bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factor analysis for progressive spinal deformity after resection of intracanal tumors─ a retrospective study of 272 cases
Authors: Wang Pangbo , Ma Kang , Chen Tunan , Xue Xingsen , Ma Dada , Wang Shi , Chen Xin , Meng Hui , Cui Gaoyu , Gao Boyuan , Lin Jiangkai , Feng Hua , Chu Weihua
Published: January 2020

Background

Progressive spinal deformity has become a well-recognized complication of intracanal tumors resection. However, the factors affecting post-operative spinal stability remain to be further research. Here, we described the current largest series of risk factors analysis for progressive spinal deformity following resection of intracanal tumors.

Methods

We retrospectively analyzed the medical records of the patients with resection of intracanal tumors between January 2009 and December 2018. All patients who underwent resection of intracanal tumors performed regular postoperative follow-up were identified and included in the study. Clinical, radiological, surgical, histopathological, and follow-up data were collected. The incidence of postoperative progressive kyphosis or scoliosis was calculated. The statistical relationship between postoperative progressive spinal deformity and radiographic, clinical, and surgical variables was assessed by using univariate tests and multivariate logistic regression analysis.

Results

Two hundred seventy-two patients (mean age 42.56 ± 16.18 years) with median preoperative modified McCormick score of 3 met the inclusion criteria. Among them, 7(2.6%)patients were found to have spinal deformity preoperatively, and the extent of spinal deformity in these 7 patients deteriorated after surgery. 36 (13.2%) were new cases of postoperative progressive deformity. The mean duration of follow-up was 21.8 months (median 14 months, range 6–114 months). In subsequent multivariate logistic regression analysis, age ≤ 18 years (p = 0.027), vertebral levels of tumor involvement (p = 0.019) and preoperative spinal deformity(p = 0.008) was the independent risk factors (p < 0.05), increasing the odds of postoperative progressive spinal deformity by 3.94-, 0.69- and 27.11-fold, respectively.

Conclusions

The incidence of postoperative progressive spinal deformity was 15.8%, mostly in these patients who had younger age (≤18 years), tumors involved in multiple segments and preoperative spinal deformity. The risk factors of postoperative progressive spinal deformity warrants serious reconsideration that when performing resection of spinal cord tumors in these patients with such risk factors, the surgeons should consider conducting follow-ups more closely, and when patients suffering from severe symptoms or gradually increased spinal deformity, surgical spinal fusion may be a more suitable choice to reduce the risk of reoperation and improve the prognosis of patients.
Trends in smoking during pregnancy by socioeconomic characteristics in the United States, 2010–2017
Authors: Azagba Sunday , Manzione Lauren , Shan Lingpeng , King Jessica
Published: January 2020

Background

Maternal smoking during pregnancy remains a public health concern in the United States (US). We examined whether the prevalence of smoking during pregnancy decreased between 2010 and 2017 and how trends differed by demographic subgroups.

Methods

We used 2010–2017 data from the National Center for Health Statistics. Rao-Scott Chi-Square tests were performed to compare characteristics between smoking and nonsmoking groups. Cochran–Armitage tests and logistic regression were used to assess overall changes in the prevalence of smoking during pregnancy over time and changes for age, race, and educational attainment subgroups.

Results

The prevalence of smoking during pregnancy decreased from 9.2% in 2010 to 6.9% in 2017. In 2017, the prevalence was highest among women aged 20–24 (9.9%), American Indian/Alaskan Natives (15%), and those with a high school diploma or General Educational Development (GED) (12.2%). The prevalence was lowest among women younger than 15 (1.7%), Asian/Pacific Islanders (1%), and those who had a master’s degree and higher (0.3%). Prevalence did not decrease significantly over time in the 35–39 age group (4.5 to 4.4%; p = 0.08), and increased dramatically for women with less than a high school diploma from 10.2 to 11.8%; p < 0.0001.

Conclusions

Smoking prevalence during pregnancy in the US is declining, but is highest among younger women (20–24), American Indian/Alaska Natives, and women with a high school diploma or GED. In addition, the prevalence has increased for women with the least education. Targeted research and tobacco control interventions could help address the specific needs of these high-risk subpopulations.
Strengthening routine immunization in Papua New Guinea: a cross-sectional provincial assessment of front-line services
Authors: Morgan Christopher J. , Saweri Olga P. M. , Larme Nicholas , Peach Elizabeth , Melepia Pele , Au Lucy , Scoullar Michelle J. L. , Reza Mohammad Salim , Vallely Lisa M. , McPake Barbara I. , Beeson James G.
Published: January 2020

Background

Routine immunization programs face many challenges in settings such as Papua New Guinea with dispersed rural populations, rugged geography and limited resources for transport and health. Low routine coverage contributes to disease outbreaks such as measles and the polio that re-appeared in 2018. We report on an in-depth local assessment that aimed to document immunization service provision so as to review a new national strategy, and consider how routine immunization could be better strengthened.

Methods

In East New Britain Province, over 2016 and 17, we carried out a cross-sectional assessment of 12 rural health facilities, staff and clients. The study was timed to follow implementation of a new national strategy for strengthening routine immunization. We used interview, structured observation, and records review, informed by theory-based evaluation, a World Health Organization quality checklist, and other health services research tools.

