bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of sample size on the stability of risk scores from clinical prediction models: a case study in cardiovascular disease
Authors: Pate Alexander , Emsley Richard , Sperrin Matthew , Martin Glen P. , Staa Tjeerd van
Published: February 2020

Background Stability of risk estimates from prediction models may be highly dependent on the sample size of the dataset available for model derivation. In this paper, we evaluate the stability of cardiovascular disease risk scores for individual patients when using different sample sizes for model derivation; such sample sizes include those similar to models recommended in national guidelines, and those based on recently published sample size formula for prediction models. Methods We mimicked the process of sampling N patients from a population to develop a risk prediction model by sampling patients from the Clinical Practice Research Datalink. A cardiovascular disease risk prediction model was developed on this sample and used to generate risk scores for an independent cohort of patients. This process was repeated 1000 times, giving a distribution of risks for each patient. N = 100 000, 50 000, 10 000 and N min (derived from sample size formula) were considered. The 2.5 – 97.5 percentile range of risks across these models was used to evaluate instability. Patients were grouped by a risk derived from a model developed on the entire population (population derived risk) to summarise results. Results For a sample size of 10 000, the median 2.5 – 97.5 percentile range of risks for patients across the 1000 models was approximately 60% of their population derived risk. For example, for patients with a population derived risk of 9 - 10% or 19 - 20%, the median percentile range was 6.25% and 12.59% respectively. Using the formula derived sample size, the range was approximately 170% of their average risk score. Restricting this analysis to models with high discrimination or good calibration reduced the percentile range, but high levels of instability remained. Conclusions Widely used cardiovascular disease risk prediction models suffer from high levels of instability induced by sampling variation. Stability of risk estimates should be a criterion when determining the minimum sample size to develop models.
Molecular Characteristics and Antimicrobial Susceptibility Profile of Pseudomonas aeruginosa isolated from patients attending Healthcare Facilities in Mthatha, South Africa
Authors: Hosu Mojisola C. , Vasaikar Sandeep D. , Okuthe Grace E. , apalata teke
Published: February 2020

Background Pseudomonas aeruginosa is a common pathogen causing healthcare-associated infections most especially in critically ill and immunocompromised patients. This pathogen poses a public health threat due to its innate resistance to many antimicrobial agents and its ability to acquire new resistance mechanisms under pressure. Infections with Extended spectrum β-lactamases (ESBL)-producing isolates result into outbreaks that lead to serious antibiotic management concerns with higher mortality and morbidity and significant economic causatives. In this study, we evaluated the antimicrobial resistance patterns and characterized genetically the ESBLs and Metallo- β-lactamases (MBL) produced by this pathogen. Methods Isolates of P. aeruginosa cultured from patients who attended Nelson Mandela Academic Hospital and other clinics in the four district municipalities of the Eastern Cape between August 2017 and May 2019 were identified; and their antibiotic resistance patterns were tested against amikacin, aztreonam, cefepime, ceftazidime, ciprofloxacin, doripenem, gentamicin, imipenem, levofloxacin, meropenem, piperacillin, piperacillin/tazobactam and tobramycin using the bioMérieux VITEK® 2 and confirmed by Beckman autoSCAN-4 System. Real-time PCR was done using Roche Light Cycler 2.0 to detect the presence of ESBLs; blaSHV, blaTEM and blaCTX-M genes; and MBLs; blaIMP, blaVIM. Results High antibiotic resistance in decreasing order was observed in piperacillin (64.2%), aztreonam (57.8%), cefepime (51.5%), ceftazidime (51.0%), piperacillin/tazobactam (50.5%), and imipenem (46.6%). A total of 75 (36.8%) multidrug resistant (MDR) isolates were observed of the total pool of isolates. The blaTEM, blaSHV and blaCTX-M was detected in 79.3%, 69.5% and 31.7% isolates (n=82), respectively. The blaIMP was detected in 1.25% while no blaVIM was detected in any of the isolates tested. Conclusions The study showed a high rate of MDR P. aeruginosa in our setting. The vast majority of these resistant isolates carried blaTEM and blaSHV genes. Continuous monitoring of antimicrobial resistance and strict compliance towards infection prevention and control practices are the best defence against spread of MDR P. aeruginosa.
Prediction key genes and the potential molecular mechanism for early recurrent pregnancy loss by Multi-Omics analysis
Authors: Huang Le , Wei Changqiang , Zhang Zhao , Cen Jiao , Zhu Zhiwei , Deng Lingjie , Pang Lihong
Published: February 2020

Background: The potential mechanism of early recurrent pregnancy loss (ERPL) has not been fully elucidated, a multi-omics analysis can help us find key genes.Results: We download data from Gene Expression Omnibus (GEO), 90 hypermethylation-down regulated genes and 49 hypomethylation-up regulated genes were identified by intersection. Compared with the normal early pregnancy group, the expression of ERCC2 and MLH1 was lower in ERPL group, but the expression of PLEK and FOS was higher, and the expression of MLH1 was statistically significant (p<0.05). Compared with the anembryonic (empty sac) miscarriage group, the expression of MLH1, PLEK, FOS decreased, and that of ERCC2 increased in the embryonic miscarriage group. TF-MDEGs networks predicted SP1, POLR2A, YY1, CREM and CREB1 were involved in methylation regulation of DNA promoter with MDEGs. Among them, YY1, FOXP3 and p53 may be related to the mechanism of MLH1 in ERPL.Conclusions: Our study identified possible aberrant MDEGs, and TF- MDEGs regulatory networks may be related to its mechanism. MLH1 may play an important role in early embryonic development.
A single mutation in ACTR8 gene results in lineage-specific expression in primates
Authors: Choe Se-Hee , Park Sang-je , Cho Hyeon-Mu , Park Hye-Ri , Lee Ja-Rang , Kim Young-Hyun , Huh Jae-Won
Published: February 2020

