bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular characterization of Prototheca in 11 symptomatic dogs
Authors: Falcaro Christian , Furlanello Tommaso , Binanti Diana , Fondati Alessandra , Bonfanti Ugo , Krockenberger Mark , Malik Richard , Danesi Patrizia
Published: December 2020

Protothecosis is an uncommon disease caused by algae of the genus Prototheca. In dogs, the infection is usually first localized to the colon but has the propensity to later disseminate hematogenously to many other organs, with marked tropism for the eyes and central nervous system. Diagnosis is established by culture and/or evidence of Prototheca organisms in cytologic or histologic preparations. Species characterization, however, requires molecular investigations. Our laboratory set up a real-time PCR targeting portion D1/D2 of the 28S rRNA for identification of Prototheca species from both positive cultures (of rectal swabs and urine) and formalin-fixed, paraffin-embedded tissue. Prototheca bovis, P. ciferrii, and P. wickerhamii were characterized in 11 dogs with systemic or cutaneous protothecosis. Prototheca identifications were phylogenetically consistent with the new taxonomy proposed for this genus based on the mitochondrial cytochrome b gene. As a pilot study, we screened feces and rectal scrapes from 200 asymptomatic dogs, using 2 cohorts of stray and owned animals, to determine the prevalence of intestinal carriage of Prototheca spp. The Prototheca-negative results from both cohorts of healthy dogs suggest that predisposing factors related to the host probably contribute more to the acquisition of clinical disease than exposure to contaminated environments.
COVID-19, Antiphospholipid Antibodies, and Catastrophic Antiphospholipid Syndrome: A Possible Association?
Authors: El Hasbani Georges , Taher Ali T , Jawad Ali , Uthman Imad
Published: December 2020

Since the 2019 novel coronavirus (COVID-19) was first detected in December 2019, research on the complications and fatality of this virus has hastened. Initially, case reports drew an association between COVID-19 and abnormal coagulation parameters. Subsequently, cross-sectional studies found a high prevalence of thrombosis among ICU and non-ICU COVID-19 patients. For that reason, certain studies tried to explain the pathogenic mechanisms of thrombosis, one of which was the emergence of anti-phospholipid antibodies (aPL). Although aPL have been found positive in very few patients, their association with thrombotic events stays debatable. Given the thrombotic manifestations of COVID-19 and the potential role of aPL, the catastrophic form of APS (CAPS) might be a major fatal phenomenon. However, to date, there has been no clear association of CAPS to COVID-19. Moreover, since infections, including viral respiratory similar to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are considered main etiologies for CAPS, it could be possible that SARS-CoV-2 can induce CAPS although no evidence is currently found. High quality studies are needed to develop a clear idea on the pathogenic role of aPL in the progression of thrombosis in COVID-19 patients, and how such patients could be fit into a thromboprophylaxis plan.
Principals’ involvement in comprehensive school physical activity programmes: A social-ecological perspective
Authors: Orendorff Karie , Webster Collin A , Mîndrilă Diana , Cunningham Kathleen MW , Doutis Panayiotis , Dauenhauer Brian , Stodden David F
Published: December 2020

To support school physical education, United States (US) national organizations in medicine, health, and education recommend that schools adopt comprehensive school physical activity programmes (CSPAPs). An important factor in successful CSPAP implementation is the involvement of the school principal. The purpose of this study was to examine relationships between principals’ self-reported CSPAP involvement and their social-ecological-based perceptions about CSPAPs. We analysed survey responses from a national sample of principals in the US who indicated their school had a CSPAP ( n = 198). Exploratory structural equation modelling supported a single-factor solution for CSPAP involvement (12 items) and three social-ecological factors, which we labelled ‘intrapersonal’ (nine items mainly focused on expected outcomes of CSPAPs), ‘interpersonal’ (five items focused on parents’ and teachers’ support of the CSPAP), and ‘environmental’ (12 items focused on the support of the overall school environment, the community surrounding the school, and public policy for the CSPAP). Path analysis showed involvement factor scores are predicted by intrapersonal factor scores, which, in turn, are predicted by interpersonal and environmental factor scores. The results of this study are helpful in identifying targets for future research and practice related to CSPAP implementation and can inform efforts to prepare and support principals with respect to their CSPAP involvement.
Wind tunnel testing and frequency domain buffeting analysis of a 5000 m suspension bridge
Authors: Xia Jinlin , Li Ke , Ge Yaojun
Published: December 2020

Buffeting’s importance is highlighted in the case of super-long bridges. It remains unclear how buffeting will perform and whether the traditional methods still apply when bridge’s span is approaching its upper limitation. To figure out this, a full aeroelastic model testing has been carried out with the span arrangement 2000+5000+2000 m. A comparison with the existing bridges reveals the similarities and differences. It shows vertical and torsional buffetings are important for a 5000 m bridge while lateral response is almost static. Fundamental modes contribute most kinetic energy. With the increasing of wind speed, the aerodynamic coupling effect becomes prominent while the structural coupling effect keeps limited. Afterwards, four analytical methods, namely SRSS and CQC, with and without self-induced forces, are used for the buffeting displacements. The calculation indicates the multi-mode (CQC) analysis is still applicable on a 5000 m bridge but the mode-by-mode (SRSS) method is risky since the neglection of aerodynamic coupling effect. Parameter analysis shows aerodynamic admittance function and force coherence are decisive while the cross terms are of secondary importance. Since all data is experimentally measured, the reliability of analytical results can be ensured.
Deep feature learning of in-cylinder flow fields to analyze cycle-to-cycle variations in an SI engine
Authors: Dreher Daniel , Schmidt Marius , Welch Cooper , Ourza Sara , Zündorf Samuel , Maucher Johannes , Peters Steven , Dreizler Andreas , Böhm Benjamin , Hanuschkin Alexander
Published: December 2020