Results

We documented strengths and weaknesses across six categories of program performance relevant to national immunization strategy and global standards. We found an immunization service with an operational level of staff, equipment and procedures in place; but one that could reach only half to two thirds of its target population. Stronger routine services require improvement in: understanding of population catchments, tracking the unvaccinated, reach and efficiency of outreach visits, staff knowledge of vaccination at birth and beyond the first year of life, handling of multi-dose vials, and engagement of community members. Many local suggestions to enhance national plans, included more reliable on-demand services, integration of other family health services and increased involvement of men.

Conclusions

The national strategy addresses most local gaps, but implementation and resourcing requires greater commitment. Long-term strengthening requires a major increase in centrally-allocated resources, however there are immediate locally feasible steps within current resources that could boost coverage and quality of routine immunization especially through better population-based local planning, and stronger community engagement. Our results also suggest areas where vaccination campaigns in PNG can contribute to routine immunization services.
Effects of disinfection and sterilization on the dimensional changes and mechanical properties of 3D printed surgical guides for implant therapy – pilot study
Authors: Török Gréta , Gombocz Péter , Bognár Eszter , Nagy Péter , Dinya Elek , Kispélyi Barbara , Hermann Péter
Published: January 2020

Background

The purpose of this research was to investigate the effects of disinfection and three different sterilization methods on the dimensional changes and mechanical properties of three-dimensional (3D) printed surgical guide for implant therapy. The objective was to assess the effects of sterilization procedures in 3D printed drill guide templates with destructive and non-destructive material testing.

Methods

Fifteen identical drill guide templates were produced using a 3D printer. The surgical guides were classified into five groups: three controls, three disinfected (4% Gigasept®, 60 min), three plasma sterilized, three autoclave sterilized (+ 1 bar, 121 °C, 20 min), and three autoclave sterilized (+ 2 bar, 134 °C, 10 min).

The templates were digitalized with a Steinbichler SCAN ST 3D scanner. Length was measured under an SZX16 stereomicroscope. A scanning electron microscope was used to study the surface morphology of the drill templates. The hardness, and flexural and compressive strength were measured to assess any changes in the physical characteristics of the material caused by sterilization. The drill guide templates were also examined with a Dage XiDAT 6600 X-ray. During the X-ray examinations, the following parameters were used: 100 kV voltage, 128 AVG averaging, 0.8 W power. One-way analysis of variance (ANOVA) was used to detect the difference between groups.

Results

Evaluation of the hardness measurements of the various specimens shows that the hardness of the material was not changed by the plasma sterilization (p = 0.0680), steam sterilization on 121 °C (p = 0.6033) or disinfection process (p = 0.1399). The statistical analysis revealed significant difference in hardness strength of the autoclave sterilized (134 °C) specimens (p = 0.0002). There was no significant difference between the goups regarding the scanning electron microscopic and stereomicroscopic examinations. There was no significant difference regarding the X-ray visibility of the templates to the effect of the disinfection (p = 0.7844), plasma sterilization (p = 0.4091) and steam sterilization on 121 °C (p = 0.9277) and steam sterilization on 131 °C (p = 0.093). The effect of the sterilization was the same in case of both flexural and compressive strength of the material.

Conclusions

Our findings indicate that plasma sterilization and steam sterilization at 121 °C were both suitable for sterilizing the tested 3D printed surgical guides.
Neonatal, infant, and child mortality among women exposed to intimate partner violence in East Africa: a multi-country analysis
Authors: Memiah Peter , Bond Tristi , Opanga Yvonne , Kingori Caroline , Cook Courtney , Mwangi Michelle , Gitahi-Kamau Nyawira , Mubangizi Deus , Owuor Kevin
Published: January 2020

Background

Most neonatal, infant, and child deaths occur in low- and middle-income countries (LMICs), where incidence of intimate partner violence (IPV) is highest in the world. Despite these facts, research regarding whether the two are associated is limited. The main objective was to examine associations between IPV amongst East African women and risk of death among their neonates, infants, and children, as well as related variables.

Methods

Analysis was conducted on data drawn from the Demographic and Health Surveys (DHS) conducted by ICF Macro/MEASURE DHS in five East African countries: Burundi, Kenya, Rwanda, Tanzania, and Uganda. The analytical sample included 11,512 women of reproductive age (15–49 years). The outcome variables, described by proportions and frequencies, were the presence or absence of neonatal, infant, and under-five mortality. Our variable of interest, intimate partner violence, was a composite variable of physical, sexual, and emotional abuse; chi-square tests were used to analyze its relationship with categorical variables. Adjusted odds ratios (aOR) were also used in linking sexual autonomy to independent variables.

Results

Children born to women who experienced IPV were significantly more likely to die as newborns (aOR = 1.3, 95% confidence interval [CI]: 1.4–2.2) and infants (aOR = 1.9, 95% CI: 1.6–2.2), and they were more likely to die by the age of five (aOR = 1.5, 95% CI: 1.01–1.55). Socioeconomic indicators including area of residence, wealth index, age of mother/husband, religion, level of education, employment status, and mass media usage were also significantly associated with IPV. After regression modelling, mothers who were currently using contraceptives were determined less likely to have their children die as newborns (aOR = 0.5, 95% CI: 0.3–0-7), as infants (aOR = 0.5, 95% CI: 0.3–06), and by age five (aOR = 0.4, 95% CI: 02–0.6).