Background: Alternative splicing (AS) generate various transcripts from a single gene and thus plays a significant role in transcriptomic diversity and proteomic complexity. Alu elements are primate-specific transposable elements (TEs) and can provide a donor or acceptor site for AS. In a study on TE-mediated AS, we recently identified a novel Alu Sz6-exonized ACTR8 transcript of a crab-eating monkey ( Macaca fascicularis ). In the present study, we sought to analyse the molecular mechanism of Alu Sz6-derived exonization in ACTR8 gene.Results: We performed RT-PCR and genomic PCR using the tissue RNA and DNA samples from the crab-eating monkey and various other primates, including humans, to study Alu Sz6-derived exonization in ACTR8 gene and transcript variants expression. Alu Sz6 integration was estimated to have occurred before the divergence of simians and prosimians. The novel transcript was expressed only in Old world monkeys and apes, and humans. Lineage-specific expression of ACTR8 gene was due to a ‘G’ duplication in the Alu Sz6 sequences of Old world monkey and ape lineages. Six alternative transcripts (TV1-TV6) generated by various AS mechanisms were newly identified. Based on in-silico analysis, the alternative transcripts were transcribed into new isoforms with C-terminus deletion.Conclusion: ‘G’ duplication together with TE exonization and AS via various mechanisms resulted in a different fate of ACTR8 gene expression during primate evolution.
Is the Fibula High in Children and Adolescents with Discoid Lateral Meniscus?
Authors: Jang Woo Young , Lim Chaemoon , Shin Chang Ho , Cho Tae-Joon , Choi In Ho , Yoo Won Joon
Published: February 2020

Background A high fibular location on plain radiographs has been considered suggestive of a discoid lateral meniscus (DLM). We sought to determine whether the high location of the fibular head observed in DLM patients represents a true pathologic finding. Methods Eighty-two patients with symptomatic DLM who underwent arthroscopic treatment constituted the study group (DLM group). The same number of age-matched patients without DLM (control group) were recruited. The DLM group was further divided according to the presence or absence of a knee extension block (EB) of more than 10 degrees into EB(+) and EB(-) subgroups. We defined the compensated distance to the fibular head (CDF) as the distance from the lateral joint line to the tip of the fibular head divided by the femoral condylar width. CDF values measured on anteroposterior (AP) plain radiographs and sagittal MR images were compared between the DLM and control groups and between the EB(+) and EB(-) subgroups. Results There was no significant difference in the mean preoperative CDF value on either AP plain radiographs or sagittal MR images between the DLM and control groups. However, the mean CDF value on AP plain radiographs was significantly lower in the EB(+) subgroup than in the EB(-) subgroup ( p =0.011). The knee EB disappeared in all patients after arthroscopic treatment when the CDF on AP plain radiographs showed no significant difference between subgroups ( p >0.05). Linear regression analysis revealed that the CDF on AP plain radiographs decreased significantly when knee flexion was increased from 0 to 30 degrees ( p =0.003). Conclusions The high fibular location observed on AP plain radiography in DLM patients was associated with limited knee extension. Altered X-ray beam projection to the flexed knee creates the false appearance of a high fibular location on AP plain radiography.
Cancer risk after total hip replacements. A prospective study of 41,402 patients in the Norwegian Arthroplasty Register linked to the Cancer Registry of Norway
Authors: Dybvik Eva , Furnes Ove , Havelin Leif I. , Fosså Sophie D. , Trovik Clement , Lie Stein Atle
Published: February 2020

Background Concerns have been raised that implants used in total hip replacements (THR) could lead to a future increased cancer risk. Several different materials and metals are used in joint prosthesis, as well as different fixation techniques and types of articulation for the surface of the joint can lead to an increased escape of particles or ions into the human body. Methods Patients with THR registered in the Norwegian Arthroplasty Register during 1987-2009 were linked to the Cancer registry of Norway. Patients with THR due to osteoarthritis, under the age of 75 at time of surgery, were included. Standardized incidence ratios (SIR) were applied to compare cancer risk for THR patients to the general population. Types of THR were divided into cemented (both components), uncemented (both components), and hybrid (cemented femoral and uncemented acetabular component). To account for selection mechanisms, time dependent covariates were applied in Cox-regression, adjusting for cancer risk the first 10 years after surgery. The analyses were adjusted for age, gender, and if the patient had additional THR-surgery in the same or the opposite hip. The study is according to the STROBE guidelines.Results When comparing patients with THR to the general population in Norway we found no differences in the risk. The overall SIR for the THR-patients after 10 years of follow-up was 1.02 (95% CI: 0.97-1.07). For cemented THR, the SIR after 10 years of follow-up was 0.99 (95% CI: 0.94-1.05), while it was 1.16 (95% CI: 1.02-1.30) for uncemented THRs, and 1.12 (95% CI: 0.91-1.33) for hybrid THRs. Adjusted Cox analyses showed that patients with uncemented THRs had an elevated risk of cancer (hazard ratio: HR=1.24, 95% CI: 1.05-1.46, p=0.009) when compared to patients with cemented THRs after 10 years of follow-up. The risk for patients with hybrid THRs was not significantly increased (HR=1.07, 95% CI: 0.85-1.35, p=0.55) compared to patients with cemented THRs. Conclusions We found that receiving an uncemented THR was associated with a small increased risk of cancer, in particular prostate cancer for younger men.
Ecological differentiation in Rumex crispus L. natural populations in metal mining areas
Authors: Zhang Yajing , Yang Huaju , Wang Yue , Tang Chundong , Liu Chang'e , Zhao Yonggui , Li Shiyu , Duan Changqun
Published: February 2020

