bluuebunny/crossref_metadata_2025 huggingface dataset:
Study protocol of the multi-centre, randomized controlled trial of the Frankfurt Early Intervention Program A-FFIP versus early intervention as usual for toddlers and preschool children with Autism Spectrum Disorder (A-FFIP study)
Authors: Kitzerow Janina , Freitag Christine M. , Hackbusch Matthes , Jensen Katrin , Kieser Meinhard , Noterdaeme Michele , Fröhlich Ulrike , Taurines Regina , Geißler Julia , Nicole Wolff , Roessner Veit , Bast Nico , Teufel Karoline , Kim Ziyon
Published: October 2019

Background: Naturalistic developmental behavioural interventions (NDBI) have been shown to improve autism-specific symptoms in young children with Autism Spectrum Disorder (ASD). NDBI approaches, such as the ASD-specific Frankfurt Early Intervention Program for ASD (A-FFIP), are based on ASD-specific developmental and learning aspects. A-FFIP is a low-intensity intervention which can easily be implemented in the local health care / social welfare system. The aim of the present study is to establish one-year efficacy of the manualised early intervention program A-FFIP in toddlers and preschool children with ASD. It is hypothesized that A-FFIP will result in improved ASD-specific symptoms compared to early intervention as usual (EIAU). Child and family specific secondary outcomes, as well as moderators and mediators of outcome will be explored. Methods/design: A prospective multi-centre, parallel-group, randomized, controlled, phase-III trial comparing A-FFIP versus EIAU. A total of 134 children (A-FFIP: 67, EIAU: 67) aged 24–66 months at baseline assessment meeting criteria for ASD (DSM-5) will be included. The primary outcome is the absolute change of the total score of the Brief Observation of Social Communication Change (BOSCC-AT) between baseline (T2) and one-year follow-up (T6). The treatment effect will be tested adjusted for relevant covariates applying a mixed model for repeated measures. Secondary outcomes are BOSCC social communication and repetitive behaviour scores, single ASD symptoms, language, cognition, psychopathology, parental well-being and family quality of life. Predictors, moderators and mediating mechanisms will be explored. Discussion: If efficacy of the manualised A-FFIP early intervention is established, the current study has the potential to change clinical practice strongly towards the implementation of low-intensity, evidence based, natural early intervention in ASD. Early intervention in ASD requires specialist training, which subsequently needs to be developed or included into current training curricula.
Genome-wide identification and analyses of the AHL gene family in cotton (Gossypium)
Authors: Zhao Lanjie , Lu Youjun , Chen Wei , Yao Jinbo , Li Yan , Li Qiulin , Pan Jingwen , Fang Shengtao , Sun Jie , Zhang Yongshan
Published: October 2019

Background: Members of the AT-HOOK MOTIF CONTAINING NUCLEAR LOCALIZED ( AHL ) family are involved in various plant biological processes via protein-DNA and protein-protein interaction. However, no the systematic identification and analysis of AHL gene family have been reported in cotton.
Results: To investigate the potential functions of AHLs in cotton, genome-wide identification, expressions and structure analysis of the AHL gene family were performed in this study. 48, 51 and 99 AHL genes were identified from the G.raimondii, G.arboreum and G.hirsutum genome, respectively. Phylogenetic analysis revealed that the AHLs in cotton evolved into 2 clades, Clade-A with 4-5 introns and Clade-B with intronless (excluding AHL 20-2). Based on the composition of the AT-hook motif(s) and PPC/DUF 296 domain, AHL proteins were classified into three types (Type-I/-II/-III), with Type-I AHLs forming Clade-B, and the other two types together diversifying in Clade-A. The detection of synteny and collinearity showed that the AHLs expanded with the WGD in cotton, and the sequence structure of AHL20-2 showed the tendency of increasing intron in three different Gossypium spp . The ratios of non-synonymous (Ka) and synonymous (Ks) substitution rates of orthologous gene pairs revealed that the AHL genes of G.hirsutum had undergone through various selection pressures, purifying selection mainly in A-subgenome and positive selection mainly in D-subgenome. Examination of their expression patterns showed most of AHLs of Clade-B expressed predominantly in stem, while those of Clade-A in ovules, suggesting that the AHLs within each clade shared similar expression patterns with each other. qRT-PCR analysis further confirmed that some GhAHLs higher expression in stems and ovules.
Conclusion: In this study, 48, 51 and 99 AHL genes were identified from three cotton genomes respectively. AHLs in cotton were classified into two clades by phylogenetic relationship and three type based on the composition of motif and domain. The AHLs expanded with segmental duplication, not tandem duplication. The expression profiles of GhAHLs revealed abundant differences in expression levels in various tissues and at different stages of ovules development. Our study provided significant insights into the potential functions of AHLs in regulating the growth and development in cotton.
The dishwasher rubber seal acts as a reservoir of bacteria in the home environment
Authors: Zupančič Jerneja , Turk Martina , Črnigoj Miha , Avguštin Jerneja Ambrožič , Gunde-Cimerman Nina
Published: October 2019

