bluuebunny/crossref_metadata_2025 huggingface dataset:
A Link Between Human Resource Management Practices and Customer Satisfaction: A Moderated Mediation Model
Authors: Najam Usama , Ishaque Sadia , Irshad Saadia , Salik Qurat-ul-ain , Khakwani Maria Shams , Liaquat Malka
Published: November 2020

This study attempts to investigate the linkage of human resources management practices with customer satisfaction through intervening role of employee job satisfaction. The study also examined the moderating role of procedural justice between human resource management practices and job satisfaction. A conceptual model with four hypotheses was developed and two-source field data were collected from paramedical staff members and patients ( n= 228, dyads) working in the health care sector of Pakistan. Results indicate that full mediation where job satisfaction fully mediates between human resource management practices and customer satisfaction. Furthermore, moderated regression analysis also proved the significant moderating role of procedural justice between human resource practices and job satisfaction. The findings of the study provide useful insights to evaluate and improve human resource management practices for the wellbeing of the employees and to enhance the customer satisfaction.
Family Engagement in Schools: Parent, Educator, and Community Perspectives
Authors: Kelty Noel E. , Wakabayashi Tomoko
Published: November 2020

How engaged families are in their children’s lives, whether at home or in school, predicts their success in school and in life. The purpose of this study was to explore parent, educator, and community member perspectives of family engagement, preschool through grade 12, to inform state-level policy from an ecological framework. Ten semi-structured focus groups were conducted throughout one midwestern state, including five urban groups, four rural groups, and one suburban group. All focus groups were held in high-poverty areas serving high-need communities. All school communities received Title I funds and the average free and reduced lunch rate across participating districts was 75%. Several themes emerged through focus groups, including the importance of relationships, inclusive opportunities, communication, parent education, and family activities. Potential outcomes are included for policy and program development, as well as implications to further expand on issues relative to special education, fatherhood, and English language learners.
Agile and Value Creation in Agent-Based Social Simulation
Authors: Navarro-Meneses Francisco J.
Published: November 2020

Agile software development is having a profound impact on the software industry. Agent-Based Social Simulation (ABSS) has led a paradigm shift in the way social scientists understand and manipulate complex systems. However, little is known about the relationship between the two and how they can create meaningful synergies. A review of the evidence available on the connection agile-ABSS was conducted. The review investigates what is currently known about agile adoption by ABSS and the value and limitations that can be derived from the connection. The main implication for researchers is the need to implement agile methods in a greater number of ABSS projects, on which to support further research and experimentation. For practitioners, the review raises awareness on the topic and reveals that there is a long road ahead of challenges and opportunities for those willing to unlock value from ABSS. For both, it would be highly beneficial if they joined forces and agreed on a common research agenda.
Beyond the success/failure of travelling urban models: Exploring the politics of time and performance in Cape Town’s East City
Authors: Robin Enora , Nkula-Wenz Laura
Published: November 2020

In this paper, we highlight the importance for policy mobility research to engage with the ‘multiple temporalities’ of globally prevalent urban policy ideas to understand how these eventually come to shape localities incrementally, and as we show, in sometimes unexpected manners. Through the study of over 10 years of (failed) redevelopment policies in Cape Town’s East City, we formulate two distinct contributions to existing urban policy mobility research. Firstly, we show that looking at the micro-politics of policy mobility in particular places, and over time, can help elucidate how conflicts and resistance to globally mobile urban models shape which aspects of a policy solutions are rendered mobile or immobile, present or absent and, finally, what ends up being implemented in the local context through specific projects. Secondly, we expand on new materialist approaches to urban policy mobility, bringing insights from performativity theory, to look at how ideas and models come to be ‘enacted’ in the real world through various and, perhaps more importantly, uncoordinated means. Our case study shows that policy mobility research should attend to disparate, uncoordinated, more-than-human activities, and how these end up shaping places even in the absence of purposive planning. That way, we show how changing and complex configurations of more than human networks, objects, money, buildings, etc. support the concrete performance of abstract and mobile urban models – in place and over time.
Using betweenness metrics to investigate the geographical distribution of retailers
Authors: Buzzacchi Luigi , Leveque Philippe , Taramino Roberta , Zotteri Giulio
Published: November 2020

In retailing, a location’s accessibility and attractiveness depends on the spatial distribution of other stores and consumers. In particular, the literature shows that a place is more attractive for retailers if the generic routes taken by consumers often cross it. However, previous studies failed to consider that there are at least two possible consumer routes: job commutes from residential to workplaces and shopping trips among stores. In this paper, we analyze the impact of both consumer routes on the commercial patterns in Turin. The paper demonstrates that daily commutes to workplaces do not benefit a retailer along the trip, as much as journeys for shopping purposes do. In particular, we show that the benefits that a store can have when localized on the routes depend on the kind of goods it sells. Finally, the paper shows that stores selling homogeneous products and stores selling differentiated goods subject to comparison can differently benefit from being located in population hotspots and in commercial areas.
Adjustment for the measurement error in evaluating biomarker performances at baseline for future survival outcomes: Time-dependent receiver operating characteristic curve within a joint modelling framework
Authors: Kolamunnage-Dona Ruwanthi , Kamarudin Adina Najwa
Published: November 2020

