bluuebunny/crossref_metadata_2025 huggingface dataset:
COVID-19 – Protocol for Observational Studies Utilising Near Real-Time Electronic Australian General Practice Data to Promote Effective Care and Best-Practice Policy – A Design Thinking Approach
Authors: Georgiou Andrew , Li Julie , Pearce Christopher , McLeod Adam , Wabe Nasir , Hardie Rae-Anne , Franco Guilherme Saffi , Imai Chisato , Sezgin Gorkem , Thomas Judith , Dai Zhaoli , Sheikh Muhammad Kashif , Proposch Amanda , Weeding Stephen , Wickham Brendon , Badrick Tony , Murgatroyd Darnel
Published: December 2020

Background: Health systems around the world have been forced to make choices about how to prioritise care, manage infection control and maintain reserve capacity for future disease outbreaks. Primary health care has moved into the frontline as COVID-19 testing transitions from hospitals to multiple providers, where tracking testing behaviours can be fragmented and delayed. Pooled general practice data are a valuable resource which can be used to inform population and individual care decision-making. This project aims to utilise near real-time electronic general practice data to promote effective care and best-practice policy. Methods: The project will utilise a design thinking approach involving all collaborators (Primary Health Networks [PHNs], general practices, consumer groups, researchers, and digital health developers, pathology professionals) to enhance the development of meaningful and translational project outcomes. The project will be based on a series of observational studies utilising near real-time electronic general practice data from a secure and comprehensive digital health platform [POpulation Level Analysis and Reporting (POLAR) general practice data warehouse]. The study will be carried out over 1.5 years (July 2020 – December 2021) using data from over 350 general practices within three Victorian Primary Health Networks (PHNs) and Gippsland PHN, Eastern Melbourne PHN and South Eastern Melbourne PHN, supplemented by data from consenting general practices from two PHNs in New South Wales, Central and Eastern Sydney PHN and South Western Sydney PHN. Discussion: Developed using a design thinking approach, this project will deliver: 1) A near real-time geo-spatial reporting framework at community, state and nation-wide levels to identify emerging trends and monitor the impact of interventions/policy decisions. 2) Timely evidence about the impact of the COVID-19 pandemic related to its diagnosis, treatment and medications prescribed and its impact on patients. 3) A predictive geo-spatial analytics dashboard for timely, evidence-based decision-making at community, state and nation-wide levels. 4) An evidence-based suite of general practice outcome measures to monitor incidence, prevalence, recovery and mortality in response to the COVID-19 pandemic.
A preliminary study of schema therapy for adults with high-functioning autism spectrum disorder: A single-arm, uncontrolled trial
Authors: Oshima Fumiyo , Murata Tomokazu , Ohtani Toshiyuki , Seto Mikuko , Shimizu Eiji
Published: December 2020

Objective: Schema therapy (ST) has recently been shown to be effective for the treatment of various mental disorders, including personality disorders. This pilot clinical trial aimed to explore the feasibility, acceptability, and effectiveness of ST for adults with high-functioning autism spectrum disorder (HF-ASD)Results: From pre- to post-treatment, we found signiﬁcant improvements in social functions (GAF and WHO-QOL), early maladaptive schema (YSQ), and depression and anxiety (BDI-II and STAI).Trial registration: UMIN000014535; registered on July 11, 2014.
Nitrogen removal from summer to winter in a field pilot-scale multistage constructed wetland-pond system
Authors: Xiao Liping , Wang Tao , Lu Hongbin , Lu Shaoyong , Li Jiaxin , Guo Xiaochun , Zhao Xiaoliang
Published: December 2020

Background

Single-stage constructed wetlands (CWs) has a single ecological service function and is greatly affected by temperature, which are general in removal of total nitrogen. Multistage hybrid CWs were proven to capable of enhancing removal of nitrogen. Therefore, this study aimed to explore the variation in nitrogen removal in the combined CWs-pond process from summer to winter and the contribution of plant harvesting and the functions of bacteria to nitrogen removal.
Methods

A pilot-scale multistage constructed wetland-pond system (MCWP) with the process of "the pre-ecological oxidation pond + the two-level horizontal subsurface flow constructed wetland (HSCW) + the surface flow constructed wetland (SFCW) and the submerged plant pond (SPP)" was used to treat actual polluted river water in the field. During the 124 days of operation, the nitrogen concentrations in the units influent and effluent of the system were measured every two days, and the plant height in HSCWs and SFCW was measured once per month. When the system operated stably to the 72nd day, the substrates in the CWs were sampled to analyze the bacterial community structure and composition.
Results

The concentration of total nitrogen (TN) in the MCWP gradually decreased from 3.46 mg/L to 2.04 mg/L, and the average removal efficiency of TN was approximately 40.74%. The SPP performed the best among all units, and the TN removal efficiency was as high as 16.08%. The TN removal efficiency was significantly positively affected by the daily highest temperature. A formula between the total TN removal efficiency and the highest temperature was obtained by nonlinear fitting. The TN removal load rate in the HSCWs was 2.7–3.7 times that of the SFCW. Furthermore, the TN transformed by Iris pseudacorus L. accounted for 54.53% in the SFCW.
Conclusion

