bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of long-term prognosis for differentiated thyroid cancer according to the 7th and 8th editions of the AJCC/UICC TNM staging system
Authors: Kim Kwangsoon , Kim Jin Kyong , Lee Cho Rok , Kang Sang-Wook , Lee Jandee , Jeong Jong Ju , Nam Kee-Hyun , Chung Woong Youn
Published: May 2020

Background:

The 8th edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) tumor-node-metastasis (TNM) staging system was released with major revisions. The purpose of this retrospective study was to investigate differences between the 7th and 8th editions of the AJCC/UICC TNM staging system and to compare the predictability of prognosis between the two staging systems with patients who underwent thyroidectomy for differentiated thyroid cancer (DTC) at a single institution.

Methods:

A total of 3238 patients underwent thyroid operation from January 2002 to December 2006 at Yonsei University Hospital (Seoul, Korea), of which 2294 with complete clinical data and sustained follow up were enrolled. Clinicopathologic features and TNM staging by applying the 7th and 8th editions of the AJCC/UICC were analyzed retrospectively by the complete review of medical charts and pathology reports of patients. Mean follow-up duration was 132.9 ± 27.9 months.

Results:

A significant number of T3 patients were downstaged to T1 (838, 36.5%) and T2 (122, 5.3%). After applying the 8th edition of the AJCC/UICC TNM staging system, the number of stage I patients increased significantly from 1434 (62.5%) to 2058 (89.7%), whereas numbers of stage III and IV patients decreased significantly from 644 (28.1%) to 33 (1.4%) and from 199 (8.7%) to 17 (0.7%), respectively. According to Kaplan–Meier survival analyses and values of the Harrell’s c-index and integrated area under the curve (iAUC), the 8th edition has significantly better predictive performance for disease-free survival (DFS) and disease-specific survival (DSS) than the 7th edition.

Conclusions:

A significant population was downstaged after applying the 8th edition of the AJCC/UICC TNM staging system, and the 8th edition provided significantly better accuracy in predicting DFS and DSS in patients with DTC.
Antacid-induced acute hypercalcemia: An increasingly common and potentially dangerous occurrence
Authors: Cimpeanu Emanuela , Mammadova Aytan , Valdes Bracamontes Jose , Otterbeck Philip
Published: May 2020

Hypercalcemia is frequently encountered in both hospital wards and the primary care setting; 90% of cases can be attributed to primary hyperparathyroidism and malignancy. However, a minority are caused by medications, of which calcium supplements have been an increasingly common etiology. We are presenting a case of hypercalcemia resulted after acute oral intake of a moderate amount of antacids (calcium tablets) and normalized after supplement withdrawal.
Planetary art beyond the human: Rethinking agency in the Anthropocene
Authors: Page Joanna
Published: May 2020

A growing number of transdisciplinary art-science projects across the world are taking up the challenge of representing geological and cosmic time and of rendering visible, audible and tangible the powerful forces that shape the planet’s systems. While art historians have often found the earth art movement to exemplify a new awareness of the geological impact of human activity on the planet, I argue that art may engender a more genuinely planetary perspective when it pays attention to those forces we cannot compel. Gesturing towards the limits of human agency with regard to the Earth may ultimately be a more effective way of challenging anthropocentrism, and of locating human history within planetary time. My analysis draws on works by four contemporary artists – Rafael Lozano-Hemmer (Canada/Mexico), Claudia Müller (Chile), Paul Rosero Contreras (Ecuador) and Michelle-Marie Letelier (Germany/Chile) – that explore the science of turbulent dynamics that are impervious to human action, such as solar flares, earthquakes, winds, tides, tsunamis and volcanic eruptions. As Nigel Clark argues, the fundamental asymmetry that governs our relationship with a volatile planet is often lost in accounts of the entanglement of human and nonhumans that have recently prevailed in the humanities and social sciences. The works I discuss revise the practices of earth art to create a ‘planetary art’, cultivating a sense of the planet beyond the human that allows us to understand its dynamics more fully, and to resituate human agency more properly within geohistories of matter and energy. In many cases, this art remains fully alert to the geopolitics of the Anthropocene, focusing on the increased vulnerability of the Global South to climate change and environmental disaster, and gesturing towards a decolonial critique of the objectification of nature and the dissociative, rationalist knowledge produced by modern science.
The Effect of Color on Letter Discrimination Can Be Modulated by the Global/Local Processing and Attention Level
Authors: Sun Meng , Zhang Xiaorong , Wang Jiangmeng , Liu Hailan , Zhang Qin , Cui Lixia
Published: May 2020