The performance of a biomarker is defined by how well the biomarker is capable to distinguish between healthy and diseased individuals. This assessment is usually based on the baseline value of the biomarker; the value at the earliest time point of the patient follow-up, and quantified by ROC (receiver operating characteristic) curve analysis. However, the observed baseline value is often subjected to measurement error due to imperfect laboratory conditions and limited machine precision. Failing to adjust for measurement error may underestimate the true performance of the biomarker, and in a direct comparison, useful biomarkers could be overlooked. We develop a novel approach to account for measurement error when calculating the performance of the baseline biomarker value for future survival outcomes. We adopt a joint longitudinal and survival data modelling formulation and use the available longitudinally repeated values of the biomarker to make adjustment of the measurement error in time-dependent ROC curve analysis. Our simulation study shows that the proposed measurement error-adjusted estimator is more efficient for evaluating the performance of the biomarker than estimators ignoring the measurement error. The proposed method is illustrated using Mayo Clinic primary biliary cirrhosis (PBC) study.
Nitrogen dioxide increases the risk of mortality in idiopathic pulmonary fibrosis
Authors: Yoon Hee-Young , Kim Sun-Young , Kim Ok-Jin , Song Jin Woo
Published: November 2020

Ambient air pollution is associated with the prognosis of idiopathic pulmonary fibrosis (IPF) patients. We aimed to identify the impacts of individual exposure to particulate matter with a 50% cut-off aerodynamic diameter of 10 μm (PM10) and nitrogen dioxide (NO2) on IPF patients' mortality.

1114 patients (mean age 65.7 years; male 80.5%) diagnosed with IPF between 1995 and 2016 were included in this study. Individual-level long-term concentrations of PM10and NO2at residential addresses of patients were estimated using a national-scale exposure prediction model. The effect of PM10and NO2on mortality was estimated using a Cox proportional hazards model adjusted for individual- and area-level covariates.

The median follow-up period was 3.8 years and 69.5% of the patients died or underwent lung transplantation. When adjusted for individual- and area-level covariates, a 10 ppb increase in NO2concentration was associated with a 17% increase in mortality (hazard ratio (HR) 1.172, 95% CI 1.030–1.344; p=0.016). When IPF patients were stratified by age (≥65versus<65 years) or by sex, NO2was a significant prognostic factor for mortality in the elderly (HR 1.331, 95% CI 1.010–1.598; p=0.010). When stratified by age and sex jointly, NO2showed the stronger association with mortality in elderly males (HR 1.305, 95% CI 1.072–1.598; p=0.008) than in other groups. PM10was not associated with IPF mortality in all patients and in subgroups stratified by age or sex.

Our findings suggest that increased exposure to NO2can increase the risk of mortality in patients with IPF, specifically in elderly males.
Genome-wide identification and functional characterization of the Camelina sativa WRKY gene family in response to abiotic stress
Authors: Song Yanan , Cui Hongli , Shi Ying , Xue Jinai , Ji Chunli , Zhang Chunhui , Yuan Lixia , Li Runzhi
Published: November 2020

Background

WRKY transcription factors are a superfamily of regulators involved in diverse biological processes and stress responses in plants. However, there is limited knowledge about the WRKY family in camelina (Camelina sativa), an important Brassicaceae oil crop with strong tolerance for various stresses. Here, a genome-wide characterization of WRKY proteins is performed to examine their gene structures, phylogenetics, expression, conserved motif organizations, and functional annotation to identify candidate WRKYs that mediate stress resistance regulation in camelinas.

Results

A total of 242 CsWRKY proteins encoded by 224 gene loci distributed unevenly over the chromosomes were identified, and they were classified into three groups by phylogenetic analysis according to their WRKY domains and zinc finger motifs. The 15 CsWRKY gene loci generated 33 spliced variants. Orthologous WRKY gene pairs were identified, with 173 pairs in the C. sativa and Arabidopsis genomes as well as 282 pairs in the C. sativa and B. napus genomes, respectively. A total of 137 segmental duplication events were observed, but there was no tandem duplication in the camelina genome. Ten major conserved motifs were examined, with WRKYGQK being the most conserved, and several variants were present in many CsWRKYs. Expression analysis revealed that 50% more CsWRKY genes were expressed constitutively, and a set of them displayed tissue-specific expression. Notably, 11 CsWRKY genes exhibited significant expression changes in seedlings under cold, salt, and drought stresses, showing a preferentially inducible expression pattern in response to the stress.

