bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of mental health supports by civilians exposed to the November 2015 terrorist attacks in Paris
Authors: Pirard Philippe , Baubet Thierry , Motreff Yvon , Rabet Gabrielle , Marillier Maude , Vandentorren Stéphanie , Vuillermoz Cécile , Stene Lise Eilin , Messiah Antoine
Published: October 2020

Background

The use of mental health supports by populations exposed to terrorist attacks is rarely studied despite their need for psychotrauma care. This article focuses on civilians exposed to the November 2015 terrorist attacks in Paris and describes the different combinations of mental health supports (MHSu) used in the following year according to type of exposure and type of mental health disorder (MHD).

Methods

Santé publique Franceconducted a web-based survey of civilians 8–11 months after their exposure to the November 2015 terrorist attacks in Paris. All 454 respondents met criterion A of the DSM-5 definition of post-traumatic stress disorder (PTSD). MHD (anxiety, depression, PTSD) were assessed using the PCL-5 checklist and the Hospital Anxiety and Depression Scale. MHSu provided were grouped under outreach psychological support, visits for psychological difficulties to a victims’ or victim support association, consultation with a general practitioner (GP), consultation with a psychiatrist or psychologist (specialist), and initiation of regular mental health treatment (RMHT). Chi-squared tests highlighted differences in MHSu use according to type of exposure (directly threatened, witnessed, indirectly exposed) and MHD. Phi coefficients and joint tabulations were employed to analyse combinations of MHSu use.

Results

Two-thirds of respondents used MHSu in the months following the attacks. Visits to a specialist and RMHT were more frequent than visits to a GP (respectively, 39, 33, 17%). These were the three MHSu most frequently used among people with PTSD (46,46,23%), with depression (52,39,20%), or with both (56,58, 33%). Witnesses with PTSD were more likely not to have RMHT than those directly threatened (respectively, 65,35%). Outreach support (35%) and visiting an association (16%) were both associated with RMHT (Phi = 0.20 and 0.38, respectively). Very few (1%) respondents initiated RMHT directly. Those who indirectly initiated it (32%) had taken one or more intermediate steps. Visiting a specialist, not a GP, was the most frequent of these steps.

Conclusion

Our results highlight possibilities for greater coordination of mental health care after exposure to terrorist attacks including involving GP for screening and referral, and associations to promote targeted RMHT. They also indicate that greater efforts should be made to follow witnesses.
Outpatient health care utilization and health expenditures of asylum seekers in Halle (Saale), Germany - an analysis of claims data
Authors: Niedermaier Andreas , Freiberg Anna , Tiller Daniel , Wienke Andreas , Führer Amand
Published: October 2020

Background

Asylum seekers are a vulnerable group with special needs in health care due to their migration history and pre-, peri- and postmigratory social determinants of health. However, in Germany access to health care is restricted for asylum seekers by law and administrative regulations.

Methods

Using claims data generated in the billing process of health care services provided to asylum seekers, we explore their utilization of health care services in the outpatient sector. We describe the utilization of outpatient specialties, prevalences of diagnoses, prescribed drugs and other health care services, as well as total costs of health care provision.

Results

The estimated prevalence for visiting an ambulatory physician at least once per year was 67.5% [95%-Confidence-Interval (CI): 65.1–69.9%], with a notably higher prevalence for women than men. The diagnoses with the highest one-year prevalence were “Acute upper respiratory infections” (16.1% [14.5–18.0%]), “Abdominal and pelvic pain” (15.6% [13.9–17.4%]) and “Dorsalgia” (13.8% [12.2–15.5%]). A total of 21% of all prescriptions were for common pain killers. Women received more diagnoses across most diagnosis groups and prescribed drugs from all types than men. Less than half (45.3%) of all health care costs were generated in the outpatient sector.

Conclusion

The analysis of claims data held in a municipal social services office is a novel approach to gain better insight into asylum seekers’ utilization of health services on an individual level. Compared to regularly insured patients, four characteristics in health care utilization by asylum seekers were identified: low utilization of ambulatory physicians; a gender gap in almost all services, with higher utilization by women; frequent prescription of pain killers; and a low proportion of overall health care costs generated in the outpatient sector. Further research is needed to describe structural and individual factors producing these anomalies.
Value of biopsy in a cohort of children with high-titer celiac serologies: observation of dynamic policy differences between Europe and North America
Authors: Badizadegan Kamran , Vanlandingham David M. , Hampton Wesley , Thompson Kimberly M.
Published: October 2020

Background

Healthcare systems implement change at different rates because of differences in incentives, organizational processes, key influencers, and management styles. A comparable set of forces may play out at the national and international levels as demonstrated in significant differences in the diagnostic management of pediatric Celiac Disease (CD) between European and North American practitioners.

