bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient pathways of tuberculosis care-seeking and treatment: an individual-level analysis of National Health Insurance data in Taiwan
Authors: Ku Chu-Chang , Chen Chien-Chou , Dixon Simon , Lin Hsien Ho , Dodd Peter J
Published: June 2020

Introduction

Patients with tuberculosis (TB) often experience difficulties in accessing diagnosis and treatment. Patient pathway analysis identifies mismatches between TB patient care-seeking patterns and service coverage, but to date, studies have only employed cross-sectional aggregate data.

Methods

We developed an algorithmic approach to analyse and interpret patient-level routine data on healthcare use and to construct patients’ pathways from initial care-seeking to treatment outcome. We applied this to patients with TB in a simple random sample of one million patients’ records in the Taiwan National Health Insurance database. We analysed heterogeneity in pathway patterns, delays, service coverage and patient flows between different health system levels.

Results

We constructed 7255 pathways for 6258 patients. Patients most commonly initially sought care at the primary clinic level, where the capacity for diagnosing TB patients was 12%, before eventually initiating treatment at higher levels. Patient pathways are extremely heterogeneous prior to diagnosis, with the 10% most complex pathways accounting for 48% of all clinical encounters, and 55% of those pathways yet to initiate treatment after a year. Extended consideration of alternative diagnoses was more common for patients aged 65 years or older and for patients with chronic lung disease.

Conclusion

Our study demonstrates that longitudinal analysis of routine individual-level healthcare data can be used to generate a detailed picture of TB care-seeking pathways. This allows an understanding of several temporal aspects of care pathways, including lead times to care and the variability in patient pathways.
The cost of maternal health services in low-income and middle-income countries from a provider’s perspective: a systematic review
Authors: Banke-Thomas Aduragbemi , Abejirinde Ibukun-Oluwa Omolade , Ayomoh Francis Ifeanyi , Banke-Thomas Oluwasola , Eboreime Ejemai Amaize , Ameh Charles Anawo
Published: June 2020

Introduction

Maternal health services are effective in reducing the morbidity and mortality associated with pregnancy and childbirth. We conducted a systematic review on costs of maternal health services in low-income and middle-income countries from the provider’s perspective.

Methods

We searched multiple peer-reviewed databases (including African Journal Online, CINAHL Plus, EconLit, Popline, PubMed, Scopus and Web of Science) and grey literature for relevant articles published from year 2000. Articles meeting our inclusion criteria were selected with quality assessment done using relevant cost-focused criteria of the Consolidated Health Economic Evaluation Reporting Standards checklist. For comparability, disaggregated costs data were inflated to 2019 US$ equivalents. Costs and cost drivers were systematically compared. Where heterogeneity was observed, narrative synthesis was used to summarise findings.

Results

Twenty-two studies were included, with most studies costing vaginal and/or caesarean delivery (11 studies), antenatal care (ANC) (9) and postabortion care (PAC) (8). Postnatal care (PNC) has been least costed (2). Studies used different methods for data collection and analysis. Quality of peer-reviewed studies was assessed average to high while all grey literature studies were assessed as low quality. Following inflation, estimated provision cost per service varied (ANC (US$7.24–US$31.42); vaginal delivery (US$14.32–US$278.22); caesarean delivery (US$72.11–US$378.940; PAC (US$97.09–US$1299.21); family planning (FP) (US$0.82–US$5.27); PNC (US$5.04)). These ranges could be explained by intercountry variations, variations in provider type (public/private), facility type (primary/secondary) and care complexity (simple/complicated). Personnel cost was mostly reported as the major driver for provision of ANC, skilled birth attendance and FP. Economies of scale in service provision were reported.

Conclusion

There is a cost savings case for task-shifting and encouraging women to use lower level facilities for uncomplicated services. Going forward, consensus regarding cost component definitions and methodologies for costing maternal health services will significantly help to improve the usefulness of cost analyses in supporting policymaking towards achieving Universal Health Coverage.
Modelling the pandemic: attuning models to their contexts
Authors: Rhodes Tim , Lancaster Kari , Lees Shelley , Parker Melissa
Published: June 2020

The evidence produced in mathematical models plays a key role in shaping policy decisions in pandemics. A key question is therefore how well pandemic models relate to their implementation contexts. Drawing on the cases of Ebola and influenza, we map how sociological and anthropological research contributes in the modelling of pandemics to consider lessons for COVID-19. We show how models detach from their implementation contexts through their connections with global narratives of pandemic response, and how sociological and anthropological research can help to locate models differently. This potentiates multiple models of pandemic response attuned to their emerging situations in an iterative and adaptive science. We propose a more open approach to the modelling of pandemics which envisages the model as an intervention of deliberation in situations of evolving uncertainty. This challenges the ‘business-as-usual’ of evidence-based approaches in global health by accentuating all science, within and beyond pandemics, as ‘emergent’ and ‘adaptive’.
Prehospital notification of injured patients presenting to a trauma centre in India: a prospective cohort study
Authors: Mitra Biswadev , Kumar Vineet , O'Reilly Gerard , Cameron Peter , Gupta Amit , Pandit Amol P , Soni Kapil D , Kaushik Gaurav , Mathew Joseph , Howard Teresa , Fahey Madonna , Stephenson Michael , Dharap Satish , Patel Pankaj , Thakor Advait , Sharma Naveen , Walker Tony , Misra Mahesh C , Gruen Russell L , Fitzgerald Mark C
Published: June 2020

Objectives

To assess the effect of a mobile phone application for prehospital notification on resuscitation and patient outcomes.