Bacteria that colonise the extreme environment of household dishwasher rubber seals were investigated using cultivation-dependent and metagenomic approaches. All 30 dishwashers investigated were colonised by various bacteria. Cultivation approaches resulted in 632 bacterial isolates in total, belonging to four phyla, eight classes, 40 genera and 74 species. The majority were Gram-positive, as solely Firmicutes (dominated by the Bacillus cereus group) and Actinobacteria. Gammaproteobacteria were primarily represented by Stenotrophomonas maltophilia, Pseudomonas aeruginosa and Escherichia coli. All isolates were tested for resistance to seven selected antibiotics. Metagenomic assessment of the bacterial biodiversity of the dishwasher rubber seals confirmed the predominance of Gram-positive bacteria, as primarily Actinobacteria, followed by Proteobacteria dominated by Gammaproteobacteria, and by pathogenic species such as Escherichia sp., Acinetobacter baumannii, Pseudomonas sp., Stenotrophomonas maltophilia, and Enterobacter sp.. Metagenomic assessment of bacterial biodiversity in the tap water connected to dishwashers revealed predominance of Gram-negative bacteria, in particular Proteobacteria, mainly represented by Tepidimonas sp.. Both Actinobacteria and Firmicutes showed low numbers in the tap water. These data indicate that colonisation of dishwasher rubber seals probably depends primarily on the bacterial input from the dirty vessels, and much less on the bacteria in the tap water. Based on the antibiotic resistance data, the dishwasher rubber seal bacterial isolates do not represent a serious threat for the spread of antibiotic resistance into the household environment. Nevertheless dishwashers cannot be ignored as potential sources of human infections, in particular for immuno-compromised individuals.
Patient-level factors influencing hypertension control in adults in Accra, Ghana
Authors: Okai Darlene Esinam , Manu Abubakar , Amoah Emefa Modey , Laar Amos , Akamah Joseph , Torpey Kwasi
Published: October 2019

Background : Effective control of blood pressure is necessary to avert the risk of cardiovascular diseases from uncontrolled hypertension. Despite evidence on the benefits of hypertension control, rates of control in Ghana remain low. This study assessed the patient-level factors that influence hypertension control among adults in Accra, Ghana.
Methods: A total of 360 hypertensive patients from two hospitals in Accra, Ghana were enrolled in the study. Client socio-demographic characteristics were tabulated and associations between client characteristics and hypertension control were estimated using chi-square tests and logistic regression.
Results: The client’s sex [AOR=3.53 (95% CI:1.73-7.25], educational at junior high school [AOR=3.05(95% CI 1.40-6.67)], senior high school [AOR=2.67 (95% CI 1.05-6.76)] and presence of a comorbidity [AOR=2.41 (95% CI 1.32; 4.42)] predicted BP control among clients. An increased pill burden, however, was associated with reduced BP control [AOR=0.32(95% CI: 0.18-0.56)]. The majority of patients reported forgetfulness, side effects of medication and high pill burden as reasons for missing their medications.
Conclusion: Knowledge of hypertension among patients is low. Sex, formal education and the presence of comorbidity and more specifically dyslipidaemia influences blood pressure control. A high pill burden negatively affects the attainment of blood pressure control.
Correlation between visual acuity and human leukocyte antigen (HLA)-DRB1*04 in patients with Vogt-Koyanagi-Harada disease
Authors: Misawa Norihiko , Tagami Mizuki , Kohno Takeya , Honda Shigeru
Published: October 2019

Abstract
Background: The common presence of human leukocyte antigen (HLA)-DRB1*04 in Vogt-Koyanagi-Harada (VKH) disease is well known. The aim of this study was to investigate the relationship between visual prognosis and HLA-DRB1*04 alleles during systemic corticosteroid therapy in patients with VKH disease.
Methods: This retrospective case series included 57 eyes from 29 consecutive patients with treatment-naïve VKH disease who received systemic corticosteroid therapy. Visual acuity, sex, refractive error, central retinal thickness (CRT), central choroidal thickness (CCT), and duration from onset to treatment were measured at initial and final visits. Mean values of parameters were compared with each visit. Genotyping was performed by polymerase chain reaction amplification with sequence-specific primer.
Results: Linear regression showed significant differences in logMAR best-corrected visual acuity between the three groups of homozygotes, heterozygotes, and normal subjects at baseline ( p <0.01), at three months after treatment ( p <0.01).There was no significant differences at six months after treatment ( p =0.257). No significant differences were detected between the three groups in age, sex, refractive error, CRT, CCT, or duration from onset to treatment.
Conclusion: Alleles of HLA-DRB1*04 might affect visual prognosis and be related to early response after initiation of treatment in VKH disease.
Development of microsatellite markers for the Japanese endemic conifer Thuja standishii and transfer to other East Asian species
Authors: Worth James Raymond Peter , Chang K. S. , Ha Y.-H. , Qin Aili
Published: October 2019