Methods

We use retrospective clinical cohorts of 27,868 serum tissue transglutaminase (tTG) immunoglobulin A levels and 7907 upper gastrointestinal endoscopy pathology reports to create a dataset of 793 pathology reports with matching tTG results between July 1 of 2014 and July 1 of 2018. We use this dataset to characterize histopathological findings in the duodenum, stomach and esophagus of patients as a function of serum tTG levels. In addition, we use the dataset to estimate the local and national cost of endoscopies performed in patients with serum tTG levels greater than 10 times the upper limit of normal.

Results

Using evidence from a US tertiary care center, we show that in the cohort of pediatric patients with high pre-test probability of CD as determined by serum tTG levels, biopsy provides no additional diagnostic value for CD, and that it counter-intuitively introduces diagnostic uncertainty in a number of patients. We estimate that using the European diagnostic algorithms could avoid between 4891 and 7738 pediatric endoscopies per year in the US for evaluation of CD.

Conclusions

This study considers the North American and European management guidelines for the diagnosis of pediatric CD and highlights the slow adoption in North America of evidence-based algorithms developed and applied in Europe for triage of endoscopy and biopsy. We suggest that system dynamics influences that help maintain the status quo in North America include a variety of social and economic factors in addition to medical evidence. This work contributes to the growing body of evidence that the dynamics that largely favor maintaining status quo management policies in a variety of systems extend to clinical medicine and potentially influence clinical decisions at the level of individual patients and the population.
Associations between characteristics of the patients at municipal acute bed unit admission and further transfer to hospital: a prospective observational study
Authors: Hernes Synnøve Karin , Baste Valborg , Krokmyrdal Kurt Arild , Todnem Silje Longva , Ruths Sabine , Johansen Ingrid Hjulstad
Published: October 2020

Background

As an alternative to acute hospitalisations, all communities in Norway are required to provide inpatient care in municipal acute bed units (MAUs) for patients who can be treated at the primary care level. Patient selection is challenging, and some patients need transfer from MAUs to hospitals. The aim of this study was to examine associations between characteristics of the patient at admission to MAU and further transfer to hospital.

Methods

In a prospective observational study on all admissions to a large MAU, March 2016–August 2017, information was obtained on patient age, gender, comorbidities, drug use, reason for stay and Triage Early Warning Score (TEWS) on admission and at discharge, and length of stay. Comparison between admissions resulting in discharge to hospital, nursing home or own home were performed with chi-square and ANOVA tests. Estimated relative risks (RR) with 95% confidence interval for transfer to hospital versus being retained at primary care level was estimated for age, gender, comorbidity and TEWS in generalized linear models, crude and adjusted.

Results

Two thousand seven hundred forty-four admissions were included. Mean age of the patients was 69.5 years (SD 21.9), 65.2% were women. In 646 admissions (23.6%), the patients were transferred to hospital. Male gender and TEWS > 2 were associated with transfer to hospital. Most transfers to hospital occurred within 24 h, and these patients had unchanged or increasing TEWS during their stay at MAU. When transferred to hospital 41.5% of the patients had the same reason for stay as on MAU admission, 14.9% had another reason for stay, 25.2% had a medical condition outside the treatment scope of MAU, and 18.4% needed further diagnostic clarification in hospital.

Conclusions

Likelihood of transfer to hospital increased with male gender and higher TEWS on admission. Main reasons for transfer to hospital were lack of improvement and identification of clinical conditions that needed hospital care. TEWS > 2 at admission should make physicians alert to the need of close monitoring for lack of improvement.
Prognostic impact of admission high-sensitivity C-reactive protein in acute myocardial infarction patients with and without diabetes mellitus
Authors: Lucci Claudia , Cosentino Nicola , Genovese Stefano , Campodonico Jeness , Milazzo Valentina , De Metrio Monica , Rondinelli Maurizio , Riggio Daniela , Biondi Maria Luisa , Rubino Mara , Celentano Katia , Bonomi Alice , Capra Nicolò , Veglia Fabrizio , Agostoni Piergiuseppe , Bartorelli Antonio L. , Marenzi Giancarlo
Published: October 2020

Background

High-sensitivity C-reactive protein (hs-CRP) elevation frequently occurs in acute myocardial infarction (AMI) and is associated with adverse outcomes. Since diabetes mellitus (DM) is characterized by an underlying chronic inflammation, hs-CRP may have a different prognostic power in AMI patients with and without DM.