Machine learning (ML) models based on a large data set of in-cylinder flow fields of an IC engine obtained by high-speed particle image velocimetry allow the identification of relevant flow structures underlying cycle-to-cycle variations of engine performance. To this end, deep feature learning is employed to train ML models that predict cycles of high and low in-cylinder maximum pressure. Deep convolutional autoencoders are self-supervised-trained to encode flow field features in low dimensional latent space. Without the limitations ascribable to manual feature engineering, ML models based on these learned features are able to classify high energy cycles already from the flow field during late intake and the compression stroke as early as 290 crank angle degrees before top dead center ([Formula: see text]) with a mean accuracy above chance level. The prediction accuracy from [Formula: see text] to [Formula: see text] is comparable to baseline ML approaches utilizing an extensive set of engineered features. Relevant flow structures in the compression stroke are revealed by feature analysis of ML models and are interpreted using conditional averaged flow quantities. This analysis unveils the importance of the horizontal velocity component of in-cylinder flows in predicting engine performance. Combining deep learning and conventional flow analysis techniques promises to be a powerful tool for ultimately revealing high-level flow features relevant to the prediction of cycle-to-cycle variations and further engine optimization.
Investigation of the mechanical properties of concrete containing recycled aggregate and scrap crumb rubber and polypropylene fibers
Authors: Khoshroo Moein , Javid Ali Akbar Shirzadi , Bakhshandeh Nima Rajabi , Shalchiyan Mohamad
Published: December 2020

In this study, the effect of using crumb rubber and recycled aggregates on the mechanical properties of concrete has been evaluated as areplacement of fine and coarse aggregates In order to add the admixtures and evaluate their combined effect, 20 different types of concrete mixture ratio were prepared. The results indicated that in those samples containing crumb rubber and recycled aggregates the compressive strength is reduced and adding fiber up to 0.1%. to these concrete samples can improve the compressive strength Also, the tensile strength of the samples mixed with crumb rubber and recycled aggregates were decreased, and with the addition of propylene fiber up to 0.4%. the tensile strength slightly increased Moreover by adding the crumb rubber to the samples the elasticity modulus was reduced but by adding fiber to samples about 0.1% and 0.2.% the modulus of elasticity of concrete in all samples were increased. According to the results, it can be said that using the combination of 5% of crumb rubber as a replacement of fine aggregate, and the combination of 35% of recycled aggregates as a replacement of coarse aggregate, and also by adding 0.1% polypropylene fiber in volumetric percentage of concrete along with adding 7% of micro silica as a replacement of cement led to the best effect on the mechanical properties of concrete.
Effectiveness of an infection prevention strategy to limit exposure of high-risk patients to COVID-19 in a hospital-based subacute unit: a descriptive report
Authors: McBeth Brian D , Dass Sharad , Rai Daljeet , Michelli Elizabeth
Published: December 2020

The coronavirus (COVID-19) epidemic has put unprecedented stress on hospitals as well as skilled nursing facilities, where reside some of the most vulnerable individuals at high risk of mortality and complications of this infection. This report highlights the strategy and success of hospital infection prevention efforts to protect the residents of an in-hospital subacute unit with 24 at-risk patients with chronic pulmonary disease in northern California. Specific efforts are detailed, with results of surveillance testing reported, including both viral PCR and serological IgG assays. Implications for other long-term subacute care facilities are discussed, as well as advantages and specific challenges for ‘distinct part’ versus ‘free-standing’ subacute care units.
Validation of the Clance Impostor Phenomenon Scale with female Hebrew-speaking students
Authors: Yaffe Yosi
Published: December 2020

The Clance Impostor Phenomenon Scale (CIPS) is a measure widely used to assess individuals’ self-perceptions of intellectual and professional fraudulence. The study aimed to investigate the psychometric properties of the Hebrew form for the CIPS (HCIPS) in female Hebrew-speaking students, in an attempt to further clarify its structure and strengthen its validity in international settings. The study comprised a sample of 248 female students ( M age = 27.74, SD = 7.32), who completed an online version of the questionnaire. Our results generally demonstrated satisfactory psychometric properties of the HCIPS total scale, with its internal consistency, reliability, and item-total-correlations meeting the standard criteria. The exploratory factor analysis yielded a stable four-factor solution for the 19-items, with its factors accounting for 54.81% of the model’s variance. The confirmatory factor analysis confirmed the four-factor model as compatible, with its fit-indices meeting the minimal standards of goodness of fit. The study’s findings are the first to identify a four-factor model, which improves the imbalanced factorial composition characterizing the common three-factor model. Subject to the study’s limitations, this evidence suggests that the HCIPS is a sound instrument for assessing impostor feelings among female Hebrew-speaking students.
Risk and protective factors for intention of contraception use among women in Ghana
Authors: Ahuja Manik , Frimpong Esther , Okoro Joy , Wani Rajvi , Armel Sarah
Published: December 2020

