bluuebunny/crossref_metadata_2025 huggingface dataset:
Rsp Activates Expression of the Cnt System in Staphylococcus aureus
Authors: Vinué Laura , Hooper David C.
Published: August 2020

Background: The Cnt system is crucial for the optimal import of essential metals in metal-limiting conditions and contributes to virulence in S. aureus. In a screen for regulators of efflux pumps in a phage-based ultra-high-density transposon library, we identified Rsp as a candidate regulator of the cntE gene. Results: A twofold decrease in expression of all genes of the cnt operon was observed by RT-qPCR in the rsp mutant compared to the parental strain, indicating that Rsp acts as an activator of the cnt operon. To determine whether the Rsp activation depends on iron, we compared mutant and parent cnt expression under varying metal conditions. A 2-fold reduction in cnt gene expression was detected in the rsp mutant in TSB, and a slightly smaller decrease (1.9, 1.7, and 1.5-fold changes for cntK, cmtA, and cntE respectively) was observed after addition of dipyridyl. The greatest decrease was seen with addition of FeSO4 (4.1, 5.3 and 6.3-fold changes for cntK, cmtA and cntE respectively). These findings suggest that Rsp activates the cnt operon in low and high iron conditions. To study the relationship between Rsp and the cnt repressors Fur and Zur, we created single and double mutants. Both fur and zur single mutants had significant increases in cnt gene expression compared to the parental strain, as did the fur rsp double mutant. The zur rsp double mutant also had a significant increase in cntK expression and a trend in increases in cntA and cntE expression just below statistical significance. Thus, the ability of Fur and Zur to repress cnt gene expression are not eliminated by the presence of Rsp. However, there were significantly smaller increases in cnt gene expression in the double mutants compared to single mutants, suggesting that Rsp activation can still occur in the absence of these repressors. To determine if Rsp directly modulates expression of cnt genes, incubation of purified Rsp caused a DNA-specific band shift for the cntK and cntA promoters. Conclusions: Rsp activation may act to maintain basal cellular levels of staphylopine to scavenge free metals when needed, in addition to metal dependent regulation by Fur and Zur.
pH-responsive and hyaluronic acid-functionalized metal-organic frameworks for therapy of osteoarthritis
Authors: Xiong Feng , Qin Zainen , Chen Haimin , Lan Qiumei , Wang Zetao , Lan Nihan , Yang Yuan , Zheng Li , Zhao Jinmin , Kai Dan
Published: August 2020

Drug therapy of osteoarthritis (OA) is limited by the short retention and lacking of stimulus-responsiveness after intra-articular (IA) injection. The weak acid microenvironment in joint provides a potential trigger for controlled drug release systems in the treatment of OA. Herein, we developed an pH-responsive metal−organic frameworks (MOFs) system modified by hyaluronic acid (HA) and loaded with an anti-inflammatory protocatechuic acid (PCA), designated as MOF@HA@PCA, for the therapy of OA. Results demonstrated that MOF@HA@PCA could smartly respond to acidic conditions in OA microenvironment and gradually release PCA, which could remarkably reduce synovial inflammation in both IL-1β induced chondrocytes and the OA joints. MOF@HA@PCA also down-regulated the expression of inflammatory markers of OA and promoted the expression of cartilage-specific makers. This work may provide a new insight for the design of efficient nanoprobes for precision theranostics of OA.
Is Anopheles gambiae attraction to floral and human skin-based odours and their combination modulated by previous blood meal experience?
Authors: KEMIBALA ELISON ELIEZA , Mafra-Neto Agenor , Saroli Jesse , Silva Rodrigo , Philbert Anitha , Ng’habi Kija , Foster Woodbridge A , Dekker Teun , Mboera Leonard E.G.
Published: August 2020

BackgroundMosquitoes use odours to find energy resources, blood hosts and oviposition sites. While these odour sources are normally spatio-temporally segregated in a mosquito’s life history, here this study explored to what extent a combination of flower- and human-mimicking synthetic volatiles would attract the malaria vector Anopheles gambiae sensu stricto (s.s.)MethodsIn the laboratory and in large (80 m2) outdoor cages in Tanzania, nulliparous and parous An. gambiae s.s. were offered choices between a blend of human skin volatiles (Skin Lure), a blend of floral volatiles (Vectrax), or a combination thereof. The blends consisted of odours that induce distinct, non-overlapping activation patterns in the olfactory circuitry, in sensory neurons expressing olfactory receptors (ORs) and ionotropic receptors (IRs), respectively. Catches were compared between treatments.ResultsIn the laboratory nulliparous and parous mosquitoes preferred skin odours and combinations thereof over floral odours. However, in semi-field settings nulliparous were significantly more caught with floral odours, whereas no differences were observed for parous females. Combining floral and human volatiles did not augment attractiveness.ConclusionsNulliparous and parous An. gambiae s.s. are attracted to combinations of odours derived from spatio-temporally segregated resources in mosquito life-history (floral and human volatiles). This is favourable as mosquito populations are comprised of individuals whose nutritional and developmental state steer them to diverging odours sources, baits that attract irrespective of mosquito status could enhance overall effectiveness and use in monitoring and control. However, combinations of floral and skin odours did not augment attraction in semi-field settings, in spite of the fact that these blends activate distinct sets of sensory neurons. Instead, mosquito preference appeared to be modulated by blood meal experience from floral to a more generic attraction to odour blends. Results are discussed both from an odour coding, as well as from an application perspective.
Interleukin-6 Promotes Primitive Endoderm Development in Bovine Blastocysts
Authors: Wooldridge Lydia K. , Ealy Alan D.
Published: August 2020