Methods

We prospectively included 2064 AMI patients; hs-CRP was measured at hospital admission. Patients were grouped according to hs-CRP quartiles and DM status. The primary endpoint was a composite of in-hospital mortality, cardiogenic shock, and acute pulmonary edema. Two-year all-cause mortality was the secondary endpoint.

Results

Twenty-six percent (n = 548) of patients had DM and they had higher hs-CRP levels than non-DM patients (5.32 vs. 3.24 mg/L; P < 0.0001). The primary endpoint incidence in the overall population (7%, 9%, 13%, 22%; P for trend < 0.0001), in DM (14%, 9%, 21%, 27%; P = 0.0001), and non-DM (5%, 8%, 10%, 19%; P < 0.0001) patients increased in parallel with hs-CRP quartiles. The adjusted risk of the primary endpoint increased in parallel with hs-CRP quartiles in DM and non-DM patients but this relationship was less evident in DM patients. In the overall population, the adjusted OR of the primary endpoint associated with an hs-CRP value ≥ 2 mg/L was 2.10 (95% CI 1.46-3.00). For the same risk, hs-CRP was 7 and 2 mg/L in patients with and without DM. A similar behavior was observed for the secondary endpoint when the HR associated with an hs-CRP value ≥ 2 mg/L found in the overall population was 2.25 (95% CI 1.57-3.22). For the same risk, hs-CRP was 8 and 1.5 mg/L in DM and non-DM patients.

Conclusions

This study shows that hs-CRP predicts in-hospital outcome and two-year mortality in AMI patients with and without DM. However, in DM patients, the same risk of developing events as in non-DM patients is associated to higher hs-CRP levels.
Time in therapeutic range, quality of life and treatment satisfaction of patients on long-term warfarin for non-valvular atrial fibrillation: a cross-sectional study
Authors: Ng Diana-Leh-Ching , Malik Natasya Marliana Bt Abdul , Chai Chee-Shee , Goh Greta-Miranda-Kim-Choo , Tan Seng-Beng , Bee Ping-Chong , Gan Gin-Gin , Said Asri B.
Published: October 2020

Background

The use of warfarin in patients with non-valvular atrial fibrillation (NVAF) can be challenging. In this study, we evaluate the time in therapeutic range (TTR), health-related quality of life (HRQoL) and treatment satisfaction of patients on long-term warfarin for NVAF. The HRQoL and treatment satisfaction were compared based on the TTR.

Methods

A cross-sectional study was conducted among patients on warfarin for NVAF who attended the anticoagulant clinic of a tertiary cardiology referral center in Sarawak from 1st June 2018 to 31st May 2019. Patients’ TTR was calculated by using Rosendaal technique, while their HRQoL and treatment satisfaction were assessed by using Short Form 12 Health Survey version 2 (SF12v2) and Duke Anticoagulant Satisfaction Scale (DASS), respectively.

Results

A total of 300 patients were included, with mean TTR score of 47.0 ± 17.3%. The physical component summary (PCS) and mental component summary (MCS) score of SF-12v2 were 47.0 ± 9.0 and 53.5 ± 9.6, respectively. The total score for DASS was 55.2 ± 21.3, while the score for limitations (L), hassles and burdens (H&B) and positive psychological impacts (PPI) were 18.0 ± 10.0, 15.6 ± 9.1 and 21.6 ± 5.9, respectively. Seventy-three (24.3%) patients had good TTR (≥ 60%), with mean of 70.2 ± 8.7%; while 227 (75.5%) patients with poor TTR had significantly lower mean of 39.5 ± 11.9% (p = 0.006). There was no significant difference in the score of PCS (p = 0.150), MCS (p = 0.919) and each domain of SF-12v2 (p = 0.184–0.684) between good and poor TTR, except for social functioning (p = 0.019). The total DASS score was also not significantly different between group (p = 0.779). Similar non-significant difference was also reported in all the DASS sub dimensions (p = 0.502–0.699).