The use of various forms of contraception in Ghana gained prominence after the government resorted to investing more in family planning programs when maternal mortality was declared an emergency in the country. In Ghana, the intention to use and actual usage of contraceptives is influenced by many factors, which may lead to non-usage or discontinuation. This quantitative study was conducted to determine risk and protective factors impacting on the intention and usage of contraceptives. Survey data from the Ghana 2014 Demographic and Health Survey (DHS) ( n = 9396) was used. A sub-sample of 7661 women in their reproductive age were included in this study, who reported being sexually active within the last year. Logistic regression analyses were conducted to test the association between a broad range of risk and protective factors including religion, early sexual intercourse, frequency of sex, number of lifetime sexual partners with intention to use contraception. We controlled for income, educational attainment, and age. Overall ( n = 3661; 47.8%) reported no intention of contraception use. Logistic regression analysis revealed that no formal education (OR = 1.49; 95% CI, 1.29–1.72; p < 0.001), and primary school as highest educational level (OR = 1.19; 95% CI, 1.04–1.25; p < 0.001), Islamic religion (OR = 0.73; 95% CI, 0.59–0.90; p < 0.001), not currently employed (OR = 1.50; 95% CI, 1.34–1.69; p < 0.001), husband opposing contraception use (OR = 2.19; 95% CI, 1.42–3.46; p < 0.001), and currently pregnant (OR = 1.30; 95% CI, 1.09–1.54; p < 0.001) were also positively associated with no intention of use. Engaging religious leaders for advocacy in the community was identified as an approach to address barriers and increase awareness on contraceptive use. Targeted family planning programs should intensify public education on safe sex behaviors.
Comparing Bone-Tendon Autograft With Bone-Tendon-Bone Autograft for ACL Reconstruction: A Matched-Cohort Analysis
Authors: Cruz Christian A. , Goldberg Daniel , Wake Jeffrey , Sy Joshua , Mannino Brian J. , Min Kyong S. , Bottoni Craig R.
Published: December 2020

Background:

Anterior cruciate ligament (ACL) reconstruction (ACLR) using bone-tendon-bone (BTB) autograft is associated with increased postoperative anterior knee pain and pain with kneeling and has the risk of intra- and postoperative patellar fracture. Additionally, graft-tunnel mismatch is problematic, often leading to inadequate osseous fixation. Given the disadvantages of BTB, an alternative is a bone-tendon autograft (BTA) procedure that has been developed at our institution. BTA is a patellar tendon autograft with the single bone plug taken from the tibia.

Purpose/Hypothesis:

The purpose of this study was to evaluate the short-term outcomes of BTA ACLR. We hypothesized that this procedure will provide noninferior failure rates and clinical outcomes when compared with a BTB autograft, as well as a lower incidence of anterior knee pain, pain with kneeling, and patellar fracture.

Methods:

A consecutive series of 52 patients treated with BTA ACLR were retrospectively identified and compared with 50 age-matched patients who underwent BTB ACLR. The primary outcome was ACL graft failure, while secondary outcomes included subjective instability, anterior knee pain, kneeling pain, and functional outcome scores (Single Assessment Numeric Evaluation, Lysholm, and International Knee Documentation Committee subjective knee form).

Results:

At a mean follow-up of 29.3 months after surgery, there were 2 reruptures in the BTA cohort (4.0%) and 2 in the BTB cohort (4.0%). In the BTA group, 18% of patients reported anterior knee pain versus 36% of the BTB group ( P = .04). A total of 22% of patients noted pain or pressure with kneeling in the BTA cohort, as opposed to 48% in the BTB cohort ( P = .006). There were no differences in functional scores. In the BTA group, 94.2% of patients reported that their knees subjectively felt stable, as compared with 86% in the BTB group ( P = .18).

Conclusion:

This study demonstrated that the BTA ACLR leads to similarly low rates of ACL graft failure requiring revision surgery, with significantly decreased anterior knee pain and kneeling pain when compared with a BTB. Additionally, the potential complications of graft-tunnel mismatch and patellar fracture are eliminated with the BTA ACLR technique.
Criminal Justice Contact and Indebtedness in Young Adulthood: Investigating the Potential Role of State-level Hidden Sentences
Authors: Warner Cody , Houle Jason N. , Kaiser Joshua
Published: December 2020

Contact with the American criminal justice system is associated with socioeconomic disadvantage and financial insecurity, but little research has explored the link between criminal justice contact and indebtedness. In this study, we ask whether contact in young adulthood is associated with access to credit and unsecured debt burdens. We also focus on state-level policies that operate alongside official punishments and restrict citizenship and societal participation among the justice-involved (termed hidden sentences), and ask whether such policies moderate the association between criminal justice contact and indebtedness. We find that criminal justice contact, especially incarceration, is associated with reduced access to unsecured credit and greater absolute and relative debt burdens. These associations are strongest for individuals residing in states with more onerous hidden sentence regimes. We argue that indebtedness is a key socioeconomic consequence of criminal justice contact and that hidden sentences may exacerbate these consequences.
Women’s Caregiving Experience of Older Persons Living With Alzheimer Disease and Related Dementias and Multiple Chronic Conditions: Using Wuest’s Theory
Authors: Peacock Shelley , Bayly Melanie , Duggleby Wendy , Ploeg Jenny , Pollard Lori , Swindle Jennifer , Lee Heun Jung , Williams Allison , Markle-Reid Maureen , McAiney Carrie
Published: December 2020

Introduction

Care of persons living with chronic conditions rests heavily on women within the context of the family. Research demonstrates that women experience more caregiving strain compared to men, yet less is known about the differences in experiences between women carers: namely, wives and daughters.