Conclusions

The present article describes a detailed analysis of the CsWRKY gene family and its expression profiles in 12 tissues and under several stress conditions. Segmental duplication is the major force underlying the broad expansion of this gene family, and a strong purifying pressure occurred for CsWRKY proteins during their evolution. CsWRKY proteins play important roles in plant development, with differential functions in different tissues. Exceptionally, eleven CsWRKYs, particularly five alternative spliced isoforms, were found to be the possible key players in mediating plant responses to various stresses. Overall, our results provide a foundation for understanding the roles of CsWRKYs and the precise mechanism through which CsWRKYs regulate high stress resistance as well as the development of stress tolerance cultivars among Cruciferae crops.
The piperazine compound ASP activates an auxin response in Arabidopsis thaliana
Authors: Xu Fengyang , Xue Shuqi , Deng Limeng , Zhang Sufen , Li Yaxuan , Zhao Xin
Published: November 2020

Background

Auxins play key roles in the phytohormone network. Early auxin response genes in the AUX/IAA, SAUR, and GH3 families show functional redundancy, which makes it very difficult to study the functions of individual genes based on gene knockout analysis or transgenic technology. As an alternative, chemical genetics provides a powerful approach that can be used to address questions relating to plant hormones.

Results

By screening a small-molecule chemical library of compounds that can induce abnormal seedling and vein development, we identified and characterized a piperazine compound 1-[(4-bromophenoxy) acetyl]-4-[(4-fluorophenyl) sulfonyl] piperazine (ASP). The Arabidopsis DR5::GFP line was used to assess if the effects mentioned were correlated with the auxin response, and we accordingly verified that ASP altered the auxin-related pathway. Subsequently, we examined the regulatory roles of ASP in hypocotyl and root development, auxin distribution, and changes in gene expression. Following ASP treatment, we detected hypocotyl elongation concomitant with enhanced cell elongation. Furthermore, seedlings showed retarded primary root growth, reduced gravitropism and increased root hair development. These phenotypes were associated with an increased induction of DR5::GUS expression in the root/stem transition zone and root tips. Auxin-related mutants including tir1–1, aux1–7 and axr2–1 showed phenotypes with different root-development pattern from that of the wild type (Col-0), and were insensitive to ASP. Confocal images of propidium iodide (PI)-stained root tip cells showed no detectable damage by ASP. Furthermore, RT-qPCR analyses of two other genes, namely, Ethylene Response Factor (ERF115) and Mediator 18 (MED18), which are related to cell regeneration and damage, indicated that the ASP inhibitory effect on root growth was not attributable to toxicity. RT-qPCR analysis provided further evidence that ASP induced the expression of early auxin-response-related genes.

Conclusions

ASP altered the auxin response pathway and regulated Arabidopsis growth and development. These results provide a basis for dissecting specific molecular components involved in auxin-regulated developmental processes and offer new opportunities to discover novel molecular players involved in the auxin response.
Pelvic collateral pathway during endovascular aortoiliac aneurysm repair with internal iliac artery interruption: a retrospective observational study
Authors: Nishi Satoshi , Hayashi Shogo , Omotehara Takuya , Kawata Shinichi , Suematsu Yoshihiro , Itoh Masahiro
Published: November 2020

Background

Ipsilateral branches of the deep femoral artery (DFA) are qualitatively identified as collateral arteries based on angiography after internal iliac artery (IIA) interruption. The purpose of this study was to quantitatively identify the major collateral pathway after unilateral IIA interruption during endovascular aortoiliac aneurysm repair to preserve the pelvic circulation and reduce the risk of ischemic complications.

Methods

The study population included 28 patients (mean age 76.3 years) with aortoiliac aneurysm who underwent endovascular aneurysm repair with unilateral IIA interruption from August 2012 to January 2020. The diameters of the bilateral preoperative and postoperative DFA, lateral femoral circumflex artery (LFCA), medial femoral circumflex artery (MFCA) and obturator artery (ObA) were measured on contrast-enhanced computed tomography using a 3-dimensional image analysis system. The measured values were evaluated and analyzed with a repeated measures two-way analysis of variance and Dunnett’s test.

Results

The postoperative diameters of the MFCA (P = 0.051) and ObA (P = 0.016) were observed to be larger than the preoperative diameters. Such increases in the MFCA (P < 0.001) and ObA (P < 0.001) diameters were only found to be significant on the unilateral side of the IIA interruption, and the diameter of the ipsilateral LFCA (P < 0.001) was also found to have significantly increased in size. However, no significant arterial extension was found on the contralateral side.

Conclusions

The ipsilateral MFCA-ObA pathway might therefore be a major collateral pathway arising from the DFA to preserve pelvic circulation after unilateral IIA interruption.
Lung tumor presenting with acute myocardial infarction and lower extremity arterial embolism
Authors: Liu Jichun , Chen Hao , Xie Xiangrong , Yang Yuwen , Tang Shengxing
Published: November 2020

Background

Lung tumor embolization leading to acute myocardial infarction (AMI) is rare. Previouscases of lung tumor embolization were reported in the coronary artery. We describe here a case of lung tumor embolization leading to the simultaneous occurrence of AMI and lower extremity arterial embolism.

Case presentation

A 64-year-old patient was admitted to the emergency department complaining of chest pain and was diagnosed with AMI.An echocardiography showed a mass in the left atrium that was speculated to be a myxoma. An emergency coronary angiography found no evidence of atherosclerosis. On the second day of admission, the patient was diagnosed with lower extremity arterial embolism. Initially, we speculated that the left atrium myxoma caused an embolism resulting in the AMI and lower extremity arterial embolism.However, a lung tumor was the real cause of both conditions. Unfortunately, the patient abandoned treatment when he learned of his disease and died three days later after being discharged from the hospital.