Conclusions

Majority of the patients on long-term warfarin for NVAF in the current study have poor TTR. Their HRQoL and treatment satisfaction are independent of their TTR. Achieving a good TTR do not compromise the HRQoL and treatment satisfaction. Therefore, appropriate measures should be taken to optimise INR control, failing which direct oral anticoagulant therapy should be considered.
Ensuring quality of health workforce education and practice: strengthening roles of accreditation and regulatory systems
Authors: Burdick William , Dhillon Ibadat
Published: October 2020

Regulation of the health workforce and accreditation of educational institutions are intended to protect the public interest, but evidence of the impact of these policies is scarce and occasionally contradictory. The body of research that does exist primarily focuses on policies in the global north and on the major health professions. Stress on accreditation and regulatory systems caused by surges in demand due to the COVID-19 pandemic, privatization of education, rising patient expectations, and emergence of new health worker categories has created urgency for innovation and reform. To understand and evaluate this innovation, we look forward to receiving manuscripts which contribute to the evidence base on the implementation, management, and impact of health worker education and practice regulation, including the intersection of education accreditation and workforce regulation policy. We particularly look forward to manuscripts from underrepresented parts of the globe and underrepresented health workforce sectors that address policy effectiveness, explore different models of regulation, and present innovations that we can all learn from.
Correction to: The role of microRNA-133b and its target gene FSCN1 in gastric cancer
Authors: Guo Lihua , Bai Hua , Zou Dongling , Hong Tao , Liu Jie , Huang Jiaqiang , He Pengfei , Zhou Qi , He Jinsheng
Published: October 2020

An amendment to this paper has been published and can be accessed via the original article.
Synthesis of cyclic carbonates from epoxides and carbon dioxide catalyzed by talc and other phyllosilicates
Authors: Nakibuule Fiona , Nyanzi Steven Allan , Oshchapovsky Igor , Wendt Ola F. , Tebandeke Emmanuel
Published: October 2020

Naturally occurring phyllosilicate minerals such as talc and vermiculite in conjunction with n-tetra butyl ammonium bromide (TBAB) co-catalyst were found to be efficient in the coupling of CO2 with epoxides to form cyclic carbonates. The reaction was carried out in a pressurized autoclave reactor at moderate pressures of 10–35 bars and temperatures of 100–150 °C. The optimized catalyst system exhibited > 90% conversion of the epoxides and > 90% selectivity for the desired cyclic carbonates, in the presence or absence of a solvent. The selectivity of the catalytic system could be improved with heat pre-treatment of the phyllosilicates albeit this resulted in slightly lower epoxide conversion. The results obtained using the heat treated phyllosilicates strongly support the hydrogen bond assisted mechanism for the cycloaddition of epoxides and CO2. The cycloaddition reaction could also be carried out in the absence of TBAB, although lower cyclic carbonate yields were observed. The phyllosilicate part of the catalyst system is heterogeneous, easy to separate after completion of reactions and reusable a number of runs without loss of activity.
Identification of fetal unmodified and 5-hydroxymethylated CG sites in maternal cell-free DNA for non-invasive prenatal testing
Authors: Gordevičius Juozas , Narmontė Milda , Gibas Povilas , Kvederavičiūtė Kotryna , Tomkutė Vita , Paluoja Priit , Krjutškov Kaarel , Salumets Andres , Kriukienė Edita
Published: October 2020

Background

Massively parallel sequencing of maternal cell-free DNA (cfDNA) is widely used to test fetal genetic abnormalities in non-invasive prenatal testing (NIPT). However, sequencing-based approaches are still of high cost. Building upon previous knowledge that placenta, the main source of fetal circulating DNA, is hypomethylated in comparison to maternal tissue counterparts of cfDNA, we propose that targeting either unmodified or 5-hydroxymethylated CG sites specifically enriches fetal genetic material and reduces numbers of required analytical sequencing reads thereby decreasing cost of a test.

Methods

We employed uTOPseq and hmTOP-seq approaches which combine covalent derivatization of unmodified or hydroxymethylated CG sites, respectively, with next generation sequencing, or quantitative real-time PCR.

