bluuebunny/crossref_metadata_2025 huggingface dataset:
Partnership for the implementation of mental health policy in Nigeria: a case study of the Comprehensive Community Mental Health Programme in Benue State
Authors: Ryan G. K. , Nwefoh E. , Aguocha C. , Ode P. O. , Okpoju S. O. , Ocheche P. , Woyengikuro A. , Abdulmalik J. , Eaton J.
Published: February 2020

Background

71% of countries in the World Health Organisation’s (WHO’s) African Region have a stand-alone mental health policy or plan, but only 14% have fully implemented it. In Nigeria, integration of mental health into primary care has been a stumbling block to the implementation of the 1991 National Mental Health Policy, 2013 Policy on Mental Health Services Delivery and the National Mental, Neurological and Substance Use Programme and Action Plan. A partnership between public and private not-for-profits in Benue State, the Comprehensive Community Mental Health Programme (CCMHP) has successfully integrated mental health into primary care in alignment with the national mental health policy and the WHO’s mental health Gap Action Programme Intervention Guide (mhGAP-IG). There is a need to document such examples in order to inform policy implementation in Nigeria and other low- and middle-income countries (LMICs).

Methods

We followed the Case Study Methodology to Monitor and Evaluate Community Mental Health Programmes in LMICs. Four field visits were conducted between 2013 and 2017 to document the first phase of activities of CCMHP, covering the period of January 2011 through June 2016.

Results

In its first phase, CCMHP trained 19 community psychiatric nurses and 48 community health extension workers in mhGAP-IG, establishing 45 new mental health clinics in primary care facilities across Benue, a state more populous than many countries. As a result, 13,785 clients (55% male, 45% female) were enrolled in mental health services either in primary care or in one of two pre-existing community-based rehabilitation facilities. Most are adults over age 18 (82.75%), and present to services with epilepsy (52.38%) or psychosis (38.41%).

Conclusion

The case of CCMHP demonstrates it is possible to rapidly scale-up mental health services in line with national mental health policy using the mhGAP-IG, even in a challenging, low-resource setting. Multi-sectoral partnerships may help to overcome some of the barriers to successful integration of mental health into general healthcare by capitalising on the resources and expertise of both state and non-state actors. However, a difficult political context could threaten the sustainability of the programme if funder requirements force a rapid transition to full government ownership.
Surgical site infection and pathogens in Ethiopia: a systematic review and meta-analysis
Authors: Birhanu Yeneabat , Endalamaw Aklilu
Published: February 2020

Background

Surgical site infection is a common complication in patients who underwent surgery. The prevalence is higher in low-income countries. In Ethiopia, prevalence and pathogens of surgical site infection (SSI) reported are variable. This systematic review and meta-analysis aimed to find the pooled prevalence of SSI. Besides, it aimed to find pathogens of surgical site infection in Ethiopia.

Methods

The databases for the search were PubMed, Web of Science, and Google Scholar by the date 21/08/2018. To assess publication bias Egger’s test regression analysis was applied. Subgroup analysis was conducted based on the study population and region.

Results

This meta-analysis included a total of 15 studies with 8418 study subjects. The pooled prevalence of surgical site infection was 25.22% (95% CI: 17.30 to 33.14%). Staphylococcus aureus (30.06%) was the most common pathogen identified. Followed by Escherichia coli (19.73%), Klebsiella species (17.27%), and Coagulase-Negative staphylococci (12.43%) were the commonly isolated pathogens.

Conclusions

The national prevalence of surgical site infection was high. The most common identified pathogen was Staphylococcus aureus. Followed by Escherichia coli, Klebsiella species, and Coagulase-Negative staphylococci. Strict adherence to surgical site infection prevention techniques needs to get more attention.
Jakyakgamcho-tang in the relief of delayed-onset muscle soreness in healthy adults: study protocol for a randomized, double-blind, placebo-controlled, crossover design clinical trial
Authors: Han Kyungsun , Kwon Ojin , Jung So-Young , Park In-hwa , Hwang Man-Suk , Park Sun-Young , Hwang Eui-Hyoung , Lee Jun-Hwan
Published: February 2020

Background

Muscle soreness after exercise, called delayed-onset muscle soreness (DOMS), may cause significant changes in muscle function and may increase the risk of sports injuries. Therefore, various therapeutic strategies have been studied to help recovery after exercise. Jakyakgamcho-tang (JGT) is a widely prescribed herbal medicine to treat muscle pain and cramps in traditional Eastern medicine. The aim of this study is to evaluate the effect of JGT for reducing pain and improving muscle damage after exercise.

Methods

This study is a randomized, double-blind, placebo-controlled, crossover design clinical trial. A total of 30 healthy male adults will be recruited. Subjects who voluntarily wish to participate in this study will be hospitalized for 4 days. On the first day, the subjects will perform a standardized treadmill exercise for 1 h to induce DOMS. After the exercise, the subjects will take either JGT or a placebo for 3 days. After a more than 1 week wash-out period, the subjects will repeat the same process with the other drug. Pain intensity, calf circumference, and pain threshold will be measured as outcome measures. Blood tests and blood pressure will be measured as safety assessments. In addition, blood tests for muscle damage and inflammation markers, such as creatine kinase, interleukin-6, and C-reactive protein, will be analyzed.

Discussion

This will be the first trial to assess the effect of JGT on exercise-induced muscle soreness. Our findings will provide valuable data to determine the clinical effects of JGT on DOMS.