Objective

The purpose of this study was to examine and compare the experiences of wife and daughter carers of older adults living with Alzheimer disease and related dementias, plus at least two other chronic conditions.

Methods

Using qualitative description with Wuest’s feminist caring theory of precarious ordering as an analytic framework, interview transcripts of women carer participants who were from the control group of a larger multi-site mixed methods study evaluating the web-based intervention My Tools 4 Care were analyzed.

Findings

Both wives and daughters experienced daily struggles, altered prospects, and ambivalent feelings around their caring role. Negotiating the role of professional carer was an important part of balancing caring demands and anticipating the future, and women took an active role in trying to harness caring resources. Findings indicated wives and daughters were generally similar in how they described their caregiving, although daughters reported more shared caring and decision-making, and needed to balance paid employment with caregiving.

Conclusion

Wives and daughters face similar challenges caring for persons with a dementia and multiple chronic conditions, and actively engage in strategies to manage caring demands. The findings illuminate the importance of accessible, appropriate support from professional carers/health care providers, and suggest that assistance navigating such supports would benefit women carers.
Mössbauer and Raman spectroscopic characterization of iron and carbon in iron-loaded Japanese cypress charcoal
Authors: Yamagishi Takayuki , Yamauchi Shigeru , Suzuki Kyoko , Suzuki Tsutomu , Kurimoto Yasuji , Takayama Tsutomu , Sakai Yoichi
Published: December 2020

Japanese cypress (Chamaecyparis obtusa) wood powder impregnated with Fe3+ ions was carbonized using one-step and two-step procedures, and the iron-loaded charcoal was examined using Mössbauer and Raman spectroscopy to elucidate the physicochemical states of iron and carbon after carbonization at various temperatures. In the one-step procedure, the Mössbauer spectra confirmed that charcoal carbonized at 750 °C and 800 °C contained Fe3C, suggesting that the reduction of Fe3+ started at lower than 750 °C. The content of Fe3C increased substantially in charcoal carbonized at 850 °C and 900 °C, and metallic iron (γ-Fe and/or α-Fe) was also detected in these charcoal samples. Raman spectral line-shapes of the charcoal carbonized at 750 °C and 800 °C were notably different from those of charcoal carbonized at 850 °C and 900 °C, which indicated that crystallization of carbon progressed rapidly in the temperature range 800–850 °C. The changes in Raman spectra probably corresponded to those in the Mössbauer spectra, namely, the graphitization was closely related to the reduction of Fe3+. The degree of graphitization in the charcoal carbonized at 850 °C using the two-step procedure was higher than that using the one-step procedure. Mössbauer spectra suggested that the two-step carbonization enhances the yield of ferromagnetic iron species in iron-loaded charcoal.
Regional registration of whole slide image stacks containing major histological artifacts
Authors: Paknezhad Mahsa , Loh Sheng Yang Michael , Choudhury Yukti , Koh Valerie Koh Cui , Yong Timothy Tay Kwang , Tan Hui Shan , Kanesvaran Ravindran , Tan Puay Hoon , Peng John Yuen Shyi , Yu Weimiao , Tan Yongcheng Benjamin , Loy Yong Zhen , Tan Min-Han , Lee Hwee Kuan
Published: December 2020

Background

High resolution 2D whole slide imaging provides rich information about the tissue structure. This information can be a lot richer if these 2D images can be stacked into a 3D tissue volume. A 3D analysis, however, requires accurate reconstruction of the tissue volume from the 2D image stack. This task is not trivial due to the distortions such as tissue tearing, folding and missing at each slide. Performing registration for the whole tissue slices may be adversely affected by distorted tissue regions. Consequently, regional registration is found to be more effective. In this paper, we propose a new approach to an accurate and robust registration of regions of interest for whole slide images. We introduce the idea of multi-scale attention for registration.

Results

Using mean similarity index as the metric, the proposed algorithm (mean ± SD$$0.84 \pm 0.11$$0.84±0.11) followed by a fine registration algorithm ($$0.86 \pm 0.08$$0.86±0.08) outperformed the state-of-the-art linear whole tissue registration algorithm ($$0.74 \pm 0.19$$0.74±0.19) and the regional version of this algorithm ($$0.81 \pm 0.15$$0.81±0.15). The proposed algorithm also outperforms the state-of-the-art nonlinear registration algorithm (original:$$0.82 \pm 0.12$$0.82±0.12, regional:$$0.77 \pm 0.22$$0.77±0.22) for whole slide images and a recently proposed patch-based registration algorithm (patch size 256:$$0.79 \pm 0.16$$0.79±0.16, patch size 512:$$0.77 \pm 0.16$$0.77±0.16) for medical images.

Conclusion

Using multi-scale attention mechanism leads to a more robust and accurate solution to the problem of regional registration of whole slide images corrupted in some parts by major histological artifacts in the imaged tissue.
Designing a chimeric subunit vaccine for influenza virus, based on HA2, M2e and CTxB: a bioinformatics study
Authors: Jafari Davod , Malih Sara , Gomari Mohammad Mahmoudi , Safari Marzieh , Jafari Rasool , Farajollahi Mohammad Morad
Published: December 2020

Background

Type A influenza viruses are contagious and even life-threatening if left untreated. So far, no broadly protective vaccine is available due to rapid antigenic changes and emergence of new subtypes of influenza virus. In this study, we exploited bioinformatics tools in order to design a subunit chimeric vaccine from the antigenic and highly conserved regions of HA and M2 proteins of H7N9 subtype of influenza virus. We used mucosal adjuvant candidates, including CTxB, STxB, ASP-1, and LTB to stimulate mucosal immunity and analyzed the combination of HA2, M2e, and the adjuvant. Furthermore, to improve the antigen function and to maintain their three-dimensional structure, 12 different linkers including six rigid linkers and six flexible linkers were used. The 3D structure model was generated using a combination of homology and ab initio modeling methods and the molecular dynamics of the model were analyzed, either.