This study explored whether the color of letters could influence letter discrimination task performances and whether this effect of color could be modulated by processing level (global vs. local) and attention level of color (color-attended vs. color-unattended). We used the Navon letters in red, green, or white as stimuli at a relatively small (Experiment 1) or large visual angle (Experiments 2, 3, and 4). Each experiment included two tasks: color-attended task in which participants were told to respond only to target letters in a designated color; color-unattended task in which color was task-irrelevant. Experiment 1 found that the responses to red stimuli were significantly faster than those to the other color stimuli in the color-attended task. In Experiment 2, the same pattern occurred only at the local level in the color-attended task. Experiments 3 and 4 further controlled the brightness and chroma of stimuli and the results replicated the enhancement effect of red at the local level in the color-attended task and demonstrated an interference effect of red and green in the color-unattended task. These results suggested that red facilitated letter discrimination at the local processing level, reflecting the effect of avoidance motivation evoked by red on cognition and behavior which was consistent with color-in-context model. Moreover, this study found that the effect of color was modulated by attention level of color, and the interference effect of color in the color-unattended task confirmed that the color effect might mainly arise from controlled processes but not automatic processes.
Improving the Efficacy of English Instruction at Qawmi Madrasas (Islamic Seminaries) in Bangladesh
Authors: Golam Azam Md , Kusakabe Tatsuya
Published: May 2020

This study examined English teaching and learning (Grade 8 level) in Qawmi Madrasa schools, which are not recognized by the Bangladeshi government’s Education Department. The study investigated the improvements needed in Qawmi Madrasas English teaching programs to enable students to secure public university admission and Bangladeshi civil service positions. We conducted ethno-methodological surveys in 2018 with the students, teachers, and principals of eight Qawmi Madrasas in the south-central and southeastern areas of Bangladesh. The study found that the environment in Qawmi Madrasas in the south-central region was not conducive to English learning, in contrast to the situation in the southeastern region. In addition, teacher salaries and other resources were inadequate in the south-central region in comparison to the southeastern region. In the south-central region, the student interviewees commented that classroom resources, that is, English textbooks, should be more effectively implemented. The findings of this research also indicate an urgent need for teacher training in English-language learning in the south-central region to develop teachers’ skills in teaching methodologies and strategies.
Empirical Study on the Evaluation Model of Public Satisfaction With Local Government Budget Transparency: A Case From China
Authors: Hu Qiuxian , Zhang Leibao , Zhang Wenyu , Zhang Shuai
Published: May 2020

For policymakers across the world, the importance of budget transparency is self-evident. However, most scholars mainly focus on the economic performance of budget transparency while ignoring satisfaction of the public as the recipients of this policy. Therefore, this study examines the main factors of public satisfaction with the local government budget transparency based on the theory of customer satisfaction in the context of the Chinese budget transparency policy. Data for this study were collected through an online survey involving 235 participants. Structural equation modeling (SEM) was employed to examine the proposed model. The results indicate that the budget information quality, budget information acquisition method, and public engagement are good indicators of budget transparency perceived quality, which are positively related to public satisfaction. The government image also exerts a positive effect toward public satisfaction. Furthermore, public satisfaction is also positively related to public trust toward the local government, even though the hypotheses linking public expectation to public satisfaction, and to budget transparency perceived quality are statistically insignificant. The implications of promoting budget transparency and suggestions for future work are also included in this study.
“Gethok Tular” as the Leadership Strategy of School Principals to Strengthen Multi-Stakeholder Forum Role in Improving the Quality of One-Roof Schools in Remote Areas in Indonesia
Authors: Juharyanto Juharyanto , Sultoni Sultoni , Arifin Imron , Bafadal Ibrahim , Nurabadi Ahmad , Hardika Hardika
Published: May 2020

This study aimed at finding an effective leadership strategy carried out by one-roof school principals in remote areas. This study was conducted qualitatively with a multi-site approach. The data were obtained from the school principals as key informants and focus group discussion (FGD) involving all school principals, Indonesian Institute of Education Innovation Training and Consultant (LPKIPI), education staff, school supervisors, and stakeholders as the participants and resource persons. Findings suggested that (a) the problems encountered by one-roof school principals in the remote areas were significantly related to culture, economy, demography, geography, and historical aspects, (b) the characteristics of success of school principals in remote areas include a clear vision, high-spirit performance, andhab asor (low profile), active involvement in various social activities, strong motivation for continuous learning, open to feedback, having commitment to cooperate with various parties, having a high awareness that school is an educational system and the essential part from the social system in general, persistent, high confidence that they are not alone in carrying out school policies, creative, able to see the context in various perspectives, patient, polite, warm, and smart or attractive, (c) “Gethok Tular1” is the most effective leadership strategy to strengthen the role of multi-stakeholder forum (MSF), and (d) the involvement of MSF members needs to be done selectively and effectively through the identification of TKU, intensive communication with TKU, identification of other figures, discussions, and sharing roles and strengthening MSF on an ongoing basis.
Lateral Meniscal Oblique Radial Tears Are Common With ACL Injury: A Classification System Based on Arthroscopic Tear Patterns in 600 Consecutive Patients
Authors: Krych Aaron J. , LaPrade Matthew D. , Cook Corey S. , Leland Devin , Keyt Lucas K. , Stuart Michael J. , Smith Patrick A.
Published: May 2020

Background:

Meniscal root tears and ramp lesions have been rigorously characterized in recent literature. However, one of the most common lateral meniscal injuries identified with an acute anterior cruciate ligament (ACL) disruption, a posterior horn lateral meniscal oblique radial tear (LMORT), has not been thoroughly described.