Trial registration

Clinical Research Information Sevice, KCT0003457. Registered on 29 January 2019.
Medication adherence and survival among hospitalized heart failure patients in a tertiary hospital in Tanzania: a prospective cohort study
Authors: Pallangyo Pedro , Millinga Jalack , Bhalia Smita , Mkojera Zabella , Misidai Nsajigwa , Swai Happiness J. , Hemed Naairah R. , Kaijage Alice , Janabi Mohamed
Published: February 2020

Objective

Management of heart failure is complex and multifaceted but adherence to medications remains the cornerstone of preventing avoidable readmissions, premature deaths, and unnecessary healthcare expenses. Despite of evidence-based efficacy on anti-failure drugs, poor adherence is pervasive and remains a significant barrier to improving clinical outcomes in heart failure population.

Results

We enrolled 459 patients with diagnosis of heart failure admitted at a tertiary cardiovascular hospital in Dar es Salaam, Tanzania. The mean age was 46.4 years, there was a female predominance (56.5%), 67.5% resided in urban areas and 74.2% had primary education. Of the 419 participants eligible for assessment of medication adherence, 313 (74.7%) had poor adherence and 106 (25.3%) had good adherence. Possession of a health insurance was found to be the strongest associated factor for adherence (adjusted OR 8.7, 95% CI 4.7–16.0, p < 0.001). Participants with poor adherence displayed a 70% increased risk for rehospitalization compared to their counterparts with good adherence (adjusted RR 1.7, 95% CI 1.2–2.9, p = 0.04). Poor adherence was found to be the strongest predictor of early mortality (HR 2.5, 95% CI 1.3–4.6, p < 0.01). In conclusion, Poor medication adherence in patients with heart failure is associated with increased readmissions and mortality.
Role of antibiotic stress in phenotypic switching to persister cells of antibiotic-resistant Staphylococcus aureus
Authors: Dawan Jirapat , Wei Shuai , Ahn Juhee
Published: February 2020

Purpose

This study was designed to evaluate phenotypic and genotypic properties of persister cells formed by Staphylococcus aureus ATCC 15564 (SAWT), oxacillin-induced S. aureus (SAOXA), ciprofloxacin-induced S. aureus (SACIP), and clinically isolated multidrug-resistant S. aureus CCARM 3080 (SAMDR).

Methods

The dose-dependent biphasic killing patterns were observed for SAWT, SAOXA, SACIP, and SAMDR in response to twofold minimum inhibitory concentrate (MIC) of ciprofloxacin. The surviving cells of SAWT, SAOXA, SACIP, and SAMDR after twofold MIC of ciprofloxacin treatment were analyzed using a metabolic-based assay to estimate the fractions of persister cells.

Results

The least persister formation was induced in SACIP after twofold MIC of ciprofloxacin treatment, showing 58% of persistence. The lowest fitness cost of resistance was observed for the recovered persister cells of SACIP (relative fitness = 0.95), followed by SAMDR (relative fitness = 0.70), while the highest fitness cost was observed for SAWT (relative fitness = 0.26). The mRNA transcripts were analyzed by RT-PCR assay in recovered persister cells pre-incubated with ciprofloxacin. The highest expression levels of stress-related genes (dnaK and groEL) and efflux pump-related genes (mepR, norA, and norB) were observed in the recovered persister cells of SAOXA and SAMDR.

Conclusion

This study provides valuable information for understanding crosstalk between antibiotic resistance, tolerance, and persistence in different antibiotic-resistant S. aureus strains.
Transplantation of human induced pluripotent stem cell-derived cardiomyocytes improves myocardial function and reverses ventricular remodeling in infarcted rat hearts
Authors: Guan Xumin , Xu Wanzi , Zhang He , Wang Qian , Yu Jiuyang , Zhang Ruyi , Chen Yamin , Xia Yunlong , Wang Jiaxian , Wang Dongjin
Published: February 2020

Background

Human-induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) have shed great light on cardiac regenerative medicine and specifically myocardial repair in heart failure patients. However, the treatment efficacy and the survival of iPSC-CMs in vivo after transplantation have yielded inconsistent results.

Objectives

The objective of this study was to evaluate the ability of human iPSC-CMs to improve myocardial function in a rat postinfarction heart failure model.

Methods

Eight-week-old male Sprague-Dawley rats were randomly selected to receive an intramyocardial injection of 5% albumin solution with or without 1 × 107 human iPSC-CMs 10 days after undergoing left anterior descending (LAD) coronary artery ligation. Cyclosporine A and methylprednisolone were administered before iPSC-CM injection and until the rats were killed to prevent graft rejection. Cardiac function was evaluated by echocardiography. The survival of grafted cardiomyocytes was confirmed by observing the fluorescent cell tracer Vybrant™ CM-DiI or expression of the enhanced green fluorescent protein (eGFP) in transplanted cells, or survival was demonstrated by polymerase chain reaction (PCR)-based detection of human mitochondrial DNA. Sirius red stain was used to evaluate the fibrosis ratio. Hematoxylin-eosin staining was used to observe the formation of teratomas.

Results

Four weeks after intramyocardial injection of iPSC-CMs, animals undergoing iPSC-CM transplantation had lower mortality than the control group. Animals injected with cell-free solution (control group) demonstrated significant left ventricular (LV) functional deterioration, whereas grafting of iPSC-CMs attenuated this remodeling process. In the control group, the ejection fraction deteriorated by 10.11% (from 46.36 to 41.67%), and fractional shortening deteriorated by 9.23% (from 24.37 to 22.12%) by 4 weeks. In the iPSC-CM injection group, the ejection fraction improved by 18.86% (from 44.09 to 52.41%), and fractional shortening improved by 23.69% (from 23.08 to 28.54%). Cell labeling, tracking, and molecular biology techniques indicated that the grafted cardiomyocytes survived in the rat heart 1 month after iPSC-CM transplantation. Myocardial fibrosis was also attenuated in the iPSC-CM treatment group.