Background: Variations in phenotypic traits of various plants living in either normal or stressed environments have been well studied, but ecological responses of plants to long-term persistent toxic metal pollution have little been reported. In this study, in order to explore the effects of continuous metal pollution in soil on variation and differentiation in the plants, Rumex crispus L. populations exposed to different levels of long-term persistent toxic metal pollution were studied, and corresponding R. crispus populations that had not been exposed to pollution were used as controls. Results: Six phenotypic traits of R. crispus—root diameter, leaf area, leaf length, leaf width, leaf perimeter, and leaf length-to-width ratio—differed significantly among and within populations. Traits ranked in descending order of coefficient of variation were leaf area, leaf perimeter, root diameter, leaf length, leaf width, leaf length-to-width ratio. The average coefficient of variation was 46%. Phenotypic variation in R. crispus was much greater among populations (92.69%) than within populations (6.55%). The mean phenotypic differentiation coefficient (Vst) of 93.37% indicates that the interpopulation variability was the main source of phenotypic variation in R. crispus. Finally, root diameter was significantly positively correlated with metal factors, but leaf area, leaf length, and leaf aspect ratio were significantly negatively correlated with Pb, Zn, Mn, and Fe contents. Overall, underground growth is superior to aboveground growth in populations that have experienced long-term exposure to toxic metal pollution, and there were phenotypic differences between uncontaminated and contaminated populations. Conclusions: These results indicate that R. crispus adapts to the heterogeneous environment caused by toxic metal pollution through rich phenotypic variation, and ecological differentiation has occurred among different populations.
Temporal and spatial changes in phyllosphere microbiome of acacia trees growing in arid environments
Authors: Al-Ashhab Ashraf , Meshner Shiri , Alexander-Shani Rivka , Dimerets Hana , Brandwein Michael , Bar-Lavan Yael , Winters Gidon
Published: February 2020

Background: The evolutionary relationships between plants and their microbiome are of high importance to the survival of plants in extreme conditions. Changes in microbiome of plants can affect plant development, growth and health. Along the arid Arava, southern Israel, acacia trees ( Acacia raddiana and Acacia tortilis ) are considered keystone species. In this study, we investigated the ecological effects of plant species, microclimate (different areas within the tree canopies) and seasonality on the endophytic and epiphytic microbiome associated with these two tree species. 186 leaf samples were collected along different seasons throughout the year and their microbial communities were studied using the diversity of the 16S rDNA gene sequenced on the 150-PE Illumina sequencing platform. Results: our results showed amplifying V4 region of the 16S rDNA better presented the bacterial communities of both end and epiphytes of Acacia trees than V2, V3 and V5 regions of the 16S r DNA. When comparing the bacterial diversity of endo and epiphytes of the two acacia trees (shannon, choa1, PD and observed number of OTU’s), the epiphytes diversity indices showed about twice higher diversity compared to endophytes. The bacterial community compositions comparing both end and epiphytes were also significantly different. Interestingly, Acacia tortilis (umbral canopy shape) had a higher epiphytes bacterial diversity compared to Acacia raddiana, but were not statistically different. However the endophyte bacterial communities were significantly different compared to the two Acacia species (Firmicutes dominated Acacia raddiana and Proteobacteria dominated the Acacia tortilis ) . Alongside the biotic factor, Abiotic factors such as air temperature and precipitation also showed to significantly effect endo and epiphytes bacterial communities, while air humidity only affected the epiphytes bacterial communities.Conclusions: These results shed light on the unique desert phyllosphere microbiome in mitigating stress conditions highlighting the importance of epiphytic and endophytic microbial communities which are driven by different genotypic and abiotic factors. This paper also shows only a few bacteria species (OTUS’s) to dominate both epi and endophytes highlighting the importance of climate change (precipitation, Air temperature) in affecting arid land ecosystems where acacia trees are considered keystone species in many arid regions.
Self-reported Precipitating Factors for the Development of Eating Disorders in Young Adulthood: A Preliminary Study
Authors: Lenza Cassandra
Published: February 2020