Background: Interleukin-6 (IL6) was recently identified as an embryotrophic factor in bovine embryos, where it acts primarily to mediate inner cell mass (ICM) size. This work explored whether IL6 affects epiblast (EPI) and primitive endoderm (PE) development, the two embryonic lineages generated from the ICM after its formation. Nuclear markers for EPI (NANOG) and PE (GATA6) were used to differentiate the two cell types. Results: Increases (P<0.05) in total ICM cell numbers and PE cell numbers were detected in bovine blastocysts at day 8 and 9 post-fertilization after exposure to 100 ng/ml recombinant bovine IL6. Also, IL6 increased (P<0.05) the number of undifferentiated ICM cells (cells containing both PE and EPI markers). The effects of IL6 on EPI cell numbers were inconsistent. Studies were also completed to explore the importance of Janus kinase 2 (JAK2)-dependent signaling in bovine PE cells. Definitive activation of STAT3, a downstream target for JAK2, was observed in PE cells. Also, pharmacological inhibition of JAK2 decreased (P<0.05) PE cell numbers. Conclusions: To conclude, IL6 manipulates ICM development after EPI/PE cell fates are established. The PE cells are the target for IL6, where a JAK-dependent signal is used to regulate PE numbers.
Reliability and Validity of Pelvic Floor Muscle Strength Assessment Using the MizCure Perineometer
Authors: Abe-Takahashi Yui , Kitta Takeya , Ouchi Mifuka , Okayauchi Minori , Chiba Hiroki , Higuchi Madoka , Togo Mio , Shinohara Nobuo
Published: August 2020

Background
The purpose of this study was to clarify the reliability and validity of pelvic floor muscle (PFM) strength assessment using the MizCure perineometer in healthy women.
Methods
Twenty healthy women (age 20–45 years) participated in this study. The vaginal pressure measurements using the MizCure and Peritron perineometers were repeated during PFM contraction in the supine and standing positions. All women were evaluated twice by examiners 1 and 2. Following the measurements in the first session (Test 1), they were repeated after an interval of between 2 and 6 weeks (Test 2). Within- and between-session intra- and inter-rater reliabilities in vaginal pressure were analyzed using intraclass correlation coefficients (ICC) (1, 1) and (2, 1), respectively. Validity was assessed by Pearson’s product-moment correlation coefficient and Spearman’s rank correlation analysis.
Results
Within-session intra-rater reliabilities for both examiners 1 and 2 for all vaginal pressures in Tests 1 and 2 were 0.90 to 0.96 for both perineometers. Between-session intra-rater reliability for the MizCure was 0.72 to 0.79 for both positions for examiner 1, and 0.63 in the supine position and 0.80 in the standing position for examiner 2. Inter-rater reliability for Test 1 was 0.91 in the supine position and 0.87 in the standing position for the MizCure. The vaginal pressures using the MizCure and Peritron were significantly associated with the supine position (r = 0.68, P < .001) and the standing position (rs = 0.82, P < .001).
Conclusion
Measurement of PFM strength using the MizCure perineometer is a reliable and valid method in healthy women.
Bivalves are NO Different: Nitric Oxide as Negative Regulator of Metamorphosis in the Pacific Oyster, Crassostrea Gigas.
Authors: Vogeler Susanne , Carboni Stefano , Li Xiaoxu , Nevejan Nancy , Monaghan Sean J , Ireland Jacqueline H , Joyce Alyssa
Published: August 2020

Background Nitric oxide (NO) is a presumed regulator of metamorphosis in many invertebrate species, and although NO pathways have been comparatively well-investigated in gastropods, annelids and crustaceans, there has been very limited research on the effects of NO on metamorphosis in bivalve shellfish.Results In this paper, we investigate the effects of NO pathway inhibitors and NO donors on metamorphosis induction in larvae of the Pacific oyster, Crassostrea gigas, demonstrating that the nitric oxides synthase (NOS) inhibitors s-methylisothiourea hemisulfate salt (SMIS), aminoguanidine hemisulfate salt (AGH) and 7-nitroindazole (7-NI) induce metamorphosis in a concentration-dependent manner ranging from 75%, 76–83% respectively. Additional induction resulted from exposures to 1H-[1, 2, 4]Oxadiazole[4,3-a]quinoxalin-1-one (ODQ), an inhibitor of soluble guanylyl cyclase, with which NO interacts to catalyse the synthesis of cyclic guanosine monophosphate (cGMP). Conversely, high concentrations of the NO donor sodium nitroprusside dihydrate in combination with metamorphosis inducers epinephrine, MK-801 or SMIS, significantly decreased metamorphosis. Expression of CgNOS also decreased in larvae after metamorphosis regardless of the inducers used, but intensified again post-metamorphosis in spat. Fluorescent detection of NO in competent larvae with DAF-FM diacetate and localisation of the oyster nitric oxide synthase CgNOS expression by in-situ hybridisation showed that NO occurs primarily in two key larval structures, the velum and foot. cGMP was also detected in the foot using immunofluorescent assays, and is potentially involved in the foot’s smooth muscle relaxation.Conclusion Together, these results suggest that NO is a negative regulator of metamorphosis in Pacific oyster larvae, and that NO reduction induces metamorphosis by inhibiting swimming or crawling behaviour, in conjunction with a cascade of additional neuroendocrine downstream responses.
Optimization of Extraction Yield and Phytochemical Characterization of Crude Methanolic Extract and Its Fractions of Mitragyna Speciosa Leaves
Authors: Razak Nur Haziqah Zakirat Abd , zakaria fazila binti , Rahman Mohd Basyaruddin bin Abdul , Ashari Siti Efliza
Published: August 2020