Purpose:

To determine the incidence of all meniscal tears and, more specifically, the incidence of posterior horn LMORTs in a multicenter cohort of consecutive, acute ACL reconstructions. Additionally, the authors aimed to develop a new classification system to help guide treatment of posterior horn LMORTs.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A multicenter retrospective cohort design was used to analyze 200 consecutive cases of acute ACL reconstruction from each of 3 different surgeons, for a total of 600 patients. The operative notes and intraoperative photos were analyzed to determine the incidence and laterality of all meniscal tears. A classification system based on tear characterization was then used to categorize tear patterns into similar groups.

Results:

A total of 396 (66%) of the 600 patients with acute ACL disruption had concomitant meniscal tears. Specifically, 187 (31%) had a lateral meniscal injury, 89 (15%) had a medial meniscal injury, and 122 (20%) had both medial and lateral meniscal injuries. The most common lateral meniscal tear was an LMORT; 71 (18%) patients with meniscal tears had a posterior horn LMORT. Overall, the incidence of ACL injury with a concomitant posterior horn LMORT was 12%. A classification was developed, which included type 1 tear (partial thickness <10 mm from the root attachment), type 2 tear (complete radial oblique tear that extended <10 mm from root), type 3 tear (incomplete LMORT that extended >10 mm from root), and type 4 tear (complete LMORT >10 mm from root).

Conclusion:

In 600 consecutive acute ACL reconstructions, the incidence of concomitant ACL injury with meniscal injury was 66%, and posterior horn LMORTs represented a large proportion of all meniscal tears (12%). A classification scheme was developed for posterior horn LMORTs to aid reporting and clinical decision making for these common tears.
The Appreciative Team Huddle: Real-Time, Best-Self Feedback in Student Teams
Authors: Passarelli Angela M.
Published: May 2020

Team experiences afford opportunities for students to expand their self-knowledge based on peer feedback, yet feedback processes tend to be cumbersome and difficult to manage. Thus, educators often provide feedback only on the team’s work output. The purpose of this article is to introduce a simple, structured exercise in which team members share feedback about valued individual inputs to team process. The Appreciative Team Huddle helps students discover or refine knowledge about their best selves, experience positive emotions, and balance attention to deficits with a focus on leveraging strengths in team settings. Detailed instructions for facilitating the Appreciative Team Huddle for various target audiences and conducting the exercise online are included.
Identification of potentially undiagnosed patients with nontuberculous mycobacterial lung disease using machine learning applied to primary care data in the UK
Authors: Doyle Orla M. , van der Laan Roald , Obradovic Marko , McMahon Peter , Daniels Flora , Pitcher Ashley , Loebinger Michael R.
Published: May 2020

Nontuberculous mycobacterial lung disease (NTMLD) is a rare lung disease often missed due to a low index of suspicion and unspecific clinical presentation. This retrospective study was designed to characterise the prediagnosis features of NTMLD patients in primary care and to assess the feasibility of using machine learning to identify undiagnosed NTMLD patients.

IQVIA Medical Research Data (incorporating THIN, a Cegedim Database), a UK electronic medical records primary care database was used. NTMLD patients were identified between 2003 and 2017 by diagnosis in primary or secondary care or record of NTMLD treatment regimen. Risk factors and treatments were extracted in the prediagnosis period, guided by literature and expert clinical opinion. The control population was enriched to have at least one of these features.

741 NTMLD and 112 784 control patients were selected. Annual prevalence rates of NTMLD from 2006 to 2016 increased from 2.7 to 5.1 per 100 000. The most common pre-existing diagnoses and treatments for NTMLD patients were COPD and asthma and penicillin, macrolides and inhaled corticosteroids. Compared to random testing, machine learning improved detection of patients with NTMLD by almost a thousand-fold with AUC of 0.94. The total prevalence of diagnosed and undiagnosed cases of NTMLD in 2016 was estimated to range between 9 and 16 per 100 000.

This study supports the feasibility of machine learning applied to primary care data to screen for undiagnosed NTMLD patients, with results indicating that there may be a substantial number of undiagnosed cases of NTMLD in the UK.
A comprehensive echocardiographic method for risk stratification in pulmonary arterial hypertension
Authors: Ghio Stefano , Mercurio Valentina , Fortuni Federico , Forfia Paul R. , Gall Henning , Ghofrani Ardeschir , Mathai Stephen C. , Mazurek Jeremy A. , Mukherjee Monica , Richter Manuel , Scelsi Laura , Hassoun Paul M. , Tello Khodr
Published: May 2020

Question addressed

Echocardiography is not currently considered as providing sufficient prognostic information to serve as an integral part of treatment goals in pulmonary arterial hypertension (PAH). We tested the hypothesis that incorporation of multiple parameters reflecting right heart function would improve the prognostic value of this imaging modality.