We found that the significant positive correlation between the daily highest temperature and the total TN removal rate a field MCWP system. The SFCW, as an advanced treatment unit, increased the proportion of nitrogen removed by plant harvesting. The bacteria completed the nitrogen cycle in the SFCW, which had high-density planting, through a variety of nitrogen removal pathways.
Investigating the Interaction Between EEG and HRV Protocol for Study of Three-Circle Post Standing Qigong
Authors: Lyu Jiaxuan , Wei Yulong , Tan Tianyang , Hu Qingchuan , Li Hangyu , Dong Jingjing , Zhang Xinzheng
Published: December 2020

Background Qigong has a long-term application as an initiative therapy for prevent and cure diseases, as a mindful exercise, it’s unique function of integrate mind, breath and body gets a lot of attention, researches show that qigong practice could adjust brain and heart function. Currently we have limitations on study qigong’s coordinate mechanism between mind and body, existing studies lack of evidence on electrophysiology research.Our object here is to propose a method to evaluate the effects of qigong on mind body adjustment, and to analyse the coordinate function of Electroencephalogram (EEG) and Heart rate variability (HRV) by complex signal process.MethodsA two-arm randomized clinical trial with eighty-four qigong naïve subjects without cerebral or cardiovascular diseases or other severe syndromes will be allocate to either intervention group(n=42) or wait in list control group(n=42). Participants in the intervention group will conduct Three-circle post standing qigong exercise 5 times per week for 8 weeks, while wait in list group will maintain their current lifestyle during 8 weeks period. The outcome will be complexity-based measures of heart rate and EEG signals assessed at baseline and 8 weeks. Multiscale entropy analysis will be used as measures of complexity.ConclusionThis study will be investigate the effects of qigong exercise by EEG and HRV analyse before and after Three-circle post standing practice, and to measure their synergies by complex signal process method. Results of this study may lead to novel biomarkers that help us monitor and understand the physiological processes of brain and heart function and explore the potential benefits of Qigong and will provide a research evidence for qigong’s mind and body synergy function and to direct future clinical treatment.Ethics and disseminationThe protocol has been approved by the institutional review boards of Beijing University of Chinese Medicine, where the study will take place(approval number: 2018BZHYLL0109).Trail registrationThis study has been registered with the“Chinese Clinical Trail Registry”, Republic of China, which is a registry in the WHO Registry Network. Register number: ChiCTR-Bon-17010840.
Conventional Craniotomy Versus Conservative Treatment in Patients With Minor Spontaneous Intracerebral Hemorrhage in the Basal Ganglia
Authors: Wang Ning , Zhu Xuanhao , Tu Qi , Zhu Daqian , Qu Shuai , Yang Jianjing , Ruan Linhui , Zhuge Qichuan
Published: December 2020

Background: The treatment for spontaneous intracerebral hemorrhage (ICH) is still controversial, especially for hematomas in the basal ganglia. A retrospective case-control study with propensity score matching was performed to compare the outcomes of conventional craniotomy and conservative treatment for patients with minor ICH in the basal ganglia.Methods: We retrospectively collected the data of consecutive patients with minor basal ganglia hemorrhage from January 2018 to August 2019. We compared clinical outcomes of two groups using propensity score matching. The extended Glasgow outcome scale obtained by phone interviews based on questionnaires at 12 months follow-up was used as the primary outcome measure. On the basis of their clinical status at admission, patients were divided into good and poor prognosis groups to obtain a dichotomized (favorable or unfavorable) outcome as the primary outcome. Secondary outcomes included hospitalized complications, mortality and modified Rankin score at 12 months.Results: A total of 54 patients were analyzed, and the baseline characteristics of patients in the surgery and conservative treatment groups were well matched. The primary favorable outcome at 12 months was significantly higher in the conservative treatment group than in the surgery group (81% vs 44%; OR 1.833, 95% CI 1.159–2.900; P=0.005). The incidence of pneumonia in the surgery group was significantly higher than that in the conservative treatment group (p=0.005).Conclusions: It is not recommended to undertake conventional craniotomy for patients with a minor hematoma (25–40 ml) in the basal ganglia. An open craniotomy might induce worse long-term functional outcomes than the conservative treatment.
Ultrasonography for Serial Monitoring and Management of CSF Dynamic Disorders After Decompressive Craniectomy
Authors: Zhu Meng , Zhang Jiahui , Mu Shuang , Liu Wei , Deng Wenshuai , Liu Xin , He Zhaozhong , Gong Anjing , Li Huanting , Feng Yugong
Published: December 2020