Design

Longitudinal prospective cohort study with preintervention and postintervention cohorts.

Setting

Major trauma centre in India.

Participants

Injured patients being transported by ambulance and allocated to red (highest) and yellow (medium) triage categories.

Intervention

A prehospital notification application for use by ambulance and emergency clinicians to notify emergency departments (EDs) of an impending arrival of a patient requiring advanced lifesaving care.

Main outcome measures

The primary outcome was the proportion of eligible patients arriving at the hospital for which prehospital notification occurred. Secondary outcomes were the availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest X-ray, and ED and in-hospital mortality.

Results

Data from January 2017 to January 2018 were collected with 208 patients in the preintervention and 263 patients in the postintervention period. The proportion of patients arriving after prehospital notification improved from 0% to 11% (p<0.001). After the intervention, more patients were managed with a trauma call-out (relative risk (RR) 1.30; 95% CI: 1.10 to 1.52); a trauma bay was ready for more patients (RR 1.47; 95% CI: 1.05 to 2.05) and a trauma team leader present for more patients (RR 1.50; 95% CI: 1.07 to 2.10). There was no difference in time to the initial chest X-ray (p=0.45). There was no association with mortality at hospital discharge (RR 0.94; 95% CI: 0.72 to 1.23), but the intervention was associated with significantly less risk of patients dying in the ED (RR 0.11; 95% CI: 0.03 to 0.39).

Conclusions

The prehospital notification application for severely injured patients had limited uptake but implementation was associated with improved trauma reception and reduction in early deaths. Quality improvement efforts with ongoing data collection using the trauma registry are indicated to drive improvements in trauma outcomes in India.

Trial registration number

NCT02877342.
Prevalence and risk factors of postpartum depression, general depressive symptoms, anxiety and stress (PODSAS) among mothers during their 4-week postnatal follow-up in five public health clinics in Perak: A study protocol for a cross-sectional study
Authors: Mohammad Redzuan Saidatul Akmar , Suntharalingam Priyasini , Palaniyappan Thenmoli , Ganasan Venotha , Megat Abu Bakar Puteri Normalina , Kaur Paream , Marmuji Lili Zuryani , Ambigapathy Subashini , Paranthaman V , Chew Boon How
Published: June 2020

Introduction

Postpartum depression, general depressive symptoms, anxiety and stress (PODSAS) are often overlooked, and may cause morbidity to new mothers, their babies and families. This study aims to determine the point prevalence of depression (post partum and general), anxiety and stress among mothers in five public health clinics in Perak at 4 weeks postdelivery and identify their associated risk factors. Findings from this study will be used to identify the needs for early screening and detection, encourage development of interventions to reduce its occurrence and support mothers with PODSAS.

Methods and analysis

This cross-sectional study will recruit 459 postpartum mothers during their 4-week postnatal follow-up in five selected public health clinics in Perak from September 2019 to May 2020. Participants will be mothers aged 18 years and above at 4 weeks postdelivery who are able to understand the English and Malay languages. Non-Malaysians and mothers with known diagnosis of psychotic disorders will be excluded from the study. Sociodemographic information and possible risk factors of the participants will be captured via a set of validated questionnaires, postpartum depression (PPD) will be measured using the Edinburgh Postpartum Depression Scale questionnaire and general depressive symptoms, anxiety and stress will be measured using the 21-item Depression, Anxiety and Stress Scale. Data analysis will be conducted using SPSS V.25.0 (IBM). Besides descriptive statistics, multivariable regression analyses will be done to identify possible risk factors and their independent associations with depression (PPD and general depressive symptoms, combined and separately), anxiety and stress.

Ethics and dissemination

The study protocol was reviewed and approved by the Medical Research Ethics Committee, Ministry of Health Malaysia on 7 August 2019. Results of this study will be reported and shared with the local health stakeholders and disseminated through conference proceedings and journal publications.

Registration number

This study is registered in the Malaysian National Medical Research Register with the ID: NMRR-19-868-47647
Consumers’ consciousness of health-friendly products and services and its association with sociodemographic characteristics and health status: a cross-sectional survey of the South Korean population
Authors: Yun Young Ho , Sim Jin Ah , Kim Yaeji , Lee Sujee , Kim Kyoung-Nam
Published: June 2020

Objectives

To identify consumers’ consciousness of health-friendly products and services (consumer reaction, purchase intention and willingness to pay more) and its association with sociodemographic characteristics and multidimensional health status.

Methods

From March to May 2018, we administered questionnaires to 1200 individuals from the general Korean population asking about their perception of health-friendly labels, and if they would purchase such labelled products (foods, pharmaceuticals, etc) and services (purifying water, preventing air pollution, etc) at extra cost.