Methods and main results

We pooled individual patient data from a total of 517 patients (mean age 52±15 years, 64.8% females) included in seven observational studies conducted at five European and United States academic centres. Patients were subdivided into three groups representing progressive degrees of right ventricular dysfunction based on a combination of echocardiographic measurements, as follows. Group 1 (low risk): normal tricuspid annular plane systolic excursion (TAPSE) and nonsignificant tricuspid regurgitation (TR) (n=129); group 2 (intermediate risk): normal TAPSE and significant TR or impaired TAPSE and nondilated inferior vena cava (IVC) (n=256); group 3 (high risk): impaired TAPSE and dilated IVC (n=132). The 5-year cumulative survival rate was 82% in group 1, 63% in group 2 and 43% in group 3. Low-risk patients had better survival rates than intermediate-risk patients (log-rank Chi-squared 12.25; p<0.001) and intermediate-risk patients had better survival rates than high-risk patients (log-rank Chi-squared 26.25; p<0.001). Inclusion of other parameters such as right atrial area and pericardial effusion did not provide added prognostic value.

Answer to the question

The proposed echocardiographic approach integrating the evaluation of TAPSE, TR grade and IVC is effective in stratifying the risk for all-cause mortality in PAH patients, outperforming the prognostic parameters suggested by current guidelines.
Cardiac function and pulmonary hypertension in Central Asian highlanders at 3250 m
Authors: Lichtblau Mona , Saxer Stéphanie , Furian Michael , Mayer Laura , Bader Patrick R. , Scheiwiller Philipp M. , Mademilov Maamed , Sheraliev Ulan , Tanner Felix C. , Sooronbaev Talant M. , Bloch Konrad E. , Ulrich Silvia
Published: May 2020

The question addressed by the study

Chronic exposure to hypoxia increases pulmonary artery pressure (PAP) in highlanders, but the criteria for diagnosis of high-altitude pulmonary hypertension (HAPH) are debated. We assessed cardiac function and PAP in highlanders at 3250 m and explored HAPH prevalence using different definitions.

Patients and methods

Central Asian highlanders free of overt cardiorespiratory disease, permanently living at 2500–3500 m compared to age-matched lowlanders living <800 m. Participants underwent echocardiography close to their altitude of residence (at 3250 mversus760 m).

Results

173 participants (97 highlanders, 76 lowlanders), mean±sdage 49±9 years (49% females) completed the study. Results in lowlandersversushighlanders were systolic PAP (23±5versus30±10 mmHg), right ventricular fractional area change (42±6%versus39±8%), tricuspid annular plane systolic excursion (2.1±0.3versus2.0±0.3 cm), right atrial volume index (20±6versus23±8 mL·m−2), left ventricular ejection fraction (62±4%versus57±5%) and stroke volume (64±10versus57±11 mL); all between-group comparisons p<0.05. Depending on criteria, HAPH prevalence varied between 6% and 35%.

The answer to the question

Chronic exposure to hypoxia in highlanders is associated with higher PAP and slight alterations in right and left heart function compared to lowlanders. The prevalence of HAPH in this large highlander cohort varies between 6% according to expert consensus definition of chronic high-altitude disease to 35% according to the most recent definition of pulmonary hypertension proposed for lowlanders.
Fully weekly antituberculosis regimen: a proof-of-concept study
Authors: Kort Fatma , Fournier Le Ray Laure , Chauffour Aurélie , Jarlier Vincent , Lounis Nacer , Andries Koen , Aubry Alexandra , Guglielmetti Lorenzo , Veziris Nicolas
Published: May 2020

Background

The World Health Organization recommends supervising the treatment of tuberculosis. Intermittent regimens have the potential to simplify the supervision and improve compliance. Our objective was to analyse the sterilising activity of once-weekly regimens based on drugs with a long half-life, bedaquiline and rifapentine, in a murine model of tuberculosis.

Methods

300 Swiss mice were infected intravenously infected with ×10−6 CFUMycobacterium tuberculosisH37Rv. Mice were treated once weekly with regimens containing: 1) bedaquiline, rifapentine and pyrazinamide (BPZ); 2) BPZ plus moxifloxacin (BPZM); 3) BPZM plus clofazimine (BPZMC); 4) the standard daily regimen of tuberculosis. All regimens were given for 4 or 6 months. Bactericidal and sterilising activity were assessed.

Results

After 2 months of treatment, the mean count in lungs was 0.76±0.60 log10CFU in mice treated with the daily control regimen and negative in all mice treated with once-weekly regimens (p<0.05 compared to the daily control). All mice had negative lung cultures on completion of either 4 or 6 months of treatment, whereas 3 months after 4 and 6 months of treatment, respectively, the relapse rate was 64% and 13% in the standard daily regimen, 5% and 0% in BPZ, 0% and 0% in BPMZ and 0% and 5% in BPMZC (p<0.05 for all once-weekly regimensversus4-month daily control; p>0.05 for all once-weekly regimensversus6-month daily control).

