bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating Relationships between Perception-Reaction Times, Emergency Deceleration Rates, and Crash Outcomes using Naturalistic Driving Data
Authors: Wood Jonathan S. , Zhang Shaohu
Published: November 2020

Perception-reaction time (PRT) and deceleration rate are two key components in geometric design of highways and streets. Combined with a design speed, they determine the minimum required stopping sight distance (SSD). Current American Association of Highway Transportation Officials (AASHTO) SSD guidance is based on 90th percentile PRT and 10th percentile deceleration rate values from experiments completed in the mid-1990s. These experiments lacked real-world distractions, and so forth. Thus, the values from these experiments may not be applicable in real-world scenarios. This research evaluated (1) differences in PRTs and deceleration rates between crash and near-crash events and (2) developed predictive models for PRT and deceleration rate that could be used for roadway design. This was accomplished using (1) genetic matching (with Rosenbaum’s sensitivity analysis) and (2) quantile regression. These methods were applied to the Strategic Highway Research Program 2 (SHRP2) Naturalistic Driving Study (NDS) data.

The analysis results indicated that there were differences in PRT and deceleration rates for crash and near-crash events. The specific estimates were that, on average, drivers involved in crash events took 0.487 s longer to react and decelerated at 0.018 g’s (0.58 ft/s2) slower than drivers in equivalent near-crashes. Prediction models were developed for use in roadway design. These models were used to develop tables comparing existing SSD design criteria with SSD criteria based on the results of the predictive models. These predicted values indicated that minimum design SSD values would increase by 10.5–129.2 ft, dependent on the design speed and SSD model used.
The Statistical Fragility of Hamstring Versus Patellar Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review of Comparative Studies
Authors: Ehlers Cooper B. , Curley Andrew J. , Fackler Nathan P. , Minhas Arjun , Chang Edward S.
Published: November 2020

Background:

Evidence-based medicine utilizes data to inform clinical decision making, despite the ability of a small number of outcome reversals to change statistical significance. P values are common measurements of statistical significance that possess inherent flaws. The inclusion of the fragility index (FI) and fragility quotient (FQ) may provide a clearer conveyance of statistical strength.

Purpose/Hypothesis:

The purpose was to examine the statistical stability of studies comparing hamstring tendon and bone–patellar tendon–bone autografts in primary single-bundle anterior cruciate ligament reconstruction with independent tunnel drilling. We hypothesized that the findings of these studies are vulnerable to a small number of outcome event reversals, often fewer than the number of patients lost to follow-up.

Study Design:

Systematic review.

Methods:

Comparative studies and randomized controlled trials (RCTs) published in 10 leading orthopaedic journals between 2000 and 2020 were analyzed. Statistical significance was defined as a P value ≤.05. FI for each outcome was determined by the number of event reversals necessary to alter significance. FQ was calculated by dividing the FI by the respective sample size.

Results:

Of the 1803 studies screened, 643 met initial search criteria, with 18 comparative studies ultimately included for analysis, 8 of which were RCTs. A total of 114 outcomes were examined. Overall, the mean (interquartile range) FI and FQ were 3.77 (2-4) and 0.040 (0.016-0.055), respectively. The FI was less than the number of patients lost to follow-up for 76.3% of outcomes.

Conclusion:

Studies examining graft choice for anterior cruciate ligament reconstruction may not be as statistically stable as previously thought. Comparative studies and RCTs are at substantial risk for statistical fragility, with few event reversals required to alter significance. The reversal of <4 outcome events in a treatment group can alter the statistical significance of a given result; this is commonly fewer than the number of patients lost to follow-up. Future comparative study analyses might consider including FI and FQ with P values in their statistical analysis.
Closure, equality or organisation: Trade union responses to EU labour migration
Authors: Afonso Alexandre , Negash Samir , Wolff Emily
Published: November 2020

This paper explores trade union strategies to protect wages in the face of EU migration after the enlargement of the European Union. We argue that unions have three instruments at their disposal to deal with the risks linked to downward wage pressure: closure through immigration control, equalisation through collective bargaining and minimum wages, and the organisation of migrant workers. Using comparative case studies of Sweden, Germany and the UK, we show how different types of power resources shape union strategies: unions with substantial organisational resources (in Sweden) relied on a large membership to pursue an equalisation strategy and expected to be able to ‘afford’ openness. German unions with low membership but access to the political system pushed for a mix of closure and equality drawing on political intervention (e.g. minimum wages). British unions, unable to pursue either, focused their efforts on organisation.
Industrial relations and migrant integration in European cities: A comparative perspective
Authors: Scalise Gemma , Burroni Luigi
Published: November 2020

