bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic relevance of pericardial effusion in STEMI patients treated by primary percutaneous coronary intervention: a 10-year single-centre experience
Authors: Albani Stefano , Fabris Enrico , Stolfo Davide , Falco Luca , Barbati Giulia , Aquaro Giovanni Donato , Vitrella Giancarlo , Rakar Serena , Korcova Renata , Lardieri Gerardina , Giannini Francesco , Perkan Andrea , Sinagra Gianfranco
Published: November 2019

Background

Pericardial effusion is frequent in the acute phase of ST-segment elevation myocardial infarction. However, its prognostic role in the era of primary percutaneous coronary intervention is not completely understood.

Methods

We investigated the association between pericardial effusion, assessed by transthoracic echocardiography, and survival in a large cohort of ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention, enrolled in the Trieste primary percutaneous coronary intervention registry from January 2007 to March 2017. Multivariable analysis and a propensity score approach were performed.

Results

A total of 1732 ST-segment elevation myocardial infarction patients were included. Median follow-up was 45 (interquartile range 19–79) months. Pericardial effusion was present in 246 patients (14.2%). Thirty-day all-cause mortality was similar between patients with and without pericardial effusion (7.8% vs. 5.4%, P=0.15), whereas crude long-term survival was worse in patients with pericardial effusion (26.2% vs. 17.7%, P≤0.01). However, at multivariable analyses the presence of pericardial effusion was not associated with long-term mortality (hazard ratio 1.26, 95% confidence interval 0.86–1.82, P=0.22). Matching based on propensity scores confirmed the lack of association between pericardial effusion and both 30-day (hazard ratio 1, 95% confidence interval 0.42–2.36, P=1) and long-term (hazard ratio 1.14, 95% confidence interval 0.74–1.78, P=0.53) all-cause mortality. Patients with per effusion experienced a higher incidence of free wall rupture (2.8% vs. 0.5%, P<0.0001) independently of the entity of pericardial effusion.

Conclusions

In acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention, the onset of pericardial effusion after ST-segment elevation myocardial infarction is not independently associated with short and long-term higher mortality. Free wall rupture has to be considered rare compared to the fibrinolytic era and occurs more frequently in patients with pericardial effusion, suggesting a close monitoring of these patients in the early post-primary percutaneous coronary intervention phase.
Surgical Management of the Lumbar Spine in Rheumatoid Arthritis
Authors: Joo Peter , Ge Laurence , Mesfin Addisu
Published: November 2019

Study Design:

Narrative review.

Objective:

To provide an overview on the diagnosis and surgical management of rheumatoid involvement of the lumbar spine. Rheumatoid arthritis (RA) is a chronic inflammatory disease of synovial joints, most commonly appendicular followed by axial. Although cervical spine involvement of RA is well documented, data on lumbar spine involvement and surgical management remains limited.

Methods:

Using PubMed, studies published prior to November 2018 with the keywords “RA, etiology”; “RA, spine management”; “RA, surgical management”; “RA, treatment”; “RA, DMARDs”; “RA, lumbar spine”; “RA, spine surgical outcomes”; “RA, imaging” were evaluated.

Results:

The narrative review addresses the epidemiology, manifestations, imaging, surgical complications, and operative and nonoperative management of RA involvement of the lumbar spine.

Conclusions:

Rheumatoid involvement of the lumbar spine can present with lower back pain, neurogenic claudication, radiculopathy, spinal deformity, and instability. Patients with RA have significantly higher rates of vertebral fractures and complications following surgical intervention. However, in the setting of instability and spinal deformity, thoughtful surgical planning in conjunction with optimal medical management is recommended.
Zionism, Colonialism, and Post-colonial Migrations: Moroccan Jews’ Memories of Displacement
Authors: Cohen Yolande
Published: November 2019

The emigration of Jews from Morocco to Israel, in particular, is the subject of intense debate among historians, signaling the difficulty of telling a unified story of this moment. I want to contribute to this debate by showing that the combining and often opposing forces of Colonialism and Zionism were the main factors that triggered these migrations, in a period of rising Moroccan nationalism. But those forces were also seen as opportunities by some migrants to seize the moment to better their fate and realize their dreams. If we cannot assess every migrant story, I want here to suggest through my family’s experience and memory and other collected oral histories, how we could intertwine those memories to a larger narrative to shed more light on this history. The push and pull forces that led to Moroccan Jewry’s migrations and post-colonial circulations between the 1940s and 1960s were the result of a reordering of the complex relationships between the different ethnic and religious communities well before the migration took place. The departures of the people interviewed for this study are inscribed in both the collective and family dynamics, but were organized in secret, away from the gaze of the others, particularly that of non-Jewish neighbors. Their belonging to a sector of the colonial world, while still prevalent in their narratives, is blurred by another aspect of post-colonial life in Morocco, that is the cultural/education nexus. Depending on where one has been educated and socialized, the combined effects of Colonialism and Zionism strongly impacted the time of their departures and the places they went to.
Making Products That Matter: How Value-driven Development Accelerates Your Teams
Authors: Kwakernaak Marcel
Published: November 2019