Conclusions

Human iPSC-CM grafts survived in infarcted rat hearts and restored myocardial function 4 weeks after transplantation. Cell replacement therapy also reversed ventricular remodeling, indicating the potential of iPSC-CMs for cardiac repair strategies.
A novel multi-enzyme preparation produced from Aspergillus niger using biodegradable waste: a possible option to combat heterogeneous biofilms
Authors: Kaur Arashdeep , Rishi Valbha , Soni Sanjeev Kumar , Rishi Praveen
Published: February 2020

Extracellular polymeric substance (EPS) produced by the microorganisms provides protection and stability to them when they are encased within biofilms. Heterogeneous polysaccharides form a major constituent of the EPS and are crucial for the formation and integrity of the biofilms/slime. Thus, breakdown of polysaccharides might help in dispersion of biofilms from abiotic surfaces. In the present study we isolated a fungus, Aspergillus niger APS, capable of concurrently producing a cocktail of carbohydrases and optimized the conditions for higher yields of all the enzymes by one variable at a time (OVAT) approach. The optimization studies resulted in 1.5 to 12 fold augmentation in the enzyme yields using biodegradable waste. Further, keeping in view the heterogeneous nature of polysaccharides in biofilm matrix, the in-house produced enzyme cocktail was used for the dispersal of biofilms formed by Salmonella enterica serovar Typhi, Escherichia coli and Staphylococcus aureus. Treatment with enzyme preparation caused 90.23 ± 4.0, 82.64 ± 5.0 and 76.32 ± 5.0% reduction of the biofilms formed by these organisms respectively which was also evidenced by Field emission scanning electron microscopy (FESEM) revealing the loss of biofilm architecture. Interestingly, the enzyme cocktail could also remove viscous slime formed under natural conditions in the kitchen drainage pipe (KDP). To the best of our knowledge, this is the first report on biotreatment of abiotic surfaces for removal of biofilms/slime formed under natural conditions. The study thus indicates the prospects of using multiple carbohydrases as an anti-biofouling agent on abiotic surfaces like equipments as well as implants/prostheses and pipelines.
Performance management methods and practices among nurses in primary health care settings: a systematic scoping review protocol
Authors: Madlabana Cynthia Zandile , Mashamba-Thompson Tivani Phosa , Petersen Inge
Published: February 2020

Background

Nurses make up the largest constituent of the health workforce. The success of health care interventions depends on nurses’ ability and willingness to provide quality health care services. A well-implemented performance management (PM) system can be a valuable asset in ensuring that nurses are motivated, promoted, trained and rewarded appropriately. Despite the significant benefits of effective PM such as improved motivation, job satisfaction and morale, PM systems are highly contested. Therefore, it is important to examine evidence on PM methods and practices in order to understand its consequences among nursing professionals in primary health care (PHC) settings.

Methods

The search strategy of this systematic scoping review will involve various electronic databases which include Academic Search Complete, PsycARTICLES. PsycINFO, Cumulative Index to Nursing and Applied Health Literature, Medline and Cochrane Library from the EbsocHost Database Platform. Electronic databases such as PubMed and Google Scholar, Union catalogue of theses and dissertations via SABINET online and WorldCat dissertations will be incorporated. A grey literature search will be conducted on websites such as the World Health Organization and government websites to find relevant policies and guidelines. The period for the search is from 1978 to 2018. This time period was chosen to coincide with the Declaration of Alma-Ata on PHC adopted in 1978. All references will be exported to Endnote library. Two independent reviewers will begin screening for eligible titles, abstracts and full articles. During title and abstract screening, duplicates will be removed. The Mixed Method Appraisal Tool will determine the quality of included studies. Thematic analysis will be used to analyse the included articles.

Discussion

Evidence of preferences on PM methods and practices will generate insight on the use of PM systems in PHC and how this can be used for the purpose of improving nurses’ performance and in turn, the provision of quality health care. We hope to expose knowledge gaps and inform future research.
Torsional Strengthening of RC Beams with Continuous Spiral Near-Surface Mounted Steel Wire Rope
Authors: Askandar Nasih Habeeb , Mahmood Abdulkareem Darweesh
Published: February 2020

The strength of reinforced concrete members can be enhanced using externally bonded reinforcement (EBR) and near surface mounted (NSM) methods. However, small number of studies has adopted the NSM method for torsional strengthening. To date, no study has examined the use of spiral NSM steel wire rope and epoxy adhesives for torsional strengthening. Therefore, this study examines the behaviour of RC beams subjected to the combined actions of torsion and bending moment when they are strengthened with spiral NSM steel wire rope (Ø8 mm) in different configurations. For this purpose, six beams of 15 cm × 25 cm × 200 cm were casted. One of these beams was conventional, whereas all the other beams were strengthened with spiral NSM steel wire rope. During the testing process, the twist angle at the torque intervals, first cracking torque, ultimate torque and ultimate twist angle of the conventional beam were compared with those of the strengthened beams. The torsional performance of the RC beams was significantly improved using spiral NSM steel wire rope in various spiral NSM configurations.
Correction to: Coral microbiome composition along the northern Red Sea suggests high plasticity of bacterial and specificity of endosymbiotic dinoflagellate communities
Authors: Osman Eslam O. , Suggett David J. , Voolstra Christian R. , Pettay D. Tye , Clark Dave R. , Pogoreutz Claudia , Sampayo Eugenia M. , Warner Mark E. , Smith David J.
Published: February 2020

Following publication of the original article [1], the authors reported an error on the legend of of P.damicornis in Fig. 1.
Development of rosuvastatin flexible lipid-based nanoparticles: promising nanocarriers for improving intestinal cells cytotoxicity
Authors: Ahmed Tarek A.
Published: February 2020

Background

Rosuvastatin (RSV) is a poorly water-soluble drug that has an absolute oral bioavailability of only 20%. The aim of this work was to prepare a positively charged chitosan coated flexible lipid-based vesicles (chitosomes) and compare their characteristics to the corresponding negatively charged flexible liposomal nanoparticles (NPs) in order to develop new RSV nanocarrier systems.