Conclusion

Understanding IPV as a risk indicator for neonatal, infant, and child deaths can help in determining appropriate interventions. IPV against women should be considered an urgent priority within programs and policies aimed at maximizing survival of infants and children in East Africa and the wellbeing and safety of their mothers.
Supporting women of childbearing age in the prevention and treatment of overweight and obesity: a scoping review of randomized control trials of behavioral interventions
Authors: Hutchesson Melinda J. , de Jonge Mulock Houwer Mette , Brown Hannah M. , Lim Siew , Moran Lisa J. , Vincze Lisa , Rollo Megan E. , Hollis Jenna L.
Published: January 2020

Background

Women of childbearing age are vulnerable to weight gain. This scoping review examines the extent and range of research undertaken to evaluate behavioral interventions to support women of childbearing age to prevent and treat overweight and obesity.

Methods

Eight electronic databases were searched for randomized controlled trials (RCT) or systematic reviews of RCTs until 31st January 2018. Eligible studies included women of childbearing age (aged 15–44 years), evaluated interventions promoting behavior change related to diet or physical activity to achieve weight gain prevention, weight loss or maintenance and reported weight-related outcomes.

Results

Ninety studies met the inclusion criteria (87 RCTs, 3 systematic reviews). Included studies were published from 1998 to 2018. The studies primarily focused on preventing excessive gestational weight gain (n = 46 RCTs, n = 2 systematic reviews), preventing postpartum weight retention (n = 18 RCTs) or a combination of the two (n = 14 RCTs, n = 1 systematic review). The RCTs predominantly evaluated interventions that aimed to change both diet and physical activity behaviors (n = 84) and were delivered in-person (n = 85).

Conclusions

This scoping review identified an increasing volume of research over time undertaken to support women of childbearing age to prevent and treat overweight and obesity. It highlights, however, that little research is being undertaken to support the young adult female population unrelated to pregnancy or preconception.
Development of a program theory for shared decision-making: a realist synthesis
Authors: Waldron Tamara , Carr Tracey , McMullen Linda , Westhorp Gill , Duncan Vicky , Neufeld Shelley-May , Bandura Lori-Ann , Groot Gary
Published: January 2020

Background

Shared Decision-making (SDM), a medical decision-making model, was popularized in the late 1980s in reaction to then predominate paternalistic decision-making, aiming to better meet the needs of patients. Extensive research has been conducted internationally examining the benefits of SDM implementation; however, existing theory on how SDM works, for whom, in which circumstances, and why is limited. While literature has shown positive patient, health care provider, and system benefits (SDM outputs), further research is required to understand the nuances of this type of decision-making. As such, we set out to address: “In which situations, how, why, and for whom does SDM between patients and health care providers contribute to improved engagement in the Shared Decision-making process?”

Methods

To achieve our study goals we conducted a seven-step realist synthesis process, which included: (1) preliminary program theory development, (2) search strategy development, (3) selection and appraisal of literature in accordance with realist methodology, (4) data extraction, (5) identification of relevant formal theories, (6) data analysis and synthesis, and (7) formation of a revised program theory with the input of stakeholders. This process was done in accordance with RAMESES guidelines and publication standards for a realist synthesis. Expert consultations were also held to ensure consistency within the SDM literature.

Results

Through our realist synthesis, we developed a program theory of SDM which includes three contexts (pre-existing relationship, difficulty of decision, and system support), eight mechanism sets (anxiety, trust, perception of other party capacity, perception of time, self-efficacy, world view, perception of capacity to external support, and recognition of decision), and one outcome (engagement in SDM).

Conclusions

As far as the authors of this paper are aware, this paper is the first to begin unpacking how SDM works, for whom, in which circumstances, and why. By examining key mechanism sets and exploring how they facilitate or inhibit SDM, we have produced a program theory that may assist health care professionals, policy makers, and patients. While further research is suggested to further unpack the concepts identified within this paper, this provides an initial understanding into the theory behind SDM.

Registration

PROSPERO: CRD42017062609.
Effectiveness of motivational interviewing on improving Care for Patients with type 2 diabetes in China: A randomized controlled trial
Authors: Li Zhe , Chen Qingqi , Yan Jingya , Liang Wei , Wong William C. W.
Published: January 2020

Background

To assess the effects of a motivational interviewing (MI)-based patient empowerment program (PEP) on type 2 diabetes mellitus (DM) patient self-management compared to traditional diabetes health education.

Methods

Two hundred and twenty-five patients, recruited from community health centers (CHCs) and the family medicine clinic in the University of Hong Kong-Shenzhen Hospital in Shenzhen, were randomly assigned to the intervention or control groups. Patients in the intervention group (n = 117) received a four-session PEP in small groups over 1 month by trained nurses and doctors. The control group (n = 108) received the traditional lecture-style health education on DM. All the patients were followed up for 3 months. Outcomes included problem areas in diabetes (PAID) that measures diabetes-related emotional distress, patient enablement index (PEI), mental health, patient satisfaction respectively as well as lifestyle behaviors were assessed at baseline, post-activity and 3 months.