An increasing number of businesses are seeking new Agile ways to deliver valuable products to their customers. However, many companies that adopt Agile principles soon experience early indicators of struggle, such as starting development before the value to the end user is fully understood or delivering products that are not done. These problems limit the ability of organizations to create value for both their end users and the company. The purpose of this article is to share our experience as practitioners on a range of Agile development practices from a value-driven perspective. Common blind spots are highlighted and the value-driven principles that enable development teams to sustainably create value are explained. Our experimentation with various improvement approaches has provided insight into value-driven principles and the framework that interconnects these principles. This article describes the value-driven framework (VDF) as a methodology developed by practitioners for businesses that struggle to enable their workforce to increase the value of their products. The VDF provides an approach to overcome these struggles in a four-step process: (1) explore to find opportunity, (2) discover the most valuable next step, (3) experiment to try-out and learn, and (4) value will emerge as a sustainable user benefit.
Green Criminology and Environmental Crime: Criminology That Matters in the Age of Global Ecological Collapse
Authors: Lynch Michael J.
Published: November 2019

An overview of green criminology (GC) is provided. That substantial literature is not easily summarized, and here, some core issues are reviewed: defining green crimes, the scope of GC, measuring green crimes, and empirical studies of green crimes. Special attention is paid to political economic approaches to GC, which was the foundation for GC. Connections are made to environmental sociology, theories of metabolic rift and unequal ecological exchange, and scientific evidence on planetary boundaries and ecological footprints. Examples of widespread human and nonhuman being green victimization are reviewed. In an era of anthropogenic-driven global ecological collapse, academic disciplines must pay increased attention to ecological disorganization, ecosystem destruction, and excessive production/consumption, which is the proper subject matter of GC.
Rolling Out a New Policy/Concept is the Key to Ensuring Corporate Governance
Authors: Mathen Annie
Published: November 2019

Rolling out and implementing new policies in a corporate environment is often seen as a challenging task. This situation stems from the array of hurdles it must overcome to reach and, more importantly, be implemented by each and every employee. This article deals with a very lucid and easy to replicate model on how to get the same done correctly every time, if not at the first go.
Contemporary Vistas in Geriatric Sexuality
Authors: Mathur Supriya , Manohar Shivananda , Chandran Suhas , Raman Rajesh , Pereira Pratibha , Rao T.S. Sathyanarayana
Published: November 2019

There is a substantial increase in the total geriatric population worldwide. This change in demography calls for a greater, deeper, and thorough understanding of elderly and age-related issues. Even though sexuality is a basic and vital driving force, human sexuality, especially elderly sexuality, is frequently misunderstood. Many myths and misconceptions regarding elderly sexuality exist which need attention. Contrary to the popular belief, studies reveal that sexual life continues to be an important aspect in later life and is often viewed by elderly as an expression of love, passion, affection, admiration, and loyalty. Various factors play a role in elderly sexuality including that of bio-psycho-social factors, changes in the body, presence of comorbid conditions along with sexual disorders. Sexual disorders, if present, should be treated and addressed adequately.
Crafting Project Managers’ Careers: Integrating the Fields of Careers and Project Management
Authors: Akkermans Jos , Keegan Anne , Huemann Martina , Ringhofer Claudia
Published: November 2019

Project managers experience unique careers that are not yet sufficiently understood, and more people than ever before are pursuing such careers. The research on project management and careers is therefore urgently needed in order to better understand the processes and systems shaping the careers of project managers. We address this gap by reviewing several key career theories and constructs and examining how these are mobilized to understand project managers’ careers in existing research. Our main conclusion is that boundaryless career theory has been the dominant career perspective in project management research, whereas other career theories—specifically protean career theory, social cognitive career theory, career construction theory, and sustainable career theory—are far less often mobilized as a basis for studies. We also find that some of the most popular constructs in careers research, such as career success and employability, have been used in recent project management research. However, their use in these studies is often implicit and does not necessarily leverage existing work from the careers field. We argue that there is strong potential for further and more systematic integration between project management and careers research in order to enrich both fields, and we offer a research agenda as a starting point.
Organ transcriptomes of the lucinid clam Loripes orbiculatus (Poli, 1791) provide insights into their specialised roles in the biology of a chemosymbiotic bivalve
Authors: Yuen Benedict , Polzin Julia , Petersen Jillian M.
Published: November 2019

Background

The lucinid clamLoripes orbiculatuslives in a nutritional symbiosis with sulphur-oxidizing bacteria housed in its gills. Although our understanding of the lucinid endosymbiont physiology and metabolism has made significant progress, relatively little is known about how the host regulates the symbiosis at the genetic and molecular levels. We generated transcriptomes from fourL. orbiculatusorgans (gills, foot, visceral mass, and mantle) for differential expression analyses, to better understand this clam’s physiological adaptations to a chemosymbiotic lifestyle, and how it regulates nutritional and immune interactions with its symbionts.

Results

The transcriptome profile of the symbiont-housing gill suggests the regulation of apoptosis and innate immunity are important processes in this organ. We also identified many transcripts encoding ion transporters from the solute carrier family that possibly allow metabolite exchange between host and symbiont. Despite the clam holobiont’s clear reliance on chemosynthesis, the clam’s visceral mass, which contains the digestive tract, is characterised by enzymes involved in digestion, carbohydrate recognition and metabolism, suggesting thatL. orbiculatushas a mixotrophic diet. The foot transcriptome is dominated by the biosynthesis of glycoproteins for the construction of mucus tubes, and receptors that mediate the detection of chemical cues in the environment.