Methods

Three formulation factors affecting the development of chitosomes nano-formulation were optimized for their effects on the particles size, entrapment efficiency (EE) and zeta potential. The optimized flexible chitosomes and their corresponding liposomal NPs were characterized for morphology, in vitro release, flexibility and intestinal cell viability. The half maximum inhibitory concentrations (IC50) for both formulations were calculated.

Results

The drug to lipid molar ratio, edge activator percent and the chitosan concentration were significantly affecting the characteristics of NPs. The optimized chitosomes nano-formulation exhibited larger size, higher EE and greater zeta potential value when compared to the corresponding liposomal NPs. Both formulations showed a spherical shape nanostructure with a marked outer shell for the chitosomes nano-formulation. Chitosomes illustrated an extended drug release profile when compared with the corresponding liposomal NPs and the prepared drug suspension. Flexibility of both vesicles was confirmed with superiority of liposomal NPs over chitosomes. RSV loaded chitosomes nano-formulation exhibited lower IC50 values and higher therapeutic window while liposomal NPs were compatible with the intestinal cells.

Conclusions

RSV loaded chitosomes nano-formulation could be considered as a promising nanocarrier system with a marked cytotoxic activity while, RSV loaded liposomal NPs are suitable nanocarrier to improve RSV activity in treatment of cardiovascular disorders.
Do we need to go further to train healthcare providers in the targeted regions for malaria elimination in Myanmar? A mixed-methods study
Authors: Hein Zar Ni Min , Maung Thae Maung , Aung Poe Poe , Mon Nwe Oo , Han Wai Wai , Oo Tin , Linn Nay Yi Yi , Thi Aung , Wai Khin Thet
Published: February 2020

Background

The National Malaria Control Programme (NMCP) in Myanmar trained health staff at the township level starting in mid-2016 in order to achieve the Plasmodium falciparum malaria elimination target by 2020. This study aimed to evaluate the knowledge and perception of Basic Health Staff (BHS) and Vector-borne Diseases Control (VBDC) teams exposed to a short training course on malaria elimination in six targeted townships which included two conflict-affected townships between 2016 and 2017.

Methods

This was a cross-sectional mixed-methods study using quantitative and qualitative data extracted from one survey database conducted between October 2018 and March 2019. Modified Poisson regression analysis was performed to ascertain the determinants of low knowledge scores after the training programme.

Results

Altogether, 544 trained frontline health workers involved in malaria elimination at the time of the survey were recruited and 56% (302/544) were stationed at sub-Rural Health Centers. More than half of the respondents had correct knowledge of malaria case categories although relapse and recrudescent cases (39% and 37% respectively) were less well known. Over two-thirds of respondents could mention those eligible for malaria testing. Less than 30% knew the foci classification. The overall knowledge scores ranged from 10 to 31. The significant predictors of low level of knowledge [the cut-off point was set at the median value of 21 (IQR 12–30)] in multivariate analysis were the younger age group (18–29 years) and health staff who had attended malaria elimination training in 2017, [(APR = 1.6, 95% CI 1.2–2.2)]; and (APR = 1.5, 95%CI 1.2–1.8)]. Qualitative data from 10 key informants identified perceived challenges in conflict-affected areas as well as in areas of high population mobility with further implications for case surveillance. In addition, the low level of education of community members was noted as one of the barriers that hampered public readiness in the elimination scenario.

Conclusion

A significant impact on knowledge improvement after the training programme was not visible especially for correct notification of malaria cases and treatment according to National Malaria Elimination Guidelines. Regular monitoring and continuing guidance by the higher level management is critical to support the field staff.
Early environmental factors and somatic comorbidity in schizophrenia and nonschizophrenic psychoses: A 50-year follow-up of the Northern Finland Birth Cohort 1966
Authors: Korpela Hanna , Miettunen Jouko , Rautio Nina , Isohanni Matti , Järvelin Marjo-Riitta , Jääskeläinen Erika , Auvinen Juha , Keinänen-Kiukaanniemi Sirkka , Nordström Tanja , Seppälä Jussi
Published: February 2020

Background.

We studied the cumulative incidence of physical illnesses, and the effect of early environmental factors (EEFs) on somatic comorbidity in schizophrenia, in nonschizophrenic psychosis and among nonpsychotic controls from birth up to the age of 50 years.

Methods.

The sample included 10,933 members of the Northern Finland Birth Cohort 1966, of whom, 227 had schizophrenia and 205 had nonschizophrenic psychosis. Diagnoses concerning physical illnesses were based on nationwide registers followed up to the end of 2016 and classified into 13 illness categories. Maternal education and age, family type at birth and paternal socioeconomic status were studied as EEFs of somatic illnesses.

Results.

When adjusted by gender and education, individuals and especially women with nonschizophrenic psychosis had higher risk of morbidity in almost all somatic illness categories compared to controls, and in some categories, compared to individuals with schizophrenia. The statistically significant adjusted hazard ratios varied from 1.27 to 2.42 in nonschizophrenic psychosis. Regarding EEFs, single-parent family as the family type at birth was a risk factor for a higher somatic score among men with schizophrenia and women with nonschizophrenic psychosis. Maternal age over 35 years was associated with lower somatic score among women with nonschizophrenic psychosis.

Conclusions.