Results

Analysis of different adjuvants showed that using CtxB as an adjuvant, results in higher overall vaccine stability and higher half-life among four adjuvant candidates. Fusion of antigens and the CTxB in the form of M2e-linker-CTxB-linker-HA2 has the most stability and half life compared to other combination forms. Furthermore, the KPKPKP rigid linker showed the best result for this candidate vaccine among 12 analyzed linkers. The changes in the vaccine 3D structure made by linker insertion found to be negligible, however, although small, the linker insertion between the antigens causes the structure to change slightly. Eventually, using predictive tools such as Ellipro, NetMHCpan I and II, CD4episcore, CTLpred, BepiPred and other epitope analyzing tools, we analyzed the conformational and linear epitopes of the vaccine. The solubility, proteasome cleavage sites, peptidase and potential chemical cutters, codon optimization, post translational modification were also carried out on the final vaccine.

Conclusions

It is concluded that M2e-Linker-CTxB-Linker-HA2 combination of chimeric vaccine retains its 3D structure and antigenicity when KPKPKP used as linker and CTxB used as adjuvant.
Efficient COI barcoding using high throughput single-end 400 bp sequencing
Authors: Yang Chentao , Zheng Yuxuan , Tan Shangjin , Meng Guanliang , Rao Wei , Yang Caiqing , Bourne David G. , O’Brien Paul A. , Xu Junqiang , Liao Sha , Chen Ao , Chen Xiaowei , Jia Xinrui , Zhang Ai-bing , Liu Shanlin
Published: December 2020

Background

Over the last decade, the rapid development of high-throughput sequencing platforms has accelerated species description and assisted morphological classification through DNA barcoding. However, the current high-throughput DNA barcoding methods cannot obtain full-length barcode sequences due to read length limitations (e.g. a maximum read length of 300 bp for the Illumina’s MiSeq system), or are hindered by a relatively high cost or low sequencing output (e.g. a maximum number of eight million reads per cell for the PacBio’s SEQUEL II system).

Results

Pooled cytochrome c oxidase subunit I (COI) barcodes from individual specimens were sequenced on the MGISEQ-2000 platform using the single-end 400 bp (SE400) module. We present a bioinformatic pipeline, HIFI-SE, that takes reads generated from the 5′ and 3′ ends of the COI barcode region and assembles them into full-length barcodes. HIFI-SE is written in Python and includes four function modules of filter, assign, assembly and taxonomy. We applied the HIFI-SE to a set of 845 samples (30 marine invertebrates, 815 insects) and delivered a total of 747 fully assembled COI barcodes as well as 70 Wolbachia and fungi symbionts. Compared to their corresponding Sanger sequences (72 sequences available), nearly all samples (71/72) were correctly and accurately assembled, including 46 samples that had a similarity score of 100% and 25 of ca. 99%.

Conclusions

The HIFI-SE pipeline represents an efficient way to produce standard full-length barcodes, while the reasonable cost and high sensitivity of our method can contribute considerably more DNA barcodes under the same budget. Our method thereby advances DNA-based species identification from diverse ecosystems and increases the number of relevant applications.
The characteristics and risk factors of in-stent restenosis in patients with percutaneous coronary intervention: what can we do
Authors: Wang Pengfei , Qiao Haixia , Wang RuiJuan , Hou Ruitian , Guo Jingtao
Published: December 2020

Background

Percutaneous coronary intervention (PCI) is a common treatment for patients with coronary heart disease, and intra-stent restenosis (ISR) is a serious complication after PCI. It’s necessary to identify the potential risk factors to provide evidence for the prevention of ISR.

Methods

The patients who underwent coronary angiography 1 year after PCI in our hospital from January 2017 to May 2019 were selected. The characteristics and results of clinical examination of ISR and no-ISR patients were compared, Multivariate logistic regression analyses were performed to identify the risk factors.

Results

A total of 209 patients were included, the incidence of ISR after PCI was 30.62%. There were significant differences on the hypertension, diabetes, number of coronary artery lesions, reasons for stent implantation, the diameter of stent, the length of stent and stent position between ISR group and no-ISR patients (all p < 0.05). The LDL-C in ISR groups was significantly higher than that of no-ISR group (p = 0.048), there were no significant differences between two groups in FPG, TG, TC, HDL-C, Apo A1, Apo B, LP-a and glycated haemoglobin (all p > 0.05). The hypertension (OR 4.30, 95% CI 1.12–9.34), diabetes (OR 5.29, 95% CI 1.25–9.01), number of coronary artery lesions ≥ 2 (OR 4.84, 95% CI 1.21–9.55), LDL-C ≥ 1.9 mmol/L (OR 5.93, 95% CI 2.29–10.01), unstable angina (OR 2.92, 95% CI 1.20–4.55), left anterior descending artery (OR 4.01, 95% CI 1.73–7.58), diameter of stent ≥ 3 mm (OR 5.42, 95% CI 1.24–10.84), the length of stent > 20 mm (OR 3.06, 95% CI 1.19–5.22) were the independent risk factor for ISR (all p < 0.05).