Results

At post-intervention and the 3-month follow-up, the PAID score improved significantly in the intervention group (12.7 ± 13.6, 5.8 ± 7.6) compared to the control group (22.7 ± 22.8, 11.7 ± 14.6). No difference was found between groups for changes to exercise, diet, and medication adherence. The PEI score improved significantly at the 3-month follow-up in the MI group (7.27 ± 2.45 vs 5.81 ± 2.97).

Conclusion

The PEP has a significant effect on improving diabetes-related distress, but MI was not significantly different from the traditional health education programs when it comes to the readiness to change.

Trial registration

NCT04120844, ClinicalTrials.Gov. Date of registration: October 9th 2019 (Retrospectively registered).
HopPER: an adaptive model for probability estimation of influenza reassortment through host prediction
Authors: Yin Rui , Zhou Xinrui , Rashid Shamima , Kwoh Chee Keong
Published: January 2020

Background

Influenza reassortment, a mechanism where influenza viruses exchange their RNA segments by co-infecting a single cell, has been implicated in several major pandemics since 19th century. Owing to the significant impact on public health and social stability, great attention has been received on the identification of influenza reassortment.

Methods

We proposed a novel computational method named HopPER (Host-prediction-based Probability Estimation of Reassortment), that sturdily estimates reassortment probabilities through host tropism prediction using 147 new features generated from seven physicochemical properties of amino acids. We conducted the experiments on a range of real and synthetic datasets and compared HopPER with several state-of-the-art methods.

Results

It is shown that 280 out of 318 candidate reassortants have been successfully identified. Additionally, not only can HopPER be applied to complete genomes but its effectiveness on incomplete genomes is also demonstrated. The analysis of evolutionary success of avian, human and swine viruses generated through reassortment across different years using HopPER further revealed the reassortment history of the influenza viruses.

Conclusions

Our study presents a novel method for the prediction of influenza reassortment. We hope this method could facilitate rapid reassortment detection and provide novel insights into the evolutionary patterns of influenza viruses.
Roles of circRNAs in the tumour microenvironment
Authors: Zhang Qiuge , Wang Weiwei , Zhou Quanbo , Chen Chen , Yuan Weitang , Liu Jinbo , Li Xiaoli , Sun Zhenqiang
Published: January 2020

The tumour microenvironment (TME) constitutes the area surrounding the tumour during its development and has been demonstrated to play roles in cancer-related diseases through crosstalk with tumour cells. Circular RNAs (circRNAs) are a subpopulation of endogenous noncoding RNAs (ncRNAs) that are ubiquitously expressed in eukaryotes and have multiple biological functions in the regulation of cancer onset and progression. An increasing number of studies have shown that circRNAs participate in the multifaceted biological regulation of the TME. However, details on the mechanisms involved have remained elusive until now. In this review, we analyse the effects of circRNAs on the TME from various perspectives, including immune surveillance, angiogenesis, hypoxia, matrix remodelling, exo-circRNAs and chemoradiation resistance. Currently, the enormous potential for circRNA use in targeted therapy and as noninvasive biomarkers have drawn our attention. We emphasize the prospect of targeting circRNAs as an essential strategy to regulate TME, overcome cancer resistance and improve therapeutic outcomes.
Correction to: Quality of life in bladder cancer patients receiving medical oncological treatment; a systematic review of the literature
Authors: Taarnhøj G. A. , Johansen C. , Pappot H.
Published: January 2020

The original article contains a major error whereby a main Table is omitted. Thus, the following corrections to the original article should be considered:
Correction to: C3aR signaling and gliosis in response to neurodevelopmental damage in the cerebellum
Authors: Young Kevin G. , Yan Keqin , Picketts David J.
Published: January 2020

Following publication of the original article, the authors noticed missing labels in Fig. 1a
Testing a method of sampling for entomological determination of transmission of Wuchereria bancrofti to inform lymphatic filariasis treatment strategy in urban settings
Authors: Nditanchou Rogers , Dixon Ruth , Pam Dung , Isiyaku Sunday , Nwosu Christian , Sanda Safiya , Schmidt Elena , Koudou Benjamin , Molyneux David
Published: January 2020

Background

There is on-going debate about scale-up of lymphatic filariasis treatment to include urban areas. Determining Wuchereria bancrofti transmission is more complex in these settings and entomological methodologies suggested as a solution as yet have no clear guidance.

Methods

The study was conducted in six communities in Minna and Kaduna cities in Nigeria selected based on pre-disposing risk factors for mosquitoes and Transmission Assessment Survey (TAS) results in 2016 indicating need for treatment (> 1% prevalence). In each community, 4 gravid traps (GT), 15 exit traps (ET) and 21 pyrethrum spray catches (PSC) were used for 5 months targeting a sample size of 10,000 mosquitoes inclusive of at least 1500 Anopheles. Community researchers were selected and trained to facilitate community acceptability and carry out collection. We have evaluated the mosquito sampling and trapping methodology in terms of success at reaching targeted sample size, cost effectiveness, and applicability.