Conclusions

The transcriptome profiles of gills, mantle, foot and visceral mass provide insights into the molecular basis underlying the functional specialisation of bivalve organs adapted to a chemosymbiotic lifestyle.
Standardized warfarin monitoring decreases adverse drug reactions
Authors: Shields Lisa B. E. , Fowler Paula , Siemens Diane M. , Lorenz Douglas J. , Wilson Kenneth C. , Hester Steven T. , Honaker Joshua T.
Published: November 2019

Background

While warfarin is the most commonly prescribed medication to prevent thromboembolic disorders, the risk of adverse drug reactions (ADR) poses a serious concern. This prospective study evaluated how primary care providers (PCP) and cardiologists at our Institution managed patients treated with warfarin with the goal of decreasing the number of warfarin ADRs.

Methods

A multidisciplinary anticoagulation task force was established at our Institution in 2014 to standardize warfarin monitoring and management. Between 2013 and 2017, we analyzed patients who were prescribed warfarin by their PCP or cardiologist upon hospital discharge and in the ambulatory setting to determine the international normalized ratio (INR) within 5, 10, and 30 days after discharge, time in therapeutic range (TTR), number of severe warfarin ADRs, and total and average cost reduction of all severe warfarin ADRs to determine whether there was an organizational cost savings following the implementation of standardized warfarin care.

Results

The warfarin ADR rate significantly decreased over the 5-year period, from 3.8 to 0.98% (p < 0.0001). The proportion of warfarin prescriptions out of all anticoagulants significantly decreased, from 72.2 to 42.1% (p < 0.001). The proportion of individuals who received an INR at 5, 10, and 30 days after hospital discharge compared to the total number of patients prescribed warfarin significantly increased (p < 0.001). The total cost of severe warfarin ADRs decreased by 57.6% between 2013 and 2017.

Conclusions

This study serves as a model to reduce the number of severe warfarin ADRs by the following tactics: (1) educating PCPs and cardiologists about evidence-based guidelines for warfarin management, (2) increasing the use of our Institution’s electronic warfarin module, and (3) enhancing patient compliance with obtaining INR.
Acute obstructive cholangitis due to fishbone in the common bile duct: a case report and review of the literature
Authors: Yu Min , Huang Bowen , Lin Ye , Nie Yuxue , Zhou Zixuan , Liu Shanshan , Hou Baohua
Published: November 2019

Background

Choledocholithiasis is an endemic condition in the world. Although rare, foreign body migration with biliary complications needs to be considered in the differential diagnosis for patients presenting with typical symptoms even many years after cholecystectomy, EPCP, war-wound, foreign body ingestion or any other particular history before. It is of great clinical value as the present review may offer some help when dealing with choledocholithiasis caused by foreign bodies.

Case presentation

We reported a case of choledocholithiasis caused by fishbone from choledochoduodenal anastomosis regurgitation. Moreover, we showed up all the instances of choledocholithiasis caused by foreign bodies published until June 2018 and wrote the world’s first literature review of foreign bodies in the bile duct of 144 cases. The findings from this case suggest that the migration of fishbone can cause various consequences, one of these, as we reported here, is as a core of gallstone and a cause of choledocholithiasis.

Conclusion

The literature review declared the choledocholithiasis caused by foreign bodies prefer the wrinkly and mainly comes from three parts: postoperative complications, foreign body ingestion, and post-war complications such as bullet injury and shrapnel wound. The Jonckheere-Terpstra test indicated the ERCP was currently the treatment of choice. It is a very singular case of choledocholithiasis caused by fishbone, and the present review is the first one concerning choledocholithiasis caused by foreign bodies all over the world.
Surveillance study of the prevalence, species distribution, antifungal susceptibility, risk factors and mortality of invasive candidiasis in a tertiary teaching hospital in Southwest China
Authors: Zeng Zhang-rui , Tian Gang , Ding Yin-huan , Yang Kui , Liu Jin-bo , Deng Jian
Published: November 2019

Background

Invasive candidiasis (IC) is the most common invasive fungal infection. The epidemiology of IC in hospitalized patients has been widely investigated in many metropolitan cities; however, little information from medium and small cities is known.

Methods

A 5-year retrospective study was carried out to analyze the prevalence, species distribution, antifungal susceptibility, risk factors and mortality of inpatients with invasive Candida infection in a regional tertiary teaching hospital in Southwest China.

Results

A total of 243 inpatients with invasive Candida infection during the five-year study period were identified, with a mean annual incidence of 0.41 cases per 1000 admissions and a 30-day mortality rate of 12.3%. The species distributions of Candida albicans, Candida glabrata, Candida tropicalis, Candida krusei, Candida parapsilosis and other Candida species was 45.3, 30.0, 15.2, 4.9, 2.1 and 2.5%, respectively. The total resistance rates of fluconazole (FCA), itraconazole (ITR) and voriconazole (VRC) were 18.6, 23.1 and 18.5%, respectively. Respiratory dysfunction, pulmonary infection, cardiovascular disease, chronic/acute renal failure, mechanical ventilation, abdominal surgery, intensive care in adults, septic shock and IC due to C. albicans were associated with 30-day mortality (P < 0.05) according to the univariate analyses. Respiratory dysfunction [odds ratio (OR), 9.80; 95% confidence interval (CI), 3.24–29.63; P < 0.001] and IC due to C. albicans (OR, 3.35; 95% CI, 1.13–9.92; P = 0.029) were the independent predictors of 30-day mortality.