Results

We detected increased 5-hydroxymethylcytosine (5hmC) levels in fetal chorionic villi (CV) tissue samples as compared with peripheral blood. Using our previously developed uTOP-seq and hmTOP-seq approaches we obtained whole-genome uCG and 5hmCG maps of 10 CV tissue and 38 cfDNA samples in total. Our results indicated that, in contrast to conventional whole genome sequencing, such epigenomic analysis highly specifically enriches fetal DNA fragments from maternal cfDNA. While both our approaches yielded 100% accuracy in detecting Down syndrome in fetuses, hmTOP-seq maintained such accuracy at ultra-low sequencing depths using only one million reads. We identified 2164 and 1589 placenta-specific differentially modified and 5-hydroxymethylated regions, respectively, in chromosome 21, as well as 3490 and 2002 Down syndrome-specific differentially modified and 5-hydroxymethylated regions, respectively, that can be used as biomarkers for identification of Down syndrome or other epigenetic diseases of a fetus.

Conclusions

uTOP-seq and hmTOP-seq approaches provide a cost-efficient and sensitive epigenetic analysis of fetal abnormalities in maternal cfDNA. The results demonstrated that T21 fetuses contain a perturbed epigenome and also indicated that fetal cfDNA might originate from fetal tissues other than placental chorionic villi. Robust covalent derivatization followed by targeted analysis of fetal DNA by sequencing or qPCR presents an attractive strategy that could help achieve superior sensitivity and specificity in prenatal diagnostics.
Leveraging locus-specific epigenetic heterogeneity to improve the performance of blood-based DNA methylation biomarkers
Authors: Miller Brendan F. , Pisanic II Thomas R. , Margolin Gennady , Petrykowska Hanna M. , Athamanolap Pornpat , Goncearenco Alexander , Osei-Tutu Akosua , Annunziata Christina M. , Wang Tza-Huei , Elnitski Laura
Published: October 2020

Background

Variation in intercellular methylation patterns can complicate the use of methylation biomarkers for clinical diagnostic applications such as blood-based cancer testing. Here, we describe development and validation of a methylation density binary classification method called EpiClass (available for download at https://github.com/Elnitskilab/EpiClass) that can be used to predict and optimize the performance of methylation biomarkers, particularly in challenging, heterogeneous samples such as liquid biopsies. This approach is based upon leveraging statistical differences in single-molecule sample methylation density distributions to identify ideal thresholds for sample classification.

Results

We developed and tested the classifier using reduced representation bisulfite sequencing (RRBS) data derived from ovarian carcinoma tissue DNA and controls. We used these data to perform in silico simulations using methylation density profiles from individual epiallelic copies of ZNF154, a genomic locus known to be recurrently methylated in numerous cancer types. From these profiles, we predicted the performance of the classifier in liquid biopsies for the detection of epithelial ovarian carcinomas (EOC). In silico analysis indicated that EpiClass could be leveraged to better identify cancer-positive liquid biopsy samples by implementing precise thresholds with respect to methylation density profiles derived from circulating cell-free DNA (cfDNA) analysis. These predictions were confirmed experimentally using DREAMing to perform digital methylation density analysis on a cohort of low volume (1-ml) plasma samples obtained from 26 EOC-positive and 41 cancer-free women. EpiClass performance was then validated in an independent cohort of 24 plasma specimens, derived from a longitudinal study of 8 EOC-positive women, and 12 plasma specimens derived from 12 healthy women, respectively, attaining a sensitivity/specificity of 91.7%/100.0%. Direct comparison of CA-125 measurements with EpiClass demonstrated that EpiClass was able to better identify EOC-positive women than standard CA-125 assessment. Finally, we used independent whole genome bisulfite sequencing (WGBS) datasets to demonstrate that EpiClass can also identify other cancer types as well or better than alternative methylation-based classifiers.