Conclusions

BPZ-based once-weekly regimens have higher sterilising activity than the standard daily regimen and could greatly simplify treatment administration and possibly shorten the duration of tuberculosis treatment.
Development of colorless wood via two-step delignification involving alcoholysis and bleaching with maintaining natural hierarchical structure
Authors: Horikawa Yoshiki , Tsushima Rino , Noguchi Keiichi , Nakaba Satoshi , Funada Ryo
Published: May 2020

Lignin-free wood has been successfully developed via a two-step chemical treatment while maintaining its inherent hierarchical structure. The first step was alcoholysis which was conducted using ethylene glycol, and whose condition was optimized by monitoring the removal of lignin using infrared spectroscopy. The second step was bleaching wherein the delignification proceeded from the surface to the core of the wood block, and finally resulted in complete decolorization. Although the wood block was free from lignin and hemicellulose as approximately confirmed by the chemical composition analysis, the 3-dimensional colorless wood block was almost unaltered, even after freeze–drying. Then, multidirectional observation was performed to investigate whether the natural hierarchical structure from anatomical- to nano-level was maintained. Optical microscopy, X-ray microcomputed tomography, X-ray diffractometry, and transmission electron microscopy demonstrated that all the stages of hierarchical structure were maintained. The lignin-free wood block has great potential for novel materials that are supported by a 3-dimensional wooden architecture. The derived lignin-free wood is also a suitable specimen that can be used to understand the formation and functionality of the anatomical structure and lignified cell wall.
A qualitative research of adolescents with behavioral problems about their experience in a dialectical behavior therapy skills training group
Authors: Pardo Eva Sesma , Rivas Aránzazu Fernández , Barnier Pablo Orgaz , Mirabent Marina Beá , Lizeaga Iñaki Kerexeta , Cosgaya Aída Díaz , Alcántara Ana Catalán , González Esther Vivanco , Aguirre Blaise , Torres Miguel Angel González
Published: May 2020

Background

Several quantitative studies support the effectiveness of the Dialectical Behavior Therapy (DBT) psychosocial skills training group component for adolescents with impulse-control disorder and/or emotional dysregulation. However, qualitative research to assess this psychotherapeutic tool in the adolescent population is sparse. This study aims to examine the subjective experience of adolescents with behavioral issues who have completed DBT skills training group, as well as using this experience to extract hypotheses regarding its usefulness which can then be verified at a later time by means of quantitative instruments.

Methods

We developed a qualitative study by using focus groups with adolescents (N = 20) whose diagnosis includes symptoms such as behavior disorder, impulse-control disorder and/or emotional dysregulation, and good informants, who have completed DBT skills training. Three focus groups were created.

Results

The subjective experience of adolescents who have completed a DBT skills training group is collected in four main categories: experience of illness, motivation for therapy, experience of therapy and results of the therapy.

Conclusions

Adolescents with behavioral problems assess their participation in the DBT skills training group positively, even recommending its usefulness to healthy population. Beyond learning skills, they emphasize the intrapsychic changes (as improvement in reflective activity) that they objectify after the group experience.
Effect of lifestyle modifications on anthropometric, clinical, and biochemical parameters in adolescent girls with polycystic ovary syndrome: a systematic review and meta-analysis
Authors: Abdolahian Somayeh , Tehrani Fahimeh Ramezani , Amiri Mina , Ghodsi Delaram , Yarandi Razieh Bidhendi , Jafari Mahdi , Majd Hamid Alavi , Nahidi Fatemeh
Published: May 2020

Background

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of childbearing age. This study aimed to compare the effects of lifestyle interventions on anthropometric, clinical, and biochemical parameters in adolescent girls with PCOS.

Methods

PubMed, Scopus, and Web of Science was systematically searched to retrieve studies investigating the effects of lifestyle modifications in adolescent girls with PCOS, which were published up to December 2019. The primary outcome was Body Mass Index (BMI) and secondary outcomes were all manifestations of PCOS, including clinical, metabolic, and hormonal parameters. Random effect meta-analysis was applied for significant results. Publication bias was assessed using the Egger test.

Results

This study showed significant improvements in luteinizing hormone (LH) (Pooled SMD = − 0.1.23; 95% CI, − 2.44 to − 0.03), and Free Androgen Index (FAI) levels (Pooled SMD = − 0.78 95% CI, − 0.1.42 to − 0.13) in adolescent girls receiving lifestyle intervention compared to baseline. This study also revealed that diet modifications alone were associated with a significant decrease in Body Mass Index (BMI) (Pooled SMD = − 0.45; 95% CI, − 0.76 to − 0.13), and FG score (Pooled SMD = − 0.81; 95% CI, − 1.33 to − 0.28). Exercise interventions were associated with significant changes in the menstrual cycles (Pooled SMD = 1.16; 95% CI, 0.72 to 1.61), Ferriman-Gallwey (FG) score (Pooled SMD = − 0.57; 95% CI, − 0.99 to − 0.15), LH (Pooled SMD = − 056; 95% CI, − 0.98 to − 0.14), Anti-Müllerian Hormone (AMH) (Pooled SMD = − 0.81; 95% CI, − 0.1.24 to − 0.38), and Triglyceride (TG) levels (Pooled SMD = − 0.32; 95% CI, − 0.62 to − 0.02).

Conclusion

This meta-analysis concluded lifestyle interventions, such as diet and exercise, can improve some clinical, metabolic, and hormonal parameters in adolescent girls with PCOS.
Access to Oral health care: a focus on dental caries treatment provision in Enugu Nigeria
Authors: Uguru Nkolika , Onwujekwe Obinna , Ogu Udochukwu Ugochukwu , Uguru Chibuzo
Published: May 2020

Background

Dental caries, despite improvement in oral health across the globe, is still a large contributor to the global burden of oral diseases and a major public health concern. In Enugu state, Nigeria, there is minimal access to adequate and proper oral health care. This study examined the determinants of dental caries treatment provision and the challenges of providing equitable access to oral health care.