Objective: This study aimed to identify the perceived precipitating factors for seeking eating disorder treatment in the Millennial population. The purpose of this study was to understand the Millennial population, and determine if self-reported causes of eating concerns are different for this age demographic than that of the general population. Method: An exploratory analysis of the charts of one hundred individuals, mainly women, who sought eating disorder treatment at an outpatient eating disorder treatment center, for the period of 2014-2018, was completed. Respondents met the age criteria and were 18-36 years old. Results: The majority of individuals reported beginning dieting behaviors or restricting their food intake as the main cause of their eating disorder (44%). Discussion: Millennial individuals are comparative to the general public when self-reporting precipitating events that lead to the development of an eating disorder. Risk factors inherent to eating disorders, such as early dieting, body dissatisfaction, anxiety, and depression remain the same for this population.
A predict model to evaluate the HbeAg-positive of Chronic Hepatitis B in clinic: a cross-sectional study
Authors: Zheng Jinli , Zhu Yunfeng , Jiang Li
Published: February 2020

Background: The previous studies showed the correlation between HBsAg and serum HBV DNA levels were weak or missing. Objective：The study aims to investigate the correlation between HBeAg and HBV DNA levels, and to find an alternative tool to evaluate the HBV DNA level for clinicians. Methods: We enrolled 1020 patients in this cross-sectional study. We divided the patients into four groups as: HBeAg positivity and negativity groups, high and low HBV DNA levels groups. Further, as to the levels of HBV DNA, we performed subgroups’ in HBeAg-positive and HBeAg-negative groups. Results: Results showed that the ALT, ALB and HBeAg are independent factors to estimate the serum HBV DNA in CHB patients. When the level of HBeAg is higher than 16.15 S/CO, predicting the patient with high levels of HBV DNA and 4 folds to have the high levels of HBV DNA than the HBeAg-negativ. The levels of ALT and TB are the independent risk factors in HBeAg-negative group. Conclusion: HBeAg is an independent factor that reflects the levels of serum HBV DNA with a strong correlation, and we draw a predict model to evaluate the HBV DNA levels as: Y1 (high HBV DNA levels) = 1.412 × (1 for HBeAg-positive >16.15 S/CO or 0 for others) + 0.004 × (1 for ALT > 42.5 U/L or 0 for others) −0.029 × (1 for ALB > 25.5 g/L or 0 for others) + 0.779. For the patients with HBeAg(-), we should evaluate by the levels of ALT and TB, and the predict model is:Y2 (low levels of HBV DNA) = 0.385 − 0.005 × (1 for ALT > 36.5 IU/L or 0 for others) − 0.006 × (1 for TB > 11.15 umol/L or 0 for others).
Inequalities in participation and time spent in moderate-to-vigorous physical activity: analysis using the Health Surveys for England 2008, 2012, and 2016
Authors: Scholes Shaun , Mindell Jennifer S
Published: March 2020

Background
Evidence is unclear on whether inequalities in average levels of moderate-to-vigorous physical activity (MVPA) reflect differences in participation, differences in the amount of time spent active, or both. Using self-reported data from 24,882 adults (Health Survey for England 2008, 2012, 2016), we examined gender-specific inequalities in these separate aspects for total and domain-specific MVPA.
Methods
Hurdle models accommodate continuous data with excess zeros and positive skewness. Such models were used to assess differences between income groups in three aspects: (1) the probability of doing any MVPA, (2) the average hours/week spent in MVPA, and (3) the average hours/week spent in MVPA conditional on participation (MVPA-active). Absolute inequalities were summarised using average marginal effects (AMEs) after confounder adjustment.
Results
Inequalities were robust to adjustment in each aspect for total MVPA and for sports/exercise. Differences between adults in high-income versus low-income households in sports/exercise MVPA were 2.2 hours/week among men (95% confidence interval (CI): 1.6, 2.8) and 1.7 hours/week among women (95% CI: 1.3, 2.1); differences in sports/exercise MVPA-active were 1.3 hours/week (95% CI: 0.4, 2.1) and 1.0 hours/week (95% CI: 0.5, 1.6) for men and women, respectively. Heterogeneity in associations was evident for the other domains. For example, adults in high-income versus low-income households were more likely to do any walking (men: 13.0% (95% CI: 10.3, 15.8%); women: 10.2% (95% CI: 7.6, 12.8%)). Among all adults (including those who did no walking), the average hours/week spent walking showed no difference by income. Among those who did any walking, adults in high-income versus low-income households walked on average 1 hour/week less (men: -0.9 hours/week (95% CI: -1.7, -0.2); women: -1.0 hours/week (95% CI: -1.7, -0.2)).
Conclusions
Participation and the amount of time spent in MVPA typically favours those in high-income households. Monitoring inequalities requires assessing different aspects of the distribution within each domain. Reducing inequalities in sports/exercise requires policy actions and interventions to move adults in low-income households from inactivity to activity, and to enable those already active to do more. Measures to promote walking should focus efforts on reducing the sizeable income gap in the propensity to do any walking.
Description of Pharmacists’ Reported Interventions to Prevent Prescribing Errors among in Hospital Inpatients: A Cross Sectional Retrospective Study
Authors: Alzahrani Abdulhakim , Alwhaibi Monira , Asiri Yousif , Kamal Khalid , Alhawassi Tariq
Published: March 2020