Conclusions

Our results indicate that assessment of intramolecular methylation density distributions calculated from cfDNA facilitates the use of methylation biomarkers for diagnostic applications. Furthermore, we demonstrated that EpiClass analysis of ZNF154 methylation was able to outperform CA-125 in the detection of etiologically diverse ovarian carcinomas, indicating broad utility of ZNF154 for use as a biomarker of ovarian cancer.
Time course of altered DNA methylation evoked by critical illness and by early administration of parenteral nutrition in the paediatric ICU
Authors: Verlinden Ines , Güiza Fabian , Derese Inge , Wouters Pieter J. , Joosten Koen , Verbruggen Sascha C. , Van den Berghe Greet , Vanhorebeek Ilse
Published: October 2020

Background

A genome-wide study identified de novo DNA methylation alterations in leukocytes of children at paediatric intensive care unit (PICU) discharge, offering a biological basis for their impaired long-term development. Early parenteral nutrition (early-PN) in PICU, compared with omitting PN in the first week (late-PN), explained differential methylation of 23% of the affected CpG-sites. We documented the time course of altered DNA methylation in PICU and the impact hereon of early nutritional management.

Results

We selected 36 early-PN and 36 late-PN matched patients, and 42 matched healthy children. We quantified DNA methylation on days 3, 5 and 7 for the 147 CpG-sites of which methylation was normal upon PICU admission in this subset and altered by critical illness at PICU discharge. Methylation in patients differed from healthy children for 64.6% of the 147 CpG-sites on day 3, for 72.8% on day 5 and for 90.5% on day 7 as revealed by ANOVA at each time point. Within-patients methylation time course analyses for each CpG-site identified different patterns based on paired t test p value and direction of change. Rapid demethylation from admission to day 3 occurred for 76.2% of the CpG-sites, of which 67.9% remained equally demethylated or partially remethylated and 32.1% further demethylated beyond day 3. From admission to day 3, 19.7% of the CpG-sites became hypermethylated, of which, beyond day 3, 34.5% remained equally hypermethylated or partially demethylated again and 65.5% further hypermethylated. For 4.1% of the CpG-sites, changes only appeared beyond day 3. Finally, for the CpG-sites affected by early-PN on the last PICU day, earlier changes in DNA methylation were compared for early-PN and late-PN patients, revealing that 38.9% were already differentially methylated by day 3, another 25.0% by day 5 and another 13.9% by day 7.

Conclusions

Critical illness- and early-PN-induced changes in DNA methylation occurred mainly within 3 days. Most abnormalities were at least partially maintained or got worse with longer time in PICU. Interventions targeting aberrant DNA methylation changes should be initiated early.
Design and analysis of e-commerce and modern logistics for regional economic integration in wireless networks
Authors: Tang Xiaodong , Wang Gangyi
Published: October 2020

The rapid development of e-commerce has greatly promoted the development of modern logistics. The application level of e-commerce and the application status of modern logistics largely determine the development of a regional economic structure. Under such circumstances, it is particularly important to comprehensively strengthen the research on the impact of e-commerce and modern logistics on the network regional economy. China is as one of the most active regions over the world. Therefore, in this paper, we take the network regional economic as the research object. Firstly, we obtain relevant regional logistics nodes and e-commerce information through wireless networks. Secondly, based on information acquisition, we propose an empirical analysis of the development status of the logistics industry and e-commerce, and we also explain their contributions to regional economic growth. Finally, this paper proposes countermeasures to further increase the contribution of logistics and e-commerce to economic growth. This will provide a reference for building a regionally coordinated logistics-e-commerce system and realizing regional economic integration.
A robotic end-effector with rolling up mechanism for pick-and-release of a cotton sheet
Authors: Abe Taiki , Kawasaki Yuichi , Yamazaki Kimitoshi
Published: October 2020

In this paper we introduce a novel robotic end-effector for pick-and-release of a sheet of cotton cloth. One of the main operations in a factory for sewing cloth products is to pick up cloth parts, provide them to a sewing machine, and sew them together. Fabric products are assembled by performing this work in various processes. Each work starts with a lot of cloth parts stacked near a sewing machine. In the case of underwear, thin cotton cloth is the target of manipulation, but such cloth parts tend to stick to each other, and a certain skill or technical acuity is required for picking up. Therefore, this work is basically done manually in the present. The purpose of this study is to automate such manipulation, so we devise an end-effector that picks up only the top one of stacked cotton sheets. The proposed end-effector has a mechanism that is a cylindrical brush attached with a remover cloth on its surface. The cylindrical brush is grounded on a cotton sheet, and then is rotated to roll up only the cotton sheet. This mechanism makes it possible to release the sheet by rotating the brush in the reverse. We constructed hardware with this function and attached it to the tip of a robotic manipulator. In addition, we performed system integration so that the initial position of rolling up a cotton sheet could be automatically determined from images taken by a camera. We also conducted evaluation experiments.
Comparative study between intranasal dexmedetomidine and intranasal ketamine as a premedication for anxiolysis and sedation before pediatric general anesthesia
Authors: Elshafeey Ahmed Elsayed Ahmed Mohamed , Youssef Gehan Fouad Kamel , Elsalam Ehab Hamed Abd , Saleh Mohamed , Mahrose Ramy
Published: October 2020