Objective: Design polymorphic microsatellite loci that will be useful for studies of the genetic diversity, structure and reproduction in the Japanese endemic conifer Thuja standishii and test the transferability of these loci to the two other East Asian species, T. sutchuenensis and T. koraiensis .
Results: Fifteen loci were developed which displayed 3 to 21 alleles per locus (average = 9.2) among 97 samples from three populations of T. standishii . Observed heterozygosity for all samples varied between 0.33-0.75 (average 0.54) while expected heterozygosity values were higher with an average over the 15 loci of 0.62 (0.37-0.91). Low multi-locus probability of identity values (< 0.00001) indicate that these markers will be effective for identifying individuals derived from clonal reproduction. All 15 loci amplified in 13 samples of T. sutchuenensis , the sister species of T. standishii , with 1 to 11 alleles per locus (average = 4.33) while 13 loci amplified in four samples of the more distantly related T. koraiensis with 1 to 5 alleles per locus (average = 2.15).
The Expression of P16 and S100 Associated with Elastin Degradation and Fibrosis of the Ligamentum Flavum Hypertrophy
Authors: Author) Wei hu(Former Corresponding , Kan Shunli , Liu Guang , Cao Zegang , Author) Rusen Zhu(New Corresponding
Published: October 2019

Background: One of the characteristics of lumbar spinal stenosis (LSS) is elastin degradation and ﬁbrosis in the ligamentum ﬂavum (LF). However, the biochemical factors that cause these histologic changes is unclear. P16 and S100 participate in scar formation and collagen development in wound healing and ﬁbrosis diseases. In this study, we investigate the association between P16 and S100 expression and the ﬁbrosis of the hypertrophic LF in LSS.

Methods: The LF specimens were surgically obtained from thirty patients with single-segment LSS (SLSS), 30 patients with double-segment LSS (DLSS) and 30 patients with L4/5 lumbar disc herniation (LDH). The LF thickness was measured by axial T1-weighted MRI. The extent of LF elastin degradation and fibrosis were graded based on hematoxylin-eosin (HE) and Verhoff’s Van Gieson’s (VVG) stain, respectively. The localization of P16 and S100 was determined by immunohistochemistry.

Results: The Absolute and relative LF thickness were greater in the DLSS group compared with the SLSS and LDH groups (p < 0.05). The elastic tissue from the dorsal aspect to the dural aspect in SLSS and DLSS groups was significantly increased. The amount of collagen deposition and elastic tissue is significantly higher in the DLSS group compared with the SLSS and LDH groups (p < 0.05). The specimens in the DLSS group showed positive staining of P16, especially in the dorsal layer. Almost all samples in the SLSS group were partially positive for P16. The LDH group showed negative staining of P16 in both the dural and dorsal layers. All the three groups were stained with S100 in the dorsal layer of the LF. On the contrary, S100 staining was absent in the dural layer of the LF in the three groups.

Conclusions : Elastin degradation and fibrosis of the LF in the DLSS patients is more severe compared with the SLSS and LDH patients. Increased expression of P16 associated with LF fibrosis and thickness, suggested that the expression of P16 may related to LF hypertrophy in the patients who suffer with LSS. LF hypertrophy process may not be associated with high expression of S100.
House-hold contact tuberculosis screening adherence and associated factors among tuberculosis patients attending at Health facilities in Gondar town, Northwest, Ethiopia
Authors: Shiferaw Dessie Alemnew , Mekonnen Habtamu Sewunet , Abate Addisu Taye
Published: October 2019

Background

Contacting patients with tuberculosis have a substantial risk of developing the disease. Household contact screening has recently been recommended as a strategy to enhance case detection in high-burden countries. But there is no enough information in Gondar town regarding household contact screening practice among TB patients.Objective

The aim of this study was to assess the magnitude of household contact screening adherence and its associated factors among adult tuberculosis patients attending at health facilities in Gondar town, Northwest Ethiopia.Methods

An institution-based cross-sectional study was conducted from March 1 to 30, 2019 on 404 tuberculosis patients attending at health facilities in Gondar Town. Epi-Info version 7 for data entry and SPSS version 20 for data analysis were used. Descriptive statistics were carried out to illustrate the means, standard deviations, and frequencies. Bivariable and multivariable logistic regression analyses were used to identify significantly associated variables with the dependent variable.Results

From 412 study populations, 404 were completed the study with 98.06% response rate. The overall household contact TB screening adherence was 47.5% (95% CI: 43.1, 52.5). In the multivariable analysis, having certificate and above educational level (AOR=2.83, 95% CI:1.40,5.67), having sufficient knowledge about TB (AOR=8.26, 95% CI:4.34,15.71), being satisfied with health care service (AOR=3.26, 95% CI:1.58,6.76), health education given by health care workers (AOR=2.60, 95% CI:1.54,4.40),and having HIV/AIDS co-infection (AOR=3.54, 95% CI:1.70,7.39), were factors associated with household contact TB screening adherence.Conclusion

Compared to other previous studies, the current finding was high but it was low as compared with WHO and Ethiopian Ministry of Health recommendations (all persons having TB contact should be screened). Educational status, knowledge on TB, satisfaction with delivered health care service, health education given by HCWs about TB and HIV/AIDS co-infection were factors associated with household contact TB screening practice. Thus, strengthening household TB contact screening and educational programs regarding the risk of getting TB infection from household contacts is crucial.
Analysis of fungal bloodstream infection in intensive care units in the Meizhou region of China: species distribution and resistance and the risk factors for patient mortality
Authors: Xiao Guang-Wen , Liao Wan-qing , Zhang Yuenong , Luo Xiaodong , Zhang Cailing , Li Guodan , Yang Yingping , Xu Yunyao
Published: October 2019