Conclusion

It is necessary to take preventive measures against these risk factors to reduce ISR, and studies with larger sample size and longer follow-up on this issue are needed in the future.
Integrating nurse practitioners into primary care: policy considerations from a Canadian province
Authors: Black Stacey , Fadaak Raad , Leslie Myles
Published: December 2020

Background

The integration of nurse practitioners (NPs) into primary care health teams has been an object of interest for policy makers seeking to achieve the goals of improving care, increasing access, and lowering cost. The province of Alberta in Canada recently introduced a policy aimed at integrating NPs into existing primary care delivery structures. This qualitative research sought to understand how that policy – the NP Support Program (NPSP) – was viewed by key stakeholders and to draw out policy lessons.

Methods

Fifteen semi-structured interviews with NPs and other stakeholders in Alberta’s primary care system were conducted, recorded, transcribed and analyzed using the interpretive description method.

Results

Stakeholders predominantly felt the NPSP would not change the status quo of limited practice opportunities and the resulting underutilization of primary care NPs in the province. Participants attributed low levels of NP integration into the primary care system to: 1) financial viability issues that directly impacted NPs, physicians, and primary care networks (PCNs); 2) policy issues related to the NPSP’s reliance on PCNs as employers, and a requirement that NPs panel patients; and 3) governance issues in which NPs are not afforded sufficient authority over their role or how the key concept of ‘care team’ is defined and operationalized.

Conclusions

In general, stakeholders did not see the NPSP as a long-term solution for increasing NP integration into the province’s primary care system. Policy adjustments that enable NPs to access funding not only from within but also outside PCNs, and modifications to allow greater NP input into how their role is utilized would likely improve the NPSP’s ability to reach its goals.
Trends in the process and outcome indicators of type 2 diabetes care: a cohort study from Eastern Finland, 2012–2017
Authors: Lamidi Marja-Leena , Wikström Katja , Inglin Laura , Rautiainen Päivi , Tirkkonen Hilkka , Laatikainen Tiina
Published: December 2020

Background

Evidence-based guidelines include concrete treatment targets that can be used as process and outcome indicators in the evaluation of the quality of healthcare services and diabetes care. Quality improvement can be evaluated by monitoring longitudinal trends in the care indicators on the system level. The aim of this study is to describe trends in the processes and outcomes of care among people with type 2 diabetes in North Karelia, Finland.

Methods

The data consist of all adults with type 2 diabetes (identified from the EHRs using ICD-10 codes) who used primary or specialized care services in North Karelia during 2012–2017. The diabetes care was evaluated using the measurement activity, treatment levels, and the achievement of the treatment targets for HbA1c and LDL as care indicators. Logistic and linear models with generalized estimating equations were used to assess the differences between years, sexes, and age groups.

Results

The proportion of patients with annual measurement varied between 75.8 and 78.1% for HbA1c and between 67.4 and 69.1% for LDL during a five-year follow-up. The changes in average levels were moderate: a 0.2% (2 mmol/mol) increase for HbA1c and a 0.1 mmol/l decrease for LDL. Anyway, the proportion of patients meeting the treatment target for HbA1c decreased from 72.7 to 67.3% (age-adjusted decrease: 5.7%p, 95% CI: 4.5–6.9) and for LDL it increased from 53.4 to 59.5% (age-adjusted increase: 5.6%p, 95% CI: 4.2–7.0). Women were measured and met the HbA1c target level more often compared with men. Conversely, men met the LDL target level more often than women, and the age-adjusted difference between sexes increased smoothly from 7.9%p to 11.7%p.

Conclusions

The achievements in relation to type 2 diabetes care in North Karelia are very good, but no major improvement was observed during follow-up. HbA1c levels had a rising tendency and LDL levels declining tendency indicating quality improvement in LDL management, but challenges in further improvement in glucose control.
High burden of viral respiratory co-infections in a cohort of children with suspected pulmonary tuberculosis
Authors: van der Zalm M. M. , Walters E. , Claassen M. , Palmer M. , Seddon J. A. , Demers A.M. , Shaw M. L. , McCollum E. D. , van Zyl G. U. , Hesseling A. C.
Published: December 2020

Background

The presentation of pulmonary tuberculosis (PTB) in young children is often clinically indistinguishable from other common respiratory illnesses, which are frequently infections of viral aetiology. As little is known about the role of viruses in children with PTB, we investigated the prevalence of respiratory viruses in children with suspected PTB at presentation and follow-up.

Methods

In an observational cohort study, children < 13 years were routinely investigated for suspected PTB in Cape Town, South Africa between December 2015 and September 2017 and followed up for 24 weeks. Nasopharyngeal aspirates (NPAs) were tested for respiratory viruses using multiplex PCR at enrolment, week 4 and 8.

Results

Seventy-three children were enrolled [median age 22.0 months; (interquartile range 10.0–48.0); 56.2% male and 17.8% HIV-infected. Anti-tuberculosis treatment was initiated in 54.8%; of these 50.0% had bacteriologically confirmed TB. At enrolment, ≥1 virus were detected in 95.9% (70/73) children; most commonly human rhinovirus (HRV) (74.0%). HRV was more frequently detected in TB cases (85%) compared to ill controls (60.6%) (p = 0.02). Multiple viruses were detected in 71.2% of all children; 80% of TB cases and 60.6% of ill controls (p = 0.07). At follow-up, ≥1 respiratory virus was detected in 92.2% (47/51) at week 4, and 94.2% (49/52) at week 8.