Conclusions

Lung tumor embolism is an extremely rare cause of AMI. Even rarer is the case presented here, in which a lung tumor embolism caused AMI and lower extremity arterial embolism. Clinicians should recognize lung tumor embolism as a potential cause of AMI.
Tuberculosis sanatorium treatment at the advent of the chemotherapy era
Authors: Zwick Erin D. , Pepperell Caitlin S.
Published: November 2020

Background

The discovery of antibiotics in the mid-twentieth century marked a major transition in tuberculosis (TB) treatment and control. There are few studies describing the duration of TB disease and its treatment from the pre-chemotherapy era and little data on how these treatments changed in response to the development of effective antibiotics. The goal of this research is to understand how inpatient treatment for high incidence populations, the First Nations peoples of Saskatchewan, Canada, changed in response to increasing availability of antibiotics effective against TB. We expected that as treatment regimens transitioned from convalescence-only to triple antibiotic therapy, the length of inpatient treatment would shorten.

Methods

Analyses were performed on records of sanatoria admissions and discharges occurring between 1933 and 1959 in Saskatchewan, Canada. Year of antibiotic discovery was taken as a proxy for treatment regimen: no chemotherapy (pre-1944), mono-therapy (Streptomycin, 1944–1946), dual-therapy (Streptomycin and PAS, 1946–1952), and triple-therapy (Streptomycin, PAS, and INH 1952-). A pooled linear regression of log-transformed length of first admission as predicted by year of admission was modeled to assess the relationship between admission length and year of admission, corrected for clinical and demographic variables.

Results

First admission length increased 19% in the triple-therapy era as compared to the pre-chemotherapy era, from 316 days (10.4 months) to 377 days (12.4 months). After the discovery of INH (1952), we find statistically significant increases in the proportion of successfully completed therapies (0.55 versus 0.60, p = 0.035), but also in patients who left hospital against medical advice (0.19 versus 0.29, p < 0.0001), indicating that as hospitalizations lengthened, more patients chose to discharge without the sanction of their physician. The readmission rate increased from 10 to 50% of all admissions while the province-level TB-specific death rate fell from 63.1 per 10,000 in 1933 to 4.7 per 10,000 in 1958.

Conclusion

Counterintuitively, we find that the length of first admissions increased with the discovery of TB-treating antibiotics. Increasing admission volume and readmission rate indicate an intensification of inpatient TB treatment during this era. These analyses provide a novel estimate of the effect of changing treatment policy on sanatorium admissions in this population.
Is the superbug fungus really so scary? A systematic review and meta-analysis of global epidemiology and mortality of Candida auris
Authors: Chen Jingjing , Tian Sufei , Han Xiaoxu , Chu Yunzhuo , Wang Qihui , Zhou Baosen , Shang Hong
Published: November 2020

Background

Candida aurisis a new pathogen called “superbug fungus” which caused panic worldwide. There are no large-scale epidemiology studies by now, therefore a systematic review and meta-analysis was undertaken to determine the epidemic situation, drug resistance patterns and mortality ofC. auris.

Methods

We systematically searched studies on the clinical report ofCandida aurisin Pubmed, Embase and Cochrane databases until October 6, 2019. A standardized form was used for data collection, and then statics was performed with STATA11.0.

Results

It showed that more than 4733 cases ofC. auriswere reported in over 33 countries, with more cases in South Africa, United States of America, India, Spain, United Kingdom, South Korea, Colombia and Pakistan.C. auirsexhibited a decrease in case count after 2016. Clade I and III were the most prevalent clades with more cases reported and wider geographical distribution. Blood stream infection was observed in 32% of the cases, which varied depending on the clades. Resistance to fluconazole, amphotericin B, caspofungin, micafungin and anidulafungin inC. auriswere 91, 12, 12.1, 0.8 and 1.1%. The overall mortality ofC. aurisinfection was 39%. Furthermore, subgroup analyses showed that mortality was higher in bloodstream infections (45%), and lower in Europe (20%).

Conclusions

Over 4000 cases ofC. auriswere reported in at least 33 countries, which showed high resistance to fluconazole, moderate resistance to amphotericin B and caspofungin, high sensitivity to micafungin and anidulafungin. The crude mortality for BSI ofC. auriswas 45% which was similar to some drug-resistant bacteria previously reported. In conclusion,C. aurisdisplayed similar characteristics to some drug resistance organisms. This study depicts several issues ofC. auristhat are most concerned, and is of great significance for the clinical management.
Prenatal diagnosis of Duchenne muscular dystrophy revealed a novel mosaic mutation in Dystrophin gene: a case report
Authors: Wang Yan , Chen Yuhan , Wang San Mei , Liu Xin , Gu Ya Nan , Feng Zhichun
Published: November 2020

Abstracts

Background

Duchenne muscular dystrophies (DMDs) are X-linked recessive neuromuscular disorders with malfunction or absence of the Dystrophin protein. Precise genetic diagnosis is critical for proper planning of patient care and treatment. In this study, we described a Chinese family with mosaic DMD mutations and discussed the best method for prenatal diagnosis and genetic counseling of X-linked familial disorders.