In this study, Response surface methodology (RSM) was applied to optimize the yield of crude methanolic extract of Mitragyna speciosa leaves using Ultrasound-assisted extraction (UAE). The crude methanolic extract and its fractions were quantified in terms of total phenolic content and total flavonoid content, along with characterized using Fourier-transform infrared and Gas chromatography–mass spectrometry. The results showed the maximum yield of 49.72% at the optimal conditions (temperature, 34 °C; time, 25 min; and volume of solvent, 166 mL). The recovery crude methanolic extract for TPC and TFC were 137.3 ± 15.7 mg GAE/g and 90.3 ± 15.3 mg RE/g, respectively.
Genetic Basis of Tiller Dynamics of Rice Revealed by Genome-Wide Association Studies
Authors: Zhao Shuyu , Jang Su , Lee Yoon Kyung , Kim Dong-Gwan , Jin Zhengxun , Koh Hee-Jong
Published: August 2020

Background: Tiller number is the key determinant of rice plant architecture and panicle number and consequently controls grain yield. Thus, it is necessary to optimize the tiller number to achieve the maximum yield in rice. However, comprehensive analyses of the genetic basis of tiller number, considering the development stage, tiller type, and related traits, are lacking.Results: We sequenced 219 Korean rice accessions and constructed a high-quality single nucleotide polymorphism (SNP) dataset. The tiller number at different development stages and heading traits involved in phase transitions were evaluated. By a genome-wide association study (GWAS), we detected 20 significant association signals for all traits. Five signals were detected in genomic regions near known candidate genes. Most of the candidate genes were involved in the phase transition from vegetative to reproductive growth. In particular, HD1 was simultaneously associated with the productive tiller ratio and heading date, indicating that the photoperiodic heading gene directly controls the productive tiller ratio. Multiple linear regression models of lead SNPs showed coefficients of determination (R2) of 0.49, 0.22, and 0.41 for the tiller number at the maximum tillering stage, productive tiller number, and productive tiller ratio, respectively. Furthermore, the model was validated using independent japonica rice collections, implying that the lead SNPs included in the linear regression model were generally applicable to tiller number prediction.Conclusions: We revealed the genetic basis of tiller number in rice plants during growth by a GWAS and formulated a prediction model by linear regression. Our results improve our understanding of tillering in rice plants and provide a basis for breeding high-yield rice varieties with the optimum tiller number.
Genome-wide identification and expression analysis of the CLC gene family in pomegranate (Punica granatum) reveals its role in salt resistance
Authors: Liu Cuiyu , Zhao Yujie , Zhao Xueqing , Dong Jianmei , Yuan Zhaohe
Published: August 2020

BackgroundsPomegranate (Punica granatum L.) is an important commercial fruit tree, with moderate tolerance to salinity. The balance of Cl− and other anions in pomegranate tissues are affected by salinity, however, the accumulation patterns of anions are poorly understood. The chloride channel (CLC) gene family is involved in conducting Cl−, NO3−, HCO3− and I−, but its characteristics have not been reported on pomegranate.ResultsIn this study, we identified seven PgCLC genes, consisting of four antiporters and three channels, based on the presence of the gating glutamate (E) and the proton glutamate (E). Phylogenetic analysis revealed that seven PgCLCs were divided into two clades, with clade I containing the typical conserved regions GxGIPE (I), GKxGPxxH (II) and PxxGxLF (III), whereas clade II not. Multiple sequence alignment revealed that PgCLC-B had a P [proline, Pro] residue in region I, which is suspected to be a NO3–/H+ exchanger, while PgCLC-C1, PgCLC-C2, PgCLC-D and PgCLC-G contained a S [serine, Ser] residue, with a high affinity to Cl−. We were determined the content of Cl−, NO3−, H2PO4−, and SO42− in pomegranate tissues after 18 days of salt treatments (0, 100, 200 and 300 mM NaCl). Compared with control, the Cl− content increased sharply in tissues and was ranked as leaf > stem > root. The uptake of NO3− and SO42− was inhibited by high salinity, while that of H2PO4− increased. The results of real-time reverse transcription PCR (qRT-PCR) revealed that PgCLC genes had tissue-specific expression patterns. The high expression levels of PgCLC-C1, PgCLC-C2 and PgCLC-D in leaves suggested they played roles in sequestrating Cl− into the vacuoles. However, the low expression levels of PgCLCs in roots might be contributed to the exclusion of Cl− from root cells. Also, the non-significantly changed concentration of NO3− in leaves and the up-regulated PgCLC-B indicated an acceleration of transporting NO3− into leaves to mitigate the nitrogen deficiency.ConclusionsOur findings suggested that PgCLC genes played important roles in balance of Cl− and NO3− in pomegranate tissues under salt stress. This study establishes a theoretical foundation for the further functional characterization of CLC genes in pomegranate.
The Costs of Delivering Emergency Care at Regional Referral Hospitals in Uganda: A Micro-Costing Study
Authors: Werner Kalin , Lin Tracy Kuo , Risko Nicholas , Osiro Martha , Kalanzi Joseph , Wallis Lee A
Published: August 2020