Background : Fungal bloodstream infections (FBI) among intensive care unit (ICU) patients are increasing. Our objective was to characterize the fungal pathogens that cause bloodstream infections and determine the epidemiology and risk factors for patient mortality among ICU patients in Meizhou, China. Methods Eighty-one ICU patients with FBI during their stays were included in the study conducted from January 2008 to December 2017. Blood cultures were performed and the antimicrobial susceptibility profiles of the resulting isolates were determined. Logistic multiple regression and receiver operating characteristics (ROC) curve analysis were used to assess the risk factors for mortality among the cases. Results The prevalence of FBI in ICU patients was 0.38% (81/21,098) with a mortality rate of 35.8% (29/81). Ninety-eight strains of bloodstream-infecting fungi, mainly Candida spp., were identified from these patients. Candida albicans was most common (42.9%). Two strains of C. parapsilosis were no-sensitive to caspofungin, C. glabrata were less than 80% sensitive to azole drugs.. Logistic multiple regression showed that age, serum albumin, Acute Physiology and Chronic Health Evaluation (APACHE) II score, three or more underlying diseases, and length of stay in ICU were independent risk factors for mortality in FBI. ROC curve analysis showed that APACHE II scores > 19 and serum albumin ≤ 25g/L were the best predictors of mortality. Conclusion Candida spp. predominated with high mortality rates among cases of FBI in ICU. Thus, clinical staff should enhance overall patient monitoring and especially monitor fungal susceptibility to reduce mortality rates.
Flight muscles degenerate by programmed cell death after migration in the wheat aphid, Sitobion avenae
Authors: Feng Honglin , Guo Xiao , Sun Hongyan , Zhang Shuai , Xi Jinghui , Yin Jiao , Cao Yazhong , Li Kebin
Published: October 2019

Objective

Previous studies showed that flight muscles degenerate after migration in some aphid species; however, the underlying molecular mechanism remains virtually unknown. In this study, using the wheat aphid, Sitobion avenae , we aim to investigate aphid flight muscle degeneration and the underlying molecular mechanism.Results

S. avenae started to differentiate winged or wingless lines at the second instar, the winged aphids were fully determined at the third instar, and their wings were fully developed at the fourth instar. After migration, the aphid flight muscles degenerated via programmed cell death, which is evidenced by a Terminal deoxynucleotidyl transferase dUTP-biotin nick end labeling assay. Then, we identified a list of differentially expressed genes before and after tethered flights using differential-display reverse transcription-PCR. One of the differentially expressed genes, ubiquitin-ribosomal S27a, was confirmed using qPCR. Ubiquitin-ribosomal S27a is drastically up regulated following the aphids’ migration and before the flight muscle degeneration. Our data suggested that aphid flight muscles degenerate after migration. During flight muscle degeneration, endogenous proteins may be degraded to reallocate energy for reproduction.
Thrombocytopenia according to Antiretroviral Drug Combinations, Viremia and CD4 Lymphocytes among HIV-Infected Patients in Cameroon A Snapshot from the City of Yaoundé
Authors: NKA Alex Durand , Sosso Samuel Martin , Fokam Joseph , Yagai Bouba , Teto Georges , Kamgaing Rachel , Tiga Aline , Yimga Junie , Nukenine Elias Nchiwan , Nanfack Aubin Joseph , Takou Désiré , Aroga Zélateur , Colizzi Vittorio , Ndjolo Alexis
Published: October 2019

Objective: Thrombocytopenia is an abnormal decrease in blood platelets, which can affect the prognosis of people living with HIV (PLHIV). In order to assess the burden of this haematological disorder, we evaluated the frequency of thrombocytopenia according to antiretroviral drug combinations, viremia and the immune status of PLHIV.
Results: A cross-sectional and analytical study was conducted from June-November 2016 among 310 PLHIV at the “Chantal BIYA” International Reference Centre, Yaoundé, Cameroon. Overall rate of thrombocytopenia was 19.0% (59/310).The rate of thrombocytopenia was 64.6% (42/65) versus 6.9% (17/245) in ART-naïve versus ART-treated patients respectively, p<0.0001. Following viral load, rate of thrombocytopenia was 15.8% (20/130) in those with undetectable viral load, and 34.1% (27/79) with viral loads>3 log10 RNA/ml (p=0.03). As concerns CD4-count, rate of thrombocytopenia was 16.2% (42/259) in those with ≥200 CD4/mm 3 versus 33.3% (17/51) with <200 CD4/mm 3 (p=0.0003) . After adjusting for sex, ART, viral load and CD4, Viral load and ART exposure were significantly associated with decreased risk of thrombocytopenia (p<0.05). Thrombocytopenia occurs especially among ART-naïve, high viremia and severe immune-compromised patients. Interestingly, ART coverage appears as an independent factor in preventing the occurrence of thrombocytopenia.
The association of circulating irisin with metabolic risk factors in Chinese adults: a cross-sectional community-based study
Authors: Tang Lizhi , Tong Yuzhen , Zhang Fang , Chen Guilin , Zhang Yun Cong , Jobin John , Tong Nanwei
Published: October 2019