Methods

We investigated all variants of the whole dystrophin gene using multiple DNA samples isolated from the affected family and identified two variants of the DMD gene in a sick boy and two female carriers by targeted next generation sequencing (TNGS), Sanger sequencing, and haplotype analysis.

Results

We identified the hemizygous mutation c.6794delG (p.G2265Efs*6) of DMD in the sick boy, which was inherited from his mother. Unexpectedly, a novel heterozygous mutation c.6796delA (p.I2266Ffs*5) of the same gene, which was considered to be a de novo variant, was detected from his younger sister instead of his mother by Sanger sequencing. However, further NGS analysis of the mother and her amniotic fluid samples revealed that the mother carried a low-level mosaic c.6796delA mutation.

Conclusions

We reported two different mutations of the DMD gene in two siblings, including the novel mutation c.6796delA (p.I2266Ffs*5) inherited from the asymptomatic mosaic-carrier mother. This finding has enriched the knowledge of the pathogenesis of DMD. If no mutation is detected in obligate carriers, the administration of intricate STR/NGS/Sanger analysis will provide new ideas on the prenatal diagnosis of DMD.
Along came a spider: an unusual organism identified in a peritoneal dialysis patient, a case report and literature review
Authors: Carnall Victoria Jane , Murdock Stephanie , Auckland Cressida , Mulgrew Christopher J.
Published: November 2020

Background

Peritoneal dialysis-associated peritonitis can uncommonly be caused by fungal infections. When they do present, they are associated with significant mortality and morbidity. We describe a case where a sample of peritoneal dialysate fluid grew Rhodotorula muciliginosa, a yeast organism present in the normal environment which has previously been reported as rarely causing peritonitis. We believe this is the first case where the Rhodotorula spp. and its origin has been identified.

Case presentation

A 20 year old male grew Rhodotorula muciliginosa from his peritoneal dialysis fluid on three separate occasions when a fluid sample was sent following a disconnection and subsequent set change. He was not systemically unwell and his peritoneal dialysate was clear. As Rhodotorula spp. is exceedingly difficult to treat our patient had his Tenchkoff catheter removed. Subsequent samples of soil and sand from his bearded dragon and Chilean tarantula cases, kept in his bedroom where dialysis occurred, were tested. The tarantula sand was identified as the source of the Rhodotorula spp. Of note, Candida was isolated from sand from the bearded dragon case. Once his Tenchkoff was removed he was treated with an intravenous course of antifungal therapy. He has since had a new Tenchkoff catheter inserted and recommenced PD following education around pets and hygiene.

Conclusions

In this era where people are keeping increasingly rare and unusual wildlife in their homes, this case highlights the need for clinician and nursing staff awareness of a patient’s home environment and hobbies when they are undergoing peritoneal dialysis. Sand from our patient’s tarantula case grew the colonising organism but interestingly soil from his bearded dragon case also isolated candida. This can also cause difficult to treat peritonitis.
Identification of biomarkers and pathways in hypertensive nephropathy based on the ceRNA regulatory network
Authors: Wang Zhen , Liu Zhongjie , Yang Yingxia , Kang Lei
Published: November 2020

Background

Hypertensive nephropathy (HTN) is a kind of renal injury caused by chronic hypertension, which seriously affect people’s life. The purpose of this study was to identify the potential biomarkers of HTN and understand its possible mechanisms.

Methods

The dataset numbered GSE28260 related to hypertensive and normotensive was downloaded from NCBI Gene Expression Omnibus. Then, the differentially expressed RNAs (DERs) were screened using R limma package, and functional analyses of DE-mRNA were performed by DAVID. Afterwards, a ceRNA network was established and KEGG pathway was analyzed based on the Gene Set Enrichment Analysis (GSEA) database. Finally, a ceRNA regulatory network directly associated with HTN was proposed.

Results

A total of 947 DERs were identified, including 900 DE-mRNAs, 20 DE-lncRNAs and 27 DE-miRNAs. Based on these DE-mRNAs, they were involved in biological processes such as fatty acid beta-oxidation, IRE1-mediated unfolded protein response, and transmembrane transport, and many KEGG pathways like glycine, serine and threonine metabolism, carbon metabolism. Subsequently, lncRNAs KCTD21-AS1, LINC00470 and SNHG14 were found to be hub nodes in the ceRNA regulatory network. KEGG analysis showed that insulin signaling pathway, glycine, serine and threonine metabolism, pathways in cancer, lysosome, and apoptosis was associated with hypertensive. Finally, insulin signaling pathway was screened to directly associate with HTN and was regulated by mRNAs PPP1R3C, PPKAR2B and AKT3, miRNA has-miR-107, and lncRNAs SNHG14, TUG1, ZNF252P-AS1 and MIR503HG.