Results

The participants placed a high value on the importance of mental, social, spiritual and physical health factors in terms of the company’s products and services with a score of about 8 out of 10 (range, 7.74–8.33). Most respondents (72.4%) said that they were interested in adopting health-friendly labels. When a health-friendly label is introduced (such as one by the Business for Social Responsiveness), 65.1% of the respondents said that they intended to purchase the product or service, while 6.8% said that they did not and 75.0% said that they were willing to pay extra for the health-friendly product or service. Multivariate logistic regression models showed urban residence, high education level and good social health to be significantly associated with positive attitudes towards health-friendly labels. People with high income, no religion or normal weight were more likely to say that they intend to purchase products and services with health-friendly labels. They also had a more positive attitude towards paying more for such products and services, as did people with good spiritual health.

Conclusion

This study provides data that illustrate the importance of health-friendly products and services to the general population and companies.
Risk of recurrent corneal erosion in patients with diabetes mellitus in Taiwan: a population-based cohort study
Authors: Jan Ren-Long , Tai Ming-Cheng , Ho Chung-Han , Chu Chin-Chen , Wang Jhi-Joung , Tseng Sung-Huei , Chang Yuh-Shin
Published: June 2020

Objective

To investigate the risk of recurrent corneal erosion (RCE) in patients with diabetes mellitus (DM).

Design, setting and participants

This retrospective, nationwide, matched cohort study included 239 854 patients with DM recruited between 2003 and 2005 from the Longitudinal Cohort of Diabetes Patients database. The control group included the same number of age-matched and sex-matched patients without DM selected from the Taiwan Longitudinal Health Insurance Database, 2000. Data for each patient were collected from the index date until December 2013.

Main outcomes and measures

The incidence and risk of RCE were compared between the two groups. Cox proportional hazards regression was used to calculate the HR for RCE after adjustment for potential confounders. The cumulative RCE incidence rate was calculated using Kaplan–Meier analysis.

Results

In total, 1236 patients with DM and 884 controls developed RCE during the follow-up period, resulting in an incidence rate of RCE in patients with DM (5.87/10 000 person-years (PY)) higher than that in the controls (4.23/10 000 PY). After adjustment for potential confounders, including hypertension, hyperlipidaemia, chronic renal disease and keratoconjunctivitis sicca, patients with DM were 1.35 times (95% CI, 1.24 to 1.48) more likely to develop RCE than the total sample cohort.

Conclusions

DM increases the risk of RCE, which is an interdisciplinary issue. Therefore, close collaboration between endocrinologists and ophthalmologists is important in managing RCE following DM.
Quality of reporting for randomised clinical trials published in Latin American and Spanish journals: A protocol for a systematic survey of three clinical specialities
Authors: Bachelet Vivienne C , Carrasco Víctor A , Bravo-Córdova Fabiana , Díaz Ruben A , Lizana Francisca J , Meza-Ducaud Nicolás , Pardo-Hernandez Hector , Uribe Francisco A , Vergara Alonso F , Villanueva Julio , Navarrete María S
Published: June 2020

Introduction

Quality of reporting refers to how published articles communicate how the research was done and what was found. Gaps and imprecisions of reporting hamper the assessment of the methodological quality and internal and external validity. The CONsolidated Standards of Reporting Trials (CONSORT) are a set of evidence-based recommendations of the minimum elements to be included in the reporting of randomised controlled trials (RCTs) to ensure a complete and transparent account of what was done, how it was done and what was found. Few studies have been conducted on the impact of CONSORT on RCTs published in Latin American and Spanish journals. We aim to assess the reporting quality of RCTs of three clinical specialities published in Spanish and Latin American journals, as well as to assess changes over time and associations of quality with journal and country indicators.

Methods and analysis

We will conduct a systematic survey of all RCTs published in Spanish-language journals in three clinical fields (dentistry, neurology and geriatrics) from 1990 to 2018. We will include RCTs from previous work that has identified all RCTs on these medical fields published in Spain and Latin America. We will update this work via handsearching of relevant journals. Assessment of quality of reporting will be conducted independently and in duplicate using the CONSORT 2010 Statement. We will also extract journal and country indicators. We will conduct descriptive statistics and secondary analyses considering the year, country, and journal of publication, among others.

Ethics and dissemination

The Universidad de Santiago de Chile’s ethics committee approved the protocol. We will disseminate the results of this work in peer-reviewed scientific journals and conference proceedings. We expect to raise awareness among researchers, journal editors and funders on the importance of training in reporting guidelines and using them from the inception of RCT protocols.
How far are we from a medication use process aiming at well-informed adherent patients with long-term medications in Finland? Qualitative study
Authors: Mononen Niina , Pohjanoksa-Mäntylä Marika , Airaksinen Marja SA , Hämeen-Anttila Katri
Published: June 2020

Objective

Finland is one of the few countries that has established a national Medicines Information (MI) Strategy. The ultimate goal of the strategy is a well-implemented medication use process resulting in well-informed adherent patients. This study aimed at evaluating the implementation of the strategy 3 years after its launch.

Design

The evaluation applied a pragmatic approach and was conducted by interviewing stakeholders involved in the National MI Network enhancing the MI Strategy’s implementation. The network comprises national key stakeholders producing and using MI. Data were deductively analysed according to the medication use process of the MI Strategy using the framework method, complemented with inductively derived categories.