Migrant inclusion in a society is a process that ultimately succeeds or fails at the local level and cities have increasingly taken a proactive stance in delivering their own policies for integration. The literature on the topic has focused particularly on the cooperation between local political institutions and civil society organizations, underestimating the key role played by social partners. This paper demonstrates the participation of social partners in the local governance of migrant integration in three European cities: Barcelona, Lyon and Gothenburg. Drawing on process tracing analysis and qualitative interviews, the article illustrates the different responses of local unions and employers’ organizations to immigration and the variety of approaches to supporting migrant integration into employment and society. The article argues that these approaches, which take place within different institutional and structural contexts, shape different patterns of migrant inclusion and allow us to explain the new and traditional ways in which social partners operate as social and political actors.
Unions and the rights of migrants in the long run
Authors: Boräng Frida , Kalm Sara , Lindvall Johannes
Published: November 2020

We use historical data on union density and new historical data on policies toward migrants to study the long-run relationship between the strength of trade unions and the social and economic rights of migrants in the Global North. In countries with strong trade unions, there was, for a long time, a widening distance between the rights of migrants and the rights of citizens, probably because the rights of citizens expanded sooner and more quickly than the rights of migrants. Over time, however, the differences between countries with strong and weak unions have diminished, and in more recent years, the ‘rights gap’ between citizens and migrants has in fact been smaller in countries with strong unions than in countries with weak unions.
Youth mental health competencies in regional general practice
Authors: Smith Oliver , Bergmann Jessica , Schall Ulrich
Published: November 2020

Objective:

General practitioners (GPs) are key health professionals for referrals to mental health specialists. Youth mental health issues are particularly challenging, requiring a competent assessment and understanding of appropriate referral pathways. We surveyed local GPs about their understanding of youth mental health problems and needs to competently look after young patients.

Methods:

GPs working in the Hunter region were contacted via email, fax and post over a 6-month period in 2019.

Results:

Seventy-five GPs participated. They reported 577 of 1698 (34%) of young people seen 2 weeks prior to being surveyed presented with a mental health problem. Predominantly, referrals were to private practice psychologists and Headspace. Almost a third (31%) reported having limited understanding of ‘at-risk mental state’ and are ‘not always comfortable’ when facing a young person with a mental health problem. Nearly all (95%) expressed interest in attending specialised training. GPs identified treatment costs, scarce access to psychiatrists and limited patient engagement as the main obstacles to help young people.

Conclusions:

Effective treatment of a mental health problem relies on early identification. GPs are seeing young people on a regular basis but don’t feel well equipped for this task and are keen to up-skill, which needs to be addressed by targeted training.
Art-making in mental health – a Fijian pilot study
Authors: Ryan Brigid , Fenner Patricia , Chang Odille , Qaloewai Sefanaia , Nabukavou Thelma , Chetty Salochana
Published: November 2020

Objective:

A pilot art-making and mental health recovery project addressed consumer and carer mental health and well-being in Suva, Fiji.

Method:

Using feedback surveys, the project evaluated initial training, and a 12-month art programme for consumers, carers and staff across several mental health services.

Results:

First person and stakeholder group reports from the project reflected broad-scale approval for the novel modality and its potential for continued application in keeping with local cultural values. A broad stakeholder base was involved in planning and participation, aligned with the values of inclusive recovery-oriented mental health service approaches.

Conclusions:

These results suggest that the programme can add value to mental health care being provided for people with a mental illness in Fiji.
Urgent Creation of a Palliative Care Team in a Small Hospital During the COVID Crisis
Authors: Martinez Nydia , Tanev Hilah , Gurevich Samuel , Davis Candilla , Cazeau Mirlande , Mehta Jinesh , Gillenwater Samantha , Daya Andrew , Rahaghi Franck
Published: November 2020

The COVID-19 pandemic created a global health emergency that has changed the practice of medicine and has shown the need for palliative care as an essential element of hospital care. In our small South Florida hospital, a palliative care service was created to support the frontline caregivers. Thanks to the hospital support, our team was formed rapidly. It consisted of 3 advanced care practitioners, a pulmonary physician with palliative care experience and the cooperation of community resources such as hospice and religious support. We were able to support patients and their families facilitating communication as visitation was not allowed. We also addressed goals of care, providing comfort care transition when appropriate, and facilitating allocation of scarce resources to patients who were most likely to benefit from them. With this article we describe a simplified framework to replicate the creation of a Palliative Care Team for other hospitals that are experiencing this need.
Transition to secondary progression in relapsing-onset multiple sclerosis: Definitions and risk factors
Authors: Iaffaldano Pietro , Lucisano Giuseppe , Patti Francesco , Brescia Morra Vincenzo , De Luca Giovanna , Lugaresi Alessandra , Zaffaroni Mauro , Inglese Matilde , Salemi Giuseppe , Cocco Eleonora , Conte Antonella , Ferraro Diana , Galgani Simonetta , Bergamaschi Roberto , Pozzilli Carlo , Salvetti Marco , Lus Giacomo , Rovaris Marco , Maniscalco Giorgia Teresa , Logullo Francesco Ottavio , Paolicelli Damiano , Achille Mariaclara , Marrazzo Giuseppina , Lovato Valeria , Comi Giancarlo , Filippi Massimo , Amato Maria Pia , Trojano Maria ,   on behalf of the Italian MS Register
Published: November 2020

Background:

No uniform criteria for a sensitive identification of the transition from relapsing–remitting multiple sclerosis (MS) to secondary-progressive multiple sclerosis (SPMS) are available.