Background: Prescribing errors (PEs) are a common cause of morbidity and mortality, both in community practice and in hospitals. Pharmacists have an essential role in minimizing and preventing PEs, thus, there is a need to document the nature of pharmacists’ interventions in preventing PEs. The purpose of this study was to describe reported interventions conducted by pharmacists that to prevent or minimize PEs in a tertiary care hospital. Methods: A retrospective analysis of the electronic medical records data was conducted to identify pharmacists’ interventions related to reported PEs. The PE-related data was extracted for a period of six-month (April to September 2017) and comprised of patient demographics, medication-related information, and the different interventions by the pharmacists. The study was conducted in a tertiary care hospital in Riyadh region. The study was ethically reviewed and approved by the hospital IRB committee. Descriptive analyses were appropriately conducted using the IBM SPSS Statistics. Results: A total of 2,564 pharmacists’ interventions related to PEs were recorded. These interventions were reported in 1,565 patients. Wrong dose (54.3%) and unauthorized prescription (21.9%) were the most commonly encountered PEs. Anti-infectives for systemic use (49.2%) and alimentary tract and metabolism (18.2%) were the two most common medications, which involved PEs. Most commonly reported pharmacists’ interventions included dose adjustments (44.0%), restricted medication approvals (21.9%), and therapeutic duplications (11%). Conclusions: PEs occur commonly in hospitals and pharmacists’ interventions are critical is preventing possible harm to patients. Care coordination and prioritizing patient safety through quality improvement initiatives at all levels of the health care system can play a key role in this quality improvement drive. Future studies should evaluate the impact of pharmacists’ interventions on patient outcomes.
Costs and Effectiveness of a Culturally Tailored Communication Training Program to Increase Cultural Competence Among Multi-Disciplinary Care Management Teams
Authors: Parker Brenda Marie , Fang Xiangming , Bradlyn Andrew S
Published: March 2020

Background. Several studies have demonstrated that cultural competence improves patient-provider communication, which promotes adherence to established care plans and improves patient satisfaction and health outcomes. However, there is very little data available regarding the costs associated with the development and implementation of cultural competence training, or the cost-effectiveness of these programs. To that end, this evaluation aims to describe programmatic effectiveness, cost, and cost-effectiveness of a culturally tailored communication training program to improve cultural competence among multi-disciplinary care management teams.Methods. As part of a region-wide quality improvement initiative to reduce healthcare disparities among African American patients with uncontrolled hypertension, three multi-disciplinary care management teams were invited to participate in a two-part communication training program. A paired samples t-test was used to assess program effectiveness based on participant responses to a validated cultural competence self-assessment survey two weeks before and after the training program. A micro-costing approach was used to estimate programmatic costs for content development and delivery. Cost-effectiveness was then determined using the average cost-effectiveness ratio, and sensitivity analyses were conducted to assess the impact of participant mix on this result.Results. All scores (n=17) improved after training; however, only the culturally competent behaviors (CCB) subscale change was statistically significant (p=0.02). Overall program costs were $5,754.19. The average program cost per participant was $138.51, with an ACER of $337.83 per 1-unit increase in CCB score. Sensitivity analyses yielded a range of ACERs between $122.59 and $457.07, where all participants are support staff and nurses, respectively.Conclusions. Culturally tailored communication training increases how frequently participants demonstrate culturally competent behaviors and may be a cost-effective intervention for care management teams to address individual cultural competence. Detailed costs associated with cultural competence training are largely unavailable in the literature; as such, these data may serve as a financial framework for organizations considering the implementation of similar programs.
Relationship of Breastfeeding Duration with Joint Pain and Knee Osteoarthritis in Middle-aged Korean Women: A Cross-sectional Study using the Korea National Health and Nutrition Examination Survey
Authors: Kim Min-Young , Kim Hyun-Joong , Noh Je-Heon , Kim Sun-A , Hwang Deok-Sang , Lee Chang-Hoon , Ha In-Hyuk
Published: March 2020

Background The effect of joint health on quality of life in middle-aged and older women is becoming more widely recognized with the aging of the world’s population. However, the association of long-term breastfeeding with joint pain and knee osteoarthritis has not been fully examined. The aim of this study was to determine the association of long-term breastfeeding with joint pain and knee osteoarthritis in middle-aged Korean women. Methods A cross-sectional study was conducted among 3,454 women aged ≥50 years who underwent knee radiography and answered a questionnaire on breastfeeding and joint pain for the 5 th Korean National Health and Nutrition Examination Survey (2010–2011). After adjusting for confounding sociodemographic, medical history, and obstetric and gynecologic variables, logistic regression analysis was conducted to analyze the incidence of joint pain and knee osteoarthritis according to breastfeeding and its duration. Among the 3,454 participants, 298 had not breastfed and 1,042, 815, and 1,299 had breastfed for 1–24, 25–48, and ≥49 months, respectively. Of all participants, 1,731 had joint pain and 739 were diagnosed with knee osteoarthritis after radiography. Results The odds ratio (OR) for joint pain among women who breastfed was 1.493 times higher than that among women who did not (p=0.044). As breastfeeding duration increased, the OR of joint pain incidence also increased (p for trend; p=0.002). For knee osteoarthritis, the OR was significantly different between the 25–48 and ≥49 months groups (2.299 [p=0.03] and 2.166 [p=0.047], respectively). Reanalysis after selecting only participants aged ≥60 years showed that the prevalence of joint pain and knee osteoarthritis was more positively correlated with extended breastfeeding duration (joint pain, p for trend; p=0.005) (knee osteoarthritis, p for trend; p=0.012). Conclusions Long-term feeding of more than 25 months was associated with an increased prevalence of arthralgia and degenerative arthritis after menopause in Korean elderly women.
Spatio-temporal impact of self-financed Rotavirus vaccination on Rotavirus and acute gastroenteritis hospitalisations in the Valencia Region, Spain
Authors: López-Lacort Mónica , Orrico-Sánchez Alejandro , Martínez-Beneito Miguel Ángel , Muñoz-Quiles Cintia , Díez-Domingo Javier
Published: March 2020