Persons with nonschizophrenic psychoses have higher incidence of somatic diseases compared to people with schizophrenia and nonpsychotic controls, and this should be noted in clinical work. EEFs have mostly weak association with somatic comorbidity in our study.
Frailty in Older Adults With Multiple Myeloma: A Study of US Veterans
Authors: Patel Bindiya G. , Luo Suhong , Wildes Tanya M. , Sanfilippo Kristen M.
Published: February 2020

PURPOSE

Age-associated cumulative decline across physiologic systems results in a diminished resistance to stressors, including cancer and its treatment, creating a vulnerable state known as frailty. Frailty is associated with increased risk of adverse outcomes in patients with cancer. Identification of frailty in administrative data can allow for assessment of prognosis and facilitate control for confounding variables. The purpose of this study was to assess frailty from claims-based data using the accumulation of deficits approach in veterans with multiple myeloma (MM).

METHODS

From the Veterans Administration Central Cancer Registry, we identified patients who were diagnosed with MM between 1999 and 2014. Using the accumulation of deficits approach, we calculated a Frailty Index (FI) using 31 health-associated deficits and categorized scores into five groups: nonfrail (FI, 0 to 0.1), prefrail (FI, 0.11 to 0.20), mild frailty (FI, 0.21 to 0.30), moderate frailty (FI, 0.31 to 0.40), and severe frailty (FI, > 0.4). We used Cox proportional hazards regression analysis to assess association between FI score and mortality while adjusting for potential confounders.

RESULTS

We calculated an FI for 3,807 veterans age 65 years or older. Among the cohort, 28.7% were classified as nonfrail, 41.3% prefrail, 21.6% mildly frail, 6.6% moderately frail, and 1.7% severely frail. Frailty was strongly associated with mortality independent of age, race, MM treatment, body mass index, or statin use. Higher FI score was associated with higher mortality with hazard ratios of 1.33 (95% CI, 1.21 to 1.47), 1.97 (95% CI, 1.70 to 2.20), 2.86 (95% CI, 2.45 to 3.34), and 3.22 (95% CI, 2.46 to 4.22) for prefrail, mildly frail, moderately frail, and severely frail, respectively.

CONCLUSION

Frailty status is a significant predictor of mortality in older veterans with MM. Assessment of frailty status using the readily available electronic medical records data in administrative data allows for assessment of prognosis.
Predicting Acute Graft-Versus-Host Disease Using Machine Learning and Longitudinal Vital Sign Data From Electronic Health Records
Authors: Tang Shengpu , Chappell Grant T. , Mazzoli Amanda , Tewari Muneesh , Choi Sung Won , Wiens Jenna
Published: February 2020

PURPOSE

Acute graft-versus-host disease (aGVHD) remains a significant complication of allogeneic hematopoietic cell transplantation (HCT) and limits its broader application. The ability to predict grade II to IV aGVHD could potentially mitigate morbidity and mortality. To date, researchers have focused on using snapshots of a patient (eg, biomarkers at a single time point) to predict aGVHD onset. We hypothesized that longitudinal data collected and stored in electronic health records (EHRs) could distinguish patients at high risk of developing aGVHD from those at low risk.

PATIENTS AND METHODS

The study included a cohort of 324 patients undergoing allogeneic HCT at the University of Michigan C.S. Mott Children’s Hospital during 2014 to 2017. Using EHR data, specifically vital sign measurements collected within the first 10 days of transplantation, we built a predictive model using penalized logistic regression for identifying patients at risk for grade II to IV aGVHD. We compared the proposed model with a baseline model trained only on patient and donor characteristics collected at the time of transplantation and performed an analysis of the importance of different input features.

RESULTS

The proposed model outperformed the baseline model, with an area under the receiver operating characteristic curve of 0.659 versus 0.512 ( P = .019). The feature importance analysis showed that the learned model relied most on temperature and systolic blood pressure, and temporal trends (eg, increasing or decreasing) were more important than the average values.

CONCLUSION

Leveraging readily available clinical data from EHRs, we developed a machine-learning model for aGVHD prediction in patients undergoing HCT. Continuous monitoring of vital signs, such as temperature, could potentially help clinicians more accurately identify patients at high risk for aGVHD.
Growth Rates of Genetically Defined Renal Tumors: Implications for Active Surveillance and Intervention
Authors: Ball Mark W. , An Julie Y. , Gomella Patrick T. , Gautam Rabindra , Ricketts Christopher J. , Vocke Cathy D. , Schmidt Laura S. , Merino Maria J. , Srinivasan Ramaprasad , Malayeri Ashkan A. , Metwalli Adam R. , Linehan W. Marston
Published: February 2020

PURPOSE

Published series of growth rates of renal tumors on active surveillance largely consist of tumors without pathologic or genetic data. Growth kinetics of genetically defined renal tumors are not well known. Here, we evaluate the growth of genetically defined renal tumors and their association with patient clinical and genetic characteristics.

PATIENTS AND METHODS

We evaluated patients with an inherited kidney cancer susceptibility syndrome as a result of a pathologic germline alteration of VHL, MET, FLCN, or BAP1 with at least 1 solid renal mass managed with active surveillance at our institution. Tumor growth rates (GR) were calculated and patients were stratified by genetic alteration and other clinical and genetic factors to analyze differences in growth rates using linear regression and comparative statistics.

RESULTS

A total of 292 patients with 435 genetically defined tumors were identified, including 286 VHL-deficient, 91 FLCN-deficient, 52 MET-activated, and 6 BAP1-deficient tumors. There were significant differences in GRs when stratified by genetic alteration. BAP1-deficient tumors had the fastest median GR (0.6 cm/y; interquartile range [IQR], 0.57-0.68 cm/y), followed by VHL-deficient tumors (GR, 0.37 cm/y; IQR, 0.25-0.57 cm/y), FLCN-deficient tumors (GR, 0.10 cm/y; IQR, 0.04-0.24 cm/y), and tumors with MET activation (GR, 0.15 cm/y; IQR, 0.053-0.32 cm/y; P < .001). Tumors from the same patient had similar GRs. Younger age was independently associated with higher GR ( P = .005).