Objective:

To compare risk factors of SPMS using two definitions: one based on the neurologist judgment (ND) and an objective data-driven algorithm (DDA).

Methods:

Relapsing-onset MS patients ( n = 19,318) were extracted from the Italian MS Registry. Risk factors for SPMS and for reaching irreversible Expanded Disability Status Scale (EDSS) 6.0, after SP transition, were estimated using multivariable Cox regression models.

Results:

SPMS identified by the DDA ( n = 2343, 12.1%) were older, more disabled and with a faster progression to severe disability ( p < 0.0001), than those identified by the ND ( n = 3868, 20.0%). In both groups, the most consistent risk factors ( p < 0.05) for SPMS were a multifocal onset, an age at onset >40 years, higher baseline EDSS score and a higher number of relapses; the most consistent protective factor was the disease-modifying therapy (DMT) exposure. DMT exposure during SP did not impact the risk of reaching irreversible EDSS 6.0.

Conclusion:

A DDA definition of SPMS identifies more aggressive progressive patients. DMT exposure reduces the risk of SPMS conversion, but it does not prevent the disability accumulation after the SP transition.
Iatrogenic Pseudoaneurysm of the Dorsalis Pedis Artery
Authors: Bender Melinda , Quercioli Jacqueline , Evans Natalie
Published: November 2020

Iatrogenic pseudoaneurysm of the dorsalis pedis artery is an extremely rare complication of ankle arthroscopy. This case is of a 26-year-old female who developed a pseudoaneurysm after ankle arthroscopy. This case study follows her through diagnosis, surgical repair, and postoperative follow-up.
Black markets: Fascist constructions of race in East African marketplace newsreels
Authors: Garvin Diana
Published: November 2020

This article investigates East African marketplace films to trace the developmental arc and varieties of Italian Fascist racism in empire. Totalling over 70 in number, these bantam adventures in souks and bazaars were among the most popular formats for 1930s newsreels purporting to document daily life in the colonies. The short documentary-style films were produced by LUCE, the cinematic arm for state-run propagandistic projects. Like many of the films produced by this larger cinematic body, marketplace newsreels cast Italian technology in starring roles. Tractors and sewing machines frame Italian as modernizing heroes. By focusing on visual and acoustic examples, the article examines the markets of propaganda through a sensory focus. Ultimately, this approach intertwines two modes of inquiry: the history of East African architecture and urbanism, and Fascist Italian empire film.
The prognostic significance of long non-coding RNAs in hepatocellular carcinoma: An updated meta-analysis
Authors: Liu Jie , Wei Yue , Wang Tao , Zhang Zhexiao , Huang Hairong , Wang Chenfei , Li Huawen , Jia Qing , Wu Hongfu , Zou Tangbin
Published: November 2020

Background:

Recently, many studies have demonstrated that long non-coding RNAs (lncRNAs) are abnormally expressed in hepatocellular carcinoma (HCC) and may serve as a potential molecular biomarker to evaluate the prognosis of hepatocellular carcinoma. Therefore, we accomplished a meta-analysis built on current studies to assess the prognostic value of lncRNAs in hepatocellular carcinoma.

Methods:

The PubMed database was carefully searched to collect all eligible studies until February 20, 2019. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) of the overall survival, relapse-free survival, and progression-free survival were calculated to evaluate the prognostic significance of lncRNAs expression in hepatocellular carcinoma using Stata12.0 software. Heterogeneity, sensitivity analysis, and publication bias were also evaluated.

Results:

The results showed that the expression level of lncRNAs was significantly correlated with clinical outcomes. Abnormally expressed lncRNAs predicted poor overall survival (HR=2.19, 95% CI: 1.99-2.42, P<0.001; I2=44.7%, P=0.005), relapse-free survival (HR=2.68, 95% CI: 1.74-4.14, P<0.001; I2=0.0%, P=0.763) and progression-free survival of hepatocellular carcinoma patients (HR=2.44, 95% CI: 1.53-3.89, P<0.001; I2=0.0%, P=0.336). Statistical significance was also noted in subgroup meta-analyses that were stratified by follow-up time, cutoff value, and quality score. Moreover, the pooled results indicated that lncRNAs expression was significantly associated with tumor size (HR=1.48, 95% CI: 1.24-1.79), tumor number (HR=1.34, 95% CI: 1.08-1.66), and tumor node metastasis stage (HR=2.10, 95% CI: 1.48-2.99), but not liver cirrhosis and tumor differentiation ( P>0.05).