Conclusions

We found a high prevalence of viral respiratory co-infections in children investigated for PTB, irrespective of final PTB diagnosis, which remained high during follow up. Future work should include investigating the whole respiratory ecosystem in combination with pathogen- specific immune responses.
Urine collection in cervical cancer screening – analytical comparison of two HPV DNA assays
Authors: Tranberg Mette , Jensen Jørgen Skov , Bech Bodil Hammer , Andersen Berit
Published: December 2020

Background

To reach non-participants, reluctant to undergo clinician-based cervical cancer screening and vaginal self-sampling, urine collection for high-risk human papillomavirus detection (hrHPV) may be valuable. Using two hrHPV DNA assays, we evaluated the concordance of hrHPV positivity in urine samples in comparison with vaginal self-samples and cervical cytology samples taken by the general practitioner (GP). We also studied women’s acceptance of urine collection and preferences towards the different sampling procedures.

Methods

One hundred fifty paired self-collected urine and vaginal samples and GP-collected cervical cytology samples were obtained from 30 to 59-year-old women diagnosed with ASC-US within the Danish cervical cancer screening program. After undergoing cervical cytology at the GP, the women collected first-void urine and vaginal samples at home and completed a questionnaire. Each sample was hrHPV DNA tested by the GENOMICA CLART® and COBAS® 4800 assays. Concordance in hrHPV detection between sample types was determined using Kappa (k) statistics. Sensitivity and specificity of hrHPV detection in urine was calculated using cervical sampling as reference.

Results

With the COBAS assay, urine showed good concordance to the vaginal (k = 0.66) self-samples and cervical samples (k = 0.66) for hrHPV detection. The corresponding concordance was moderate (k = 0.59 and k = 0.47) using CLART. Compared to cervical sampling, urinary hrHPV detection had a sensitivity of 63.9% and a specificity of 96.5% using COBAS; compared with 51.6 and 92.4% for CLART. Invalid hrHPV test rates were 1.8% for COBAS and 26.9% for CLART. Urine collection was well-accepted and 42.3% of the women ranked it as the most preferred future screening procedure.

Conclusions

Urine collection provides a well-accepted screening option. With COBAS, higher concordance between urine and vaginal self-sampling and cervical sampling for hrHPV detection was found compared to CLART. Urinary hrHPV detection with COBAS is feasible, but its accuracy may need to be improved before urine collection at home can be offered to non-participants reluctant to both cervical sampling and vaginal self-sampling.
Revealing two dynamic dengue epidemic clusters in Thailand
Authors: Lim Jue Tao , Han Yiting , Dickens Borame Sue Lee , Choo Esther Li Wen , Chew Lawrence Zheng Xiong , Cook Alex R.
Published: December 2020

Background

Thailand is home to around 69 million individuals. Dengue is hyper-endemic and all 4 serotypes are in active circulation in the country. Dengue outbreaks occur almost annually within Thailand in at least one province but the spatio-temporal and environmental interface of these outbreaks has not been studied.

Methods

We develop Bayesian regime switching (BRS) models to characterize outbreaks, their persistence and infer their likelihood of occurrence across time for each administrative province where dengue case counts are collected. BRS was compared against two other classification tools and their agreement is assessed. We further examine how these spatio-temporal clusters of outbreak clusters arise by comparing reported dengue case counts, urban population, urban land cover, climate and flight volumes on the province level.

Results

Two dynamic dengue epidemic clusters were found nationally. One cluster consists of 47 provinces and is highly outbreak prone. Provinces with a large number of case counts, urban population, urban land cover and incoming flight passengers are associated to the epidemic prone cluster of dengue. Climate has an effect on determining the probability of outbreaks over time within provinces, but have less influence on whether provinces belong to the epidemic prone cluster. BRS found high agreement with other classification tools.

Conclusions

Importation and urbanization drives the risk of outbreaks across regions strongly. In provinces estimated to have high epidemic persistence, more resource allocation to vector control should be applied to those localities as heightened transmission counts are likely to occur over a longer period of time. Clustering of epidemic and non-epidemic prone areas also highlights the need for prioritization of resource allocation for disease mitigation over provinces in Thailand.
Factors and HCV treatment outcomes associated with smoking among people who inject drugs on opioid agonist treatment: secondary analysis of the PREVAIL randomized clinical trial
Authors: Pericot-Valverde Irene , Heo Moonseong , Akiyama Matthew J. , Norton Brianna L. , Agyemang Linda , Niu Jiajing , Litwin Alain H.
Published: December 2020

Background

Cigarette smoking has emerged as a leading cause of mortality among people with hepatitis C virus (HCV). People who inject drugs (PWID) represent the largest group of adults infected with HCV in the US. However, cigarette smoking remains virtually unexplored among this population. This study aimed at (1) determining prevalence and correlates of cigarette smoking among HCV-infected PWID enrolled in opiate agonist treatment programs; (2) exploring the association of smoking with HCV treatment outcomes including adherence, treatment completion and sustained virologic response (SVR); and 3) exploring whether cigarette smoking decreased after HCV treatment.

Methods

Participants were 150 HCV-infected PWID enrolled in a randomized clinical trial primarily designed to test three intensive models of HCV care. Assessments included sociodemographics, presence of chronic health and psychiatric comorbidities, prior and current drug use, quality of life, and HCV treatment outcomes.