Background Several studies have shown a substantial impact of Rotavirus (RV) vaccination on the burden of RV and all-cause acute gastroenteritis (AGE). However, the results of most impact studies could be confused by a dynamic and complex space-time process. Therefore, there is a need to analyse the impact of RV vaccination on RV and AGE hospitalisations in a space-time framework to detect geographical-time patterns while avoiding the potential confusion caused by population inequalities in the impact estimations. Methods A retrospective population-based study using real-world data from the Valencia Region was performed among children aged less than 3 years old in the period 2005-2016. A Bayesian spatio-temporal model was constructed to analyse RV and AGE hospitalisations and to estimate the vaccination impact measured in averted hospitalisations. Results We found important spatio-temporal patterns in RV and AGE hospitalisations, RV vaccination coverage and in their associated adverted hospitalisations. Overall, ~1866 hospital admissions for RV were averted by RV vaccination during 2007–2016. Despite the low-medium vaccine coverage (~50%) in 2015-2016, relevant 36% and 20% reductions were estimated in RV and AGE hospitalisations respectively. Conclusions The introduction of the RV vaccines has substantially reduced the number of RV hospitalisations, averting ~1866 admissions during 2007-2016 which were space and time dependent. This study improves the methodologies commonly used to estimate the RV vaccine impact and their interpretation.
Co-regulation role of endogenous hormones and transcriptomics profiling under cold stress in Tetrastigma hemsleyanum
Authors: Peng Xin , Qiu Wenyu , Li Mingjie , Wu Hao , Chen Hongjiang , Zhang Zhongyi
Published: March 2020

Background: Tetrastigma hemsleyanum Diels et Gilg is a valuable medicinal herb, Chilling sensitivity is the dominant environmental factor limiting the artificial domestication of the plant. Hormone-related gene regulation and hormone signaling pathways in response to cold stress in T. hemsleyanum remain unknown. Results: Some key genes involved in hormones biosynthesis, such as ZEP and NCED genes of ABA biosynthesis, GA2ox, GA3ox, and GA20ox genes of GA biosynthesis, ACO genes of ET biosynthesis pathway were screened to be crucial in cold response. Consistently, the response of ABA and ABA/GA1+3 to cold stress was prior to that of GA1+3, ZR, ABA/IAA, and ABA/ZR. The increasing changes in ABA/GA1+3 turned to a steep decline with the extension of stress time, which might be one factor contributing to cold-sensitivity of T. hemsleyanum under prolonged stress. The cold tolerance of T. hemsleyanum would be enhanced by ABA but repressed by GA3 when each phytohormone was applied alone. The ABA-mediated promotion and GA-mediated repression of cold tolerance could both be attenuated by the co-application of the two phytohormones within 6h. When the biosynthesis of endogenous ABA and GA were inhibited by FLU and PAC, respectively, the effects of GA and ABA treatment were reversed partially. Conclusions: In summary, we presented the ﬁrst study of global expression patterns of hormone-regulated transcripts in T. hemsleyanum. This study suggested that GA and ABA could work antagonistically to balance the responses to cold in T. hemsleyanum. PAC, a GA biogenesis inhibitor, as well as exogenous ABA, might be potential plant growth regulators that can promote cold tolerance of T. hemsleyanum. The study also provided valuable hints in revealing a new theoretical basis and potential candidate genes that govern cold tolerance of T. hemsleyanum.
Whole genome resequencing reveals an association of ABCC4 variants with preaxial polydactyly in pigs
Authors: Ma Cheng , Khederzadeh Saber , Adeola Adeniyi C. , Han Xu-Man , Xie Hai-Bing , Zhang Ya-Ping
Published: March 2020

Background: Polydactyly is one of the most common congenital limb dysplasia in many animal species. Although preaxial polydactyly (PPD) has been comprehensively studied in humans as a common abnormality, the genetic variations in other animals have not been fully understood. Herein, we focused on the pig, as an even-toed ungulate mammal model with its unique advantages in medical and genetic researches, two PPD families consisting of four affected and 20 normal individuals were sequenced.Results: Our results showed that the PPD in the sampled pigs were not related to the variants reported in earlier studies. A strong association was identified at ABCC4 and it encodes a transmembrane protein involved in ciliogenesis. We found that the affected and normal individuals were highly differentiated at ABCC4, and all the PPD individuals shared long haplotype stretches as compared with the unaffected individuals. A highly differentiated missense mutation (I85T) in ABCC4 was observed at a residue from a transmembrane domain highly conserved among a variety of organisms.Conclusions: This study reports ABCC4 as a new candidate gene for PPD in pigs and identifies a missense mutation. Our results illustrate a putative role of ciliogenesis process in PPD, coinciding with an earlier observation of ciliogenesis abnormality resulting in pseudo-thumb development in pandas. These results expand our knowledge on the genetic variations underlying PPD in animals.
Maternal Morbidity and Co-morbidity During and After Pregnancy in Women in Low- and Middle-Income Countries: A Systematic Literature Review
Authors: McCauley Mary , Zafar Shamsa , Broek Nynke van den
Published: March 2020