Conclusions:

This meta-analysis indicates that lncRNAs are strongly associated with prognosis in hepatocellular carcinoma and may serve as a promising indicator for prognostic evaluation of patients with hepatocellular carcinoma. But larger clinical studies are needed to verify its feasibility.
Is Absolute Pitch Associated With Musical Tension Processing?
Authors: Jiang* Jun , Hai Tang , Man Dongrui , Zhou Linshu
Published: November 2020

Absolute pitch (AP) is a superior ability to identify or produce musical tones without a reference tone. Although a few studies have investigated the relationship between AP and high-level music processing such as tonality and syntactic processing, very little is known about whether AP is related to musical tension processing. To address this issue, 20 AP possessors and 20 matched non-AP possessors listened to major and minor melodies and rated the levels of perceived and felt musical tension using a continuous response digital interface dial. Results indicated that the major melodies were perceived and felt as less tense than the minor ones by AP and non-AP possessors. However, there was weak evidence for no differences between AP and non-AP possessors in the perception and experience of musical tension, suggesting that AP may be independent of the processing of musical tension. The implications of these ﬁndings are discussed.
Perception of a Black Room Seen Through a Veiling Luminance
Authors: Gilchrist Alan , S. Langer Michael
Published: November 2020

When a black room (a room painted black and filled with objects painted black) is viewed through a veiling luminance, how does it appear? Prior work on black rooms and white rooms suggests the room will appear white because mutual illumination in the high-reflectance white room lowers image contrast, and the veil also lowers image contrast. Other work reporting high lightness constancy for three-dimensional scenes viewed through a veil suggests the veil will not make the room appear lighter. Because mutual illumination also modifies the pattern of luminance gradients across the room while the veil does not, we were able to tease apart local luminance gradients from overall luminance contrast by presenting observers with a black room viewed through a veiling luminance. The room appeared white, and no veil was perceived. This suggests that lightness judgments in a room of one reflectance depend on overall luminance contrast only.
Gut-on-chip: Recreating human intestine in vitro
Authors: Xiang Yunqing , Wen Hui , Yu Yue , Li Mingqiang , Fu Xiongfei , Huang Shuqiang
Published: November 2020

The human gut is important for food digestion and absorption, as well as a venue for a large number of microorganisms that coexist with the host. Although numerous in vitro models have been proposed to study intestinal pathology or interactions between intestinal microbes and host, they are far from recapitulating the real intestinal microenvironment in vivo. To assist researchers in further understanding gut physiology, the intestinal microbiome, and disease processes, a novel technology primarily based on microfluidics and cell biology, called “gut-on-chip,” was developed to simulate the structure, function, and microenvironment of the human gut. In this review, we first introduce various types of gut-on-chip systems, then highlight their applications in drug pharmacokinetics, host–gut microbiota crosstalk, and nutrition metabolism. Finally, we discuss challenges in this field and prospects for better understanding interactions between intestinal flora and human hosts, and then provide guidance for clinical treatment of related diseases.
Endoscopic band ligation compared to thermal therapy for gastric antral vascular ectasia: A systematic review and meta‐analysis
Authors: Chalhoub Jean M. , Umar Jalaluddin , Groudan Kevin , Hamadeh Nour , Desilets David J. , Greeff Yesenia
Published: November 2020

Background

Gastric antral vascular ectasia is an infrequent cause of gastrointestinal‐related blood loss manifesting as iron‐deficiency anemia or overt gastrointestinal bleeding, and is associated with increased healthcare burdens. Endoscopic therapy of gastric antral vascular ectasia most commonly involves endoscopic thermal therapy. Endoscopic band ligation has been studied as an alternative therapy with promising results in gastric antral vascular ectasia.

Aims

The primary aim was to compare the efficacy of endoscopic band ligation and endoscopic thermal therapy by argon plasma coagulation for the management of bleeding gastric antral vascular ectasia in terms of the mean post‐procedural transfusion requirements and the mean hemoglobin level change. Secondary outcomes included a comparison of the number of sessions needed for cessation of bleeding, the change in transfusion requirements, and the adverse events rate.

Methods

PubMed, Medline, SCOPUS, Google Scholar, and the Cochrane Controlled Trials Register were reviewed. Randomized controlled clinical trials and retrospective studies comparing endoscopic band ligation and endoscopic thermal therapy in bleeding gastric antral vascular ectasia, with a follow‐up period of at least 6 months, were included. Statistical analysis was done using Review Manager.

Results

Our search yielded 516 papers. After removing duplicates and studies not fitting the criteria of selection, five studies including 207 patients were selected for analysis. Over a follow‐up period of at least 6 months, patients treated with endoscopic band ligation had significantly lower post‐procedural transfusion requirements (MD −2.10; 95% confidence interval (−2.42 to −1.77)) and a significantly higher change in the mean hemoglobin with endoscopic band ligation versus endoscopic thermal therapy (MD 0.92; 95% confidence interval [0.39–1.45]). Endoscopic band ligation led to a fewer number of required sessions (MD −1.15; 95% confidence interval [−2.30 to −0.01]) and a more pronounced change in transfusion requirements (MD −3.26; 95% confidence interval [−4.84 to −1.68]). There was no difference in adverse events.