Method

This was a mixed-method cross-sectional descriptive urban-rural study conducted in selected oral health facilities offering primary oral health care in Enugu state. The study was conducted in two phases over a 2 month period. Quantitative data was initially collected from all selected oral health care providers using a survey questionnaire format after which qualitative data were collected through in-depth interviews of heads of the selected oral health facilities. The determinants of dental caries treatment services were explored with a focus on provider behavior, cost of dental services, human resource availability and availability of dental equipment.

Results

Quantitative findings show that to a larger extent, the cost of raw materials (100%), human resources (98.1%), infection control resources (98.1%), geographical location (98.1), Government policies (88%) and the price of other goods (80.8%) influence provision of dental caries treatment services. Qualitative results show that location and number of oral health facilities, government funding and policies for oral health, cost of dental equipment and materials, the ability of consumers to pay, human resource availability and consumer awareness of oral health are also factors that influence the provision of dental caries treatment services.

Conclusion

Adequate access to oral health care services is a major concern that affects all aspects of healthcare and a determining factor in the country’s drive to achieve universal health coverage. In order to address this, oral health facilities need to be strategically located and have adequate materials, equipment and skilled staff. There is a need to incorporate oral health into the general health care system and improve government policies and funding for oral health.
Equity and the financial costs of informal caregiving in palliative care: a critical debate
Authors: Gardiner Clare , Robinson Jackie , Connolly Michael , Hulme Claire , Kang Kristy , Rowland Christine , Larkin Phil , Meads David , Morgan Tessa , Gott Merryn
Published: May 2020

Background

Informal caregivers represent the foundation of the palliative care workforce and are the main providers of end of life care. Financial pressures are among the most serious concerns for many carers and the financial burden of end of life caregiving can be substantial.

Methods

The aim of this critical debate paper was to review and critique some of the key evidence on the financial costs of informal caregiving and describe how these costs represent an equity issue in palliative care.

Results

The financial costs of informal caregiving at the end of life can be significant and include carer time costs, out of pocket costs and employment related costs. Financial burden is associated with a range of negative outcomes for both patient and carer. Evidence suggests that the financial costs of caring are not distributed equitably. Sources of inequity are reflective of those influencing access to specialist palliative care and include diagnosis (cancer vs non-cancer), socio-economic status, gender, cultural and ethnic identity, and employment status. Effects of intersectionality and the cumulative effect of multiple risk factors are also a consideration.

Conclusions

Various groups of informal end of life carers are systematically disadvantaged financially. Addressing these, and other, determinants of end of life care is central to a public health approach to palliative care that fully recognises the value of carers. Further research exploring these areas of inequity in more depth and gaining a more detailed understanding of what influences financial burden is required to take the next steps towards meeting this aspiration. We will address the conclusions and recommendations we have made in this paper through the work of our recently established European Association of Palliative Care (EAPC) Taskforce on the financial costs of family caregiving.
Mitochondrial tRNA methylation in Alzheimer’s disease and progressive supranuclear palsy
Authors: Silzer Talisa K. , Pathak Gita A. , Phillips Nicole R.
Published: May 2020

Background

Methylation of mitochondrial tRNAs (mt-tRNA) at the 9th position (“p9 site”) is known to impact translational efficiency and downstream mitochondrial function; however, direct assessment of mt-RNA methylation is challenging. Recent RNA sequence-based methods have been developed to reliably identify post-transcriptional methylation. Though p9 methylation has been studied in healthy human populations and in the context of cancer, it has not yet been analyzed in neurodegenerative disease, where mitochondrial dysfunction is a prominent and early hallmark of disease progression.

Methods

Mitochondrial p9 methylation was inferred from multi-allelic calls in RNA-seq data. Gene-based association studies were performed in FUMA. Correlations between nuclear gene expression and p9 methylation were tested using Spearman’s rho. Fisher’s Exact test was used in PANTHER and IPA to test for overrepresentation and enrichment of biological processes and pathways in the top nuclear genes correlated with p9 methylation.

Results

Variable methylation was observed at 11 p9 sites in post-mortem cerebellar tissue of elderly subjects who were either healthy or diagnosed with Alzheimer’s disease (AD), progressive supranuclear palsy (PSP) or pathological aging (PA). Similarities in degree of methylation were observed between AD and PSP. Certain nuclear encoded genes were identified as significantly associated with p9 methylation. Expression of 5300 nuclear encoded genes was significantly correlated with p9 methylation, with AD and PSP subjects exhibiting similar expression profiles. Overrepresentation and enrichment testing using the top transcripts revealed enrichment for a number of molecular processes, terms and pathways including many of which that were mitochondrial-related.