Setting

National implementation of the MI Strategy throughout the healthcare system after the first operational period (2012–2014) in 2015.

Participants

The members of the National MI Network (n=79/111, participation rate 71%, representing 42/53 stakeholder organisations).

Outcome measures

A new conceptual framework was developed based on stakeholders’ views on well-implemented actions and actions needing development in the medication use process at (1) infrastructure (macro), (2) healthcare professionals (meso) and (3) patient (micro) levels.

Results

Medication counselling by community pharmacists was the primary implemented action, followed by physicians’ actions while starting a new medication, and advice given by nurses. The major development needs concerned (1) poor access to patient information and its transfer in healthcare, particularly the lack of reconciled medication lists and electronic health records (macro); (2) poorly functioning medication use process in home care and social care units, such as nursing homes (meso); and (3) limited patient involvement in their care (micro).

Conclusions

Far more actions for development than well-established practices in the medication use process were identified. Major challenges found in this evaluation are considered in the ongoing Rational Pharmacotherapy Action Plan 2018–2022 by the Ministry of Social Affairs and Health.
Wellness and resilience for college and beyond: protocol for a quasi-experimental pilot study investigating a dialectical behaviour therapy skill-infused college course
Authors: Chugani Carla D. , Fuhrman Barbara , Abebe Kaleab Z. , Talis Janine , Miller Elizabeth , Coulter Robert W.S.
Published: June 2020

Introduction

College students’ mental health problems and suicidal behaviour are serious, persistent and prevalent public health issues. With the need for mental health support greatly exceeding the availability of on-campus treatment, a recent trend on college campuses is to offer courses designed to teach students strategies for developing mental health or resilience. While these courses are exceptionally popular among students, a paucity of research investigates the health outcomes associated with participation. The purpose of this study is to investigate the acceptability, appropriateness, feasibility and preliminary effectiveness of a college course grounded in skills from dialectical behaviour therapy (DBT) titled, ‘Wellness and Resilience for College and Beyond’.

Methods and analysis

During the spring and fall 2020 semesters, the course will be offered on five campuses in Southwestern Pennsylvania and West Virginia. The course consists of 15 weekly 2.5-hour lessons, weekly homework assignments and a final examination with content drawn from DBT, acceptance and commitment therapy and positive psychology. Undergraduate students aged 18–24 will self-select into the course and control subjects receiving ‘university as usual’ will be recruited to serve as a comparison group. Students who receive the course will complete measures of course acceptability, appropriateness and feasibility. All study participants will complete measures of adaptive coping skills use, emotion dysregulation and suicidality.

Ethics and dissemination

All of the study procedures were approved as an exempt protocol for evaluation of educational curricula by the University of Pittsburgh Human Research Protections Office (HRPO); the study was approved as a research study by the institutional review board (IRB) of the fifth study site. The University of Pittsburgh HRPO served as the IRB of record for all except one study site, which required standard IRB review. Data from this study will be disseminated via conference presentations, peer-reviewed publications and via our online stakeholder learning collaborative.

Trial registration number

NCT04338256.
Health impacts of seated arm ergometry training in patients with a diabetic foot ulcer: protocol for a randomised controlled trial
Authors: McCarthy Matthew , Yates Thomas , Webb David , Game Frances , Gray Laura , Davies Melanie J
Published: June 2020

Introduction

Once diagnosed with a diabetic foot ulcer (DFU), patients are advised to offload, keeping pressure off the foot in order to facilitate ulcer healing. An increase in offloading is often accompanied by reductions in physical activity which can worsen the overall health of patients.

While unable to perform traditional forms of upright activity, one mode of exercise that would allow patients to be physically active while adhering to offloading instruction is seated arm ergometry. The merits of tailored aerobic exercise in DFU remain unexplored.

Methods and analysis

This is a prospective open-label randomised controlled trial. Participants will be randomised to one of two groups, an exercise intervention group or control. The intervention group are required to undertake arm ergometry training at a moderate intensity (65%–75% HRpeak), three times per week for 12 weeks as individually prescribed by an exercise physiologist, while the control group will continue to receive standard care alone. Assessment of outcome measures will occur at baseline and after the intervention period, these will include: a seated VO2 peak test, a blood sample, a short physical performance battery, a dual-energy X-ray absorptiometry scan and completing a range of health-based questionnaires. The above will be used to determine: cardiorespiratory fitness, metabolic health, physical function, body composition and quality of life, respectively. Ulcer area will also be measured as an approximate marker of ulcer healing.

Ethics and dissemination

This trial has been approved by ‘Yorkshire & The Humber—Leeds West Research Ethics Committee’ (19/YH/0269). Trial results will be published in peer-reviewed journals and through conference presentations.

Trial registration number

ISRCTN16000053. Registered in accordance with WHO Trial Registration Data Set (version 1.3.1).
Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II): protocol for an observational study using linked Scottish national data
Authors: Simpson Colin R , Robertson Chris , Vasileiou Eleftheria , McMenamin Jim , Gunson Rory , Ritchie Lewis D , Woolhouse Mark , Morrice Lynn , Kelly Dave , Stagg Helen R , Marques Diogo , Murray Josie , Sheikh Aziz
Published: June 2020

Introduction

Following the emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019 and the ensuing COVID-19 pandemic, population-level surveillance and rapid assessment of the effectiveness of existing or new therapeutic or preventive interventions are required to ensure that interventions are targeted to those at highest risk of serious illness or death from COVID-19. We aim to repurpose and expand an existing pandemic reporting platform to determine the attack rate of SARS-CoV-2, the uptake and effectiveness of any new pandemic vaccine (once available) and any protective effect conferred by existing or new antimicrobial drugs and other therapies.