Conclusion

Results should be interpreted cautiously due to the limited literature concerning the management of gastric antral vascular ectasia. Compared to endoscopic thermal therapy, endoscopic band ligation for the management of bleeding gastric antral vascular ectasia led to significantly lower transfusion requirements, showed a trend toward more remarkable post‐procedural hemoglobin elevation, and a fewer number of procedures. Endoscopic band ligation may improve outcomes and lead to decreased healthcare burden and costs.
Feasibility and Assessment of a Machine Learning-Based Predictive Model of Outcome After Lumbar Decompression Surgery
Authors: André Arthur , Peyrou Bruno , Carpentier Alexandre , Vignaux Jean-Jacques
Published: November 2020

Study design:

Retrospective study at a unique center.

Objective:

The aim of this study is twofold, to develop a virtual patients model for lumbar decompression surgery and to evaluate the precision of an artificial neural network (ANN) model designed to accurately predict the clinical outcomes of lumbar decompression surgery.

Methods:

We performed a retrospective study of complete Electronic Health Records (EHR) to identify potential unfavorable criteria for spine surgery (predictors). A cohort of synthetics EHR was created to classify patients by surgical success (green zone) or partial failure (orange zone) using an Artificial Neural Network which screens all the available predictors.

Results:

In the actual cohort, we included 60 patients, with complete EHR allowing efficient analysis, 26 patients were in the orange zone (43.4%) and 34 were in the green zone (56.6%). The average positive criteria amount for actual patients was 8.62 for the green zone (SD+/- 3.09) and 10.92 for the orange zone (SD 3.38). The classifier (a neural network) was trained using 10,000 virtual patients and 2000 virtual patients were used for test purposes. The 12,000 virtual patients were generated from the 60 EHR, of which half were in the green zone and half in the orange zone. The model showed an accuracy of 72% and a ROC score of 0.78. The sensitivity was 0.885 and the specificity 0.59.

Conclusion:

Our method can be used to predict a favorable patient to have lumbar decompression surgery. However, there is still a need to further develop its ability to analyze patients in the “failure of treatment” zone to offer precise management of patient health before spinal surgery.
A city-scale assessment of emergency response accessibility to vulnerable populations and facilities under normal and pluvial flood conditions for Shanghai, China
Authors: Yin Jie , Yu Dapeng , Liao Banggu
Published: November 2020

This paper describes the development of a scenario-based approach that couples 2D hydrodynamic modeling with Geographic Information System (GIS) network analysis to assess the vulnerability of emergency services to surface water flooding at a large city scale. The method is demonstrated for Emergency Medical Service and Fire & Rescue Service in the city of Shanghai, China. Considering four representative traffic conditions, accessibility in terms of service area, response time, and population coverage within specified timeframes (8-, 12-, and 15-minute for Emergency Medical Service and 5-, 10-, and 15-minute for Fire & Rescue Service) is quantified and mapped under normal as well as pluvial flood scenarios of various magnitudes (5-, 20-, and 100-year return periods). Results show that the performance of operational responses largely depends on the functioning of transportation system, dramatically decreasing from unobstructed to congested traffic. Surface water flooding is found to result in limited (i.e. site-specific) but nonlinear impacts on the city-wide emergency service provisions. The results provide detailed information for optimizing the distribution of emergency stations and developing strategic contingency planning for vulnerable populations and facilities.
Open-Globe Injury With Intraocular Foreign Body
Authors: Vingopoulos Filippos , Wang Yvonne , Grob Seanna , Li Chloe Yang Ling , Eliott Dean , Kim Leo A. , Vavvas Demetrios G. , Miller John B.
Published: November 2020

Purpose:

To investigate characteristics of Open Globe Injuries (OGI) that presented with Intra-Ocular Foreign Body (IOFB), along with their long-term visual outcomes and complications.

Methods:

Retrospective interventional consecutive case series of OGIs with IOFBs that presented at Massachusetts Eye and Ear from 2010 to 2015. Data collected included time from injury to OGI repair, location of IOFB, retinal detachment (RD) rate, presenting and final visual acuity and subsequent surgeries.

Results:

Fifty-seven consecutive cases of OGIs with IOFBs were included. Mean follow-up was 28 months and median time from injury to OGI repair was 0 days. Overall, 38/57 (66.7%) eyes achieved final vision of 20/40 or better and 43/57 (75.4%) 20/150 or better. Thirty-three cases had IOFBs in the anterior segment only, 24 cases had posterior segment involvement. Thirty percent of cases (17/57) were complicated by an RD, 58.3% (14/24) in the posterior versus 9.1% (3/33) in the anterior IOFB group ( P = .01). There were no cases of endophthalmitis. Posterior IOFB and higher zone of injury were risk factors for RD both at presentation (both P < .001) and post-primary repair (both P < .001). Posterior IOFB was associated with higher vitrectomy rates both at presentation ( P < .001) and post-primary repair ( P = .002) and worse long-term visual outcome ( P = .01).

Conclusions:

OGIs with IOFB involving the posterior segment are associated with higher complication and re-operation rates and worse visual prognosis compared to those involving the anterior segment only.
Immunohistochemical expression of BRCA1 and BRCA2 in a cohort of Ugandan men with prostate cancer: an analytical cross-sectional study
Authors: Amsi Patrick T. , Yahaya James J. , Kalungi Sam , Odida Michael
Published: November 2020

Background

Mutation of the tumour suppressor genes BRCA1 and BRCA2 is thought to cause early development of prostate cancer which has poor prognosis. The purpose of this study was to determine the expression of BRCA1/2 and correlate it with clinicopathological factors for patients with prostate cancer in uganda.