Conclusion

With mitochondrial dysfunction being an established hallmark of neurodegenerative disease pathophysiology, this work sheds light on the potential molecular underpinnings of this dysfunction. Here we show overlap in cerebellar pathophysiology between common tauopathies such as Alzheimer’s disease and progressive supranuclear palsy. Whether p9 hypermethylation is a cause or consequence of pathology remains an area of focus.
Regional and socioeconomic variations in dietary patterns in a representative sample of young polish females: a cross-sectional study (GEBaHealth project)
Authors: Czarnocinska Jolanta , Wadolowska Lidia , Lonnie Marta , Kowalkowska Joanna , Jezewska-Zychowicz Marzena , Babicz-Zielinska Ewa
Published: May 2020

Background

Associations between dietary patterns (DPs) and socioeconomic correlates among adolescents from emerging economy countries are not fully understood. The study analysed variations in DPs adherence depending on country regions and family socioeconomic status (SES) among Polish females.

Methods

Data from a representative sample (n = 1107) of Polish females 13–21-year-old was used. Four DPs were previously identified by principal component analysis. Regions were ranked by Gross Domestic Product. A SES index as an overall measure of family SES was developed. Multiple logistic regression models adjusted for age and body mass index were created.

Results

Higher adherence to ‘Fast-food and sweets’ DP was found in the less affluent (North) region when compared to four other regions (Odds ratio (OR): 1.94 to 1.63). Higher adherence to ‘Fruit and vegetables’ DP was found in more affluent regions when compared to poorer regions: East and North-East (OR 1.71 to 1.81 and 1.69 to 2.23, respectively). Higher adherence to ‘Traditional Polish’ DP was found in 4 out of 5 regions (OR 2.02 to 2.53) when compared to the East. Higher family SES was associated with higher adherence to ‘Fruit and vegetables’ DP (OR 2.06) and lower adherence to ‘Traditional Polish’ DP (OR 0.27).

Conclusions

The study revealed that region’s affluence is strongly reflected in dietary behaviours of young females from a transitioning country. Recognising geographical distribution of dietary patterns within the country and shifting the resources to economically disadvantaged regions might be more effective than current national public health interventions.
RNA demethylase ALKBH5 prevents pancreatic cancer progression by posttranscriptional activation of PER1 in an m6A-YTHDF2-dependent manner
Authors: Guo Xingya , Li Kai , Jiang Weiliang , Hu Yangyang , Xiao Wenqin , Huang Yinshi , Feng Yun , Pan Qin , Wan Rong
Published: May 2020

Background

N6-methyladenosine (m6A) is the most abundant reversible methylation modification of eukaryotic mRNA, and it plays vital roles in tumourigenesis. This study aimed to explore the role of the m6A demethylase ALKBH5 in pancreatic cancer (PC).

Methods

The expression of ALKBH5 and its clinicopathological impact were evaluated in PC cohorts. The effects of ALKBH5 on the biological characteristics of PC cells were investigated on the basis of gain-of-function and loss-of-function analyses. Subcutaneous and orthotopic models further uncovered the role of ALKBH5 in tumour growth. mRNA and m6A sequencing and assays of m6A methylated RNA immunoprecipitation-qPCR (MeRIP-qPCR) were performed to identify the targeted effect of ALKBH5 on PER1. P53-binding sites in the ALKBH5 promoter were investigated by ChIP and luciferase assays to reveal the interplay between ALKBH5 and PER1-activated ATM-CHK2-P53/CDC25C signalling.

Results

ALKBH5 loss characterized the occurrence and poor clinicopathological manifestations in patients with PC. Overexpression of ALKBH5 reduced tumoural proliferative, migrative, invasive activities in vitro and ameliorated tumour growth in vivo, whereas ALKBH5 knockdown facilitated PC progression. Mechanistically, ALKBH5 posttranscriptionally activated PER1 by m6A demethylation in an m6A-YTHDF2-dependent manner. PER1 upregulation led to the reactivation of ATM-CHK2-P53/CDC25C signalling, which inhibited cell growth. P53-induced activation of ALKBH5 transcription acted as a feedback loop regulating the m6A modifications in PC.

Conclusion

ALKBH5 serves as a PC suppressor by regulating the posttranscriptional activation of PER1 through m6A abolishment, which may highlight a demethylation-based approach for PC diagnosis and therapy.
Chia (Salvia hispanica)-supplemented diet ameliorates non-alcoholic fatty liver disease and its metabolic abnormalities in humans
Authors: Medina-Urrutia Aida , Lopez-Uribe Angel R. , El Hafidi Mohamed , González-Salazar Maria del Carmen , Posadas-Sánchez Rosalinda , Jorge-Galarza Esteban , del Valle-Mondragón Leonardo , Juárez-Rojas Juan G.
Published: May 2020

Background

Non-alcoholic fatty liver disease (NAFLD) is a public health problem lacking an approved pharmacological treatment. Omega-3 fatty acids have shown to reverse NAFLD. Chia is a seed rich in α-linolenic acid (ALA), antioxidants, and fiber; therefore, it could be useful to treat NAFLD.

Methods

In a single arm experimental design study, the effect of 25 g/day of milled chia was assessed in 25 patients with NAFLD. After two weeks of dietary stabilization (basal condition) and eight weeks of a chia-supplemented isocaloric diet, liver:spleen attenuation index and visceral abdominal fat (VAF) were measured by computed tomography. Lipids, lipoproteins, free fatty acids (FFA), and ALA plasma concentrations were also determined.