Methods and analysis

A prospective observational cohort will be used to monitor daily/weekly the progress of the COVID-19 epidemic and to evaluate the effectiveness of therapeutic interventions in approximately 5.4 million individuals registered in general practices across Scotland. A national linked dataset of patient-level primary care data, out-of-hours, hospitalisation, mortality and laboratory data will be assembled. The primary outcomes will measure association between: (A) laboratory confirmed SARS-CoV-2 infection, morbidity and mortality, and demographic, socioeconomic and clinical population characteristics; and (B) healthcare burden of COVID-19 and demographic, socioeconomic and clinical population characteristics. The secondary outcomes will estimate: (A) the uptake (for vaccines only); (B) effectiveness; and (C) safety of new or existing therapies, vaccines and antimicrobials against SARS-CoV-2 infection. The association between population characteristics and primary outcomes will be assessed via multivariate logistic regression models. The effectiveness of therapies, vaccines and antimicrobials will be assessed from time-dependent Cox models or Poisson regression models. Self-controlled study designs will be explored to estimate the risk of therapeutic and prophylactic-related adverse events.

Ethics and dissemination

We obtained approval from the National Research Ethics Service Committee, Southeast Scotland 02. The study findings will be presented at international conferences and published in peer-reviewed journals.
Role of children in the transmission of the COVID-19 pandemic: a rapid scoping review
Authors: Rajmil Luis
Published: June 2020

Background

As a response to the COVID-19 pandemic, most countries have adopted measures of social distance, with the childhood population being one of the main focus of attention in these measures.

Methods

A rapid scoping review was carried out by searching PubMed to know if children are more contagious than adults, and the proportion of asymptomatic cases in children. Google Scholar and MedRxiv/bioRxiv were also searched. The time period was restricted from 1 December 2019 until 28 May 2020. Only studies published in English, Italian, French or Spanish were included.

Results

Fourteen out of 1099 identified articles were finally included. Studies included cases from China (n=9 to 2143), China and Taiwan (n=536), Korea (n=1), Vietnam (n=1), Australia (n=9), Geneva (n=40), the Netherlands (n=116), Ireland (n=3) and Spain (population-based study of IgG, n=8243). Although no complete data were available, between 15% and 55%–60% were asymptomatic, and 75%–100% of cases were from family transmission. Studies analysing school transmission showed children as not a driver of transmission. Prevalence of COVID-19 IgG antibody in children <15 years was lower than the general population in the Spanish study.

Conclusions

Children are not transmitters to a greater extent than adults. There is a need to improve the validity of epidemiological surveillance to solve current uncertainties, and to take into account social determinants and child health inequalities during and after the current pandemic.
Location-specific cell identity rather than exposure to GI microbiota defines many innate immune signalling cascades in the gut epithelium
Authors: Kayisoglu Ozge , Weiss Franziska , Niklas Carolin , Pierotti Isabella , Pompaiah Malvika , Wallaschek Nina , Germer Christoph-Thomas , Wiegering Armin , Bartfeld Sina
Published: June 2020

Objective

The epithelial layer of the GI tract is equipped with innate immune receptors to sense invading pathogens. Dysregulation in innate immune signalling pathways is associated with severe inflammatory diseases, but the responsiveness of GI epithelial cells to bacterial stimulation remains unclear.

Design

We generated 42 lines of human and murine organoids from gastric and intestinal segments of both adult and fetal tissues. Genome-wide RNA-seq of the organoids provides an expression atlas of the GI epithelium. The innate immune response in epithelial cells was assessed using several functional assays in organoids and two-dimensional monolayers of cells from organoids.

Results

Results demonstrate extensive spatial organisation of innate immune signalling components along the cephalocaudal axis. A large part of this organisation is determined before birth and independent of exposure to commensal gut microbiota. Spatially restricted expression of Toll-like receptor 4 (Tlr4) in stomach and colon, but not in small intestine, is matched by nuclear factor kappa B (NF-κB) responses to lipopolysaccharide (LPS) exposure. Gastric epithelial organoids can sense LPS from the basal as well as from the apical side.

Conclusion

We conclude that the epithelial innate immune barrier follows a specific pattern per GI segment. The majority of the expression patterns and the function of TLR4 is encoded in the tissue-resident stem cells and determined primarily during development.
COVID-19 in an international European liver transplant recipient cohort
Authors: Becchetti Chiara , Zambelli Marco Fabrizio , Pasulo Luisa , Donato Maria Francesca , Invernizzi Federica , Detry Olivier , Dahlqvist Géraldine , Ciccarelli Olga , Morelli Maria Cristina , Fraga Montserrat , Svegliati-Baroni Gianluca , van Vlierberghe Hans , Coenraad Minneke J , Romero Mario Cristobal , de Gottardi Andrea , Toniutto Pierluigi , Del Prete Luca , Abbati Claudia , Samuel Didier , Pirenne Jacques , Nevens Frederik , Dufour Jean-François
Published: June 2020

Objective

Knowledge on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in liver transplant recipients is lacking, particularly in terms of severity of the disease. The aim of this study was to describe the demographic, baseline clinical characteristics and early outcomes of a European cohort of liver transplant recipients with SARS-CoV-2 infection.