Background Irisin is a myokine that leads to increased energy expenditure by stimulating the browning of white adipose tissue. We aimed to investigate the association of serum irisin levels with metabolic parameters in middle aged Chinese population.
Methods The study was based on a cross-sectional analysis of data from 524 nondiabetic subjects aged 40~65. All participants were recruited from a screening survey for Metabolic Syndrome in a community in Southwest China, including 294 subjects categorized as overweight (defined as BMI≧25 kg/m2 ) and 230 subjects as normal control (defined as 18.5≦BMI<25 kg/m2). Serum irisin concentration was quantified by enzyme linked immunosorbent assay (ELISA). The relationship of irisin with metabolic factors was determined by Pearson correlation. Multivariate linear regression was used to analyze the association of irisin with insulin resistance. Logistic regression was performed to assess the association of irisin with odds of overweight.
Results Serum irisin levels were significantly lower in nondiabetic overweight subjects compared with control (11.46 ± 4.11vs14.78 ± 7.03µg/mL, p = 0.02). Circulating irisin was positively correlated with quantitative insulin sensitivity check index (QUICKI, r = 0.178, p = 0.045) and triglycerides (r = 0.149, p = 0.022); while irisin was negatively correlated with waist circumference (WC, r = -0.185, p = 0.037), waist-to-hip ratio (WHR, r = -0.176, p = 0.047), fasting insulin (r = -0.2, p = 0.024), serum creatinine (r = -0.243, p = 0.006), homeostasis model assessment for insulin resistance (HOMA-IR, r = -0.189, p = 0.033). Multiple linear regression showed that irisin was inversely associated with HOMA-IR (β = -0.342 ± 0.154, p = 0.029). Higher irisin was associated with decreased odds of being overweight (OR = 0.281, β = -1.271, p = 0.024).
Conclusions We found that serum irisin levels were lower in overweight subjects. Moreover, serum irisin levels were inversely correlated with adverse metabolic parameters including WC, WHR, creatinine, HOMA-IR and fasting insulin, suggesting that irisin may play a role in obesity related insulin resistance.
Comparing the influence of 1-day versus 3-day low-residue diet on bowel preparation for colonoscopy:a randomized controlled trial
Authors: Jiao Li , Wang Junmin , Zhao Wenjuan , Ma Huan , Fan Xiao , Yang Liang , Zhu Xuejuan
Published: October 2019

Backgroud :A low-residue diet (LRD) can potentially reduce the hunger of patients while improving compliance and tolerance,without compromising the quality of bowel preparation.This study investigated the effects of 1-day low-residue diets compared with 3-day for colonoscopic bowel preparation . Methods: Patients undergoing bowel preparation before colonoscopy were randomly divided into 1-day and 3-day LRD groups.Oral polyethylene glycol (PEG) electrolyte solution and simethicone were applied to all patients submitted to bowel preparation. The primary outcome measure included the quality of the bowel preparation rated by the Boston bowel preparation scale(BBPS), and the secondary measures included (i) cecal intubation time and withdrawal time, (ii) polyp detection rate, (iii) patient tolerance and (iv) the willingness of the patient to repeat the diet protocol thereafter. Results: No significant difference was detected in regards the quality of the bowel preparation when comparing the two groups, since the mean of BBPS score was 6.54 versus 6.55 in the 1- and 3-day LRD groups. The cecal intubation times,withdrawal times, polyp detection rates,and the patient tolerance (i.e.hunger-comfort score[1]) showed no significant difference between the 1- and 3-day LRD groups. However,overall satisfaction was higher with the 1-day LRD group than with the 3-day LRD group. Conclusion: The 1-day and 3-day low-residue diets showed no major effect on bowel preparation previously to colonoscopy, while the tolerance and satisfaction of patients were higher after 1-day low-residue diet. Trial registration: Clinical Trial Registry Identifier:ChiCTR1900025843.Date of registration:September 10,2019 “Retrospectively registered”. Key words: colonoscopy; bowel preparation; low-residue diet; duration; bowel-cleansing quality
Effect of biological larviciding with Bacillus thuringiensis israelensis for malaria control on non-target vector mosquito species in rural Burkina Faso – A cluster randomized trial
Authors: Dambach Peter , Bärnighausen Till , Yadouleton Anges , Dambach Martin , Traore Issouf , Korir Patricia , Ouedraogo Saidou , Sié Ali , Sauerborn Rainer , Becker Norbert , Louis Valérie
Published: October 2019