Conclusions

Insulin signaling pathway was directly associated with HTN, and miRNA has-miR-107 and lncRNAs SNHG14, TUG1, ZNF252P-AS1 and MIR503HG were the biomarkers of HTN. These results would improve our understanding of the occurrence and development of HTN.
The influence of quality and respectful care on the uptake of skilled birth attendance in Tanzania
Authors: Hulsbergen Myrrith , van der Kwaak Anke
Published: November 2020

Background

An increase in the uptake of skilled birth attendance is expected to reduce maternal mortality in low- and middle-income countries. In Tanzania, the proportion of deliveries assisted by a skilled birth attendant is only 64% and the maternal mortality ratio is still 398/100.000 live births. This article explores different aspects of quality of care and respectful care in relation to maternal healthcare. It then examines the influence of these aspects of care on the uptake of skilled birth attendance in Tanzania in order to offer recommendations on how to increase the skilled birth attendance rate.

Methods

This narrative review employed the “person-centered care framework for reproductive health equity” as outlined by Sudhinaraset (2017). Academic databases, search engines and websites were consulted, and snowball sampling was used. Full-text English articles from the last 10 years were included.

Results

Uptake of skilled birth attendance was influenced by different aspects of technical quality of maternal care as well as person-centred care, and these factors were interrelated. For example, disrespectful care was linked to factors which made the working circumstances of healthcare providers more difficult such as resource shortages, low levels of integrated care, inadequate referral systems, and bad management. These issues disproportionately affected rural facilities. However, disrespectful care could sometimes be attributed to personal attitudes and discrimination on the part of healthcare providers. Dissatisfied patients responded with either quiet acceptance of the circumstances, by delivering at home with a traditional birth attendant, or bypassing to other facilities. Best practices to increase respectful care show that multi-component interventions are needed on birth preparedness, attitude and infrastructure improvement, and birth companionship, with strong management and accountability at all levels.

Conclusions

To further increase the uptake of skilled birth attendance, respectful care needs to be addressed within strategic plans. Multi-component interventions are required, with multi-stakeholder involvement. Participation of traditional birth attendants in counselling and referral can be considered. Future advances in information and communication technology might support improved quality of care.
The association of maternal age with adverse neonatal outcomes in Lusaka, Zambia: a prospective cohort study
Authors: Tembo Tannia , Koyuncu Aybüke , Zhuo Haoran , Mwendafilumba Martha , Manasyan Albert
Published: November 2020

Background

Pregnancy among adolescents, whether intended or not, is a public health concern as it is generally considered high risk for both mothers and their newborns. In Zambia, where many women engage in early sexual behaviour or marry at a young age, 28.5% of girls aged 15–19 years were pregnant with their first child in the year 2013–2014. This study sought to explore associations between maternal age and neonatal outcomes among pregnant women in Lusaka, Zambia.

Methods

This was a secondary analysis of data nested within a larger population-based prospective cohort study which was implemented in three government health facilities-two first level hospitals and one clinic in Lusaka, Zambia. Women presenting to the study sites for antenatal care were enrolled into the study and followed up for collection of maternal and neonatal outcomes at 7, 28 and 42 days postpartum. The study’s primary outcomes were the incidence of maternal and newborn complications and factors associated with adverse neonatal outcomes. Statistical significance was evaluated at a significance level of P < 0.05.

Results

The study included 11,501 women, 15.6% of whom were adolescents aged 10–19 years. Generally, adolescence did not have statistically significant associations with poor maternal health outcomes. However, the risk of experiencing obstructed labour, premature rupture of membranes and postpartum hemorrhage was higher among adolescents than women aged 20–24 years while the risk of severe infection was lower and non-significant. Adolescents also had 1.36 times the odds of having a low birthweight baby (95% CI 1.12, 1.66) and were at risk of preterm birth (aOR = 1.40, 95% CI 1.06, 1.84). Their newborns were in need of bag and mask resuscitation at birth (aOR = 0.62, 95% CI 0.41, 0.93). Advanced maternal age was significantly associated with increased odds of hypertension/ pre-eclampsia (95% CI 1.54, 5.89) and preterm labour (aOR = 2.78, 95% CI 1.24, 6.21).

Conclusions

Adolescence is a risk factor for selected pregnancy outcomes in urban health facilities in Lusaka, Zambia. Health care workers should intensify the provision of targeted services to improve neonatal health outcomes.

Trial registration

Clinical trial number and URL: NCT03923023 (Retrospectively registered). Clinical trial registration date: April 22, 2019.
Risk factors associated with adverse maternal outcomes following intrapartum cesarean birth: a secondary analysis of the WHO global survey on maternal and perinatal health, 2004–2008
Authors: Harrison Margo S. , Betrán Ana Pilar , Suresh Krithika , Vogel Joshua P. , Goldenberg Robert L. , Gülmezoglu A. Metin
Published: November 2020

Background

To identify risk factors associated with a composite adverse maternal outcomes in women undergoing intrapartum cesarean birth.

Methods

We used the facility-based, multi-country, cross-sectional WHO Global Survey of Maternal and Perinatal Health (2004–2008) to examine associations between woman-, labor/obstetric-, and facility-level characteristics and a composite adverse maternal outcome of postpartum morbidity and mortality. This analysis was performed among women who underwent intrapartum cesarean birth during the course of labor.