Objective Decompressive craniectomy (DC) is widely used to treat intracranial hypertension following severe head injury. However, impairments of cerebrospinal fluid (CSF) hydrodynamics such as hydrocephalus and subdural effusion are common complications that occur after DC. Therefore, monitoring of intracranial pressure is a staple of neurocritical care post-DC. The aim of this study was to assess the usefulness of transcranial duplex sonography (TDS) for serial monitoring and management of CSF disorders after DC. Methods A total of 100 patients who underwent DC between June 2016 and May 2019 were recruited for the study. TDS examinations were performed between 1 day and 1-year post-DC. TDS was mainly used for monitoring changes in ventricle size and morphology, and also to monitor intraventricular hemorrhage (IVH), hydrocephalus, intracranial hygromas, and ventricle changes during CSF release procedures. Results A total of 456 TDS examinations were performed on patients after DC. Of these, 402 were performed in the neuro-ICU. Two patients had IVH and underwent TDS-guided external ventricular drainage (EVD). Twenty-nine patients were diagnosed with hydrocephalus. The results of TDS were consistent with those of cranial computed tomography (CCT). Three cases of ventriculoperitoneal shunt and 1 case of lumbar peritoneal shunt underwent valve pressure reset according to TDS, in order to obtain satisfactory ventricle size. TDS was used to monitor ventricle changes and control drainage volume during CSF release procedures, including 2 EVD, 6 external lumbar drainage, and 10 lumbar punctures. Eighteen patients were detected with single or multiple intracranial effusions, including 16 subdural hygromas, 5 longitudinal fissure hygromas, and 6 brain cysts. Conclusions TDS can efficiently help monitor changes in ventricle size and morphology and intracranial effusions. Due to its noninvasive nature, suitability for bedside application, real-time and inexpensiveness, TDS can significantly replace CCT and become part of the patient's daily inspection work after DC.
Integrated bioinformatics approach to understand immune-related key genes and pathways in chronic spontaneous urticaria
Authors: su wenxing , huang biao , zhao ying , zhang xiaoyan , chen lu , ji jiang , Jiao qingqing
Published: December 2020

Background

Chronic spontaneous urticaria (CSU) refers to recurrent urticaria that lasts for more than 6 weeks in the absence of an identifiable trigger. Due to its recurrent wheal and severe itching, CSU seriously affects patients' life quality. There is currently no radical cure for it and its vague pathogenesis limits the development of targeted therapy. With the goal of revealing the underlying mechanism, two data sets with accession numbers GSE57178 and GSE72540 were downloaded from the Gene Expression Omnibus (GEO) database. After identifying the differentially expressed genes (DEGs) of CSU skin lesion samples and healthy controls, four kinds of analyses were performed, namely functional annotation, protein-protein interaction (PPI) network and module construction, co-expression and drug-gene interaction prediction analysis, and immune and stromal cells deconvolution analyses.
Results

92 up-regulated genes and 7 down-regulated genes were selected for subsequent analyses. Through the enrichment analysis of the core modules, three signal pathways were found to be closely related to the occurrence and development of CSU, including TNF signaling pathway, NF-κB signaling pathway and Jak-STAT signaling pathway. Referring to protein-protein interaction (PPI) network analysis and GeneCards database, we identified four key genes, IL6, TLR4, ICAM1, and PTGS2. In addition, according to the results of immune infiltration analysis, CSU tissue generally contained a higher proportion of dendritic cells, Th2 cells, mast cells, megakaryocyte-erythroid progenitor, preadipocytes, and macrophages M1.
Conclusions

To conclude, the key genes and pathways identified from CSU lesions and normal controls along with the immune infiltration profile may provide new insights into the development of CSU.
Kaempferol Protects Mice from D-GalN/LPS-induced Acute Liver Failure by Regulating the Autophagy Pathway
Authors: Tian Yuan , Ren Feng , Xu Ling , Li Weihua , Liu Mei , Hu Jianhua , Zhang Xiangying
Published: December 2020

Background

Kaempferol, a flavonoid compound present in many edible plants, has been used in traditional medicine and has various biological functions. Acute liver failure (ALF) is a lethal clinical syndrome with severe liver function damage. There are currently no effective treatments for ALF except for liver transplantation. The aim of this study is to explored the mechanisms underlying the therapeutic effect of kaempferol in ALF.
Methods

The ALF mouse model was established using D-galactosamine (D-GalN, 700 mg/kg)/lipopolysaccharide (LPS, 10 µg/kg). Two hours before the administration of D-GalN/LPS, different group of mice were pretreated according different doses of kaempferol, 6 hours after injection of D-GalN/LPS, and then killed. The survival rate, liver function and inflammatory cytokine levels were assessed. It was determined whether kaempferol pretreatment protected hepatocytes from ALF induced by D-GalN/LPS via autophagy pathway in vivo and in vitro.
Results

Pretreatment with a high dose of kaempferol significantly decreased the survival rate and increased severe liver damage; however, pretreatment with a low dose of kaempferol showed the opposite effect. Furthermore, pretreatment with a high dose of kaempferol augment the levels of proinflammatory cytokines and markers of the MAPK signaling pathway, while pretreatment with a low dose of kaempferol showed the opposite effect. In addition, pretreatment with a high dose of kaempferol decreased autophagy, but pretreatment with a low dose of kaempferol increased autophagy in vivo and in vitro. It was also proved that pretreatment with 3-methyadenine (3- MA) or Atg7 siRNA to inhibit autophagy partially negated the hepatoprotective effect of kaempferol (5 mg/kg) pretreatment in ALF mice induced by D-GalN/LPS.
Conclusions