Background: Biological larviciding is an additional tool that can help address the current dilemma in malaria control, namely vector resistances to pyrethroids and shifting of biting activity to times when people are not protected. Although malaria interventions primarily target Anopheles mosquitoes, there might be an impact on populations of other mosquito genera that share the same breeding sites. In this study we research to what extent Culex and Aedes mosquitoes, the primary vectors of numerous zoonotic diseases, are affected by larviciding interventions against malaria mosquitoes. Methods: We researched the impact of different larviciding choices with Bacillus thuringiensis israelensis on non-target mosquitoes in 127 rural villages and a semi-urban town in a health district in Northwestern Burkina Faso. All villages were distributed into a total of three study arms with different larviciding choices: full, selective and untreated control. Geographically close villages were distributed into clusters to avoid contamination between treated and untreated villages. Adult mosquitoes were captured in light traps inside and outside houses during the rainy seasons of a baseline and an intervention year. A negative binomial regression was used to determine the reductions achieved through larviciding among different mosquito genera.Results: Larviciding interventions against malaria showed only limited or no impact against Culex mosquitoes, while against Aedes, reductions of up to 34% were achieved when all detected breeding sites in the public space were treated. While the semi-urban setting showed high abundance of Culex, in the rural villages we captured more Aedes. Conclusions: Future larviciding programs should be evaluated for including the treatment of Aedes and Culex breeding habitats. Since the major cost components of such programs are labor and transport, other disease vectors could be targeted at little additional cost.
Family Caregivers’ Perspectives of the Economic Burden Imposed through Caring for Family Members with Cancer in KwaZulu-Natal, South Africa
Authors: Mlaba Phindile Chantalle , Ginindza Themba , Hlongwana Khumbulani
Published: October 2019

Background This study explored the perspectives of family caregivers on the economic burden imposed through caring for their family members who are living with cancer in KwaZulu-Natal.Methods This study employed qualitative methods to explore the subjective experiences of the family caregivers caring for family members living with cancer, drawing from the interpretivist paradigm. Data saturation was reached after conducting 20 in-depth interviews among family caregivers. These family caregivers were either actively involved in caring for or previously had the experience of caring for a family member with cancer. Interview questions focused on the caregivers’ perspectives of the economic burden of caring for a family member with cancer.Results Three key themes emerged from the analysis of the research findings. These themes were: loss of income, financial coping prior to the cancer diagnosis, and financial challenges due to the cancer diagnosis.Conclusions Cancer care giving can be financially taxing on families, and especially impose more strain on families with low household incomes. There is a need for health policy makers to consider exploring financial relief mechanisms for families caring for members living with cancer.
'Tobacco and alcohol use are playing critical role in the interaction of social determinants of non-communicable diseases in Nepal': a systems perspective
Authors: Sharma Sudesh Raj , Matheson Anna , Lambrick Danielle , Faulkner James , Lounsbury David W , Vaidya Abhinav , Page Rachel
Published: October 2019

Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal contributing to rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health system. Systems approach has potential to facilitate understanding of such complex causal mechanism. The objective of this paper was to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method: The study was a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n=63) and focus group discussions (n-12) at different levels (policy, district and/or community) and was informed by the adapted Social Determinants of Health Framework . The data analysis involved case study based thematic analysis using framework approach and development of causal loop diagram. The study also involved three sense making sessions with key stakeholders. Results: Five key interacting themes emerged during the data analysis. Habit and misconception relating to alcohol and tobacco use contributed to the use and addiction of tobacco and alcohol. Low focus on prevention by health system further contributed to the problem. Decline in community capital and gendered social constructs influenced tobacco and alcohol use. Socio-economic status of families/communities was discussed as a potential root cause of use and addiction of tobacco and alcohol. These interacting themes were utilized to develop iterative causal loop diagrams showing the influence of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Conclusion: Tobacco and alcohol use and addiction causally linked broader social determinants (social, economic and political) to NCD in the context of Nepal. These CLDs showed how socio-economic circumstances was influencing addiction and availability of tobacco and alcohol products in Nepal. A multi-sectoral response led by health system is urgently needed.
Perceptions and Attitudes about the Concept and Approach of Palliative Care among Carer’s and Family Members of Patients on End-of-Life Care: A Cross-sectional Survey
Authors: Shah Sameena , Qaisar Faizan , Azam Iqbal , Mansoor Khairunnisa
Published: October 2019

BACKGROUND It is necessary to assess carer's understanding of palliative care. The objectives of this study were to ascertain the attitudes and perceptions about the concept and components of palliative care. METHODS A cross-sectional survey was conducted. Data was collected from the Aga Khan University Hospital in-patient and out-patient departments and home-based palliative care services from mid 2015 to 2016. All adult care-givers who met the inclusion criteria and gave informed consent were approached by trained data collectors till the sample size was reached.Univariate and multivariable analysis and results were reported as crude prevalence’s, crude and adjusted prevalence ratios with 95% confidence intervals using Cox-proportional hazard algorithm. Mean difference of knowledge and attitude scores by care giver variables was assessed using one-way ANOVA. SPSS version 18 was used and a p-value of less than 5 percent was treated as significant. RESULTS Out of 250 care givers more than 60% were 40 years or less and the majority were males. Majority were at least graduates. Approximately 70% of the respondents agreed with the opinion that the person suffering from cancer should be informed about the diagnosis and disease progression. About forty five percent (95% C.I.: 39.03%, 51.37%) of the study respondents had correct knowledge about palliative care. Age and relationship with patient had the most variation in response in terms of significance. CONCLUSION Young individuals aged <40 years, with an education level of matric, children or relations of the patient were found to have significantly more and correct knowledge. The majority believed that the patient should be informed about the diagnosis and that patients should be encouraged to carry out routine activities and be facilitated to fulfill their wishes. Two foundational aspects showed a consistently good understanding and therefore correct knowledge across age groups, gender, education level, and relationship with the patient. Firstly, that palliative care should be offered to everyone suffering from an incurable disease and, secondly, that this approach encompasses not just physical, but also psychological and social needs of the patient, in addition to the needs of the family caring for the patient.
Effect of the duration of intraretinal or subretinal fluid persistence on the response to treatment in undertreated age-related macular degeneration
Authors: Yoshida Izumi , Sakamoto Masashi , Sakai Asao , Maeno Takatoshi
Published: October 2019