Results

We analyzed outcomes of 29,516 women from low- and middle-income countries who underwent intrapartum cesarean birth between the gestational ages of 24 and 43 weeks, 3.5% (1040) of whom experienced the composite adverse maternal outcome. In adjusted analyses, factors associated with a decreased risk of the adverse maternal outcome associated with intrapartum cesarean birth included having four or more antenatal visits (AOR 0.60; 95% CI: 0.43–0.84; p = 0.003), delivering in a medium- or high-human development index country (vs. low-human development index country: AOR 0.07; 95% CI: 0.01–0.85 and AOR 0.02; 95% CI: 0.001–0.39, respectively; p = 0.03), and malpresentation (vs. cephalic: breech AOR 0.52; CI: 0.31–0.87; p = 0.04). Women who were medically high risk (vs. not medically high risk: AOR 1.81; CI: 1.30–2.51, p < 0.0004), had less education (0–6 years) (vs. 13+ years; AOR 1.64; CI: 1.03–2.63; p = 0.01), were obstetrically high risk (vs. not high risk; AOR 3.67; CI: 2.58–5.23; p < 0.0001), or had a maternal or obstetric indication (vs. elective: AOR 4.74; CI: 2.36–9.50; p < 0.0001) had increased odds of the adverse outcome.

Conclusion

We found reduced adverse maternal outcomes of intrapartum cesarean birth in women with ≥ 4 antenatal visits, those who delivered in a medium or high human development index country, and those with malpresenting fetuses. Maternal adverse outcomes associated with intrapartum cesarean birth were medically and obstetrically high risk women, those with less education, and those with a maternal or obstetric indication for intrapartum cesarean birth.
Correction to: Assessment of choriocapillary blood flow changes in response to half-dose photodynamic therapy in chronic central serous chorioretinopathy using optical coherence tomography angiography
Authors: Liu Juejun , Chen Changzheng , Li Lu , Xu Yishuang , Yi Zuohuizi , He Lu , Zheng Hongmei
Published: November 2020

An amendment to this paper has been published and can be accessed via the original article.
OCT angiography analysis of retinal vessel density in primary open-angle glaucoma with and without Tafluprost therapy
Authors: Weindler Hannah , Spitzer Martin S. , Schultheiß Maximilian , Kromer Robert
Published: November 2020

Background

Primary open-angle glaucoma (POAG) is a progressive neurodegenerative disease which leads to irreversible blindness. An elevated intraocular pressure (IOP) is considered to be the main risk factor for the disease progression. It is known that retinal blood flow is altered in POAG eyes. Tafluprost, a prostaglandin analogue which lowers the IOP, has shown to also improve the retinal blood flow in animals.

Methods

The current study therefore evaluated the retinal vessel density in the peripapillary and macular region of POAG patients with normal IOP treated with topical Tafluprost (n = 20) compared to surgically treated patients with normal IOP (n = 22) using optical coherence tomography angiography (OCT-A). The retinal flow density was obtained after binarisation and evaluated in five sectors.

Results

There was a significantly higher peripapillary flow density in all sectors in Tafluprost treated eyes when compared to post-surgery eyes. The flow density in the inferior sector of the superficial plexus in the macular region was also significantly higher in the Tafluprost group.

Conclusions: These results indicate that Tafluprost not only lowers IOP, but may also enhance retinal blood flow in POAG patients with a normal IOP.
Differential response to intravitreal dexamethasone implant in naïve and previously treated diabetic macular edema eyes
Authors:   on behalf of the Hospital Clínic - Hospital Vall de Hebron Intravitreal Dexamethasone Implant study group, Zarranz-Ventura Javier , Romero-Núñez Barbara , Bernal-Morales Carolina , Velazquez-Villoria Daniel , Sala-Puigdollers Anna , Figueras-Roca Marc , Copete Sergio , Distefano Laura , Boixadera Anna , García-Arumi Jose , Adan Alfredo
Published: November 2020

Background

To identify different response patterns to intravitreal dexamethasone implants (IDI) in naïve and previously treated (PT) diabetic macular edema (DME) eyes in a real-life setting.

Methods

342 IDI injections (203 DME eyes) were included. Number of IDI injections, percentage (%) of eyes with 1, 2, 3 and ≥ 4 injections, time to reinjections, visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) were evaluated for naïve and PT DME eyes over 24 months.

Results

Mean number of injections was significantly lower in naïve vs PT DME eyes (1.40 ± 0.9 vs 1.82 ± 0.9, p < 0.001). The percentage of eyes receiving 1 injection was significantly higher in naïve vs PT DME eyes (76.1 vs 47.7), (p < 0.001). However, it was significantly lower for 2 (16.4 vs 29.4), or 3 injections (1.4 vs 17.6) (both p < 0.001), with no differences in eyes receiving ≥4 injections (5.9 vs 5.1 respectively, p = 0.80). Mean time to reinjection was not significantly different between both groups for the second, third and fourth injection (9.6 ± 4.0 vs 10.0 ± 5.5, p = 0.75, 13.2 ± 4.0 vs 16.0 ± 3.5, p = 0.21 and 21.7 ± 3.8 vs 19.7 ± 5.8, p = 0.55). VA scores were consistently better in naïve vs PT DME eyes at all studied timepoints, with no significant differences in CRT reduction or adverse effect rates.