Our findings demonstrate that effects of different doses of kaempferol on D-GalN/LPS-induced ALF is remarkably different by regulating the autophagy pathway. Therefore, we should consider selecting the optimal dose of kaempferol as a potential treatment method for patients with ALF.
Effect of Vitamin D3 Supplementation Combined with Exercise Training on Glycemic Control and Bone Health in Patients with Type 2 Diabetes: A Randomized, Placebo-Controlled Trial
Authors: Sun Xiaomin , Zhou Sirui , Dong Mengyue , Xiao Wenjuan , He Xin , Ma Yan , Gou Bo , Xu Jing , Cao Zhenbo , Zeng Lingxia , Wang Youfa , Cui Wei
Published: December 2020

Aims This study aimed to examine the effect of a 12-week vitamin D supplementation and exercise training alone and in combination on glycemic control and bone health in Chinese type 2 diabetes patients.MethodsSixty-one type 2 diabetes patients (age, 33–65 years; 72.0% men) with non-insulin dependence were randomized into the 12-week vitamin D group (1000 IU/day), exercise group (60%–80% of maximal heart rate, 1 h/time, 2–3 times/week), vitamin D combined with exercise group, and control group. A 75-g oral glucose tolerance test was used to estimate glycemic control. Dual X-ray absorptiometry was used to examine bone health (bone mass content and bone mass density) and body fat percentage (%).Results During the 75-g oral glucose tolerance test, lower glucose and higher insulin levels were found in the vitamin D combined with exercise group, vitamin D group, and exercise group after intervention than before intervention, although the differences were not statistically significant. A significant exercise and vitamin D interaction for the insulinogenic index (P = 0.032) and a borderline interaction for the glucose disposition index (P = 0.051) were observed, while no further independent effect was observed. Compared with non-vitamin D supplementation, vitamin D supplementation significantly alleviated the loss of total bone mass content (95% CI: -29.9–19.4 vs. -74.9–-24.7), trunk bone mass content (95% CI: -24.1–19.5 vs. -56.1–-11.7), and spine bone mass density (95% CI: -0.03–0.03 vs. -0.07–-0.01).ConclusionsThe findings suggest that 12-week combined vitamin D and exercise intervention has a potentially positive effect on glycemic control, and vitamin D supplementation plays an important role in the prevention of bone loss, which was identified in the exercise alone group. Further studies are needed to elucidate the long-term effect of combined vitamin D and exercise intervention in type 2 diabetes patients.The study was registered in the Chinese Clinical Trial System (No. ChiCTR1800015383).
Were Traditional Chinese Medicine Injections Efficacious for Angina Pectoris? A Frequentist Network Meta-Analysis of Randomized Controlled Trials
Authors: Gao Guoying , Leung Siu-wai , Jia Yongliang
Published: December 2020

Background: The efficacy of traditional Chinese medicine injections (TCMIs) for angina pectoris has never been well investigated for lacking quality assessment of evidence. This study aimed to conduct a comprehensive and rigorous network meta-analysis and assess the quality of evidence according to the Grading of Recommendations and Assessment, Development, and Evaluation (GRADE) approach to compare the efficacy of all TCMIs in treating angina pectoris.Methods: Following the protocol (reference: CRD42018117720), randomized controlled trials (RCTs) which compared one TCMI with another TCMI or conventional treatments on anginal outcome measures (i.e. symptomatic improvement, electrocardiography improvement, symptomatic recovery, and electrocardiography recovery) were included. The risk of bias among included RCTs was assessed with the revised Cochrane’s risk of bias tool 2. Frequentist statistical analyses including subgroup analysis, sensitivity analysis, meta-regression and publication bias analysis were performed. The certainty of evidence was assessed with the GRADE approach.Results: Totally, 475 RCTs including all 24 TCMIs were identified, while the quality of all but two included RCTs was poor. According to the network meta-analysis, Honghua (Safflower) injection were preferable both in improving symptoms and electrocardiography. However, significant inconsistency showed the intransitivity among indirect comparisons, results in network meta-analysis seemed thus not trustworthy. The quality of evidence was assessed as low or very low.Conclusions: The low-quality evidence reduced the confidence in the efficacious results. Current evidence hardly supports the beneficial effects of TCMIs in treating angina pectoris.
Tipping the Scales: A Theoretical Model to Describe the Opposing Effects of the COVID-19 Pandemic on Mortality
Authors: saban Mor , Myers Vicky , Luxenburng Osnat , Wilf-miron Rachel
Published: December 2020

Background. The COVID-19 pandemic has resulted in changes in almost every aspect of life. The fatal consequences of the pandemic have been clearly reported, with direct and indirect effects; however, there is some evidence of a positive secondary impact, such as fewer motor accidents and reduced air pollution. Methods. We present a model to describe the opposing effects of the COVID-19 pandemic on mortality, taking into account external pressures and internal resources and their relationship with resilience and health behaviors, which affect mortality risk. Individuals with lower resources and from more deprived communities are likely to be more negatively affected by the external changes occurring. Results. The COVID-19 pandemic has had both a positive and negative impact on mortality. Conclusions. Decision makers should consider ways to incorporate the positive changes which occurred as part of the exit strategy. Special emphasis should be given to populations most affected by external changes, in order to build resilience and reduce disparities.
Cursor Movement Detection in Brain-Computer-Interface Systems Using the Hybrid K-Means Clustering Method and LSVM
Authors: Mohammadi Leila , einalou zahra , Hosseinzadeh Hamidreza , Dadgostar Mehrdad
Published: December 2020