BACKGROUNDUganda experiences a high morbidity and mortality burden due to conditions amenable to emergency care, yet few public hospitals have dedicated emergency units. As a result, little is known about the costs and effects of delivering lifesaving emergency care, hindering health systems planning, budgeting and prioritization exercises. To determine healthcare costs of emergency care services at public facilities in Uganda, we estimate the median cost of care for five sentinel conditions and 13 interventions.METHODSA direct, activity-based costing was carried out at five regional referral hospitals over a four-week period from September to October 2019. Hospital costs were determined using bottom up micro-costing methodology from a provider perspective. Resource use was enumerated via observation and unit costs were derived from National Medical Stores lists. Cost per condition per patient and measures of central tendency for conditions and interventions were calculated. Kruskal-Wallis H-tests and Nemyeni post-hoc tests were conducted to determine significant differences between costs of the conditions.RESULTS872 patient cases were captured with an overall median cost of care of $15.17 USD ($14.08 to $18.85). The median cost per condition was highest for post-partum haemorrhage at $16.87 ($14.66 to $20.99), followed by road traffic injuries at $15.59 ($14.15 to $19.93), asthma at $15.53 ($14.39 to $18.87), pneumonia at $15.18 ($14.28 to $19.72), and paediatric diarrhoea at $14.25 ($13.38 to $15.20). The median cost per intervention was highest for fracture reduction and splinting at $27.41 ($21.63 to $31.14). Cost values differ between sentinel conditions (p <0.05) with treatments for paediatric diarrhoea having the lowest median cost of all conditions (p<0.05).CONCLUSIONThis study is the first to describe the direct costs of EC in hospitals in Uganda by observing the delivery of clinical services, using robust activity-based costing and time motion methodology. We find that emergency care interventions for key drivers of morbidity and mortality can be delivered at considerably lower costs than many priority health interventions. Further research assessing acute care delivery would be useful in planning wider health care delivery systems development.
Exploring general practitioners’ perceptions about the primary care gatekeeper role in Indonesia
Authors: Mulyanto Joko , Wibowo Yudhi , Kringos Dionne S.
Published: August 2020

Background In the current healthcare delivery system funded by National Health Insurance (NHI) in Indonesia, the gatekeeper role of primary care services is critical to ensuring equal healthcare access for the population. To be effective, gatekeeping relies on the performance of general practitioners (GPs). However, the perceptions held by Indonesian GPs about their gatekeeper role are not yet well documented. This study describes the self-perceived knowledge, attitudes and performance of Indonesian GPs with respect to the gatekeeper role and explores associated factors. Methods We conducted a cross-sectional study of all primary care facilities (N = 75) contracted by the regional NHI office in the Banyumas district. The 73 participating GPs completed a written questionnaire that assessed their knowledge, attitudes and performance in relation to the gatekeeper role. Personal and facility characteristics were analysed in a generalised linear model as possible associating factors.Results GPs scored relatively high in the domains of knowledge and performance but scored lower in their attitudes towards the gatekeeper role of primary care. In the full-adjusted model, no factors were significantly associated with the knowledge score. Work experience as GPs, private or civil service employment status and rural or urban location of the primary care facility were linked to attitude scores. Full- or part-time employment and type of facility were factors associated with the performance score. Conclusion GPs in Indonesia are knowledgeable and report that they adequately perform their function as gatekeepers in primary care. However, their attitudes towards the gatekeeper function are less positive. Attitudes and performance with respect to the primary care gatekeeper role are likely influenced more by contextual factors such as location and type of facility than by personal factors. Efforts to address contextual issues could include improvements in practice standards for privately practising physicians and public information campaigns about gatekeeping regulations. Such efforts will be crucial to improving the gatekeeper role of primary care in Indonesia and assuring efficient access to high-quality care for all.
Effects of ω-3 polyunsaturated fatty acid-supplemented parenteral nutrition on postoperative complications for patients with Crohn’s disease: a cohort study
Authors: Wu Yan , Liu Huaying , Qi Weilin , Liu Wei , Tang Shasha , Ye Lingna , Cao Qian , Ge Xiaolong , Zhou Wei
Published: August 2020