Conclusions

This report shows that the incidence and mortality rates are lower and that the resistance rates to azoles are higher in medium and small cities than in large cities and that the species distributions and risk factors in medium and small cities are different from those in large cities in China. It is necessary to conduct epidemiological surveillance in medium and small cities to provide reference data for the surveillance of inpatients with IC infections.
A NADE nomogram to predict the probability of 6-month unfavorable outcome in Chinese patients with ischemic stroke
Authors: Sun Chao , Li Xiang , Song Baili , Chen Xiangliang , Nyame Linda , Liu Yukai , Tang Dan , Ibrahim Mako , Zhao Zheng , Liu Chao , Yan Miao , Pan Xiding , Yang Jie , Zhou Junshan , Zou Jianjun
Published: November 2019

Background

Early prediction of unfavorable outcome after ischemic stroke is of great significance to the clinical and therapeutic management. A nomogram is a better visual tool than earlier models and prognostic scores to predict clinical outcomes, which incorporates different factors to develop a graphic continuous scoring system and calculates accurately the risk probability of poor outcome entirely based on individual characteristics. However, to date, no nomogram models have been found to predict the probability of 6-month poor outcome after ischemic stroke. We aimed to develop and validate a nomogram for individualized prediction of the probability of 6-month unfavorable outcome in Chinese patients with ischemic stroke.

Methods

Based on the retrospective stroke registry, a single-center study which included 499 patients from May, 2013 to May, 2018 was conducted in Nanjing First Hospital (China) for ischemic stroke within 12 h of symptoms onset. The main outcome measure was 6-month unfavorable outcome (mRS > 2). To generate the nomogram, NIHSS score on admission, Age, previous Diabetes mellitus and crEatinine (NADE) were integrated into the model. We assessed the discriminative performance by using the area under the curve (AUC) of receiver-operating characteristic (ROC) and calibration of risk prediction model by using the Hosmer–Lemeshow test.

Results

A visual NADE nomogram was constructed that NIHSS score on admission (OR: 1.190, 95%CI: 1.125–1.258), age (OR: 1.068, 95%CI: 1.045–1.090), previous diabetes mellitus (OR: 1.995, 95%CI: 1.236–3.221) and creatinine (OR: 1.010, 95%CI: 1.002–1.018) were found to be significant predictors of 6-month unfavorable outcome after acute ischemic stroke in Chinese patients. The AUC–ROC of nomogram was 0.791. Calibration was good (p = 0.4982 for the Hosmer–Lemeshow test).

Conclusion

The NADE is the first nomogram developed and validated in Chinese ischemic stroke patients to provide an individual, visual and precise prediction of the risk probability of 6-month unfavorable outcome.
Psychosocial and obstetric determinants of women signalling distress during Edinburgh Postnatal Depression Scale (EPDS) screening in Sydney, Australia
Authors: Khanlari Sarah , Eastwood John , Barnett Bryanne , Naz Sabrina , Ogbo Felix Akpojene
Published: November 2019

Background and objectives

The perinatal period presents a high-risk time for development of mood disorders. Australia-wide universal perinatal care, including depression screening, make this stage amenable to population-level preventative approaches. In a large cohort of women receiving public perinatal care in Sydney, Australia, we examined: (1) the psychosocial and obstetric determinants of women who signal distress on EPDS screening (scoring 10–12) compared with women with probable depression (scoring 13 or more on EPDS screening); and (2) the predictive ability of identifying women experiencing distress during pregnancy in classifying women at higher risk of probable postnatal depression.

Methods

We analysed routinely collected perinatal data from all live-births within public health facilities from two health districts in Sydney, Australia (N = 53,032). Perinatal distress was measured using the EPDS (scores of 10–12) and probable perinatal depression was measured using the EPDS (scores of 13 or more). Logistic regression models that adjusted for confounding variables were used to investigate a range of psychosocial and obstetric determinants and perinatal distress and depression.

Results

Eight percent of this cohort experienced antenatal distress and about 5 % experienced postnatal distress. Approximately 6 % experienced probable antenatal depression and 3 % experienced probable postnatal depression. Being from a culturally and linguistically diverse background (AOR = 2.0, 95% CI 1.8–2.3, P < 0.001), a lack of partner support (AOR = 2.9, 95% CI 2.3–3.7) and a maternal history of childhood abuse (AOR = 1.9, 95% CI 1.6–2.3) were associated with antenatal distress. These associations were similar in women with probable antenatal depression. Women who scored 10 to12 on antenatal EPDS assessment had a 4.5 times higher odds (95% CI 3.4–5.9, P < 0.001) of experiencing probable postnatal depression compared with women scoring 9 or less.

