background::

Due to the higher intake of junk food and unhealthy lifestyle, the percentage
of U.S. adults aged 50 to 75 years who were up-to-date with colorectal cancer screening increased
1.4 percentage points, from 67.4% in 2016 to 68.8% in 2018. This represents an additional
3.5 million adults screened for colorectal cancer. This is a severe concern of this research, and an attempt
was made to prepare a target-specific formulation that could circumvent chemotherapy-related
compilation and improvise higher cellular uptake. The fundamental agenda of this research was
to prepare and develop Anti-EGFR mAb and 5-Fluorouracil (5-FU) fabricated polymeric nanoparticles
for colorectal cancer.

Objective:

The main objective of this research was to prepare and evaluate more target specific formulation
for the treatment of colorectal cancer. PLGA and PEG-based polymeric nanoparticles are
capable of preventing opsonization via the reticuloendothelial system. Hence, prepared polymeric
nanoparticles are capable of higher cellular uptake.

Methods:

The Poly(d,1-lactide-co-glycolide) (PLGA) and Polyethylene Glycol (PEG) were combined
utilizing the ring-opening polymerization method. The presence of PEG prevents opsonization
and distinguished blood concentration along with enhanced targeting. The presence of PLGA
benefits in the sustained release of polymeric formulations. The optimized formulation (5-FU-PLGA-
PEG-NP) was lyophilized using 4% trehalose (cryoprotectants) and conjugated with Anti-
EGFR mAb on its surface to produce Anti-EGFR-5-FU-PLGA-PEG-NP; the final formulation,
which increases target specificity and drug delivery system of nanoparticles.

Results:

The spherical shaped optimized formulation, 5-FU-PLGA-PEG-NP-3 was found to have
higher percentage drug entrapment efficacy (71.23%), higher percentage drug content (1.98 ±
0.34%) with minimum particles size (252.3nm) and anionic zeta potential (-31.23mV). The IC50value
of Anti-EGFR-5-FU-PLGA-PEG-NP was 1.01μg/mL after 48 hours incubation period in the
HCT 116 cell line, indicating higher anticancer effects of the final formulation.

Conclusions:

From the outcomes of various experiments, it was concluded that Anti-EGFR-5-FU-PLGA-PEG-NP has
biphasic drug release kinetics, higher cellular uptake & higher cytotoxicity. Therefore, Anti-EGFR-5-FU-PLGA-PEG-NP
holds excellent potential for drug delivery to EGFR positive colorectal cancer cells.