Background: Most patients with Crohn's disease (CD), a chronic inflammatory disease, need surgery but exhibit elevated postoperative complication incidences. ω-3 polyunsaturated fatty acids (PUFAs) are considered beneficial for nutrition, anti-inflammation, immunity and intestinal microflora balance in humans. This study assessed the effects of ω-3 PUFA-supplemented parenteral nutrition (PN) on postoperative complications in CD.Methods: Overall, 186 CD patients undergoing bowel resection were eligible. Patient data were collected from a prospectively maintained database. After surgery, 103 patients received ω-3 PUFA-supplemented PN; 83 did not. Postoperative complications were compared between the groups. Complication risk factors were identified by univariate and multivariate analyses.Results: Patients with ω-3 PUFA-supplemented PN after surgery had lower C-reactive protein levels (57.2±5.3 mg/L vs 43.5±3.9 mg/L, P=0.047) and shorter postoperative hospital stays (12.1±1.1 days vs 9.3±0.6 days, P=0.041) than those without. The ω-3 PUFA group exhibited significantly reduced incidences of overall complications (40.8% vs 24.1%, P=0.016) and major complications (23.3% vs 9.6%, P=0.014). Postoperative complications were associated with infliximab, ω-3 PUFAs, C-reactive protein, operative time, and laparoscopic surgery. Multivariate regression revealed that preoperative infliximab use and postoperative ω-3 PUFA-supplemented PN were independent risk factors in CD. Conclusions: ω-3 PUFA-supplemented PN reduced post-surgery inflammatory response in CD patients, thus decreasing postoperative complications and accelerating recovery.Trial registration: This trial was registered in ClinicalTrials.gov. Identifier was NCT03901937. The date of registration was 03/04/2019.
Discriminative Validity of the Lower and Upper Quarter Y Balance Test Performance in Healthy Youth
Authors: Schwiertz Gerrit , Beurskens Rainer , Muehlbauer Thomas
Published: August 2020

Background: The Lower (YBT-LQ) and Upper (YBT-UQ) Quarter Y Balance Test have been widely used for the assessment of dynamic balance and shoulder mobility/stability, respectively. However, investigations on the validity of the two tests in youth are lacking. Therefore, we performed two studies to determine discriminative validity of the YBT-LQ (study 1) and the YBT-UQ (study 2) in healthy youth.Methods: Sixty-nine male soccer players (age: 14.4 ± 1.9 yrs) and 69 age-matched untrained male subjects (14.3 ± 1.6 yrs) participated in study 1 and 37 young swimmers (age: 12.3 ± 2.1 yrs) as well as 37 age-/sex-matched individuals (age: 12.5 ± 2.0 yrs) took part in study 2. Normalized maximal reach distances per reach direction and the composite score of the YBT-LQ/UQ were used as outcome measures. One-way analysis of variance and the receiver operator characteristic curve analysis (i.e., calculating the area under the curve [AUC]) were conducted to assess discriminative validity.Results: Youth athletes showed significantly better YBT-LQ (study 1: p < 0.001, d = 0.86-1.21) and YBT-UQ (study 2: p < 0.001, d = 0.88-1.48) test performances compared to age- and sex-matched untrained subjects. Further, AUC-values indicated a chance of ≥74% (YBT-LQ) and ≥71% (YBT-UQ) to discriminate between youth athletes and controls.Conclusions: In healthy youth, the YBT-LQ and the YBT-UQ seem to be valid test instruments for the discriminative assessment of dynamic balance and shoulder mobility/stability, respectively.
Health Education Services Utilization and Its Determinants Among Migrants : a Cross-sectional Study in Urban-rural Connection Districts of Beijing, China
Authors: Shao Shuang , Zhang Huirong , Chen Xiaolei , Xu xiaojingyuan , Zhao Yali , Wang Meirong , Du Juan
Published: August 2020

Background: Domestic migration poses a challenge for China as migrants have little access to preventive healthcare services and are vulnerable to certain risks and diseases. This research sought to unveil and explore the determinant factors associated with health education utilization as a key aspect in basic public health services for migrants in Beijing, China.Methods: A sample of 863 inter-provincial migrants, 18 years old and above, was selected by three-stage stratified cluster sampling method in urban-rural fringe areas of Beijing during 2016 to 2017. Face-to-face structured interviews were conducted in the questionnaire survey. The effects of the explanatory variables on health education utilization from predisposing, enabling, health behaviors and need variables were used to demonstrate by Anderson health service utilization model. Results: The study revealed that 61.6% migrants desired to receive health education, while only 53.8% of them received in the past year. There were differences in the utilization and needs of health education among the migrants in different ages and genders. Many migrants desired to gain access to various types of health education information from the internet. Chi-square independence test lists such major determinant factors in migrants whole health education as age, "Hukou" registration system, marital status, education level, long-term residence plan in Beijing, 1 or more children in Beijing, employment status, housing source, average daily working time, exercises, health knowledge, smoking, self-rated health. The binary logistic regression indicates that the migrants with younger age, high education level, one or more children in Beijing, exercises and good self-rated health were more likely to receive whole health education. The results also show that average daily working time of enabling variables and exercise of health behavior variables were the strong and consistent determinants of three types of health education utilization, including communicable, non-communicable and occupational diseases.Conclusion: Gaps exist between the needs and utilization in health education and more attention should be given to the migrants with heavy workload and low education level. Feasible policies and measures, such as multiple health information channels, should be vigorously implemented to ensure equitable and easy access to health education for migrants.
Characteristics of the Completed Chloroplast Genome Sequence of Xanthium Spinosum: Comparative Analyses, Identification of Mutational Hotspots and Phylogenetic Implications
Authors: Raman Gurusamy , Park KyuTae , Kim Joo Hwan , Park SeonJoo
Published: August 2020