Conclusion

Antenatal distress is more common than antenatal depressive symptoms and postnatal distress or depression. Antenatal maternal distress was associated with probable postnatal depression. Scale properties of the EPDS allows risk-stratification of women in the antenatal period, and earlier intervention with preventively focused programs. Prevention of postnatal depression could address a growing burden of illness and long-term complications for mothers and their infants.
Choroidal vascular changes in internal carotid artery stenosis: a retrospective cohort study in Chinese population
Authors: Li Shuang , Lang Xuqiang , Wang Wei , Yang Yang , Wang Jingjing , Li Hongyang , Wang Yanling , Wang Kang
Published: November 2019

Background

To evaluate choroidal vascularity index (CVI) in eyes with internal carotid artery (ICA) stenosis using binarization tool in enhanced depth images scanned by spectral domain optical coherence tomography.

Methods

A retrospective cohort study was conducted in 142 patients with ICA stenosis, and 20 normal control subjects matched with the age, sex, etc. According to the diagnostic criteria, the participants are divided into a normal control group (20 cases), a mild stenosis group (64 cases), a moderate stenosis group (61 cases), and a severe stenosis group (17 cases). Enhanced depth imaging optical coherence tomography (EDIOCT) was performed to scan macular fovea, which was separated into a luminal area and a stromal area using image binarization. The choroidal vascularity index (CVI) is luminal area divided by total choroidal area.

Results

There was no statistical difference in age or sex among groups. Subfoveal choroidal thickness (SFCT) in the severe stenosis group was significantly lower than that in the normal group (P < 0.05). Moreover, the CVI in moderate stenosis group and severe stenosis group were significantly lower compared with the normal control group (P < 0.001). When CVI = 65.16% was set as the cut-off value, all 162 subjects could be divided into two groups, CVI ≤ 65.16 (n = 83) and CVI > 65.16% (n = 79). The proportions of mild stenosis, moderate stenosis, and severe stenosis in CVI ≤ 65 .16 group and CVI > 65.16% group were statistically significant (P < 0.001).

Conclusion

CVI may be a useful indicator for early diagnosis and monitoring of choroidal vascular changes in ICA stenosis.
Association between antenatal care follow-up and institutional delivery service utilization: analysis of 2016 Ethiopia demographic and health survey
Authors: Abebe Eskezaiw , Seid Abdu , Gedefaw Getnet , Haile Zelalem T. , Ice Gillian
Published: November 2019

Background

Globally, the magnitude of maternal mortality is the major public health problem. Nearly all (99%) of maternal deaths occur in low- and middle-income countries. Of which 66% occur in sub-Saharan Africa. Institutional delivery under the hygienic environment with the necessary skills and equipment promotes to identify and treat complications, infections, and the death of the mother and baby. In Ethiopia, the utilization of maternal health services is very low. For instance, 62% of women had antenatal care utilization during pregnancy while only 26% of women utilize institutions for delivery in 2016. Therefore, this study examined the association between antenatal care follow up and intestinal delivery among a nationally representative woman in Ethiopia.

Methods

A cross-sectional study design was used to examine 7575 women from the 2016 Ethiopia Demographic and Health Survey. Both descriptive and inferential statistics were utilized. Variables in the bivariate logistic regression with p-value < 0.2 were entered into the multivariable logistic regression. Odds ratios and corresponding 95% confidence intervals (CI) were reported. In the multivariable analysis, variables with p-value < 0.05 were considered as statistically significant.

Results

The prevalence of institutional delivery service utilization for last childbirth was 11.3%. In comparison with women with no antenatal care visits, the multivariable odds ratio (95% confidence interval) of institutional delivery among those who attend one to three and four or more antenatal care visit were 2.49 (1.66, 3.74) and 3.90 (2.60, 5.84), respectively. Other factors significantly associated with institutional delivery include urban residence 2.25 (1.44, 3.51), complete primary education 3.22 (2.09, 4.98), complete secondary or higher education 1.59 (1.16, 2.17), poorer household wealth index 2.57 (1.57, 4.20), middle household wealth index 1.63 (1.05, 2.52), and richer household wealth index 1.56(1.03, 2.58).

Conclusion

Antenatal care follow-up was significantly associated with institutional delivery service utilization. As the number of antenatal care visits increased the odds of facility delivery increased. Thus, improved access and utilization of antenatal care can be an effective strategy to increase institutional deliveries and optimal maternal and child health outcomes.
Projected return on investment of a corporate global health programme
Authors: Peik Samuel , Schimmel Erik , Hejazi Sara
Published: November 2019

Background

Health and wellbeing initiatives vary in effectiveness due to programme design and offerings. The Partnership for Prevention programme expands access to up to 40 evidence-based clinical preventive services for all employees and eligible family members as part of a unique global health initiative.

Methods

Using a published RAND Europe model developed for the company, country-level return on investment was estimated over a five-year timeframe using programme utilisation data. Regional, global, and service-level averages were estimated using population-weighted country averages. Data were collected from 2012 to 2018 and analysed in 2018.

Results

The programme is estimated to generate a global return of $4.28–$11.88 (after cost of investment), based on analysis of 57 countries and nearly 125,000 delivered services. Returns were positive for all regions, and immunisations, smoking cessation, and cardiovascular treatment generated the largest individual service returns.