Conclusion

Naïve DME eyes received lower number of IDI injections and showed better VA levels than PT DME eyes for 24 months in a real-world setting. This data supports the IDI use in early DME stages and provide further evidence of better IDI response when used as first-line therapy.
Unrecognized geriatric depression in the emergency Department of a Teaching Hospital in Nepal: prevalence, contributing factors, and metric properties of 5 item geriatric depression scale in this population
Authors: Shrestha Roshana , Shrestha Anmol Purna , Shrestha Abha , Kamholz Barbara
Published: November 2020

Background

Depression is prevalent but poorly recognized in the Emergency Department (ED). We aimed to identify the frequency of unrecognized geriatric depression and its possible determinants in the ED using the 15-item geriatric depression scale (GDS). We also aimed to explore the performance of the shorter, five-item GDS as compared to the 15-item GDS.

Methods

This was a cross-sectional study of the ED patients ≥ 60 years. The previously validated Nepali version of GDS-15 screened the sample into “no”, “mild-moderate” and “severe” depression using cutoff values of 4/5, and 8/9 respectively. Demographic and socioeconomic factors, comorbidities and health seeking behaviors were studied and the relation was assessed with binary (Chi-square and Kruskal-Wallis test) and multinomial regression analysis. The performance of GDS-5 was compared with the GDS-15 as standard. Cronbach’s alpha was calculated to investigate reliability. Validity was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value, Spearman’s correlation, receiver operating characteristic curve, and kappa coefficient.

Results

Two hundred eighty patients were enrolled with an overall prevalence of unrecognized depression of 45.7% [104 (81.3%) mild-moderate depression, and 24 (18.8%) severe depression]. The mean age of the sample was 71.36 with female predominance (61%), and 82.5% were illiterate. In the binary analysis, those who had more pain, visited the ED more often, had musculoskeletal diseases and sleep problems, mobility problems, visited local healers previously, and who reported self-perceived “heart and mind” disease showed statistically significant differences among the three categories. In multinomial regression analysis, visits to local healers, sleep problems and frequency of pain were significantly related to depression. The sensitivity, specificity, area under curve and Spearman’s correlation of GDS-5 were 75.8%, 96%, 0.919, and 0.827 respectively. Cronbach’s alpha for GDS-5 was low (0.416), therefore a new version was proposed which improved the sensitivity to 90.6% and Cronbach’s alpha to 0.623.

Conclusions

Unrecognized geriatric depression was highly prevalent which urges the need for ED-based interventions for screening and referral. The proposed brief GDS-5 correlated well with the GDS-15 with better validity and internal reliability and offers a more expeditious form of screening for geriatric depression in emergency settings in Nepal.
The effectiveness of one-to-one peer support in mental health services: a systematic review and meta-analysis
Authors: White Sarah , Foster Rhiannon , Marks Jacqueline , Morshead Rosaleen , Goldsmith Lucy , Barlow Sally , Sin Jacqueline , Gillard Steve
Published: November 2020

Background

Peer support is being introduced into mental health services internationally, often in response to workforce policy. Earlier systematic reviews incorporate different modalities of peer support (i.e. group and one-to-one), offer inconsistent evidence of effectiveness, and also indicate substantial heterogeneity and issues of quality in the evidence base at that time. An updated review, focussed on one-to-one peer support, is timely given current policy interest. This study aims to systematically review evidence for the effectiveness of one-to-one peer support interventions for adults using mental health services, and to explore heterogeneity in peer support interventions.

Method

We searched MEDLINE, PsycINFO, Embase, CINAHL and Cochrane databases from inception until 13 June 2019. Included studies were assessed for risk of bias, and meta-analyses conducted where multiple trials provided usable data.

Results

Twenty-three studies reporting nineteen trials were eligible, providing data from 3329 participants. While seven trials were of low to moderate risk of bias, incomplete reporting of data in many studies suggested bias in the evidence base. Peer support interventions included peer workers in paraclinical roles (e.g. case manager), providing structured behavioural interventions, or more flexible support for recovery.

Meta-analyses were conducted for eleven outcomes, with evidence that one-to-one peer support may have a modest positive impact on self-reported recovery and empowerment. There was no impact on clinical symptoms or service use. Analyses of heterogeneity suggest that peer support might improve social network support.

Conclusions

One-to-one peer support in mental health services might impact positively on psychosocial outcomes, but is unlikely to improve clinical outcomes. In order to better inform the introduction of peer support into mental health services, improvement of the evidence base requires complete reporting of outcome data, selection of outcomes that relate to intervention mechanisms, exploration of heterogeneity in the implementation of peer support and focused reviews of specific types of one-to-one peer support.

Trial registration

Prospero identifier: CRD42015025621.