Design

We conducted an international prospective study across Europe on liver transplant recipients with SARS-CoV-2 infection confirmed by microbiological assay during the first outbreak of COVID-19 pandemic. Baseline characteristics, clinical presentation, management of immunosuppressive therapy and outcomes were collected.

Results

57 patients were included (70% male, median (IQR) age at diagnosis 65 (57–70) years). 21 (37%), 32 (56%) and 21 (37%) patients had one cardiovascular disease, arterial hypertension and diabetes mellitus, respectively. The most common symptoms were fever (79%), cough (55%), dyspnoea (46%), fatigue or myalgia (56%) and GI symptoms (33%). Immunosuppression was reduced in 22 recipients (37%) and discontinued in 4 (7%). With this regard, no impact on outcome was observed. Forty-one (72%) subjects were hospitalised and 11 (19%) developed acute respiratory distress syndrome. Overall, we estimated a case fatality rate of 12% (95% CI 5% to 24%), which increased to 17% (95% CI 7% to 32%) among hospitalised patients. Five out of the seven patients who died had a history of cancer.

Conclusion

In this European multicentre prospective study of liver transplant recipients, COVID-19 was associated with an overall and in-hospital fatality rate of 12% (95% CI 5% to 24%) and 17% (95% CI 7% to 32%), respectively. A history of cancer was more frequent in patients with poorer outcome.
Wide range of reduced penetrance alleles in spinal and bulbar muscular atrophy: a model-based approach
Authors: Laskaratos Achilleas , Breza Marianthi , Karadima Georgia , Koutsis Georgios
Published: June 2020

Background

Spinal and bulbar muscular atrophy (SBMA), also known as Kennedy’s disease, is an X-linked motor neuron disorder caused by an expanded CAG repeat in the gene coding for the androgen receptor (AR). The range and significance of reduced penetrance alleles in SBMA has not been fully determined to date. We presently sought to determine the range of reduced penetrance alleles in SBMA.

Methods

Through systematic literature review and meta-analysis, we collected and analysed data from 2576 patients with SBMA and compared the distributions of the CAG repeat number (CAG)nin the AR gene between patients and 112 248 control alleles of the general population.

Results

Our analysis revealed an unexpectedly high frequency of expanded SBMA-associated alleles, with (CAG)n≥35 present in 107/100,000 and (CAG)n≥38 present in 27/100,000 of the general population. Consequently, we suggest an updated model describing the distribution of expanded alleles in the general population. We argue against the established cut-off principle for the penetrance of SBMA and suggest that penetrance gradually increases from 35 to approximately 46 (CAG)n, above which it reaches a plateau approaching maximum value.

Conclusion

Asymptomatic men of the general population with no/unknown SBMA family history are free of risk when carrying (CAG)n≤34, are at intermediate but increasing risk for developing SBMA when carrying (CAG)n≈35–46 and have close to 100% risk of developing the disease when carrying (CAG)n≥47. The above observations should be helpful and clinically useful when providing genetic counselling to individuals and families bearing SBMA-associated alleles.
Parental obligation and compelled caesarean section: careful analogies and reliable reasoning about individual cases
Authors: Kingma Elselijn , Porter Lindsey
Published: June 2020

Whether it is morally permissible to compel women to undergo a caesarean section is a topic of longstanding debate. Despite plenty of arguments against the moral permissibility of a forced caesarean section, the question keeps cropping up. This paper seeks to scrutinise a particular moral argument in favour of compulsion: the appeal to parental obligation. We present what we take to be a distillation of the basic form of this argument. We then argue that, in the absence of an exhaustive theory of parental obligation, the question of whether a labouring woman is morally obliged to undergo emergency surgery—and especially the further question of it is morally permissible for third parties to compel this—cannot be answered via ready-made theory. We propose that the most viable option for settling both questions is by analogy. We follow earlier writers in presenting an analogous case—that of fathers being compelled to undergo non-consensual invasive surgery to save their children—but expand the analogy by considering objections that appeal to the ownership of the fetus. We offer two lines of response: (1) the parthood view of pregnancy and (2) chimaera dad. We argue that it is clear in the analogous case that compulsion cannot be justified. We also offer this analogy as a useful tool for assessing whether mothers have a moral duty to undergo caesarean sections, both in general and in particular cases, even if such a duty is insufficient to warrant compulsion.
Effect of pH and storage conditions on measured ionised calcium concentration in dogs and cats
Authors: Mazaki‐Tovi Michal , Topol Shira , Aroch Itamar
Published: June 2020

Background

Aerobic blood sample collection and processing results in increased serum pH and decreased ionised calcium (iCa) concentration. This prospective study aimed to determine the effect of pH and storage conditions on measured iCa concentration in serum samples obtained from dogs and cats and establish correction formulas for use in samples obtained aerobically.