Results

Community researchers were influential in enabling high acceptability of the methods of collection and were able to conduct collections independently. Overall, 12.1% of trapping events (one trapping event corresponds to one visit to one trap to collect mosquitoes) were affected by householder actions, weather conditions or trap malfunction leading to lower than optimal catches. Exit traps were the most cost-effective way to catch Anopheles (6.4 USD per trapping event and 12.8 USD per Anopheles caught). Sample size of 10,000 mosquitoes overall in each city was met though Anopheles catch was insufficient in one city. However, sample size was met only in one implementation unit out of the four.

Conclusions

Methods need adapting to maximise Anopheles catch: we propose planning 250 gravid trap and 3724 exit trap trapping events in similar settings in West African urban areas where Culex is dominant, not using pyrethrum spray catches, and weighting trapping events later in the rainy season. Planning should increase involvement of community researchers, incorporate null catches and participants’ actions to predict catches. Importantly, evaluation units should be analogous with implementation units, the units at which treatment decisions will be made in the urban context.
Expanded complement of Niemann-Pick type C2-like protein genes in Clonorchis sinensis suggests functions beyond sterol binding and transport
Authors: Anari Marziyeh , Stroehlein Andreas J. , Hall Ross S. , Chang Bill C. H. , Gasser Robin B. , Young Neil D.
Published: January 2020

Background

The parasitic flatworm Clonorchis sinensis inhabits the biliary tree of humans and other piscivorous mammals. This parasite can survive and thrive in the bile duct, despite exposure to bile constituents and host immune attack. Although the precise biological mechanisms underlying this adaptation are unknown, previous work indicated that Niemann-pick type C2 (NPC2)-like sterol-binding proteins might be integral in the host-parasite interplay. Expansions of this family in some invertebrates, such as arthropods, have shown functional diversification, including novel forms of chemoreception. Thus, here we curated the NPC2-like protein gene complement in C. sinensis, and predicted their conserved and/or divergent functional roles.

Methods

We used an established comparative genomic-bioinformatic approach to curate NPC2-like proteins encoded in published genomes of Korean and Chinese isolates of C. sinensis. Protein sequence and structural homology, presence of conserved domains and phylogeny were used to group and functionally classify NPC2-like proteins. Furthermore, transcription levels of NPC2-like protein-encoding genes were explored in different developmental stages and tissues.

Results

Totals of 35 and 32 C. sinensis NPC2-like proteins were predicted to be encoded in the genomes of the Korean and Chinese isolates, respectively. Overall, these proteins had low sequence homology and high variability of sequence alignment coverage when compared with curated NPC2s. Most C. sinensis proteins were predicted to retain a conserved ML domain and a conserved fold conformation, with a large cavity within the protein. Only one protein sequence retained the conserved amino acid residues required in bovine NPC2 to bind cholesterol. Non-canonical C. sinensis NPC2-like protein-coding domains clustered into four distinct phylogenetic groups with members of a group frequently encoded on the same genome scaffolds. Interestingly, NPC2-like protein-encoding genes were predicted to be variably transcribed in different developmental stages and adult tissues, with most being transcribed in the metacercarial stage.

Conclusions

The results of the present investigation confirms an expansion of NPC2-like proteins in C. sinensis, suggesting a diverse array of functions beyond sterol binding and transport. Functional explorations of this protein family should elucidate the mechanisms enabling the establishment and survival of C. sinensis and related flukes in the biliary systems of mammalian hosts.
Summary of the proceedings of the International Forum 2019: “What are the strategies to engage the young generation”
Authors:   European Society of Radiology (ESR)
Published: January 2020

The ESR International Forum at the ECR 2019 discussed strategies for engaging the young generation. The future of radiology is a crucial topic that goes hand in hand with tomorrow’s radiologists. The European Society of Radiology (ESR) established the ESR International Forum in order to discuss hot topics in the profession of radiology with non-European radiological partner societies. At the ESR International Forum 2019, different strategies, initiatives and ideas were presented by the different societies with regard to engaging young doctors into radiology.
Non-orthogonal multiple access in full-duplex-based coordinated direct and relay transmission (CDRT) system: performance analysis and optimization
Authors: V Aswathi , A V Babu
Published: January 2020

This paper considers non-orthogonal multiple access (NOMA)-based coordinated direct and relay transmission (CDRT) system, where the base station (BS) directly communicates with the nearby users while it requires the help of a dedicated relay to communicate with the cell-edge users. We derive exact closed form expression for the outage probabilities experienced by the downlink users and the system outage probability of the considered CDRT network with full-duplex relaying (FDR) technique. Further, we derive approximate closed form expressions for the ergodic rates achieved by the users. The channel of all the links experience Nakagami fading distribution and the analysis takes into account the residual interference generated due to the imperfect successive interference cancelation (I-SIC) technique. We provide numerical and simulation results to identify the impact of key system parameters on the outage and ergodic rate performance of the users and the system outage performance. The outage and ergodic rate performance of users in the considered FDR-based NOMA-CDRT system has been observed to be significantly improved compared to a FDR-based OMA (orthogonal multiple access)-CDRT system. It is observed that random selection of NOMA power allocation coefficients at the BS leads to higher outage for the near users compared to the far users. We determine numerical results for the NOMA power allocation coefficient that leads to equal outage performance for both the users. Finally, we derive analytical expression for the optimal power allocation (OPA) coefficient at the BS that minimizes the system outage probability. Through extensive numerical and simulation studies, we establish that OPA can lead to significant reduction of system outage probability compared to random selection of power allocation coefficients at the BS.
What factors affect patients’ access to healthcare? Protocol for an overview of systematic reviews
Authors: Dawkins Bryony , Renwick Charlotte , Ensor Tim , Shinkins Bethany , Jayne David , Meads David
Published: January 2020