Conclusions

This global health programme is projected to generate a significant return on investment by focusing on global utilisation of clinical preventive services.
Association of β2-adrenergic receptor gene polymorphisms (rs1042713, rs1042714, rs1042711) with asthma risk: a systematic review and updated meta-analysis
Authors: Zhao Songlin , Zhang Wei , Nie Xiuhong
Published: November 2019

Background

The published data on the association between β2-adrenergic receptor gene polymorphisms and asthma susceptibility are inconclusive. To derive a more precise estimation of this association, a meta-analysis was performed.

Methods

A literature search was conducted in PubMed, Web of Science, EMBASE, Wanfang, and the China National Knowledge Infrastructure (CNKI) databases to identify eligible studies. The pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were used to calculate the strength of the association. A sensitivity analysis was performed to evaluate the influence of individual studies on the overall effect estimates, and funnel plots and Egger’s tests were used for indications of publication bias.

Results

Seventy three studies with three single nucleotide polymorphisms (SNP) (rs1042713, c.G46A, p.Gly16Arg; rs1042714, c.G79C, p.Gln27Glu; rs1042711, c.T-47C, p.Cys19Arg) were finally identified. For the rs1042713 polymorphism, no significant association with asthma risk was found in the overall population. However, a significant protective association was found in the Indian population in the dominant model comparison (OR = 0.72, 95% CI = 0.59–0.87, I2 = 25%, studies = 5, cases = 1190, controls = 1241). A significant risk association was found in the Arab population in the dominant model comparison (OR = 1.75, 95% CI = 1.14–2.70, I2 = 0%, studies = 2, cases = 307, controls = 361) and the homozygote model comparison (OR = 1.88, 95% CI = 1.17–3.02, I2 = 0%, studies = 2, cases = 307, controls = 361), and in the Hispanic-Latino population in the dominant model comparison (OR = 1.68, 95% CI = 1.10–2.55, I2 = 77%, studies = 5, cases = 1026, controls = 1412). For the rs1042714 polymorphism, we found a significant association in the recessive model comparison (OR = 0.83, 95% CI = 0.70–0.98, I2 = 44%, studies = 52, cases = 8242, controls = 16,832), the homozygote genotype comparison (OR = 0.84, 95% CI = 0.72–0.98, I2 = 25%, studies = 52, cases = 8242, controls = 16,832) and the allelic genetic model (OR = 0.91, 95% CI = 0.83–0.99, I2 = 59%, studies = 52, cases = 8242, controls = 16,832) in the overall population. When stratified by age, a significant association was also found in children in the recessive model comparison (OR = 0.59, 95% CI = 0.39–0.88, I2 = 58%, studies = 18, cases = 2498, controls = 2510) and the homozygote genotype comparison (OR = 0.63, 95% CI = 0.43–0.92, I2 = 46%, studies = 18, cases = 2498, controls = 2510), but not in adult. For the rs1042711 polymorphism, no significant associations were found in the any genetic model.

Conclusion

The meta-analysis suggests that the ADRB2 rs1042714 polymorphism has a protective association with asthma in the overall population and the pediatric subgroup.
The impact of patient preferences and costs on the appropriateness of spinal manipulation and mobilization for chronic low back pain and chronic neck pain
Authors: Herman Patricia M. , Whitley Margaret D. , Ryan Gery W. , Hurwitz Eric L. , Coulter Ian D.
Published: November 2019

Background

Although the delivery of appropriate healthcare is an important goal, the definition of what constitutes appropriate care is not always agreed upon. The RAND/UCLA Appropriateness Method is one of the most well-known and used approaches to define care appropriateness from the clinical perspective—i.e., that the expected effectiveness of a treatment exceeds its expected risks. However, patient preferences (the patient perspective) and costs (the healthcare system perspective) are also important determinants of appropriateness and should be considered.

Methods

We examined the impact of including information on patient preferences and cost on expert panel ratings of clinical appropriateness for spinal mobilization and manipulation for chronic low back pain and chronic neck pain.

Results

The majority of panelists thought patient preferences were important to consider in determining appropriateness and that their inclusion could change ratings, and half thought the same about cost. However, few actually changed their appropriateness ratings based on the information presented on patient preferences regarding the use of these therapies and their costs. This could be because the panel received information on average patient preferences for spinal mobilization and manipulation whereas some panelists commented that appropriateness should be determined based on the preferences of individual patients. Also, because these therapies are not expensive, their ratings may not be cost sensitive. The panelists also generally agreed that preferences and costs would only impact their ratings if the therapies were considered clinically appropriate.