In this study, we present the detection of the up- and downward as well as the right- and leftward motion of cursor based on feature extraction. Feature Extraction and selection for finding the proper classifier among the data mining methods are of great importance. In the proposed method, the hybrid K-means clustering algorithm and the linear support vector machine (LSVM) classifier have been used for extracting the important features and detecting the cursor motion. In this algorithm, the K-means clustering method is used to recognize the available hidden patterns in each of the four modes (up, down, left, and right). The identification of these patterns can raise the accuracy of classification. The membership degree of each feature vector in the proposed new patterns is considered as a new feature vector corresponding to the previous feature vector and then, the cursor motion is detected using the linear SVM classifier. The database of the Karadeniz Technical University of Turkey has been used in the present article. Applying the proposed method for data based on the hold-up cross validation causes the accuracy of the classifier in the up- and downward and left- and rightward movements in each person to increase by 2–10%.
Targeting the multidrug efflux pump; Tap protein to reduce survival of Mycobacterium tuberculosis
Authors: Dwivedi Manish , Mukhopadhyay Sutanu
Published: December 2020

Tuberculosis (TB) is a serious communicative disease caused by a bacterium named Mycobacterium tuberculosis. Albeit there are vaccines and drugs available to treat the disease, Multidrug-resistant TB (MDR-TB) is still one of the most critical challenges for the investigators where the development of efflux systems makes them resistant to drugs. Tap is a multidrug efflux pump and proposed to have a significant role in the survival of M. tuberculosis making it drug-resistant. In the present study, we have utilized various In silico approaches to predict the applicability of FDA approved ion channel inhibitors and blockers as therapeutic leads against Tuberculosis. We have analysed 18 inhibitor compounds and eventually screened three ligands as drugs, Glibenclimide, Lubiprostone and Flecainde that have displayed the novel stable binding with Tap protein aiming to affect or inhibit its activity. Structure of Tap protein is predicted by Phyre2 server followed by its characterization by 10ns MD simulations using the CABS-flex 2.0 server and validation by Ramachandran plot. PyRx software presented the binding affinity varied in the range of -8.00 kcal/mol to -9.8 kcal/mol, implies that the drug molecules can spontaneously interact with the target protein. Amongst them, Glibenclimide shows the highest binding affinity with ΔG of -9.8 kcal/mol. This study proposed Tap protein as an interesting drug target and investigated drugs may show considerable effects on the target protein showing a novel therapeutic lead against Tuberculosis.
Indonesian adolescents’ perspectives on smoking habits: a qualitative study
Authors: Fithria Fithria , Adlim Muhammad , Jannah Syarifah Rauzatul , Tahlil Teuku
Published: December 2020

Background: The prevalence of smoking among adolescents is high in Indonesia. Therefore, this qualitative research aimed to explore the perspectives of Muslim adolescents on smoking habits as a reference for developing effective prevention programs.Methods: Three focus group discussions involving 24 junior high school male students (mean age=13.75 years) were the main source of data for this phenomenological qualitative study. The discussion guide was developed by the researchers based on the reviewed literature and validated by experts. The research findings were analyzed using an inductive content analysis with systematic steps based on the stages of qualitative data analysis.Results: Adolescent perspectives on smoking were grouped into two themes: perception of smoking and smoking-related factors. The perception of smoking encompassed three sub-themes: smoking as a social habit, contradictive feelings, and the Islamic perspective. The smoking-related factors included peer pressure, the parents’ smoking status, masculinity and curiosity. The results indicated that adolescents consider smoking as a social habit but with contradictory feelings. The smoking habit was also stimulated by peer pressure, imitating parents who smoke, feeling masculine and curiosity.Conclusion:. We suggest that health professionals who are interested in developing smoking prevention programs in Indonesia should consider the adolescent perspective on smoking so that the prevention program will be more effective and appropriate for adolescents.
­­The effects of clinical decision support system for prescribing medication on patient outcomes and physician practice performance: A systematic review and meta-analysis
Authors: Moghadam Sharare Taheri , Sadoughi Farahnaz , Velayati Farnia , Ehsanzadeh Seyedjafar , Poursharif Shayan
Published: December 2020