Background

The importance of access to healthcare for all is internationally recognised as a global goal, high on the global agenda. Yet inequalities in health exist within and between countries which are exacerbated by inequalities in access to healthcare. In order to address these inequalities, we need to better understand what drives them. While there exists a wealth of research on access to healthcare in different countries and contexts, and for different patient groups, to date no attempt has been made to bring this evidence together through a global lens. This study aims to address that gap by bringing together evidence of what factors affect patients’ access to healthcare and exploring how those factors vary in different countries and contexts around the world.

Methods

An overview of reviews will be conducted using a comprehensive search strategy to search four databases: Medline, Embase, Global Health and Cochrane Systematic Reviews. Additional searches will be conducted on the Gates Foundation, the World Health Organisation (WHO) and World Bank websites. Titles and abstracts will be screened against the eligibility criteria and full-text articles will be obtained for all records that meet the inclusion criteria or where there is uncertainty around eligibility. A data extraction table will be developed during the review process and will be piloted and refined before full data extraction commences. Methodological quality/risk of bias will be assessed for each included study using the AMSTAR 2 tool. The quality assessment will be used to inform the narrative synthesis, but a low-quality score will not necessarily lead to study exclusion.

Discussion

Factors affecting patients’ ability to access healthcare will be identified and analysed according to different country and context characteristics to shed light on the importance of different factors in different settings. Results will be interpreted accounting for the usual challenges associated with conducting such reviews. The results may guide future research in this area and contribute to priority setting for development initiatives aimed at ensuring equitable access to healthcare for all.

Systematic review registration

PROSPERO CRD42019144775
Relationship between entrepreneurship education and entrepreneurial goal intentions: psychological traits as mediators
Authors: Ndofirepi Takawira Munyaradzi
Published: January 2020

Despite the commonly held view that entrepreneurship education and training nurtures future entrepreneurs, little is known about the mechanism through which this intervention impacts on its intended outcomes. The purpose of this study was to test if selected psychological traits (need for achievement, risk-taking propensity, internal locus of control) mediated the predictive relationship between the perceived effects of entrepreneurship education and entrepreneurial intentions. A cross-sectional survey of a sample of 308 vocational education students in Zimbabwe was used for this purpose. The results show that the effects of entrepreneurship education variable had a positive and statistically significant relationship with need for achievement, risk-taking propensity, internal locus of control and entrepreneurial goal intentions. Moreover, need for achievement, risk-taking propensity and internal locus of control accounted for a statistically significant amount of variance in entrepreneurial intentions. However, of the three psychological traits, only need for achievement partially mediated the relationship between the effects of entrepreneurship education and entrepreneurial goal intentions. The outcome has implications on the design and focus of entrepreneurship education programmes.
Spread of multidrug resistance among Ureaplasma serovars, Tunisia
Authors: Boujemaa Safa , Mlik Béhija , Ben Allaya Amina , Mardassi Helmi , Ben Abdelmoumen Mardassi Boutheina
Published: January 2020

Background

Ureaplasma spp. have been implicated in a variety of clinical conditions and certain serovars are likely to be disease-associated. Hence, the ascending trend of Ureaplasma spp. resistance to antimicrobials should deserve more attention. Here we assessed the extent of antimicrobial resistance of Ureaplasma serovars in Tunisia, and investigated the underlying molecular basis.

Methods

This study included 101 molecularly typed Ureaplasma spp. clinical strains isolated over a 12-year time period (2005–2017). The antimicrobial susceptibility was tested against nine antibacterial agents using the broth microdilution method. Neighbor-joining tree was constructed to establish the phylogenetic relationships among isolates.

Results

We found that all ureaplasma isolates were resistant to ciprofloxacin and erythromycin, intermediately resistant to azithromycin, and susceptible to doxycycline, moxifloxacin and josamycin. Ofloxacin and levofloxacin resistance was found in 73.27 and 17.82%, respectively, while 37.62% of isolates proved resistant to tetracycline. Consequently, we detected an elevated multidrug resistance rate among ureaplasma isolates (37.62%), particularly among serovars 2, 5, 8, and 9 (77.77% overall), as well as serovars 4, 10, 12, and 13 (52.63% overall). In most cases, drug resistance was found to be associated with known molecular mechanisms, yet we have identified two novel mutations in the L22 protein, which might be associated with macrolide-resistance.