BackgroundFor every maternal death, it is estimated that 20 or 30 women have morbidity related to pregnancy or childbirth. The majority of this burden of disease is in women living in low and middle income countries. Maternal morbidity includes physical, psychological and social ill-health. There is limited data on the strength of association between these co-morbidities. In order to address all health needs that a woman may have when attending for maternity care, it is important to be able to identify all types of co-morbidities and understand how each co-morbidity influences other aspects of a woman’s health and wellbeing during and after pregnancy.MethodsWe systematically reviewed published literature, in English, describing measurement of two or more types of maternal morbidity, and/or associations between co-morbidities, during or after pregnancy and childbirth for women living in low- and middle-income countries. CINAHL plus, Global Health, Medline and Web of Science databases were searched from 2007-2018. Outcomes were descriptions, occurrence of maternal co-morbidities, and associations between these co-morbidities. Narrative analysis was conducted.Results38 papers reporting on 36 studies were included (71,229 women; 60,911 during and 10,318 after pregnancy from 17 countries). The majority of studies (26/36) were cross-sectional surveys. Self-reported physical ill-health was documented in 26 studies but there was no standardised data collection tool used. In total, physical morbidity was included in 28 studies; psychological morbidity in 32 studies and social morbidity in 27 studies; with 3 studies assessing association between all three types of morbidity and 30 studies assessing association between two types of morbidity. In four studies, clinical examination and/or basic laboratory investigations were also conducted. There is reported association between physical and psychological morbidity (four studies); and association between psychological and social morbidity (six studies). Domestic violence increases risk of physical ill-health (two studies).ConclusionsThere is a lack of standardised, comprehensive and routine measurements and tools used to assess the burden maternal morbidity and co-morbidity in women during and after pregnancy. There is emerging data to suggest strong associations between the different types of morbidity.
A Review of Multi-dimensional Diagnosis of Alport Syndrome in 22 Children in Northeast China
Authors: Zhang Li , Sun Bai-chao , Zhao Bing-gang , Ma Qing-shan
Published: March 2020

Background Alport syndrome (AS) is progressive hereditary nephritis due to different gene mutations. Affected individuals usually develop hematuria during childhood with gradual deterioration of renal functions. We adopted multi-dimensional methods to diagnose Alport syndrome in order to decrease the misdiagnosis.Methods Twenty-two children were diagnosed and managed by the Department of Pediatric Nephrology of Jilin University First Hospital between January 2017 and January 2020 through multi-dimensional methods. Information collected included age of onset, age at diagnosis, clinical manifestations, family history (FH), renal pathology and their genotype. Results All patients presented with hematuria with various degrees of proteinuria in partial patients. While three children suffered from hearing loss, none of the children in the cohort had any visual problem or renal failure. Besides five patients estimated as Stage 2, the remain seventeen cases were at Stage 0. Renal biopsy were obtained in eighteen patients and fourteen of them showed glomerular basement membranes (GBM)-specific abnormalities. Thirteen children had mutations of the collagen IV genes.Conclusion Combined with the importance of early diagnosis and economic factors, we adopted multi-dimensional methods to diagnose Alport syndrome and estimate the risk of progression. We also reviewed the therapy progress.
Examining Innovation in Hospital Units: A Complex Adaptive Systems Approach
Authors: Glover Wiljeana , Nissinboim Noa , Naveh Eitan
Published: March 2020

Background: Health innovation has been dominant in the pharmaceutical, biomedical, and to some extent insurance institutions for quite some time. Now we are in an innovation age for healthcare delivery. Some note that the complexity of healthcare delivery may make innovation in this setting more difficult and may require more adaptive solutions. The aim of this study is to examine the relationship between departmental complexity and innovation, using a complex adaptive systems approach in a hospital setting. Methods: We conducted a quantitative study of 31 hospital units within one hospital and use complex adaptive systems (CAS) theory to examine how two CAS factors, autonomy and performance orientation, moderate the relationship between departmental complexity and innovation. Results: We find that departmental complexity is associated with higher innovation performance when autonomy is low rather than high. We also find that departmental complexity is associated with higher innovation performance when performance orientation is high rather than low. Our findings make three distinct contributions: we quantify the influence of complexity on innovation success in the health care sector, we examine the impact of autonomy on innovation in health care, and we are the first to examine performance orientation on innovation in health care. Conclusions: This study tackles the long debate about the influence of complexity on healthcare delivery, particularly innovation. Instead of being subject to the influence of complexity with no means of making progress or gaining control, hospitals looking to implement innovation programs should provide guidance to teams and departments regarding the type of innovation sought and provide support in terms of time and management commitment. Hospitals should also find ways to promote and make successful pilot implementations of such innovations visible in the organization. A close connection between the targeted innovation and the overall success and performance of the hospital unit is ideal.
Developing and implementing guidelines on culturally adapting cognitive tests: A qualitative illustration with the Addenbrooke’s Cognitive Examination Version III (ACE-III)
Authors: Waheed Waquas , Mirza Nadine , Waheed Muhammed Wali , Malik Abid , Panagioti Maria
Published: March 2020