Background: Clinical Decision Support Systems (CDSSs) for Prescribing are one of the innovations designed to improve physician practice performance and patient outcomes by reducing prescription errors. This study was therefore conducted to examine the effects of various CDSSs on physician practice performance and patient outcomes.Methods: This systematic review was carried out by searching PubMed, Embase, Web of Science, Scopus, and Cochrane Library from 2005 to 2019. The studies were independently reviewed by two researchers. Any discrepancies in the eligibility of the studies between the two researchers were then resolved by consulting the third researcher. In the next step, we performed a meta-analysis based on medication subgroups, CDSS-type subgroups, and outcome categories. Also, we provided the narrative style of the findings. In the meantime, we used a random-effects model to estimate the effects of CDSS on patient outcomes and physician practice performance with a 95% confidence interval. Q statistics and I2 were then used to calculate heterogeneity.Results: On the basis of the inclusion criteria, 45 studies were qualified for analysis in this study. CDSS for prescription drugs/COPE has been used for various diseases such as cardiovascular diseases, hypertension, diabetes, gastrointestinal and respiratory diseases, AIDS, appendicitis, kidney disease, malaria, high blood potassium, and mental diseases. In the meantime, other cases such as concurrent prescribing of multiple medications for patients and their effects on the above-mentioned results have been analyzed. The study shows that in some cases the use of CDSS has beneficial effects on patient outcomes and physician practice performance (std diff in means = 0.084, 95% CI: 0.067 to 0.102). It was also statistically significant for outcome categories such as those demonstrating better results for physician practice performance and patient outcomes or both. However, there was no significant difference between some other cases and traditional approaches. We assume that this may be due to the disease type, the quantity, and the type of CDSS criteria that affected the comparison. Overall, the results of this study show positive effects on performance for all forms of CDSSs. Conclusions: Our results indicate that the positive effects of the CDSS can be due to factors such as user-friendliness, compliance with clinical guidelines, patient and physician cooperation, integration of electronic health records, CDSS, and pharmaceutical systems, consideration of the views of physicians in assessing the importance of CDSS alerts, and the real-time alerts in the prescription.
The Potential Role of Local Pharmacies to Assess Asthma Control: an Italian Cross-sectional Study
Authors: Caminati Marco , Cegolon Luca , Bacchini Marco , Segala Nadia , Dama Annarita , Bovo Chiara , Olivieri Bianca , Furci Fabiana , Senna Gianenrico
Published: December 2020

Background. Asthma control and monitoring still represents a challenge worldwide. Although the international guidelines suggest the interplay with primary care as an effective strategy to control the disease, community pharmacies’ are seldom involved in asthma control assessment. The present cross-sectional study aimed at providing a picture of the relationship between asthma severity and control in community pharmacies of the health district of the city of Verona (Veneto Region, North-Eastern Italy).Methods. A call for participation was launched through the Pharmacists’ Association of Verona. Patients referring to the participating pharmacies with an anti-asthmatic drug medical prescription and an asthma exemption code were asked to complete the Asthma Control Test (ACT) and a brief questionnaire collecting information on their age, sex, smoking status, aerobic physical exercise and usual asthma therapy, which also defined asthma severity. A multinomial logistic regression model was fitted to investigate the risk of uncontrolled as well as poorly controlled vs. controlled asthma (base). Results were expressed as relative risk ratios (RRR) with 95% confidence interval (95%CI).Results. 57 community pharmacies accepted to participate and 584 asthmatic patients (54% females; mean-age: 51 ± 19 years) were consecutively recruited from 1st January to 30th June 2018 (6 months). Based upon ACT score 50.5% patients had a controlled asthma, 22.3% a poorly controlled and 27.2% uncontrolled. A variable proportion of patients with uncontrolled asthma were observed for every level of severity, although more frequently with mild persistent form of asthma. Most patients (92%) reported regular compliance with therapy. At multinomial regression analysis, patients under regular asthma treatment course (RRR=0.33; 95%CI: 0.15; 0.77) were less likely to have an ACT<16 compared to those not taking medications regularly.Conclusions. Overall, our findings highlighted an unsatisfactory asthma control in the general population, independently of the severity level of the disease. Community pharmacies could be a useful frontline interface between patients and the health care services, supporting an effective asthma management plan, from disease assessment and monitoring treatment compliance to referral of patients to specialist medical consultancies.
Hemodilution is Associated with Underestimation of Serum Creatinine in Cardiac Surgery Patients: A retrospective analysis
Authors: Jin Jifu , Xu Jiarui , Xu Sujuan , Hu Jiachang , Jiang Wuhua , Shen Bo , Wang Chunsheng , Teng Jie , Ding Xiaoqiang
Published: December 2020

Background: Fluid overload is related to the development and prognosis of cardiac surgery-associated acute kidney injury (CSA-AKI). The study is to investigate the influence of serum creatinine (SCr) corrected by fluid balance on the prognosis of patients with cardiac surgery.Methods: A retrospective study was conducted in 1334 patients who underwent elective cardiac surgery from January 1 to December 31, 2015. Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI were applied to identify CSA-AKI. SCr was measured every 24 hours during ICU period and was accordingly adjusted for cumulative fluid balance. Changes in SCr, defined as ∆Crea, were determined by difference between before and after adjustment for cumulative fluid balance. All patients were then divided into three groups: underestimation group (∆Crea ≥ P75), normal group (P25 < ∆Crea < P75) and overestimation group (∆Crea ≤ P25).Results: The incidence of AKI increased from 29.5% to 31.8% after adjustment for fluid balance. Patients in underestimation group showed prolonged length of ICU stay compared with normal group and overestimation group (3.2[1.0-4.0] vs 2.1[1.0-3.0] d, P < 0.001; 3.2[1.0-4.0] vs 2.3[1.0-3.0] d, P < 0.001). Length of hospital stay and mechanical ventilation dependent days in underestimation group were significantly longer than normal group (P < 0.001). Multivariate analysis showed age, baseline SCr and left ventricular ejection fraction were independently associated with underestimation of creatinine.Conclusions: Cumulative fluid balance after cardiac surgery disturbs accurate measurement of serum creatinine. Patients with underestimation of SCr were associated with poor prognosis.
The spectral scalings of magnetic fluctuations upstream and downstream of the Venusian bow shock
Authors: XIAO S. D. , Wu M. Y. , Wang G. Q. , Chen Y. Q. , Zhang T. L.
Published: December 2020