Methods

Blood samples were collected from 44 dogs and 25 cats; iCa and pH were measured immediately under anaerobic conditions and in samples stored under several aerobic conditions.

Results

Measured iCa concentrations were significantly lower in samples stored at all aerobic conditions than in samples handled anaerobically in both dogs and cats (P<0.01 for all). The largest and most clinically significant differences were noted in samples stored at −20°C for 30 days in both dogs (0.48 mmol/l; 95 per cent CI 0.40 to 0.55) and cats (0.40 mmol/l; 95 per cent CI 0.33 to 0.47). Correction formulas (corrected iCa=measured iCa+coefficient × (measured pH–7.41); coefficient=0.597 for dogs, 0.627 for cats) yielded good agreement between the corrected and the actual iCa concentrations.

Conclusions

Samples for iCa measurement can be stored at either 4°C or −20°C for 24 hours. Storage at −80°C is recommended for longer storage time periods.
Vibrational and magnetic signatures of extended defects in Fe
Authors: Meyer Robert , Mutter Andreas , Umstätter Philipp , Schünemann Volker , Beck Tilmann , Smaga Marek , Urbassek Herbert M.
Published: June 2020

Defects change the phonon spectrum and also the magnetic properties of bcc-Fe. Using molecular dynamics simulation, the influence of defects – vacancies, dislocations, and grain boundaries – on the phonon spectra and magnetic properties of bcc-Fe is determined. It is found that the main influence of defects consists in a decrease of the amplitude of the longitudinal peak, PL, at around 37 meV. While the change in phonon spectra shows only little dependence on the defect type, the quantitative decrease of PL is proportional to the defect concentration. Local magnetic moments can be determined from the local atomic volumes. Again, the changes in the magnetic moments of a defective crystal are linear in the defect concentrations. In addition, the change of the phonon density of states and the magnetic moments under homogeneous uniaxial strain are investigated.

Graphical abstract
Systematic Covariations and Emerging Asian Equity Markets’ Diversification Benefits to US Equity Investors
Authors: Kolluri Bharat , Wahab Susan , Wahab Mahmoud
Published: June 2020

Unconditional and conditional correlations have played a central role in portfolio analysis, optimization, and performance measurement. However, recent studies show these two correlation measures are inappropriate for measuring both financial integration and, therefore, diversification benefits. We use an alternative correlation measure that we refer to by factor model-implied correlation estimated from the systematic (predictable) portion of returns of a multi-factor model with several global risk factors. Estimated implied correlations, covariances, variances, and in-sample (predicted) mean returns are used to calculate optimal US and Asian equities’ asset allocation weights in alternative Global equity portfolios varying by Asian equity market combined with US equities, as well as by whether: (i) implied or unconditional statistics are used; and (ii) portfolios are optimized by Sharpe’s ratio-maximization or variance-minimization. Risk-adjusted returns of alternative actively-managed Global equity portfolios are compared to US equities’ risk-adjusted returns. We find Global equity portfolios with asset allocation weights calculated using factor model-implied statistics uniformly yield higher risk-adjusted returns than US equities and Global equity portfolios with asset allocation weights calculated using unconditional portfolio statistics. In actively-managed Global equity portfolios with asset allocation weights calculated using implied statistics, India and Taiwan consistently rank as top contributors, while South Korea, Singapore, and Hong Kong consistently rank as bottom contributors to enhancing US equities’ risk-adjusted returns. While our analyses are dynamic, they use implied portfolio statistics estimated from historical returns’ distributions. Future studies can extend this research using conditional(out-of-sample) ex-ante estimates of systematic returns, covariances, variances, and correlations in examining emerging markets’ contributions to developed markets’ equities.
Study on the Resonance Restraint of a Large Hoist System Headframe
Authors: Liu Yue , Suo Shuangfu , Meng Guoying , Li Dong
Published: June 2020

Headframe resonance is a major cause of large hoist system damage and instability. Therefore, restraining the resonance of a large hoist system headframe is critical for reducing shock and vibrations, thereby maintaining the safety and reliability of the mining equipment. In this study, an approach was developed to restrain the resonance of a large hoist system headframe. A finite element model of a large hoist system headframe was established. Simulations were carried out, and the modal characteristics of the large hoist system headframe were obtained. The results showed that the second- and third-order natural frequencies were both close to 1.5[Formula: see text]Hz. Furthermore, experiments were conducted. An analysis of the experimental and simulation results indicated that a vibrational forcing with a frequency of 1.56[Formula: see text]Hz was a key factor causing resonance of the large hoist system headframe. Moreover, 14 different retrofitting approaches were proposed to change the natural frequencies of the large hoist system headframe, thereby providing resonance restraint. The main retrofitting concept is to add new assembled steel box structures with inner stiffeners between the transverse beams and oblique brackets in the middle area of the large hoist system headframe. In addition, the weight added by the retrofitting approach should be minimized to reduce the construction difficulties and costs. After a comprehensive comparison, an optimal retrofitting design of the 14 retrofitting approaches considered was selected. This optimal retrofitting approach provides guidance for restraining the resonance of large hoist system headframes. Furthermore, this study provides a method for the design of large hoist system headframes and the determination of the vibration characteristics.
AN ATTEMPT TO INDUCE POSTACTIVATION POTENTIATION TO IMPROVE KAYAK SPRINT PERFORMANCE USING AN ON-WATER KAYAK-SPECIFIC WARM UP
Authors: SOH SZE YING , AZIZ ABDUL RASHID , LEE MARCUS J.C.
Published: June 2020