Methods

Retrospectively, we used immunohistochemistry to evaluate the expression of BRCA1/2 antibodies in tissue blocks of 188 patients with prostate cancer who were diagnosed between January 2005 and December 2014 in the Department of Pathology, Makerere College of Health Sciences. The Chi-Square test was used to determine the association of the categorical variables, whereas t-test was used to compare groups of mean of the variables in the study.

Results

Expression of BRCA1 and BRCA2 was found in 26.1% and 22.9% cases, respectively. Co-expression of BRCA1 and BRCA2 was found in only 7.4%. Gleason score was associated with expression of BRCA1 and BRCA2 (P = 0.013,P = 0.041, respectively). Age was not associated with BRCA1 and BRCA2 expression;P = 0.543,P = 0.091, respectively. Likewise, PSA was not associated with BRCA1 and BRCA2 expression;P = 0.446,P = 0.399, respectively.

Conclusion

BRCA1 and BRCA2 proteins in this study were expressed more in cases with poorly differentiated prostate cancer than in cases with either well or moderately differentiated prostate cancer. Co-expression of BRCA1 and BRCA2 proteins in the same patient in our study was 3 times less than either BRCA1 or BRCA2 alone.
Narrow band imaging under less-air condition improves the visibility of superficial esophageal squamous cell carcinoma
Authors: Iwatsubo Taro , Ishihara Ryu , Yamasaki Yasushi , Tonai Yusuke , Hamada Kenta , Kato Minoru , Suzuki Sho , Kono Mitsuhiro , Fukuda Hiromu , Shimamoto Yusaku , Nakagawa Kentaro , Ohmori Masayasu , Arao Masamichi , Matsuno Kenshi , Iwagami Hiroyoshi , Inoue Shuntaro , Nakahira Hiroko , Matsuura Noriko , Shichijo Satoki , Maekawa Akira , Kanesaka Takashi , Takeuchi Yoji , Higashino Koji , Uedo Noriya , Higuchi Kazuhide
Published: November 2020

Background

The current virtual chromoendoscopy equipment cannot completely detect superficial squamous cell carcinoma (SCC) in the esophagus, despite its development in the recent years. Thus, in this study, we aimed to elucidate the appropriate air volume during endoscopic observation to improve the visibility of esophageal SCC.

Methods

This retrospective study included a total of 101 flat type esophageal SCCs identified between April 2017 and January 2019 at the Department of Gastrointestinal Oncology, Osaka International Cancer Institute. Video images of narrow band imaging (NBI) under both less-air and standard-air conditions were recorded digitally. Videos were evaluated by five endoscopists. Relative visibility between less-air and standard-air conditions of the brownish area, brownish color change of the epithelium, and dilated intrapapillary capillary loop (IPCL) were graded as 5 (definitely better under less-air condition) to 1 (definitely worse under less-air condition), with 3 indicating average visibility (equivalent to standard-air observation).

Results

The mean (standard deviation) visibility score of the brownish area, brownish color change of the epithelium, and dilated IPCLs under less-air condition were 3.94 (0.58), 3.73 (0.57), and 4.13 (0.60), respectively, which were significantly better than that under standard-air condition (p < 0.0001). Esophageal SCC evaluated as ≥ 4 in the mean visibility score of the brownish area, brownish color change of the epithelium, and dilated IPCLs accounted for 50% (51/101 lesions), 34% (34/101 lesions), and 67% (68/101 lesions), respectively.

Conclusions

The present results suggested that NBI with less air might improve the visibility of flat type esophageal SCC compared with NBI with standard air. Less-air NBI observation may facilitate the detection of flat type esophageal SCC.

Trial registration

The present study is a non-intervention trial.
Acceptability of HIV self-testing is low among men who have sex with men who have not tested for HIV: a study with respondent-driven sampling in Brazil
Authors:   The Brazilian HIV/MSM Surveillance Group, Magno Laio , Leal Andrea Fachel , Knauth Daniela , Dourado Inês , Guimarães Mark Drew Crosland , Santana Elis Passos , Jordão Tiago , Rocha Gustavo Machado , Veras Maria Amélia , Kendall Carl , Pontes Alexandre Kerr , de Brito Ana Maria , Kerr Ligia
Published: November 2020

Background

Brazil has many people living with HIV (PLWH) who are unaware of their serostatus. The public health system has recently added HIV self-testing (HIVST) for key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and explores factors associated with acceptability among MSM who have never tested for HIV or who had a previous negative result.

Methods

Respondent-driven sampling (RDS) was used to recruit 4176 MSM in 12 Brazilian cities in 2016 to this biological and behavioral surveillance study. We excluded from this analysis all MSM who were aware of their positive HIV serostatus. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted with Gile’s estimator in RDS Analyst software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or one or more times).