We statistically investigate the spectral scalings of magnetic fluctuations at the upstream and downstream regions near the Venusian bow shock and perform a differentiation by shock geometry. Based on the Venus Express data, 115 quasi-parallel (Q∥) bow shock crossings and 303 quasi-perpendicular (Q⊥) bow shock crossings are selected. The statistical results suggest that the bow shock tends to modify the upstream spectra flatter to 1/f noise in the magnetohydrodynamics (MHD) regime and steeper to turbulence in the kinetic regime after the magnetic fluctuations crossing the bow shock, and this modification for the Q∥ and Q⊥ bow shock is basically consistent. While the upstream spectral scalings are associated with the shock geometry. The changes of the spectral scalings of magnetic fluctuations near the Q∥ bow shocks are not as significant as near the Q⊥ bow shock crossings. That might result from the fluctuations generated by the backstreaming ions which can escape across the Q∥ bow shock into the foreshock. Our results suggest that the energy cascade and dissipation near Venus can be modified by the Venusian bow shock, and the Q∥ bow shock plays an important role on the energy injection and dissipation in the solar wind interaction with Venus. The large dispersion of spectral scalings indicates that this fluctuation environment is complicated, and the shock geometry is not the only key factor in the fluctuations across the Venusian bow shock. Other possible factors in the shock modification to the upstream fluctuations will be explored in future.
Development of Integration Indexes to Determine the Extent of Family Planning and Child Immunization Services Integration in Health Facilities in Urban Areas of Nigeria
Authors: Sheahan Kate L. , Orgill-Meyer Jennifer , Speizer Ilene , Curtis Sian , Paul John , Weinberger Morris , Bennett Antonia V.
Published: December 2020

Background: Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. Methods: This study utilizes cross-sectional health facility (N= 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N= 1,479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Components Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). Results: Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. Conclusion: Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that measuring integration as a binary variable does not (a) reflect the true variation in integration within and across health facilities, (b) enable nuanced measurement of the determinants or effects of integration, or (c) provide tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.
Confocal laser endomicroscopy under propofol-based sedation for early gastric cancer and pre-cancerous lesions is associated with better diagnostic accuracy: a retrospective cohort study in China
Authors: Chu Lihua , Zhao Jialian , Sheng Cheng , Yue Min , Wang Feifei , Song Shengwen , Fang Xiangming , Cheng Baoli , Xie Guohao
Published: December 2020

Background: Confocal laser endomicroscopy (CLE) has advantages in detecting gastric neoplastic lesions, meanwhile it requires strict patient cooperation. Sedation could improve patient cooperation and quality of endoscopy. However, sedation is still not very popular in some resource-limited countries and regions. The purpose of this study was to compare propofol-based sedated versus un-sedated CLE in the value of diagnosing early gastric cancer (EGC) and precancerous lesions.Methods: A retrospective, cohort, single center study of 226 patients who underwent CLE between January 1, 2015 and December 31, 2017 was performed. Patients enrolled were allocated into the propofol-based sedated group (n=126) and the un-sedated group (n=100). The comparison of validity and reliability of CLE for identifying EGC and precancerous lesions between the two groups was performed through analyzing CLE diagnosis and pathological diagnosis. Reporting followed the STROBE guidelines.Results: The area under receiver operating characteristic curve (AUROC) of diagnosing EGC in the sedated group was 0.97 (95% CI: 0.95 to 0.99), which was higher than that in the un-sedated group (0.88 (95% CI: 0.80 to 0.97), P =0.0407). CLE with sedation performed better than without sedation in diagnosing intraepithelial neoplasia and intestinal metaplasia (P =0.0008 and P =0.0001, respectively). Conclusion: Propofol based sedation was associated with improved diagnostic value of CLE for detecting EGC as well as precancerous lesions (intraepithelial neoplasia OR intestinal metaplasia).
Genomic Context of the Two Integrons of ST-111 Pseudomonas aeruginosa AG1: A VIM-2-carrying Old-acquaintance and a Novel Imp-18-carrying Integron
Authors: Molina-Mora Jose Arturo , Chinchilla-Montero Diana , Batán Raquel García , García Fernando
Published: December 2020