Background: We aimed to devise a methodology on developing and implementing guidelines for culturally adapting any cognitive test. We demonstrated this through developing guidelines for culturally adapting the Addenbrooke’s Cognitive Examination Version III (ACE-III) and utilising them to develop an ACE-III Urdu for a British South Asian population. Methods: We had a several stage qualitative study. We collated information from our systematic review on the translation and cultural adaptation of the ACE-III and its predecessors, and feedback from previous adaptors of the ACE-III to identify steps for cultural adaptation. We formatted these into question-by-question guidelines. These guidelines were used with feedback from focus groups with cognitively healthy older British South Asians and a consensus meeting with relevant experts, to develop an ACE-III Urdu. Results: Our systematic review found 32 adaptations and we received feedback from seven adaptors to develop guidelines for culturally adapting the ACE-III. Through the use of these guidelines, two focus groups with 12 participants, and a consensus meeting of two psychiatrists with a South Asian background and familiarity with cognitive assessments and cultural adaptation, the ACE-III Urdu was developed. Conclusions: We developed a set of guidelines for culturally adapting the ACE-III that can be used by future adapters for their own language or cultural context. We demonstrated how guidelines on cultural adaptation can be developed for any cognitive test and how they can be used to culturally adapt the measure.
Internet addiction mediates the association between cyber victimization and psychological and physical symptoms：moderation by physical exercise
Authors: Lin Ling , Liu Jianbo , Cao Xiaolan , Wen Siying , Xu Jianchang , Xue Zhenpeng , Lu Jianping
Published: March 2020

Background: The potential mechanisms underlying cyber victimization and the resulting psychological and physical symptoms remain unclear. Thus, the present study investigated whether Internet addiction mediates the association between peer victimization (e.g., cyberbullying) and psychological and physical symptoms. Furthermore, it was assessed whether physical exercise moderates the hypothetical mediation.Methods: 1,854 students from 11 middle and high schools in Shenzhen, Guangdong Province, China, were sampled for this study. Psychological and physical symptoms were assessed using the World Health Organization Quality of Life-BREF, while Internet addiction was evaluated using the Internet addiction test by Young. Cyber victimization was measured using a single question. In addition, this study examined whether Internet addiction mediated the association between cyber victimization and both psychological and physical symptoms. Additional work was conducted to test if physical exercise played a moderating role in the mediation hypothesized above. Mediation and moderation were analyzed using PROCESS macro for SPSS.Results: Regression analysis showed that both cyber victimization (β = -0.102, p < 0.05) and Internet addiction (β = -0.278, p < 0.05) significantly predicted psychological and physical symptoms and demographic variables were controlled. Further mediation analysis suggested that Internet addiction mediated the relationship between cyber victimization and psychological and physical symptoms. The 95% confidence interval of the direct effect was (-4.283, -1.696) and the indirect effect (­–1.904, -0.820), respectively, excluding zero. Finally, moderation analysis indicated that physical exercise moderated the relationship between Internet addiction and psychological and physical symptoms (p = 0.047).Conclusions: Internet addiction plays a mediating role in the association between cyber victimization and both psychological and physical symptoms, Thus, addressing Internet addiction among cyberbullying victims is worthwhile. Furthermore, physical exercise alleviates negative impacts on health and should thus be promoted.
Factors And Predictors Of Length Of Stay In Offenders Diagnosed With Schizophrenia- A Machine-learning-based Approach
Authors: Kirchebner Johannes , Günther Moritz , King Alice , Lau Steffen
Published: March 2020

Background Prolonged forensic psychiatric hospitalizations have raised ethical, economic, and clinical concerns. Due to the confounded nature of factors affecting length of stay of psychiatric offender patients, prior research has called for the application of a new statistical methodology better accommodating this data structure. The present study seeks to examine factors responsible for prolonged detentions of schizophrenic offenders referred to a Swiss forensic hospital using machine learning algorithms more apt to reveal non-linear interdependencies between variables.Methods In this retrospective file and registry study, multidisciplinary notes of 143 schizophrenic delinquents were reviewed by using a structured protocol on patients’ characteristics, criminal and medical history and course of treatment. Via a forward selection procedure, the most influential predictors for length of stay were preselected. Machine learning algorithms identified the most efficient model for predicting length-of-stay.Results/ Conclusions Ten factors prolonging forensic hospitalization were identified: Six were related to aspects of the index offence (index offence, number of crimes, extend of injury to the victim of the offence), two were related to psychopathology at admission or even prior to that (hallucinations in psychiatric history), one alluded to the course of therapy (self-harming during inpatient treatment), and one referred to biographical aspects (poverty during childhood/ adolescence). Results are discussed in light of earlier reports on the subject.