Results

The majority of the patients (84%) were current cigarette smokers at baseline. There was a high prevalence of psychiatric and medical comorbidities in the overall sample of PWID. Alcohol and cocaine use were identified as correlates of cigarette smoking. Smoking status did not influence HCV treatment outcomes including adherence, treatment completion and SVR. HCV treatment was not associated with decreased cigarette smoking.

Conclusions

The present study showed high prevalence of cigarette smoking among this population as well as identified correlates of smoking, namely alcohol and cocaine use. Cigarette smoking was not associated with HCV treatment outcomes. Given the detrimental effects that cigarette smoking and other co-occurring, substance use behaviors have on HCV-infected individuals’ health, it is imperative that clinicians treating HCV also target smoking, especially among PWID. The high prevalence of cigarette smoking among PWID will contribute to growing morbidity and mortality among this population even if cured of HCV. Tailored smoking cessation interventions for PWID along with HCV treatment may need to be put into clinical practice.

Trial registration

NCT01857245. Registered May 20, 2013.
Idiopathic multicentric Castleman disease with Sjögren’s syndrome and secondary membranous nephropathy: a case report and review of the literature
Authors: Pan Yuejuan , Cui Zhuan , Wang Song , Zheng Danxia , Deng Zhenling , Tian Xinyu , Guo Hongxia , Bao Wenhan , Zhou Sijia , Wang Yue
Published: December 2020

Background

Idiopathic multicentric Castleman disease (iMCD) is an uncommon lymphoproliferative disorder and lacks treatment consensus. Herein, we report a case of iMCD complicated with Sjögren’s syndrome (SS) and secondary membranous nephropathy (SMN).

Case presentation

A 45-year-old female with dry mouth for 3 months and anasarca and proteinuria for 2 months was admitted. She also experienced chest tightness, wheezing, fever, weight loss, moderate proteinuria and hypoalbuminemia. A computed tomography (CT) scan revealed a tissue mass in the thymus area and enlarged multiple lymph nodes. Her symptoms did not improve after resection of the thymus mass. The pathological findings were “reactive hyperplasia of the mediastinal lymph nodes and thymic hyperplasia”. Lymph node biopsy findings confirmed iMCD with human herpes virus-8 (HHV-8) negativity. Based on anti-nuclear antibody (ANA) 1:320, anti-SSA and anti-SSB antibody positivity, salivary flow less than 0.1 ml/min and lip biopsy with focal lymphocytic sialadenitis, SS was diagnosed. Kidney biopsy showed secondary membranous nephropathy with endocapillary cell proliferation and infiltration of plasma cells and lymphocytes in the tubulointerstitium. Serum interleukin-6 (IL-6) levels were significantly increased, and therapy with tocilizumab (anti-IL-6 receptor antibody) worked well. The combination of cyclophosphamide (CyS) with methylprednisolone (MP) maintained satisfactory remission.

Conclusions

Our case of iMCD with SS and SMN is rare. There is a need for increased awareness of the disease to avoid unnecessary procedures and misdiagnoses. IL-6 was extremely high, and there was a rapid response to anti-IL-6 receptor agents. The combination of CyS with MP maintained complete remission.
Quality of life among injectable and oral disease-modifying therapy users in the Pacific Northwest Multiple Sclerosis Registry
Authors: Stuchiner Tamela , Lucas Lindsay , Baraban Elizabeth , Spinelli Kateri J. , Chen Chiayi , Smith Alden , Hashemi Lobat , Cohan Stanley
Published: December 2020

Background

Nine oral disease-modifying therapies (DMTs) have been approved for the treatment of multiple sclerosis (MS) in the United States. Few studies have examined self-reported quality of life (QoL) and functional status outcomes among patients who switch to oral medications from injectable MS therapies. This study compares self-reported QoL and disability status between participants switching from injectable to oral DMTs, to those who stay on injectable DMTs continuously for the same time period.

Methods

Longitudinal data were assessed from relapsing MS participants in the Pacific Northwest MS Registry completing a minimum of two surveys between 2012 and 2018 with a maximum of 36 months between surveys. Stayers were defined as those who remained on injectable DMTs continuously from Time 1 to Time 2; switchers were those who switched from injectable to either fingolimod, teriflunomide or dimethyl fumarate during the same time interval. Outcomes of interest were physical and psychological QoL, measured by the Multiple Sclerosis Impact Scale (MSIS-29), and disability, measured by the Patient Determined Disease Steps (PDDS). To analyze the effect of switching to oral DMT on outcomes at Time 2, a one-to-two propensity score matching (PSM) was used to match switchers to stayers. Outcomes at Time 2 were analyzed using paired t-test for QoL scores, and Stuart Maxwell test for PDDS as a categorical variable.

Results

Among 2385 participants who returned consecutive yearly surveys, 413 met the inclusion criteria for stayers and 66 for switchers. After one-to-two PSM, 124 stayers were matched to 62 switchers. Paired t-test showed no differences between switchers and stayers for physical (mean difference: − 0.41; [95% confidence interval CI: − 3.3-2.4]; p = 0.78) or psychological (mean difference: − 0.23; [95% CI, − 1.6- 1.1]; p = 0.74) QoL. Additionally, no differences were seen between switchers and stayers in self-reported disability status.

Conclusions

MS registry participants who switched to an oral DMT from injectable showed no significant differences in QoL or self-reported disability status compared to those remaining on injectable DMT continuously in the same time period.