Background

This study compared dexmedetomidine versus ketamine as regard sedation and anxiolysis produced by giving them through intranasal route to pediatric patients undergoing adenotonsillectomy. This study was double-blinded randomized comparative prospective interventional clinical study done in Ain Shams University Hospital (El Demerdash Hospital) on 76 pediatric patients who underwent adenotonsillectomy, and they were randomly allocated equally into two main groups; group D received 2 μg/kg intranasal dexmedetomidine and group K received 5 μg/Kg intranasal ketamine 30 min before the operation, and the aim of this study was to compare the efficacy of intranasal dexmedetomidine versus intranasal ketamine for anxiolysis and sedation to alleviate stress, agitation, and anxiety in children before general anesthesia and for promoting good level of sedation for them.

Results

Results of this study as regards sedation level that was assessed by modified Ramsay sedation score showed that there was statistically significant difference between both groups at 10, 20, and 30 min from intranasal application of the drug (P value < 0.05), the median (IQR) of sedation score at 10, 20, and 30 min preoperative in group D was (2 (2 – 2)), (3 (3 – 4)), (4 (4 – 5)) compared to (2 (2 – 3)), (3 (2 – 3)), (4 (3 – 4)) in group K respectively which revealed that there was better and effective sedation in group D more than in group K, this difference was statistically significant but clinically insignificant as both drugs produced an acceptable level of sedation and decreased the level of anxiety in children.

Conclusion

Both drugs produce effective and favorable sedation level with superiority to dexmedetomidine in sedation scores and time of onset of sedation, and also there was little decrease in heart rate and mean arterial pressure which is favorable during such surgeries; also, there was accepted level of cannulation and parental separation scores, and the parents were highly satisfied with the procedure and were grateful for us due to alleviating stress and anxiety from them and from their children.
Pharmacovigilance and incidence of adverse drug reactions in hospitalized pediatric patients: a mini systematic review
Authors: Khan Zakir , Muhammad Khayal , Karatas Yusuf , Bilen Cagri , Khan Farman Ullah , Khan Faiz Ullah
Published: October 2020

Background

Pharmacovigilance is an identifying and responding process against an adverse drug reaction (ADRs) problem encountered in the drug administration. ADRs are among the common reasons for morbidity and fatality in pediatrics throughout the globe.

Main body

A systemic review of the previous 10 years (2010–2019) published studies were taken into consideration to describe observational studies on ADRs and to determine the incidence and characteristics of ADRs in pediatrics. Electronic relevant literature was searched in PMC, PubMed, Google Scholar, and OvidSP databases using MESH heading and text words. The titles, text, and abstracts were checked for patients below 18 years of age, nature of ADRs, observational studies (prospective or retrospective), and maximum information was recorded to count their frequency. The studies which discussed specific or particular drug exposures were not selected in this review. Of the 36,689 titles retrieved, 27 studies were selected for full-text review. Ten observational studies were added in the final review. Observational studies on pediatric were carried out in seven distinct nations. The predominant study design within observational methodological studies was prospective (n= 5, 50%). The overall average occurrence of ADRs incidence was 9.52%. ADRs reporting in male patients (54.6%) were more than females (45.4%). The severe types of ADRs were reported in four studies. Anti-microbials were the most common class of drugs related to ADRs.

Conclusion

This systematic review reveals that ADRs in pediatrics are serious public health problems. Periodic drug surveillance studies are mandatory for the safe and appropriate usage of medicines in pediatrics.
Radical External-Beam Radiotherapy in Combination With Intracavitary Brachytherapy for Localized Carcinoma of the Cervix in Sri Lanka: Is Treatment Delayed Treatment Denied?
Authors: Joseph Nuradh , Jayalath Hasanthi , Balawardena Jayantha , Skandarajah Thurairajah , Perera Kanthi , Gunasekera Dehan , Weerasinghe Sujeeva , Hoskin Peter , Choudhury Ananya
Published: October 2020

PURPOSE

Radical external-beam radiotherapy (EBRT) followed by intracavitary brachytherapy is standard of care for patients with localized carcinoma of the cervix unsuitable for radical surgery. However, outcome data are scarce in resource-limited settings. We conducted a retrospective analysis of survival in a cohort of patients treated with this strategy in Sri Lanka.