Results

For this analysis, 3605 MSM were included. The acceptability of HIVST was 49.1%, lower among those who had never tested for HIV (42.7%) compared to those who had a previous HIV negative test (50.1%). In the subgroup of MSM who had never tested for HIV, those who reported discrimination or who had a medical appointment in the last 12 months reported higher HIVST acceptability. Among MSM who had a previous negative HIV test, only those reporting condomless receptive anal sex reported higher HIVST acceptability. In addition, we observed that high levels of knowledge of HIV/AIDS, taking part in lesbian, gay, bisexual, and transgender nongovernmental organizations (LGBT-NGO), or complete secondary or incomplete higher undergraduate education reported higher acceptability.

Conclusions

The acceptability of HIVST was low among MSM, especially among those who never tested for HIV. Given access to HIVST in Brazil, we point to the need for programs that enhance promotion of testing addressed to MSM.
Interpersonal relationships and drug use over time among homeless people: a qualitative study
Authors: de Espíndola Marília Ignácio , Bedendo André , da Silva Eroy Aparecida , Noto Ana Regina
Published: November 2020

Background

Homelessness is one of the most severe forms of social exclusion and is an important public health issue. It is characterized by processes of weakening of interpersonal bonds. The objective of this study was, therefore, to elucidate how interpersonal relationships change over the life cycle of homeless drug and alcohol users.

Method

We used a qualitative methodology. The participants were adults who had a history of homelessness and use of alcohol and other drugs. The interviews were semi structured and used a timeline instrument. All interview were audio recorded, transcribed, and submitted to thematic analysis.

Results

Twenty individuals participated in the study. Reports on social exclusion over time stood out in respect of four main themes and their respective subthemes: Theme 1 – Childhood: instability upbringing, abuse, violence, and an absent or not very present father figure; Theme 2 – Adolescence: school dropout and failure; acceptance of gender and sexual orientation; birth of first child, living with a partner or getting married: Theme 3 – Adulthood: estrangement or conflicting relationship with family; health problems; drug trafficking and prostitution; Theme 4 – Cross-cutting factors: death of relatives and substance use.

Conclusion

The results suggest that interpersonal relationships are permeated by successive breakups, conflicts and other events that start in childhood and can have a cumulative effect in later stages of life, and cross the subsequent phases. Substance abuse and dependence are mentioned as cross-cutting factors that intensify social exclusion in all stages of life.
Beyond the supermarket: analyzing household shopping trip patterns that include food at home and away from home retailers
Authors: Yenerall Jackie , You Wen , Hill Jennie
Published: November 2020

Background

Modifying a household’s food environment by targeting a single retailer type, like supermarkets, has a limited impact on dietary outcomes. This may be because the food environment has a limited impact on shopping behaviors, or because households are not as reliant on supermarkets as we assume. However, our understanding of how households shop for food, especially when considering the use of both food at home (FAH) retailers, such as supermarkets, and away from home retailers (FAFH), such as restaurants, is limited. Thus, understanding how households shop for food is a necessary first step when developing programs to modify food purchasing behavior.

Methods

K-means cluster analysis was used to identify weekly food shopping trip patterns based on the percentage of trips to FAH and FAFH retailers in the 2013 Food Acquisition and Purchase Survey (FoodAPS) dataset (n = 4665 households). Multinomial logistic regression was used to examine the relationship between shopping trip patterns, household and food environment characteristics.

Results

Three patterns emerged: primarily supermarket, primarily supercenter, or mix (i.e. no dominant retailer type, but high FAFH use). Households with incomes below 185% of the federal poverty line were evenly divided between patterns that rely primarily on FAH retailers, and the mix pattern. While nearly 70% of households with incomes above 185% of the federal poverty line are in the mix cluster. Supermarket and superstore availability significantly influenced the likelihood of belonging to those clusters respectively, while having a child, higher income, and attitudes towards healthy meal preparation time or taste significantly influenced the likelihood of belonging to the mix cluster.

Conclusion

Although lower-income households are more likely to rely primarily on FAH retailers, household’s, regardless of income, that primarily utilize FAH retailers show a strong preference for either superstores or supermarkets suggesting a need for interventions to reach both retailer types. However, altering the food environment alone may not be sufficient to discourage use of FAFH retailers as households relying on FAFH retailers are significantly influenced by meal preparation time and healthy food taste.
COVID-19 or clinical amyopathic dermatomyositis associated rapidly progressive interstitial lung disease? A case report
Authors: Cao Mengke , Zhang Shuangshuang , Chu Dejie , Xiao Ming , Liu Xiaohong , Yu Lingling , Li Jing , Huang Yi , Fang Fang
Published: November 2020

Background

Coronavirus disease 2019 (COVID-19) has reach pandemic proportions globally. For patients with symptoms of fever and cough accompanied by rapid lung damage progression, COVID-19 needs to be distinguished from interstitial lung disease (ILD) attributed to connective tissue disease (CTD), especially dermatomyositis (DM)/clinical amyopathic dermatomyositis (CADM) associated rapidly progressive interstitial lung disease (RP-ILD).