Background: The invasive alien species, Xanthium spinosum has been used as a traditional Chinese medicine for many years. Unfortunately, there are no extensive molecular studies for this plant. Results: Here, the complete chloroplast genome sequence of X. spinosum was assembled and analyzed. The cp genome of X. spinosum was 152,422 bp and possessed quadripartite circular structure. The cp genome contained 115 unique genes, including 80 protein-coding genes, 31 tRNA genes and 4 rRNA genes. Comparative analysis revealed that X. spinosum encoded a higher number of repeats (999 repeats) and 701 SSRs in their cp genome. Also, fourteen divergences (Pi > 0.03) were found in the intergenic regions. The accD gene underwent positive selection within Heliantheae, which contributes to further investigation of the adaptive plant evolution in the ecosystem. Additionally, the phylogenetic analysis revealed that Parthenium is a sister clade to both Xanthium and Ambrosia and it is an early-diverging lineage of subtribe Ambrosiinae though it supports with very weak bootstrap value. Conclusion: The identified hotspot regions were thought to be useful molecular markers for resolving phylogenetic relationships and species validation of Xanthium.
Differences in Standing and Sitting Spinopelvic Sagittal Alignment for Patients with Posterior Lumbar Fusion: Important Considerations for the Changes of Unfused Adjacent Segments Lordosis
Authors: Sun Zhuoran , Zhou Siyu , Wang Wei , Zou Da , Li Weishi
Published: August 2020

Objective: This study aimed to describe the changes in spinopelvic sagittal alignment in the sitting position after posterior lumbar fusion, and to identify the factors influencing unfused adjacent segment lordosis.Methods: Consecutive patients with lumbar degenerative disease who underwent posterior lumbar interbody fusion between December 2010 and April 2012 were recruited. Lateral full spine radiographs were obtained in the standing, erect sitting, and natural sitting positions. Spinopelvic parameters were measured preoperatively and at the final follow-up. Results: The data of 63 patients were analyzed in this study. The average age was 61.6±11.0 years. When changing from standing to sitting at the final follow-up, all spinopelvic sagittal parameters with the exceptions of pelvic incidence and thoracic kyphosis were significantly altered. The most noticeable changes occurred in the natural sitting position, with the spine slumped toward achieving a C-shaped sagittal profile. Multiple linear regression analysis revealed that when changing to a natural sitting position, age and fusion levels reflected the changes in lumbar lordosis (ΔLL), age and lumbosacral fusion reflected the changes in upper residual lordosis (ΔURL). Conclusion: The most noticeable changes in spinopelvic sagittal alignment occurred in the natural sitting position after lumbar fusion. Age, fusion levels, and lumbosacral fusion significantly influenced the differences in LL and URL between the standing and natural sitting position. These characteristics should be fully considered when planning spinal realignment surgery and investigating the etiological factors of junctional complications.
Spiritual Care Practices in Hospices in the Western Cape, South Africa: The Challenge of Diversity
Authors: Mahilall Ronita , Swartz Leslie
Published: August 2020

Background: South Africa is a very diverse middle-income country, still deeply divided by the legacy of its colonial and apartheid past. As part of a larger study, this article explored the experiences and views of representatives of hospices in the Western Cape province of South Africa on the provision of appropriate spiritual care, given local issues and constraints. Methods: Two sets of focus group discussions, with 23 hospice participants, were conducted with 11 of the 12 Hospice Palliative Care Association registered hospices in the Western Cape, South Africa, to understand what spiritual care practices were at play in their hospices against the backdrop of multifaceted diversities. The discussions were analysed using thematic analysis. Results:Two prominent themes emerged: providing relevant spiritual care services in a religiously, culturally, and racially diverse setting, and the organisational context impacting such a spiritual care service. Participants agreed that spiritual care is an important service and that it plays a significant role within the inter-disciplinary team. Participants recognised the need for spiritual care training and skills development, alongside the financial shortfalls. In spite of the diversities and resource constraints, the approach of individual hospices to providing spiritual care remained robust.Discussion:Given the diversities that are largely unique to South Africa, shaped essentially by past injustices, the hospices have to navigate considerable hurdles such as cultural differences, religious diversity, and language barriers to provide spiritual care services, within significant resource constraints. Conclusions:While each of the hospices have established spiritual care services to varying degrees, there was an expressed need for training in spiritual care to develop a baseline guide that was bespoke to the complexities of the South African context. Part of this training needs to focus on the complexity of providing culturally appropriate services.
Do Adolescents Consider Mind-Body Skills Groups an Acceptable Treatment for Depression: Results from a Pilot Study.
Authors: Jones Lindsey , Salgado Eduardo F. , Aalsma Matthew C. , Garabrant Jennifer M. , Staples Julie K. , Gordon James S. , Salyers Michelle P.
Published: August 2020