Results

Dietary chia supplementation induced an increase in plasma ALA concentration (75%) and dietary fiber (55%) consumption. After chia supplementation, VAF (9%), body weight (1.4%), total cholesterol (2.5%), non-high density lipoprotein cholesterol (3.2%), and circulating FFA (8%) decreased. Furthermore, NAFLD regressed in 52% of the treated patients (P < 0.05 for all).

Conclusions

The results of the present study show that 25 g/day of milled chia ameliorates NAFLD. Chia is an accessible vegetal source of omega-3 fatty acids, antioxidants, and fiber, which could have the potential to prevent metabolic abnormalities in NAFLD patients. Considering that there is no pharmacological treatment approved for NAFLD, the findings of the present study suggest that a chia-supplemented diet could be an innovative alternative to control this disease.

Retrospectively registered

https://clinicaltrials.gov/show/NCT03942822
Attitudes to functional neurology and some other ‘prescriptive’ chiropractic techniques and their associations with chiropractic conservatism: a cross-sectional survey of chiropractic students
Authors: Demortier Marine , Goncalves Guillaume , Leboeuf-Yde Charlotte , Le Scanff Christine , Wedderkopp Niels
Published: May 2020

Background

Chiropractic technique systems (‘prescriptive’ techniques) might be interpreted as helpful guidelines. However, ‘prescriptive’ techniques, such as Functional Neurology (FN), Sacro-Occipital Technique, and Applied Kinesiology are more concerned with the ‘technical’ diagnosis than the condition and its symptoms and, thus, seem to provide easy solutions.

Design and objectives

In a voluntary anonymous questionnaire survey carried out late 2017, we explored interest in ‘prescriptive’ techniques, particularly FN, among French chiropractic students in grades 3–6, and the possible link with chiropractic conservatism. We investigated their: i) attitudes to the use of ‘prescriptive’ techniques, ii) awareness of FN, and iii) attitudes to FN. Further, if their attitudes to some conservative chiropractic concepts influenced their clinical approach on iv) some ‘prescriptive’ chiropractic techniques and v) attitudes to FN.

Method

Data reported in tables illustrated the prevalence of the use of ‘prescriptive’ techniques, awareness of FN, and positive attitude to FN (i.e. interest in and acceptance of). Students were given a FN score based on five questions on their interest in and acceptance of FN (0 to 5), dichotomized into two groups: ‘not positive attitude’ (0 to 1) and ‘positive attitude’ (2 to 5). Chiropractic conservatism was graded from 1 to 4. Associations were tested between conservatism groups and i) interest in ‘prescriptive’ techniques and ii) FN attitudes groups.

Results

The response rate was 67% (N = 359), of which 90% were positive toward ‘prescriptive’ techniques. Only 10% had never heard about FN and in the 6th year all had heard about it. Only a minority, unrelated to the year of study, approved of the two examples given of FN concepts. Nevertheless, a majority were positive towards FN, more so in the higher grades. Students with the most conservative beliefs were 17 times more likely to want to use ‘prescriptive’ techniques and 11 times more likely to have a higher FN score.

Conclusion

Although not taught in the curriculum, these students were attracted to ‘prescriptive’ techniques including FN, particularly in the higher grades. Curiously, despite this interest they do not generally agree with some key concepts within FN.
Integrating clinical and research training in child psychiatry: fifteen-year outcomes of a federally supported program
Authors: Calhoun Amanda , Bloch Michael H. , Stubbe Dorothy , Leckman James F. , Martin Andrés
Published: May 2020

Background

The Albert J. Solnit Integrated Training Program (AJSP) is an educational initiative designed to prepare physician-scientists for independent careers in the investigation and treatment of childhood psychiatric disorders.

Methods

We compared fifteen cohorts (each representing a consecutive year of matriculation) of AJSP trainees and graduates (n = 30) to peers who were comparably ranked in our original match lists but ultimately pursued residency programs elsewhere (n = 60). Outcomes of interest between the two groups included professional affiliation, as measured by: (1) membership in the American Academy of Child and Adolescent Psychiatry (AACAP); and (2) certification by the American Board of Psychiatry and Neurology (ABPN), as well as three domains of research productivity: (1) Competitive awards received from AACAP; (2) Publication-related metrics derived from the National Library of Medicine (NLM); and (3) Federal grant funding from the National Institutes of Health (NIH).

Results

AJSP participants were more commonly affiliated with AACAP and board certified in CAP. AJSP graduates and trainees outperformed their control group peers in several research outcomes: (1) Receipt of AACAP awards and number of awards per recipient were higher, and time to first award shorter in the AJSP than in the control group; (2) AJSP participants had more publications in PubMed, more first-authored publications, a higher h-index, and a shorter time to first publication than participants in the control group; and (3) NIH K- or R-series funding success rate was higher among AJSP participants (p < 0.05 for all comparisons).

Conclusions

A program designed to support the development of clinician-scientists specifically dedicated to childhood mental health needs has been successful in fostering scientific creativity, productivity and independence. The expansion and replication of similar training initiatives will be an in important step forward to address the high level of morbidity and mortality associated with child and adolescent psychiatric disorders.