CONCLUSION

In a cohort of genetically defined tumors, tumor growth rates varied in a clinically and statistically different manner according to genetic subtype. Rapid growth of BAP1-deficient tumors indicates that these patients should be managed with caution. The faster growth of tumors in younger patients may support more frequent imaging, whereas the slower growth of other tumors may support extended surveillance beyond annual imaging in some instances.
Infrastructural Challenges Lead to Delay of Curative Radiotherapy in Nigeria
Authors: Leng Jim , Ntekim Atara I. , Ibraheem Abiola , Anakwenze Chidinma P. , Golden Daniel W. , Olopade Olufunmilayo I.
Published: February 2020

PURPOSE

In low- and middle-income countries, there has been an exponential increase in cancer incidence. According to the International Atomic Energy Agency, the biggest gap in radiotherapy availability and need is in Nigeria, where each machine serves an estimated 25.7 million people. This study aimed to characterize the barriers to radiotherapy and to identify areas for intervention.

METHODS

This was a cross-sectional study conducted at the University College Hospital in Ibadan, Nigeria, from June 2017 to August 2017. Demographic, sociocultural, and infrastructural factors relating to radiotherapy were collected through a questionnaire (N = 186). Ordinal logistic regression was used to identify the factors leading to delays in referral and delays in treatment initiation.

RESULTS

Patients traveled from 20 of Nigeria’s 36 states. The median age was 50 years (range, 19-79 years). The most common cancers treated were breast (37.5%), cervical (16.3%), head and neck (11.9%), and prostate (10.9%). In ordinal logistic regression, sociocultural factors, including the inability to pay (odds ratio [OR], 1.99; P = .034), a bad hospital experience (OR, 7.05; P = .001), and travel time (OR, 1.36; P = .001), increased the odds of referral delay to radiotherapy. In contrast, there was no significant relationship between time to treatment initiation and sociocultural factors including age, education, and inability to pay. Infrastructural barriers, including machine breakdown (OR, 2.92; P = .001), worker strikes (OR, 2.64; P = .001), and power outages (OR, 2.81; P = .022), increased the odds of treatment delay.

CONCLUSION

Although delays caused by patient factors are reported extensively, patients overcame these barriers in the hopes of curative treatment. However, staff and equipment malfunctions prevented patients from receiving timely radiotherapy. Policies aimed at addressing machine maintenance, health care worker satisfaction, and the aging power grid in Nigeria must be implemented in the future to strengthen the health care system to care for patients with cancer.
Enslavement and the Temporality of Childhood
Authors: Chinn Sarah E.
Published: February 2020

This article explores how thinking about the time of childhood through the lens of US slavery forces us to rethink both phenomena. According to many of the people who lived through it, enslaved childhood was a shifting, episodic phenomenon that had multiple points of definition. Throughout the nineteenth century, as their adult selves looked back on their early years, formerly enslaved people adopted a number of different strategies to understand and narrate how they came to be who they were and what their formative experiences meant in terms of the trajectory of their lives. They wrote within a literary culture that was itself partially responsible for creating (and certainly was instrumental in promoting and perpetuating) the temporal understanding of childhood as unidirectional, progressive, and only tangentially connected to material reality. But they also described quite different temporal patterns for slave childhood. These patterns are the focus of my analysis here: how African American narrators negotiated their vexed relationship to childhood as both never- and always-children in order to challenge the growing consensus on how childhood could and should be staged in literary texts. My primary sources are narratives by formerly enslaved people, written, as most slave narratives were, primarily but not exclusively for white readers.
TouchingThe Scarlet Letter : What Disability History Can Teach Us about Literature
Authors: Altschuler Sari
Published: February 2020

This essay demonstrates the value of disability history for literary and cultural studies. It develops historical cripistemology as a method through which to examine the historical experiences and epistemologies, rather than representations, of disability in particular times and places and emphasizes the vast and varied entanglements of those experiences and epistemologies with mainstream US culture. To do so, “Touching The Scarlet Letter” turns to perhaps the most canonical American novel to show how returning disability history to a text—here Nathaniel Hawthorne’s connections to and interest in blind education as well as the extensive cultural influence of the Perkins Institution and Massachusetts School for the Blind in the 1840s and 1850s—can reframe fundamental aspects of our analyses, such as how we understand reading and interpretation. In so doing, this essay argues for and begins to uncover a hidden disability history of US literature and culture.
How Would Low-Income Communities Prioritize Medicaid Spending?
Authors: Myers C. Daniel , Kieffer Edith C. , Fendrick A. Mark , Kim Hyungjin Myra , Calhoun Karen , Szymecko Lisa , LaHahnn Lynnette , Ledón Charo , Danis Marion , Rowe Zachary , Goold Susan Dorr
Published: February 2020

Context: Medicaid plays a critical role in low-income, minority, and medically underserved communities, particularly in states that have expanded Medicaid under the Affordable Care Act. Yet, the voices of underresourced communities are often unheard in decisions about how to allocate Medicaid's scarce resources, and traditional methods of public engagement are poorly suited to gathering such input. We argue that deliberative public engagement can be a useful tool for involving communities in setting Medicaid priorities.

Method: We engaged 209 residents of low-income, medically underserved Michigan communities in discussions about Medicaid spending priorities using an exercise in informed deliberation: CHAT (CHoosing All Together). Participants learned about Medicaid, deliberated in small groups, and set priorities both individually and collectively.