Pseudomonas aeruginosa is an opportunist and versatile organism responsible for infections mainly in immunocompromised hosts. This pathogen has high intrinsic resistance to most antimicrobials. P. aeruginosa AG1 (PaeAG1) is a Costa Rican high-risk ST-111 strain with resistance to multiple antibiotics, including carbapenems, due to the activity of VIM-2 and IMP-18 metallo-β-lactamases (MBLs). These genes are harbored in two class 1 integrons located inone out of the 57 PaeAG1 genomic islands. However, the genomic context associated to these determinants in PaeAG1 and other P. aeruginosa strains is unclear. Thus, we first assessed the transcriptional activity of VIM-2 and IMP-18 genes when exposed to imipenem (a carbapenem) by RT-qPCR. To select related genomes to PaeAG1, we implemented a pan-genome analysis to define and up-date the phylogenetic relationship among complete P. aeruginosa genomes. We also studied the PaeAG1 genomic islands content in the related strains and finally we described the architecture and possible evolutionary steps of the genomic regions around the VIM-2- and IMP-18-carrying integrons.Expression of VIM-2 and IMP-18 genes was demonstrated to be induced after imipenem exposure. In a subsequent comparative genomics analysis with 211 strains, the P. aeruginosa pan-genome revealed that complete genome sequences are able to separate clones by MLST profile, including a clear ST-111 cluster with PaeAG1. The PaeAG1 genomic islands were found to define a diverse presence/absence pattern among related genomes. Finally, landscape reconstruction of genomic regions showed that VIM-2-carrying integron (In59-like) is an old-acquaintance element harbored in the same known region found in other two ST-111 strains. Also, PaeAG1 has an exclusive genomic region containing a novel IMP-18-carrying integron (registered as In1666), with an arrangement never reported before. Altogether, we provide new insights about the genomic determinants associated with the resistance to carbapenems in this high-risk P. aeruginosa using comparative genomics.
Effect of a nurse-led lifestyle choice and coaching intervention on systolic blood pressure among Type 2 diabetic patients with a high atherosclerotic cardiovascular risk: study protocol for a cluster randomized trial
Authors: Lumu William , Kibirige Davis , Wesonga Ronald , Bahendeka Silver
Published: December 2020

Background:More than 50% of patients with type 2 diabetes have hypertension in Uganda. Diabetic patients with elevated systolic blood pressure experience higher all-cause mortality and cardiovascular events compared with normotensive diabetic individuals hence escalating resource utilization and cost of care.The aim of this study is to determine the effect of a nurse-led lifestyle choice and coaching intervention on systolic blood pressure among type 2 diabetic patients with a high atherosclerotic cardiovascular risk.Methods:This is a cluster-randomized study comprising of two arms (intervention and non-intervention – control arm) with four clusters per arm with 388 diabetic patients with a high predicted 10-year atherosclerotic cardiovascular risk. The study will be implemented in 8 health facilities in Uganda. The intervention arm will employ a nurse-led lifestyle choice and coaching intervention. Within the intervention, nurses will be trained to provide structured health education, protocol-based hypertension management and general atherosclerotic cardiovascular risk factor management, 24-hour phone calls, and 2-monthly text messaging. The control group will be constituted by the usual care. The primary outcome measure is the mean difference in systolic blood pressure between the intervention and usual care groups after 6 months. The study is designed to have an 80% statistical power to detect an 8.5mmhg mean reduction in systolic blood pressure from baseline to 6 months.The unit of analysis for the primary outcome is the individual participants. To monitor the effect of within-cluster correlation, generalized estimating equations will be used to assess changes over time in systolic blood pressure as a continuous variable.DiscussionThe data generated from this trial will inform change in policy of shifting task of screening of hypertension and atherosclerotic cardiovascular disease from doctors to nursesTrial registration: Pan African Trials Registry; PACTR 202001916873358. Registered on 6th October 2019.
The effects of BMMSC treatment on Lung tissue degeneration in elderly macaques
Authors: Yang Yukun , Li Ye , Wang Yanying , Ruan Guangping , Tian Chuan , Wang Qiang , He Huanyu , Zhu Gaohong , Fang Dong , Wang Mao , ZHU Xiangqing , Pan Xinghua
Published: December 2020

Background: Age-associated lung tissue degeneration is a risk factor for lung injury and exacerbated lung disease. It is also the main risk factor for chronic lung diseases (such as COPD, idiopathic pulmonary fibrosis, cancer, among others).So, it is particularly important to find new anti-aging treatments.Methods: We systematically screened and evaluated elderly senile multiple organ dysfunction macaque models to determine whether BMMSCs inhibited lung tissue degeneration.Results: The average alveolar area, Mean linear intercept（MLI）and fibrosis area in the elderly macaque models were significantly larger than in young rhesus monkeys (p <0.05), while the capillary density around the alveoli was significantly low than in young macaque models (p<0.05). Intravenous infusion of BMMSCs reduced the degree of pulmonary fibrosis, increased the density of capillaries around the alveoli (p <0.05), and the number of type Ⅱ alveolar epithelium in elderly macaques (p <0.05). In addition, the infusion reduced lung tissue ROS levels, systemic and lung tissue inflammatory levels and Treg cell ratio in elderly macaque models（p<0.05）. Indirect co-cultivation revealed that BMMSCs suppressed the expression of senescence-associated genes, ROS levels, apoptosis rate of aging type Ⅱ alveolar epithelial cells (A549 cells) and enhanced their proliferation (p<0.05).Conclusions: BMMSC treatment inhibited age-associated lung tissue degeneration.