Conclusion

To our knowledge, this is the first study that reports the widespread expansion of multidrug resistance among Ureaplasma serovars, a finding of importance in terms of both surveillance and antimicrobial usage.
N-acetylcysteine inhibits bacterial lipopeptide-mediated neutrophil transmigration through the choroid plexus in the developing brain
Authors: Mottahedin Amin , Blondel Sandrine , Ek Joakim , Leverin Anna-Lena , Svedin Pernilla , Hagberg Henrik , Mallard Carina , Ghersi-Egea Jean-Francois , Strazielle Nathalie
Published: January 2020

The etiology of neurological impairments associated with prematurity and other perinatal complications often involves an infectious or pro-inflammatory component. The use of antioxidant molecules have proved useful to protect the neonatal brain from injury. The choroid plexuses-CSF system shapes the central nervous system response to inflammation at the adult stage, but little is known on the neuroimmune interactions that take place at the choroidal blood-CSF barrier during development. We previously described that peripheral administration to neonatal mice of the TLR2 ligand PAM3CSK4 (P3C), a prototypic Gram-positive bacterial lipopeptide, induces the migration of innate immune cells to the CSF. Here we showed in neonatal rats exposed to P3C that the migration of neutrophils into the CSF, which occurred through the choroid plexuses, is abolished following administration of the antioxidant drug N-acetylcysteine. Combining light sheet microscopy imaging of choroid plexus, a differentiated model of the blood-CSF barrier, and multiplex cytokine assays, we showed that the choroidal epithelium responds to the bacterial insult by a specific pattern of cytokine secretion, leading to a selective accumulation of neutrophils in the choroid plexus and to their trafficking into CSF. N-acetylcysteine acted by blocking neutrophil migration across both the endothelium of choroidal stromal vessels and the epithelium forming the blood-CSF barrier, without interfering with neutrophil blood count, neutrophil tropism for choroid plexus, and choroidal chemokine-driven chemotaxis. N-acetylcysteine reduced the injury induced by hypoxia-ischemia in P3C-sensitized neonatal rats. Overall, the data show that a double endothelial and epithelial check point controls the transchoroidal migration of neutrophils into the developing brain. They also point to the efficacy of N-acetylcysteine in reducing the deleterious effects of inflammation-associated perinatal injuries by a previously undescribed mechanism, i.e. the inhibition of innate immune cell migration across the choroid plexuses, without interfering with the systemic inflammatory response to infection.
FTIR surface analysis for conservation
Authors: Thickett David , Pretzel Boris
Published: January 2020

Several FTIR techniques are surface-sensitive. This sensitivity can be utilized to help with a wide range conservation issues. Examples from object degradation studies, conservation materials performance assessment and monitoring are presented. These are used to discuss the issues, advantages and information that can be drawn from studies. Glass degradation was quantified on the surfaces of cover glasses from important Nineteenth century daguerreotypes using Germanium attenuated total reflectance. The very limited information depth endowed by the high refractive index crystal gave good sensitivity when other techniques such as sectioning and scanning electron microscopy had failed to detect a gel layer present. The inner glass surface was always more deteriorated and the degree of deterioration inversely correlated with the distance between the inner glass surface and the daguerreotype or brass matt surface. Reflection–absorption FTIR microscopy has been combined with an excimer laser to determine the water content of a series of sections through the depth of a wax. A common wax used to protect metals has been found to take up liquid water in humid environments and hold that water close to or at the metal surface. An adjustable height gold mirror was used to bounce the IR beam many times across a surface, which can give extreme sensitivity. Haze and smoke generators are increasingly being introduced into displays or for special events or filming. Very low detection limits (1 ng) were found using gold coated glass slides to detect haze deposits.
Circadian Misalignment of the 24-hour Profile of Endocannabinoid 2-Arachidonoylglycerol (2-AG) in Obese Adults
Authors: Hanlon Erin C , Leproult Rachel , Stuhr Kara L , Doncheck Elizabeth M , Hillard Cecilia J , Van Cauter Eve
Published: January 2020

Context

The endocannabinoid (eCB) system partly controls hedonic eating, a major cause of obesity. While some studies suggested an overactivation of the eCB system in obesity, peripheral levels of eCBs across the 24-hour cycle have not been characterized in obese individuals despite the fact that in lean adults, levels of the eCB 2-arachidonoylglycerol (2-AG) vary across the day.

Objective

We sought to examine 24-hour profiles of serum concentrations of 2-AG in healthy obese and nonobese adults, under well-controlled laboratory conditions. We also simultaneously assessed 24-hour profiles of 2-oleoylglycerol (2-OG), leptin, and cortisol in each participant.

Design

With fixed light-dark and sleep-wake cycles, blood sampling was performed over an entire 24-hour period, including identical meals at 0900, 1400, and 1900.

Participants

Twelve obese (8 women, mean body mass index [BMI]: 39.1 kg/m2) and 15 nonobese (6 women; mean BMI: 23.6 kg/m2) healthy adults were studied.

Results

We observed a 24-hour variation of 2-AG levels in obese individuals but, relative to nonobese adults, the amplitude was dampened and the timings of the nadir and peak were delayed by 4 to 5 hours. The profile of 2-OG was similarly misaligned. In contrast, when expressed relative to the 24-hour mean level, the 24-hour rhythm of cortisol and leptin were similar in obese and nonobese participants.