Backgrounds: To investigate the association between intraretinal fluid (IRF) or subretinal fluid (SRF) persistence and response to anti-vascular endothelial growth factor injection in age-related macular degeneration (ARMD). Methods: Eighty-nine eyes of ARMD patients with VA ≤ 20/100 or persistent subretinal hyper-reflective material were retrospectively assessed. Each injection’s efficacy was classified, and fluid accumulation prior to each injection was evaluated. Effect changes within the longest persistent IRF period (≥ 10 months) and their association with previous treatment and accumulated IRF and SRF were determined. Results: Injection span was shorter and the polypoidal choroidal vasculopathy and occult choroidal neovasculopathy (CNV) proportions were higher among patients with diminished than among those with maintained effects. Throughout observation, acquired refractoriness appeared rarely associated with increased IRF or SRF. VA differed significantly with IRF duration, but not accumulated fluid. Conclusions: Diminishing effect of injections during long- standing IRF was associated with highly active CNV rather than with undertreatment. The mechanism underlying acquired refractoriness remains unknown; the effect change demonstrated various patterns, including diminished and improved responses. Persistent IRF duration was associated with VA decline. To shorten the duration of persistent IRF, it may be necessary to ensure strict control in refractory patients with high CNV activity.
Imaging modality for measuring the presence and extent of the labral lesions of the shoulder: a systematic review and meta-analysis
Authors: Liu Fanxiao , Cheng Xiangyun , Dong Jinlei , Zhou Dongsheng , Sun Qian , Bai Xiaohui , Wang Dawei
Published: October 2019

Background: Multiple published studies quantitatively analysing the diagnostic value of MRI, MR arthrography (MRA) and CT arthrography (CTA) for labral lesions of the shoulder have had inconsistent results. The aim of this meta-analysis was to systematically compare the diagnostic performance of MRI, MRA, CTA and CT. Methods: Two databases, PubMed and EMBASE, were used to retrieve studies targeting the accuracy of MRI, MRA, CTA and CT in detecting labral lesions of the shoulder. After carefully screening and excluding studies, the studies that met the inclusion criteria were used for a pooled analysis, including calculation of sensitivity and specificity with 95% confidence intervals (CIs) and the area under the hierarchical summary receiver operating characteristic (HSROC) curves. Results: The retrieval process identified 2633 studies, out of which two reviewers screened out all but 14 studies, involving a total of 1216 patients who were deemed eligible for inclusion in the meta-analysis. The results assessing the diagnostic performance of MRI vs. MRA for detecting labral lesions showed a pooled sensitivity of 0.77 (95% CI 0.70-0.84) vs. 0.92 (95% CI 0.84-0.96), a specificity of 0.95 (95% CI 0.85-0.98) vs. 0.98 (95% CI 0.91-0.99), and an area under the HSROC curve of 3.78 (95% CI 2.73-4.83) vs. 6.01 (95% CI 4.30-7.73), respectively. Conclusion: MRA was suggested for use in patients with chronic shoulder symptoms or a pathologic abnormality. MRI is by far the first choice recommendation for the detection of acute labral lesions. CT should be a necessary supplemental imaging technique when there is highly suspected glenoid bone damage.
Accident-related neurogenic fecal incontinence: a retrospective study
Authors: Liu Jie , Wei Ruiling , Wu Dewei , Chen Hulin , Dong Juan , Lv Chaolan , Zhu Xiuli , Yu Yue
Published: October 2019

Abstract Background To evaluate the anorectal motility characteristics, the quality of life and psychological health of accident-related neurogenic fecal incontinence(ArNFI) patients. Methods A retrospective study was conducted on 26 patients with ArNFI visiting the gastrointestinal motility center of affiliated provincial hospital of Anhui medical university were collected as research objects from January 2016 to August 2019. The anorectal motility characteristics of these patients were recorded and analysed by high resolution manometry (HRM), 10 healthy subjects for the same period were recruited as the control group. The psychological characteristics of these patients and healthy subjects were compared by HAMA and HAMD scores,and their quality of life was investigated by SF36. Results Anal sphincter resting pressure in the ArNFI group was more lowwer than that of the control group (21.18± 4.68vs34.83± 14.13, P<0.05). Anorectal compliance in the ArNFI group was more lowwer than that of the control (1.41± 0.32vs4.03± 1.06, P<0.05). Maximal squeeze pressure were in the ArNFI group was also lowwer than that of the control(53.66±14.59 vs 143.95±19.82, P<0.05).HAMA ,HAMD scores of the ArNFI group in the ArNFI group were all higher than that of the control ( 21.29±2.06 vs 7.63±1.41 ;22.00±3.70 vs 8.75±1.91, respectively.all P<0.01). There were significant differences between SF36 scores of ArNFI group and the control group in the 8 dimensions of PF,RP,GH,VT,SF,RE and MH.(P<0.01) . Conclusion In patients with ArNFI,there were significantly reduced anorectal motility characteristics, increased HAMA.HAMD scores,and their life quality was obviously declined.
Pre- and post-sequencing recommendations for functional annotation of human fecal metagenomes
Authors: Treiber Michelle L. , Taft Diana H. , Korf Ian , Mills David A. , Lemay Danielle G.
Published: October 2019