Findings: Participants prioritized broad eligibility consistent with the ACA expansion, accepted some cost sharing, and prioritized spending in areas—including mental health—that are historically underfunded. Participants allocated less funding beyond benefit coverage, such as spending on healthy communities. Participants perceived the deliberative process as fair and informative, and they supported using it in the policy-making process.

Conclusion: The choices of participants from low-income, medically underserved communities reflect a unique set of priorities and suggest that engaging low-income communities more deeply in Medicaid policy making might result in different prioritization decisions.
Long-term sucrose solution consumption causes metabolic alterations and affects hepatic oxidative stress in wistar rats
Authors: Souza Cruz Ellen Mayra , Bitencourt de Morais Juliana Maria , Rosa Carlos Vinícius Dalto da , Simões Mellina da Silva , Comar Jurandir Fernando , Chuffa Luiz Gustavo de Almeida , Seiva Fábio Rodrigues Ferreira
Published: February 2020

The obesity and overweight cases have been increasing paralleling the number of people with metabolic syndrome, diabetes, and non-alcoholic fatty liver disease. The consumption of artificially sweetened beverages contributes to these epidemics. This study investigated the long-term effects of ingestion of a 40% sucrose solution ingestion on serum and hepatic parameters in male Wistar rats. After 180 days, the glycemic response, lipid profile, and hepatic oxidative stress were compared to those of rats maintained on water. Sucrose ingestion led to higher body weight, increased fat depots, reduced voluntary food intake, and reduced feed efficiency. Rats that received sucrose solution showed early signs of glucose intolerance and insulin resistance, such as hyperinsulinemia. Serum triacylglycerol, VLDL, cholesterol, ALT, and AST levels increased after sucrose consumption. Elevated malondialdehyde and SOD levels and reduced glutathione levels characterize the hepatic oxidative stress due to sucrose ingestion. Liver samples histology showed vacuolar traces and increased fibrotic tissue. Our data showed the harmful effects of chronic consumption of sucrose solution, which can cause alterations that are found frequently in obesity, glucose intolerance, and in non-alcoholic hepatic disease, characteristics of metabolic syndrome.
An Azide-Tethered Cremophor® ELP Surfactant Allowing Facile Post-Surface Functionalization of Nanoemulsions
Authors: Saito Airi , Yamamoto Shinkuro , Ochi Rika , Inoue Keiji , Hadano Shingo , Watanabe Shigeru , Nakayama Taku , Niko Yosuke
Published: February 2020

Nanoemulsions (NEs) comprising Labrafac WC® as an inner oil and Cremophor® ELP as an outer surfactant are promising organic nanoparticles for biomedical applications due to their characteristics, such as a low toxicity, good structural robustness, and a high capacity to encapsulate hydrophobic contrasting agents or drugs. However, NEs present a limited ability to undertake surface functionalization, resulting in uncontrollable cellular uptake or the poor targeting of specific biomolecules and cells. To address this drawback, we herein developed the Cremophor® ELP-derivative (Crem-N3), which possesses multiple azides. Remarkably, the surfaces of NEs formulated from Crem-N3 were easily modified with dibenzocyclooctyne derivatives through a copper-free azide–alkyne cycloaddition reaction known as a bioorthogonal click reaction. Förster resonance energy transfer analysis revealed that these surface-modified NEs possess the desired dispersibility and integrity. Furthermore, NEs that were functionalized with a cell-penetrating peptide, namely octaalginine (R8), were rapidly internalized into cancer cells, unlike NEs containing no R8. Based on our results, we believe that NEs composed of Crem-N3 as a co-surfactant are advanced NEs that allow flexible functionalization in response to targeted applications, such as vivo diagnostic applications that require a probe with minimum toxicity and specificity toward biological substances.
DISCRETE ISOMETRIC EXERCISE FOR THE INDIVIDUAL WITH TIME AND FACILITY CONSTRAINTS
Authors: Anastasio Albert Thomas
Published: February 2020

Apply It!

• Recent research indicates that isometric exercise appears to be safe and has a myriad of potential health benefits.

• Busy health professionals can use isometric exercise in their own personal lives to achieve additional exercise throughout the day.

• Clients who are particularly resistant to initiation of an exercise protocol given time constraints can implement isometric exercise virtually anywhere and anytime.
Efficacy of Liraglutide in clinical practice: Single centre experience
Authors: Rashid Muhammad Owais , Jabeen Sumerah , Khoja Adeel , Islam Najmul
Published: February 2020

Background and Objective: GLP-one receptor agonists are amongst the unique antidiabetes medications that have significant metabolic and cardiovascular benefits in addition to glucose lowering effect. To best of our knowledge, there is no published data on efficacy of liraglutide use among Pakistani population.Our objective was to ascertain the efficacy of liraglutide use among type two diabetes patients.

Methods: This retrospective study was conducted at the Endocrinology Clinics of Aga Khan University Hospital (AKUH) Karachi, Pakistan during the period from July 01, 2016 to 30th June, 2017. Liraglutide was prescribed to 68 obese type two diabetes patients with uncontrolled diabetes taking more than one oral medication ± insulin. Starting dose of Liraglutide was 0.6 mg, which was increased to 1.2 mg after 1-2 weeks with further increment to 1.8 mg/day based on tolerance and individual patient preference. Dose of other diabetes medications was adjusted according to clinical judgment whereas Dipeptidyl peptidase-4 (DPP-4) inhibitors were discontinued.

Results: Mean age of cohort was 55 years (SD=10.94 years) with median body mass index of 36.45 kg/m2 and majority (57.35%) were on a dose of 1.2 mg of Liraglutide per day. Median HbA1c reduced to 7.50% and 7.40% at three months and six months respectively vs 8.45% at baseline. Mean reduction in weight after three month was two kilograms and at six months, it was 1.38 kilograms respectively.