Conclusions

Obesity appears to be associated with a dampening and delay of the 24-hour variation of eCB activity relative to the central circadian signal as well as to the daily leptin rhythm. This misalignment may play a role in the pathophysiology of obesity.
An Activating Variant inCTNNB1is Associated with a Sclerosing Bone Dysplasia and Adrenocortical Neoplasia
Authors: Peng Hui , Jenkins Zandra A , White Ruby , Connors Sam , Hunter Matthew F , Ronan Anne , Zankl Andreas , Markie David M , Daniel Philip B , Robertson Stephen P
Published: January 2020

Context

The WNT/β-catenin pathway is central to the pathogenesis of various human diseases including those affecting bone development and tumor progression.

Objective

To evaluate the role of a gain-of-function variant in CTNNB1 in a child with a sclerosing bone dysplasia and an adrenocortical adenoma.

Design

Whole exome sequencing with corroborative biochemical analyses.

Patients

We recruited a child with a sclerosing bone dysplasia and an adrenocortical adenoma together with her unaffected parents.

Intervention

Whole exome sequencing and performance of immunoblotting and luciferase-based assays to assess the cellular consequences of a de novo variant in CTNNB1.

Main Outcome Measure(s)/Result

A de novo variant in CTNNB1 (c.131C>T; p.[Pro44Leu]) was identified in a patient with a sclerosing bone dysplasia and an adrenocortical adenoma. A luciferase-based transcriptional assay of WNT signaling activity verified that the activity of β-catenin was increased in the cells transfected with a CTNNB1p.Pro44Leu construct (P = 4.00 × 10–5). The β-catenin p.Pro44Leu variant was also associated with a decrease in phosphorylation at Ser45 and Ser33/Ser37/Thr41 in comparison to a wild-type (WT) CTNNB1 construct (P = 2.16 × 10–3, P = 9.34 × 10–8 respectively).

Conclusion

Increased β-catenin activity associated with a de novo gain-of-function CTNNB1 variant is associated with osteosclerotic phenotype and adrenocortical neoplasia.
Obese Adolescents With PCOS Have Altered Biodiversity and Relative Abundance in Gastrointestinal Microbiota
Authors: Jobira Beza , Frank Daniel N , Pyle Laura , Silveira Lori J , Kelsey Megan M , Garcia-Reyes Yesenia , Robertson Charles E , Ir Diana , Nadeau Kristen J , Cree-Green Melanie
Published: January 2020

Context

Alterations in gut microbiota relate to the metabolic syndrome, but have not been examined in at-risk obese youth with polycystic ovary syndrome (PCOS).

Objective

Compare the composition and diversity of the gut microbiota and associations with metabolic and hormonal measures between 2 groups of female adolescents with equal obesity with or without PCOS.

Design

Prospective, case-control cross-sectional study.

Setting

Tertiary-care center.

Participants

A total of 58 obese female adolescents (n = 37 with PCOS; 16.1 ± 0.3 years of age; body mass index [BMI] 98.5th percentile) and (n = 21 without PCOS; 14.5 ± 0.4 years of age; BMI 98.7th percentile).

Outcomes

Bacterial diversity, percent relative abundance (%RA), and correlations with hormonal and metabolic measures.

Results

Participants with PCOS had decreased α-diversity compared with the non-PCOS group (Shannon diversity P = 0.045 and evenness P = 0.0052). β-diversity, reflecting overall microbial composition, differed between groups (P < 0.001). PCOS had higher %RA of phyla Actinobacteria (P = 0.027), lower Bacteroidetes (P = 0.004), and similar Firmicutes and Proteobacteria. PCOS had lower %RA of families Bacteroidaceae (P < 0.001) and Porphyromonadaceae (P = 0.024) and higher Streptococcaceae (P = 0.047). Lower bacterial α-diversity was strongly associated with higher testosterone concentrations. Several individual taxa correlated with testosterone and metabolic measures within PCOS and across the entire cohort. Receiver operative curve analysis showed 6 taxa for which the %RA related to PCOS status and lower Bacteroidaceae conferred a 4.4-fold likelihood ratio for PCOS.

Conclusion

Alterations in the gut microbiota exist in obese adolescents with PCOS versus obese adolescents without PCOS and these changes relate to markers of metabolic disease and testosterone. Further work is needed to determine if microbiota changes are reflective of, or influencing, hormonal metabolism.
Fictions of Production
Authors: Smith Rosalind
Published: January 2020

This essay builds upon work surrounding reception and the figure of the early modern woman writer to examine textual instances in which women’s writing has been “found” or manufactured: where writing falsely or tenuously attributed to historical women was circulated under their signatures as their voice. These fictions of production circulated as prosopopoeiae within women’s lifetimes alongside writers’ own scribal and print textual productions, as well as in the centuries following their deaths in the service of editorial, antiquarian, and historical projects. The complexity of naming and attribution in the texts discussed suggests that any distinct separation of speaker and author fails to recognize the centrality of prosopopoeiae to the rhetorical formations underwriting conceptions of the early modern woman writer. The essay newly argues for prosopopoeia as a generative figure of speech that enabled rather than restricted formations of the English woman writer and her participation in literary history.