Case presentation

We report a case of a woman observed with fever, cough, and rapid lung damage during the epidemic. The patient had a suspicious epidemiological history, and her chest CT scans showed lung damage similar to that caused by COVID-19, but anti-Ro52 antibody was strongly positive. She was diagnosed with CADM associated RP-ILD and died 1 month later.

Conclusions

During the COVID-19 epidemic, it is critical to carefully assess patients with CTD related ILD, especially RP-ILD associated with CADM. Repeated nucleic acid tests for COVID-19 are necessary to achieve accurate case diagnosis. High-resolution CT (HRCT) of the chest is presently deemed an inefficient technique to distinguishing between COVID-19 and CADM associated RP-ILD. The characteristic rashes of dermatomyositis require careful observation and can often provide diagnostic clues. For patients with CADM, a high titers of anti-Ro52 antibody may be related to the pathogenesis of RP-ILD, suggesting a poor prognosis.
Comparison of deep learning with regression analysis in creating predictive models for SARS-CoV-2 outcomes
Authors: Abdulaal Ahmed , Patel Aatish , Charani Esmita , Denny Sarah , Alqahtani Saleh A. , Davies Gary W. , Mughal Nabeela , Moore Luke S. P.
Published: November 2020

Background

Accurately predicting patient outcomes in Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could aid patient management and allocation of healthcare resources. There are a variety of methods which can be used to develop prognostic models, ranging from logistic regression and survival analysis to more complex machine learning algorithms and deep learning. Despite several models having been created for SARS-CoV-2, most of these have been found to be highly susceptible to bias. We aimed to develop and compare two separate predictive models for death during admission with SARS-CoV-2.

Method

Between March 1 and April 24, 2020, 398 patients were identified with laboratory confirmed SARS-CoV-2 in a London teaching hospital. Data from electronic health records were extracted and used to create two predictive models using: (1) a Cox regression model and (2) an artificial neural network (ANN). Model performance profiles were assessed by validation, discrimination, and calibration.

Results

Both the Cox regression and ANN models achieved high accuracy (83.8%, 95% confidence interval (CI) 73.8–91.1 and 90.0%, 95% CI 81.2–95.6, respectively). The area under the receiver operator curve (AUROC) for the ANN (92.6%, 95% CI 91.1–94.1) was significantly greater than that of the Cox regression model (86.9%, 95% CI 85.7–88.2), p = 0.0136. Both models achieved acceptable calibration with Brier scores of 0.13 and 0.11 for the Cox model and ANN, respectively.

Conclusion

We demonstrate an ANN which is non-inferior to a Cox regression model but with potential for further development such that it can learn as new data becomes available. Deep learning techniques are particularly suited to complex datasets with non-linear solutions, which make them appropriate for use in conditions with a paucity of prior knowledge. Accurate prognostic models for SARS-CoV-2 can provide benefits at the patient, departmental and organisational level.
Does inpatient health services utilization vary by remoteness in the medical financial assistance population? Evidence from Shaanxi province, China
Authors: Ren Yangling , Zhou Zhongliang , Liu Guanping , Shen Chi , Cao Dan , Xu Tiange , Fry Jane M. , Nawaz Rashed , Zhao Dantong , Su Min , Ge Tingshuai , Si Yafei , Chen Gang
Published: November 2020

Background

Medical Financial Assistance (MFA) provides health insurance and financial support for millions of low income and disabled Chinese people, yet there has been little systematic analysis focused on this vulnerable population. This study aims to advance our understanding of MFA recipients’ access to health care and whether their inpatient care use varies by remoteness.

Methods

Data were collected from the Surveillance System of Civil Affairs of Shaanxi province in 2016. To better proxy remoteness (geographic access), drive time from the respondent’s village to the nearest county-level or city-level hospital was obtained by a web crawler. Multilevel models were used to explore the impacts of remoteness on inpatient services utilization by MFA recipients. Furthermore, the potential moderating role of hospital grade (i.e. the grade of medical institution where recipient’s latest inpatient care services were taken in the previous year) on the relationship between geographic access and inpatient care use was explored.

Results

The analytical sample consisted of 9516 inpatient claims within 73 counties of Shaanxi province in 2016. We find that drive time to the nearest hospital and hospital grade are salient predictors of inpatient care use and there is a significant moderation effect of hospital grade. Compared to those with shortest drive time to the nearest hospital, longer drive time is associated with a longer inpatient stay but fewer admissions and lower annual total and out-of-pocket (OOP) inpatient costs. In addition, these associations are lower when recipients are admitted to a tertiary hospital, for annual total and OOP inpatient expenditures, but higher for length of the most recent inpatient stay no matter what medical treatments are taken in secondary or tertiary hospitals for the most remote recipients.

Conclusion

Our results suggest that remoteness has a significant and negative association with the frequency of inpatient care use. These findings advance our understanding of inpatient care use of the extremely poor and provide meaningful insights for further MFA program development as well as pro-poor health strategies.