Conclusion: Liraglutide as add on therapy demonstrated favourable HbA1c and weight reduction in obese uncontrolled type two Diabetes Pakistani subjects.

doi: https://doi.org/10.12669/pjms.36.3.358

How to cite this:Rashid MO, Jabeen S, Khoja A, Islam N. Efficacy of Liraglutide in clinical practice: Single centre experience. Pak J Med Sci. 2020;36(3):432-437. doi: https://doi.org/10.12669/pjms.36.3.358

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Τα εκπαιδευτικά προγράμματα ως μέσο επικοινωνίας του μουσείου με το μαθητικό κοινό. Ευαισθητοποίηση και συμμετοχή της σχολικής κοινότητας στο χώρο του μουσείου
Authors: Χατζημαρκάκη Δήμητρα , Σηφάκη Ειρήνη
Published: February 2020

Aντικείμενο της παρούσας έρευνας αποτελούν τα εκπαιδευτικά προγράμματα που προσφέρουν τα σύγχρονα μουσεία σε μια προσπάθεια να προσελκύσουν και να ικανοποιήσουν το μαθητικό κοινό της πρώτης βαθμίδας της εκπαίδευσης. Συγκεκριμένα, μέσα από τη μελέτη της σύγχρονης βιβλιογραφίας αναζητεί τους τρόπους με τους οποίους οι εμπλεκόμενοι φορείς των εκπαιδευτικών προγραμμάτων, το μουσείο και το σχολείο, μπορούν να δημιουργήσουν μια επιτυχημένη συνεργασία με πολλαπλά οφέλη και για τις δύο πλευρές, πάντα όμως με κύριο αποδέκτη και κριτή το μαθητικό κοινό. Επιλέγοντας, ως μελέτη περίπτωσης το Μουσείο Φυσικής Ιστορίας Κρήτης, ερευνούμε μέσω επιτόπιας παρατήρησης, έρευνας στα αρχεία του μουσείου και έρευνας με ερωτηματολόγια, το βαθμό ικανοποίησης τόσο του μαθητικού κοινού, όσο και των εκπαιδευτικών από τη συμμετοχή σε αυτά. Όπως διαπιστώθηκε η μαθησιακή και κυρίως ψυχαγωγική εμπειρία της συμμετοχής στα εκπαιδευτικά προγράμματα δημιουργεί προϋποθέσεις για μια ουσιαστική και διαρκή σχέση επικοινωνίας και συμμετοχής της σχολικής κοινότητας με το μουσείο.
Ο ρόλος των γραπτών εργασιών στην εξ αποστάσεως εκπαίδευση. Η περίπτωση του Ελληνικού Ανοικτού Πανεπιστημίου.
Authors: ΙΣΜΥΡΛΗΣ ΒΑΣΙΛΕΙΟΣ
Published: February 2020

Η εξ αποστάσεως εκπαίδευση καταλαμβάνει πλέον ένα σημαντικό κομμάτι στο σύστημα εκπαίδευσης παγκοσμίως και συμβάλλει σημαντικά στην προσπάθεια για επιμόρφωση και κατάρτιση των ενδιαφερόμενων ατόμων.Το Ελληνικό Ανοικτό Πανεπιστήμιο (ΕΑΠ), ένα ίδρυμα τριτοβάθμιας εκπαίδευσης, το οποίο παρέχει εξ’ αποστάσεως εκπαίδευση στην Ελλάδα εδώ και πολλά χρόνια, επιτελεί ένα σημαντικό έργο σε αυτόν τον τομέα, έχοντας χιλιάδες εγγεγραμμένους σπουδαστές στα προγράμματά του. Έτσι είναι σημαντικό να διερευνηθούν πολλές πτυχές αυτής της διαδικασίας, ώστε να προταθούν και να εφαρμοστούν βελτιώσεις. Οι γραπτές εργασίες θεωρούνται ένα πολύ σημαντικό μέρος αυτής της προσπάθειας, καθώς είναι εργαλεία τα οποία συμβάλλουν στην καλύτερη κατανόηση της ύλης και τελικά συμβάλλουν σημαντικά στην αποτελεσματική μάθηση των εκπαιδευόμενων.Σε αυτήν την εργασία διερευνούνται τα οφέλη καθώς και άλλες πτυχές που προκύπτουν από τις διαδικασίες εκπόνησης των ΓΕ, οι οποίες εκπονούνται κατά την πραγματοποίηση των προγραμμάτων σπουδών του ΕΑΠ.Για να διερευνηθούν τα παραπάνω, διαμορφώθηκε ένα ερωτηματολόγιο με σχετικά ερωτήματα, το οποίο απευθύνθηκε σε φοιτητές του ΕΑΠ και τελικά εβδομήντα πέντε άτομα το συμπλήρωσαν ηλεκτρονικά. Τα δεδομένα αναλύθηκαν και από τα αποτελέσματα που προέκυψαν, διαπιστώνεται ότι οι φοιτητές αναγνωρίζουν τα εκπαιδευτικά οφέλη των γραπτών εργασιών και προσπαθούν να ανταπεξέλθουν στις δυσκολίες τους. Επίσης, θεωρούν ότι είναι ικανοποιημένοι από τις προσπάθειες που κάνουν κατά τη διάρκεια διαδικασίας εκπόνησης των γραπτών εργασιών.Λέξεις-κλειδιά: εξ αποστάσεως εκπαίδευση, γραπτές εργασίες, ερωτηματολόγιο, κατανόηση, αποτελεσματική μάθηση, ΕΑΠ, Ελλάδα, φοιτητές.