This study explores whether an on-water kayak-specific resistance exercise (KSRE) performed during the warm-up period can induce postactivation potentiation (PAP) to improve subsequent kayak-sprint performance. The KSRE involves stringing several tennis balls around the boat’s hull to induce drag while paddling. In a laboratory setting, 10 well-trained male ([Formula: see text]) and female ([Formula: see text]) kayakers performed three repetitions of the single-arm seated-row (SASR) at 91% one-repetition maximum to induce PAP and were assessed for their peak power output while performing SASR on the Keiser machine at two-minute intervals up to 16 min. Each individual’s latency period for the onset of PAP during this exercise was recorded. In separate sessions, athletes performed in random, a 30 m kayak-sprint in a swimming pool setting after either control (no pre-performance loading) or experimental (post-PAP induction via the KSRE taking into account the individual’ onset of PAP latencies period obtained in the laboratory) conditions. Criterion measures of boat velocities of the third and fourth stroke from the start and 30 m sprint times, assessed using video, were not significantly different between control and experimental conditions. The translation of increased power output elicited via PAP using land-based resistance exercises into water-based resistance exercises to improve kayak-sprint performance remains a challenge.
Peculiarities of electronic structure and chemical bonding in iron and cobalt metal complexes of porphyrazine and tetra(1,2,5-thiadiazole)porphyrazine
Authors: Zhabanov Yuriy A. , Sliznev Valery V. , Ryzhov Igor V. , Stuzhin Pavel A.
Published: June 2020

The geometrical and electronic structures of iron and cobalt metal complexes of porphyrazine and tetra(1,2,5-thiadiazole)porphyrazine in ground and low-lying excited electronic states were determined by DFT calculations and the complete active space (CASSCF) method with following accounting dynamic correlation by multiconfigurational quasidegenerate second-order perturbation theory (MCQDPT2). A geometrical structure of D[Formula: see text] symmetry has been obtained for all four complexes. According to data obtained by the MCQDPT2 method, the complexes of cobalt and iron possess the ground states 2A[Formula: see text] and 3A[Formula: see text], respectively, and wave functions of the ground states have the form of a single determinant. It is shown that the crystal field theory (CFT) can be used to describe the sequence of electronic states of the investigated complexes. The nature of the bonds between metal atoms and nitrogen atoms has been described using the analysis of the electron density distribution in the frame of Bader’s quantum theory of atoms in molecule (QTAIM).
Synthesis and luminescence of Li2.06Nb0.18Ti0.76O3: Eu3+ Ceramics
Authors: Chen Xi , Zeng Qun , Lei Liu , Yao Chun-Feng , Guo Chao-Chao , Feng Yan-Zhao
Published: June 2020

Li[Formula: see text]Nb[Formula: see text]Ti[Formula: see text]O3: Eu[Formula: see text] luminescent ceramics were prepared by the solid-state reaction method. By means of XRD, SEM, density testing, and fluorescence spectra data, the luminescent ceramics were characterized as functions of Eu[Formula: see text] concentration and sintering temperature. With the increase of sintering temperature and Eu[Formula: see text] concentration, the peak intensities of the PLE spectra monitored at 612[Formula: see text]nm and PL spectra excited at 396[Formula: see text]nm were dramatically improved. Li[Formula: see text]Nb[Formula: see text]Ti[Formula: see text]O3: 3[Formula: see text]wt.%Eu[Formula: see text] ceramics sintered at 1120∘C showed the highest PL intensity. The emission spectra showed orange emission at 592[Formula: see text]nm and red emission at 612[Formula: see text]nm, corresponding to the transition of 5D[Formula: see text]F1 and 5D[Formula: see text]F2 of Li[Formula: see text]Nb[Formula: see text]Ti[Formula: see text]O3: Eu[Formula: see text] ceramics.
Cross-Domain Brain CT Image Smart Segmentation via Shared Hidden Space Transfer FCM Clustering
Authors: Xia Kaijian , Yin Hongsheng , Jin Yong , Qiu Shi , Zhao Hongru
Published: June 2020

Clustering is an important issue in brain medical image segmentation. Original medical images used for clinical diagnosis are often insufficient for clustering in the current domain. As there are sufficient medical images in the related domains, transfer clustering can improve the clustering performance of the current domain by transferring knowledge across the related domains. In this article, we propose a novel shared hidden space transfer fuzzy
c-
means (FCM) clustering called SHST-FCM for cross-domain brain computed tomography (CT) image segmentation. SHST-FCM projects both the data samples of the source domain and target domain into the shared hidden space, such that the distributions of the two domains are as close as possible. In the learned shared subspace, the data samples of the source domain serve as the auxiliary knowledge to aid the clustering process in the target domain. Extensive experiments on brain CT medical image datasets indicate the effectiveness of the proposed method.