Background: Mind-Body Skills Groups (MBSGs) have shown promise in reducing adolescent depression symptoms; however, little is known about adolescents’ perspectives on this treatment. The objective of this study was to understand the acceptability of a new treatment for depressed adolescents in primary care settings. Methods: Adolescents participating in a 10-week MBSG treatment were interviewed to understand their perspectives on the acceptability and effectiveness of the treatment. Interviews were collected at post-intervention and at a 3-month follow-up visit. Results: A total of 39 adolescents completed both the post-intervention and 3-month follow-up interview. At post-intervention and follow-up, 84% of adolescents stated the MBSGs helped them. When asked how the MBSGs helped them, 3 areas were identified: learning new MBSG activities and skills, social connection with others within the group, and outcomes related to the group. Many adolescents reported no concerns with the MBSGs (49% at post- intervention; 62% at follow-up). Those with concerns identified certain activities as not being useful, wanting the group to be longer, and the time of group (after school) being inconvenient. Most adolescents reported that their life had changed because of the group (72% at post-intervention; 61% at follow-up), and when asked how, common responses included feeling less isolated and more hopeful. Conclusions: Adolescents found the MBSGs to be helpful and acceptable as a treatment option for depression in primary care. Given the strong emphasis on treatment preference autonomy and the social activities within the group, MBSGs appear well-suited for this age group. Trial Registration: NCT03363750
The Effect of a Decision-Support mHealth Application on Maternal and Neonatal Outcomes in Two District Hospitals in Rwanda: Quasi-Experimental Study
Authors: NISHIMWE Aurore , IBISOMI Latifat , NYSSEN Marc , CONCO Daphney NOZIZWE
Published: August 2020

Background: Globally, mobile health (mHealth) applications are known for their potential to improve healthcare providers’ access to relevant and reliable health information. Besides, electronic decision support tools, such as the Safe Delivery mHealth Application (SDA), help to reduce clinical errors and to ensure quality care at the point of service delivery. The current study assessed the effects of the SDA on basic emergency obstetric and newborn care (BEmONC) outcomes for the most frequent complications in Rwanda; post-partum haemorrhage (PPH) and newborn asphyxia and its complications.Methods: The study adopted a quasi-experimental design. A pre-intervention record review of the BEmONC outcomes: Apgar score and PPH progressions, was conducted. The intervention took place in two district hospitals in Rwanda and entails the implementation of the SDA for six months. Six months’ post-intervention, the effect of the SDA on BEmONC outcomes was evaluated. The study included 327 participants (114 cases of PPH and 213 cases of neonatal complications). The analysis compared the outcome variables between the baseline and the endline data. Fisher’s exact test was used to compare the proportions and test between-group differences and significance level set at p<0.05. Results: Unstable newborn outcome following neonatal resuscitation was recorded in 61.90% and 27.59% newborns cases at baseline and endline respectively, P-value = 0.000. Unstable maternal outcome following PPH management was recorded in 19.40 % and 6.38% maternal cases at baseline and endline respectively, P-value = 0.048. There was a significant association between the SDA intervention and newborns’ and maternal’ outcomes following neonatal resuscitation and PPH management, 6 months after baseline.Conclusion: The use of the SDA supported nurses and midwives in the management of PPH and neonatal resuscitation thus improved maternal and neonatal outcomes after 6 months of the SDA intervention.
Treatment of Pediatric Lateral Condylar Humerus Fractures with Closed Reduction and Percutaneous Pinning
Authors: Xie Li-wei , Wang Juan , Deng Zhi-qiang , Zhao Ren-huan , Chen Wei , Kang Chi , Ye Jia-jun , Liu Xin , Zhou Ying , Shen Hai
Published: August 2020

Background: Lateral condylar humerus fractures (LCHFs) are the second most common fractures in children. Open reduction and internal fixation is recommended for fractures displaced by more than 4 mm. Few studies described using closed reduction and percutaneous pinning (CRPP) for treating fractures with greater displacements. This study aims to explore the feasibility of CRPP in treating displaced LCHFs. Methods: All patients underwent attempted CRPP first. Once a satisfying reduction was obtained, as determined using fluoroscopy based on the relative anatomical position of the fragments, an intraoperative arthrogram was performed to further confirm the congruence of the articular surface of the distal humerus. Open reduction and fixation are necessary to ensure a fracture gap less than 2.0 mm both on anteroposterior view and oblique internal rotational view by fluoroscopy. All included fractures were treated by a single pediatric surgeon.Results: Forty-six patients were included, 29 boys and 17 girls, with an average age of 5.2 years. Of these, 22/28 (78%) Jakob type II fractures and 14/18 (78%) Jakob type III fractures were treated with CRPP. All cases in Song stages II and III, 19/25 (76%) cases in Song stage IV, and 14/18 (78%) cases of Song stage Ⅴ were treated with CRPP. The remaining converted to open reduction with internal fixation. Overall, 36 of the 46 patients (78%) were treated with CRPP. The average pre-op displacement was 7.2 mm, and the average post-op displacement was 1.1 mm on the anteroposterior or oblique internal rotational radiograph in cases treated with CRPP. CRPP was performed in an average of 37 minutes. The average casting period was 4 weeks and the average time of pin removal was 6 weeks postoperatively. The average time of follow-up was 4 months. All patients achieved union, regardless of closed or open reduction. No infection, delayed union, cubitus varus or valgus, osteonecrosis of the trochlea or capitellum, or pain were recorded during follow-up. Conclusions: Closed reduction and percutaneous pinning effectively treats LCHFs with displacement more than 4 mm. More than 3/4 of Song stage V or Jakob type III patients can avoid an incision.
A monthly spatio-temporal modelling of patterns for children on maintenance grant in Namibia
Authors: Dismas Ntirampeba , Brigitte NSHIMYIMANA , Cliff Kikawa Richard
Published: August 2020

Background

Child support grant (CSG) is one of the social protection strategies which is today widely seen as an intervention contributing to poverty reduction. However, despite substantial expenses, it has been documented that Namibia’s social protection benefits do not reach intended beneficiaries in an efficient manner.
Aims