Conclusions

This study found that the information presented on patient preferences and costs for spinal mobilization and manipulation had little impact on the rated appropriateness of these therapies for chronic low back pain and chronic neck pain. Although it was generally agreed that patient preferences and costs were important to the appropriateness of M/M for CLBP and CNP, it seems that what would be most important were the preferences of the individual patient, not patients in general, and large cost differentials.
Vertebral bone marrow fat fraction changes in postmenopausal women with breast cancer receiving combined aromatase inhibitor and bisphosphonate therapy
Authors: Dieckmeyer Michael , Ruschke Stefan , Rohrmeier Alexander , Syväri Jan , Einspieler Ingo , Seifert-Klauss Vanadin , Schmidmayr Monika , Metz Stephan , Kirschke Jan S. , Rummeny Ernst J. , Zimmer Claus , Karampinos Dimitrios C. , Baum Thomas
Published: November 2019

Background

Quantification of vertebral bone marrow (VBM) water–fat composition has been proposed as advanced imaging biomarker for osteoporosis. Estrogen deficiency is the primary reason for trabecular bone loss in postmenopausal women. By reducing estrogen levels aromatase inhibitors (AI) as part of breast cancer therapy promote bone loss. Bisphosphonates (BP) are recommended to counteract this adverse drug effect. The purpose of our study was to quantify VBM proton density fat fraction (PDFF) changes at the lumbar spine using chemical shift encoding-based water-fat MRI (CSE-MRI) and bone mineral density (BMD) changes using dual energy X-ray absorptiometry (DXA) related to AI and BP treatment over a 12-month period.

Methods

Twenty seven postmenopausal breast cancer patients receiving AI therapy were recruited for this study. 22 subjects completed the 12-month study. 14 subjects received AI and BP (AI+BP), 8 subjects received AI without BP (AI-BP).

All subjects underwent 3 T MRI. An eight-echo 3D spoiled gradient-echo sequence was used for CSE-based water-fat separation at the lumbar spine to generate PDFF maps. After manual segmentation of the vertebral bodies L1-L5 PDFF values were extracted for each vertebra and averaged for each subject.

All subjects underwent DXA of the lumbar spine measuring the average BMD of L1-L4.

Results

Baseline age, PDFF and BMD showed no significant difference between the two groups (p > 0.05). There was a relative longitudinal increase in mean PDFF (∆relPDFF) in both groups (AI+BP: 5.93%; AI-BP: 3.11%) which was only significant (p = 0.006) in the AI+BP group. ∆relPDFFshowed no significant difference between the two groups (p > 0.05). There was no significant longitudinal change in BMD (p > 0.05).

Conclusions

Over a 12-month period, VBM PDFF assessed with CSE-MRI significantly increased in subjects receiving AI and BP. The present results contradict previous results regarding the effect of only BP therapy on bone marrow fat content quantified by magnetic resonance spectroscopy and bone biopsies. Future longer-term follow-up studies are needed to further characterize the effects of combined AI and BP therapy.
A prospective single-center protocol for using near-infrared fluorescence imaging with indocyanine green during staging laparoscopy to detect small metastasis from pancreatic cancer
Authors: Shirakawa Sachiyo , Toyama Hirochika , Kido Masahiro , Fukumoto Takumi
Published: November 2019

Background

Pancreatic resection and radiotherapy are powerful tools in the multidisciplinary local treatment of pancreatic ductal adenocarcinoma (PDAC). However, 10–20% of patients with preoperatively resectable PDAC have radiographically occult metastases, which results in laparotomy without resection. This study aims to explore the utility of intraoperative near-infrared (NIR) imaging with indocyanine green (ICG) during staging laparoscopy to detect PDAC metastasis.

Methods

This prospective study will evaluate patients with radiographically non-metastatic PDAC before they undergo planned pancreatic resection or chemoradiotherapy. Enrolled patients will receive ICG intravenously (0.5 mg/kg) before the staging laparoscopy. During the staging laparoscopy, the abdominal cavity will be observed using standard white-light laparoscopic imaging and then using NIR-ICG imaging. Suspicious lesions that are detected using standard imaging and/or NIR-ICG imaging will be examined intraoperatively using frozen sections and permanent specimens. We will evaluate the benefit of NIR-ICG imaging based on its ability to identify additional liver or peritoneal lesions that were not detected during standard white-light imaging.

Discussion

This study will help establish the clinical utility of NIR-ICG imaging to more precisely identify metastases from radiographically non-metastatic PDAC. This approach may help avoid needless major surgery or radiotherapy.

Trial registration

This protocol was registered on April 1, 2017 on the UMIN Clinical Trials Registry: UMIN000025900 and February 26, 2019 on the Japan Registry of Clinical Trials: jRCT1051180076.
OncoSim and OncoWiki: an authentic learning approach to teaching cancer genomics
Authors: Schoenborn Priska , Osborne Richard , Toms Nick , Johnstone Karen , Milsom Chlöe , Muneer Reema , Jarvis Michael A. , Belshaw Robert
Published: November 2019

Background

Personalised medicine is rapidly changing the clinical environment, especially in regard to the management of cancer. However, for the large part, methods used to educate undergraduate students as future biomedical scientists and medical doctors have not reflected these changes. In order to make effective use of advances in cancer genomic knowledge, there is a need to expose students to the challenges of genomic medicine and to do so in a manner that makes this complex information accessible.

Methods

The teaching method developed, OncoSim, is a scaffolded ‘Personal Research’ module option for final year biomedical undergraduate students. It uses an authentic learning approach to teach cancer genomics via simulated cancer patient case studies that have identifiable potential therapeutic targets with associated drug therapies (so-called targeted therapy/precision oncology). In addition, these simulated case studies can be uploaded to a dedicated learning website (OncoWiki) where they can be freely downloaded and used to teach medical students the principles of targeted therapy. A preliminary evaluation of OncoSim was carried out using 3 research tools: (1) online questionnaires; (2) semi-structured interviews; and (3) analysis of whole cohort mark ranges. Thematic analysis was used to code and categorise interview data.