Background
Shotgun metagenomes are often assembled prior to annotation of genes which biases the functional capacity of a community towards its most abundant members. For an unbiased assessment of community function, short reads need to be mapped directly to a gene or protein database. The ability to detect genes in short read sequences is dependent on pre- and post-sequencing decisions. The objective of the current study was to determine how library size selection, read length and format, protein database, e-value threshold, and sequencing depth impact gene-centric analysis of human fecal microbiomes when using DIAMOND, an alignment tool that is up to 20,000 times faster than BLASTX.
Results
Using metagenomes simulated from a database of experimentally verified protein sequences, we find that read length, e-value threshold, and the choice of protein database dramatically impact detection of a known target, with best performance achieved with longer reads, stricter e-value thresholds, and a custom database. Using publicly available metagenomes, we evaluated library size selection, paired end read strategy, and sequencing depth. Longer read lengths were acheivable by merging paired ends when the sequencing library was size-selected to enable overlaps. When paired ends could not be merged, a congruent strategy in which both ends are independently mapped was acceptable. Sequencing depths of 5 million merged reads minimized the error of abundance estimates of specific target genes, including an antimicrobial resistance gene.
Conclusions
Shotgun metagenomes of DNA extracted from human fecal samples sequenced using the Illumina platform should be size-selected to enable merging of paired end reads and should be sequenced in the PE150 format with a minimum sequencing depth of 5 million merge-able reads to enable detection of specific target genes. Expecting the merged reads to be 180-250bp in length, the appropriate e-value threshold for DIAMOND would then need to be more strict than the default. Accurate and interpretable results for specific hypotheses will be best obtained using small databases customized for the research question.
Main Driving Factors and Prediction Model of Total Health Expenditure in China: A Study Based on Grey System Theory
Authors: Jia Huanhuan , Yu Xihe , Yu Jianxing , Zheng Zhou , Li Yingying , Song Fangying , Jiang Hairui , Zhang Jingru
Published: October 2019

Background: The continuous increase in total health expenditure has become a social issue of common concern in most countries. In China, the total health expenditure still maintains a fast growth trend which is much higher than the growth of the country’s economy, although the new health system reform had been going on for 8 years until 2017. The aims of the current study were thus to investigate the main driving factors affecting total health expenditure and to establish a prediction model.
Methods: Gray system theory was employed to explore the correlation degree between total health expenditure and 13 hot spots from the fields of economy, population, health service utilization, and public policy using national data in China from 2009 to 2017. Besides, a prediction model was established using the main driving factors among the 13 hot spots.
Results: The main driving factors related to the changes of total health expenditure were public policy (ranked first), health development, economics, and aging, which correlation degrees were more than 0.7. The average error of the GM(1,7) model was 3.17%, the correlation degree, β , between the predicted simulation sequence and the original sequence was 0.78, the variance ratio, C, was 0.138, and the probability of residuals, P, was 1.0000. Therefore, the prediction model of total health expenditure with 6 main driving factors was excellent.
Conclusion:
The paper finds that since the new health system reform in China, government policies and social invest have contributed greatly to reducing the burden of health expenditure. However, the development of economic and the increase in the elderly population, which are main driving factors, will increase the total health expenditure, so improving the efficiency of investment and providing the precautionary health care and nursing for the elderly are crucial. Besides, the grey system theory had a good application in the field of health economics and policy.
The Clinical Learning Environment, Supervision and Nurse Teacher Scale (CLES+T): psychometric properties measured in the context of postgraduate nursing education
Authors: Ozga Dorota , Gutysz-Wojnicka Aleksandra , Lewandowski Bogumił , Dobrowolska Beata
Published: October 2019

Background. The CLES+T instrument is internationally used for evaluation of clinical learning environment in undergraduate nursing education. However, no evidence is available on the possible applications of this instrument in the context of postgraduate nursing education.
Purpose. To examine the basic psychometric properties of the CLES+T in the context of clinical postgraduate nursing education in Poland.
Methods. Study among a sample of 417 nurses participating in the clinical postgraduate training in Poland.
Results. Cronbach’s alpha for the total scale was 0.97. A five-factor structure was confirmed in accordance with the assumptions adopted by the authors of the original version of the scale. Cronbach’s alpha coefficient for the Polish version of the CLES+T subscales ranged from 0.83 (Nursing care on the ward) to 0.95 (The content of supervisory relationship). The mean results for individual subscales ranged from 4.52±0.63 for nursing care on the ward to 4.73±0.45 for role of the nurse teacher.
Conclusions. Having shown satisfactory psychometric properties, CLES+T can be considered a useful instrument to assess those elements of clinical learning environment which are important for the assurance of education quality at the postgraduate level.