This study aims to determine factors associated with spatial and temporal variation in maintenance child grant and as well as identify regions with elevated incidence rate ratios of maintenance grant in Namibia.
Methods

We fitted a Bayesian spatio-temporal regression model on maintenance grant data available over 9 years in Namibia.
Results

The number of children on grant has almost tripled between March 2007 and October 2015(it changed from 50596 in 2007 to 132840). Unemployment and orphanhood were significantly associated with the incidence rate ratio of maintenance grant (CI:(1.634, 2.627) and CI: (1.000, 1.004), respectively. The adjustment of measurement error in orphanhood through the Berkson error model has ensured the stability of its effect.
Conclusions

This study has shown the strength of using measurement error models for analysing child grant data. Furthermore, the study has demonstrated that the northern regions of Namibia have the highest child incidence rate ratio of maintenance grant whereas the regions in central and south are at low incidence rate at present. The maps produced in this study can be particularly helpful in allocating efficiently limited resources in poor settings.
An Idea Worth Sustaining: Evaluation of the sustainability potential of Choosing Wisely across Ontario Community Hospitals and Family Health Teams
Authors: Kastner Monika , Makarski Julie , Mossman Kate , Harris Kegan , Hayden Leigh , Giraldo Manuel , Sharma Deepak , Asalya Marwan , Jussaume Linda , Eisen David , Wintemute Kimberly , Rolko Edith , Shin Phil , Zadravec Jennifer , McRitchie Donna
Published: August 2020

BackgroundEvidence shows that 30% of healthcare services are unnecessary and unlikely to benefit patients and may even be harmful. Choosing Wisely (CW) is a physician-initiated, international campaign (with campaigns in at least 20 countries) aimed at addressing unnecessary medical care through the provision of evidence-based resources and clinical guidance. Our objectives were to evaluate the sustainability potential of CW across four Ontario community hospitals and affiliated family health teams (FHT). MethodsWe recruited CW implementation teams across Ontario hospitals and their affiliated primary care family health teams (FHTs) to participate in a mixed-methods study to identify and respond to their CW implementation and sustainability challenges. The study involved the administration of a validated sustainability Survey at baseline, 6- and 12-months follow-up, and participation in two focus groups (at baseline and 6 months) to discuss identified successes and opportunities for improvement, and to respond to implementation and sustainability challenges through a team exercise involving the co-creation and implementation of an action plan to directly address them.ResultsFifteen CW implementation teams across five Ontario community hospitals and affiliated FHTs participated in the study. Three CW de-adoption priority areas were investigated by teams: de-prescribing of proton pump inhibitors (PPIs), and reducing Pre-Op testing and BUN/Urea lab testing. All 15 teams achieved a baseline sustainability team score that was well above the threshold of what is considered a potentially sustainable innovation (i.e., >55%). We observed steady improvements in sustainability scores over three time points across all primary care teams, which is a strong indication that CW is sustainable in these settings. Regardless of site or priority area, facilitators that were common across all teams were fit with existing processes and workflows, leadership support, and optimized team communication. Common challenges were: lack of awareness and buy-in, lack of leadership engagement or a champion, and lack of fit with existing workflow and culture. All teams identified at least one challenge (during the baseline focus groups) for which they co-designed and implemented a plan to address them aimed at maximizing the sustainability potential of their CW priority areas. ConclusionsEvaluating the sustainability potential of an innovation such as Choosing Wisely is critical to ensuring that they have the best potential for impact. Our work highlights that implementation teams can be empowered to influence their implementation efforts, and to realize positive outcomes for their healthcare services and patients.
A Novel Experimental Porcine Model to Assess the Impact of Differential Pulmonary Blood Flow on Primary Graft Dysfunction After Unilateral Lung Transplantation
Authors: Frick Anna Elisabeth , Orlitová Michaela , Vanstapel Arno , Ordies Sofie , Claes Sandra , Schols Dominique , Heigl Tobias , Kaes Janne , Saez-Gimenez Berta , Vos Robin , Verleden Geert M. , Vanaudenaerde Bart , Verleden Stijn E. , Raemdonck Dirk E. Van , Neyrinck Arne P.
Published: August 2020

Background Primary graft dysfunction (PGD) remains a major obstacle after lung transplantation. We developed a novel approach to selectively assess reperfusion injury in transplanted lung and investigated the impact of pulmonary flow.Materials Twelve porcine left lung transplants were divided in two groups (n = 6, in low (LF) and high flow (HF) group). Donor lungs were stored for 24 hours on ice, followed by left lung transplantation. Recipient animals were observed for 6h after reperfusion with partially clamping of right PA in HF group. Results Survival at 6 hours was 100% in both groups. PaO2/FiO2 (P/F) ratio of the transplanted lung was lower (229.1 mmHg vs 308.9 mmHg, p=0.01), mPAP was higher (34.62 mmHg vs 29.88 p=0.01) in HF versus LF group. Wet-to-dry (W/D) ratios of right native and left transplanted lung were not different after 6 h of reperfusion. Conclusions Lung transplantation in large animal settings is feasible. P/F ratio in allograft is dependent on PA flow. Our innovative approach to control blood flow to transplanted lung demonstrates that higher flows induce more PGD and allows to further study development and treatment of PGD. Our findings might have an important impact on sequential intra-operative approach during lung transplantation.