Results

The teaching materials for OncoSim and the OncoWiki site are freely accessible at https://www.oncowiki.co.uk. Questionnaire data and comparison of whole cohort marks showed OncoSim was at least as effective as alternative choices, and suggested OncoSim provided a valued alternative to traditional laboratory-based projects. No barriers to receptiveness were found. Interview analysis provided 5 broad themes (authentic learning experience; individual challenges; interest in cancer; positive learning experience; supportive structure) supporting the authentic learning aspect of the project, the strong scaffolding provided and the overall effectiveness of the approach.

Conclusions

Our preliminary, proof-of-concept, evaluation suggests that OncoSim will be effective in supporting the teaching of genomic medicine to undergraduate students. We plan and hope our study will encourage further formal evaluation in a larger cohort of students, including a control group. The OncoWiki site has the capacity to grow independently as future students create and upload simulated case studies for other students to then download and analyse.
Factors associated with the preference of institutional delivery after antenatal care attendance in Northwest Ethiopia
Authors: Nigatu Araya Mesfin , Gelaye Kassahun Alemu
Published: November 2019

Background

Even though maternal mortality during the time of delivery can be prevented with proper medical care in the health facilities with skilled healthcare professionals, unexpectedly death is still high and is a persistent challenge for low-income countries. Therefore identifying factors affecting the preference of institutional delivery after antenatal care service attendance is a key intervention to reduce maternal morbidity and mortality.

Method

A community-based cross-sectional study was conducted using face to face using interviewer-administered questionnaire from a total of 528 women who gave their last birth within 12 months prior to the study period who attended antenatal care (ANC) services. Descriptive statistics, bivariable and multivariable logistic regressions analysis were performed. Statistical significance was considered at p < 0.05 and odds ratio with 95% CI were calculated to examine factors associated with institutional delivery.

Results

Of the 528 pregnant women attending ANC services, 250 (47.3%) gave birth in health facilities (95% CI: 43.2, 51.7%). Urban residence [AOR = 7.8, 95% CI: 4.1, 15.6], four or more ANC visits [AOR = 4.5, 95% CI: 1.6, 12.3], those who got health education on ANC [AOR = 2.9, 95% CI: 1.5, 5.6] and decision on place of delivery with her partner agreement [AOR = 3.3, 95% CI: 1.3, 8.7] were found to be contributing factors for the preference of institutional delivery.

Conclusion

Institutional delivery was not adequate. Residence, number of antenatal care visits, health education, decisions making on a place of delivery and having awareness of the difference of place of delivery were contributing factors for the preference of institutional delivery.
The microbiome of the upper respiratory tract in health and disease
Authors: Kumpitsch Christina , Koskinen Kaisa , Schöpf Veronika , Moissl-Eichinger Christine
Published: November 2019

The human upper respiratory tract (URT) offers a variety of niches for microbial colonization. Local microbial communities are shaped by the different characteristics of the specific location within the URT, but also by the interaction with both external and intrinsic factors, such as ageing, diseases, immune responses, olfactory function, and lifestyle habits such as smoking. We summarize here the current knowledge about the URT microbiome in health and disease, discuss methodological issues, and consider the potential of the nasal microbiome to be used for medical diagnostics and as a target for therapy.
Redesigning the Aspergillus nidulans xylanase regulatory pathway to enhance cellulase production with xylose as the carbon and inducer source
Authors: Ballmann Patrick , Lightfoot Jorge , Müller Michael , Dröge Stephan , Prade Rolf
Published: November 2019

Background

Biomass contains cellulose (C6-sugars), hemicellulose (C5-sugars) and lignin. Biomass ranks amongst the most abundant hydrocarbon resources on earth. However, biomass is recalcitrant to enzymatic digestion by cellulases. Physicochemical pretreatment methods make cellulose accessible but partially destroy hemicellulose, producing a C5-sugar-rich liquor. Typically, digestion of pretreated LCB is performed with commercial cellulase preparations, but C5-sugars could in principle be used for “on site” production of cellulases by genetically engineered microorganism, thereby reducing costs.

Results

Here we report a succession of genetic interventions inAspergillus nidulansthat redesign the natural regulatory circuitry of cellulase genes in such a way that recombinant strains use C5-sugar liquors (xylose) to grow a vegetative tissue and simultaneously accumulate large amounts of cellulases. Overexpression of XlnR showed that under xylose-induction conditions only xylanase C was produced. XlnR overexpression strains were constructed that use thexynCppromoter to drive the production of cellobiohydrolases, endoglucanases and β-glucosidase. All five cellulases accumulated at high levels when grown on xylose. Production of cellulases in the presence of pretreated-biomass C5-sugar liquors was investigated, and cellulases accumulated to much higher enzyme titers than those obtained for traditional fungal cell factories with cellulase-inducing substrates.

Conclusions

By replacing expensive substrates with a cheap by-product carbon source, the use of C5-sugar liquors directly derived from LCB pretreatment processes not only reduces enzyme production costs, but also lowers operational costs by eliminating the need for off-site enzyme production, purification, concentration, transport and dilution.