PATIENTS AND METHODS

All patients with localized cervical cancer treated with primary EBRT and intracavitary brachytherapy from 2014 to 2015 were included in the study. Primary end point was disease-free survival (DFS), defined as time to local or systemic recurrence or death. Univariable analysis was performed to determine the prognostic significance of the following variables: age, stage, use of concurrent chemotherapy, EBRT dose, brachytherapy dose, and time to completion of treatment (dichotomized at 60 days). Factors significant on univariable analysis were included in a multivariable model.

RESULTS

A total of 113 patients with available data were included in the analysis. Mean age was 58 years (range, 35-85 years), and most patients (n = 103 of 113) presented with stage ≥ IIB disease. Median time to delivery of brachytherapy from commencement of EBRT was 110 days (range, 34-215 days), with only 12 (11%) of 113 patients completing treatment within 60 days. Median follow-up was 28 months (range, 5-60 months), and 2-year DFS was 63.7% (95% CI, 55.4% to 73.2%). Treatment delay was the only significant factor associated with inferior DFS on univariable analysis (log-rank P = .03), and therefore, multivariable analysis was not performed.

CONCLUSION

There are significant delays in receiving intracavitary brachytherapy after completing EBRT for cervical cancer in Sri Lanka, which is associated with inferior DFS. Increasing brachytherapy resources is an urgent priority to improve outcomes of patients with cervical cancer.
Elevated Plasma Branched-Chain Amino Acid Levels Correlate With Type 2 Diabetes–Related Metabolic Disturbances
Authors: Vanweert Froukje , de Ligt Marlies , Hoeks Joris , Hesselink Matthijs K C , Schrauwen Patrick , Phielix Esther
Published: October 2020

Context

Patients with type 2 diabetes mellitus (T2DM) have elevated plasma branched-chain amino acid (BCAA) levels. The underlying cause, however, is not known. Low mitochondrial oxidation of BCAA levels could contribute to higher plasma BCAA levels.

Objective

We aimed to investigate ex vivo muscle mitochondrial oxidative capacity and in vivo BCAA oxidation measured by whole-body leucine oxidation rates in patients with T2DM, first-degree relatives (FDRs), and control participants (CONs) with overweight or obesity.

Design and Setting

An observational, community-based study was conducted.

Participants

Fifteen patients with T2DM, 13 FDR, and 17 CONs were included (age, 40-70 years; body mass index, 27-35 kg/m2).

Main Outcome Measures

High-resolution respirometry was used to examine ex vivo mitochondrial oxidative capacity in permeabilized muscle fibers. A subgroup of 5 T2DM patients and 5 CONs underwent hyperinsulinemic-euglycemic clamps combined with 1-13C leucine-infusion to determine whole-body leucine oxidation.

Results

Total BCAA levels were higher in patients with T2DM compared to CONs, but not in FDRs, and correlated negatively with muscle mitochondrial oxidative capacity (r = –0.44, P < .001). Consistently, whole-body leucine oxidation rate was lower in patients with T2DM vs CON under basal conditions (0.202 ± 0.049 vs 0.275 ± 0.043 μmol kg–1 min–1, P < .05) and tended to be lower during high insulin infusion (0.326 ± 0.024 vs 0.382 ± 0.013 μmol kg–1 min–1, P = .075).

Conclusions

In patients with T2DM, a compromised whole-body leucine oxidation rate supports our hypothesis that higher plasma BCAA levels may originate at least partly from a low mitochondrial oxidative capacity.
Estratégias e serviços públicos municipais da cidade digital estratégica de São José dos Pinhais-PR
Authors: From Danieli Aparecida , Rezende Denis Alcides
Published: October 2020

Os recursos da tecnologia da informação têm revolucionado a vida de pessoas, organizações, governos e, assim, o modo como as cidades fazem a gestão dos serviços públicos. O objetivo deste artigo é analisar os subprojetos de cidade digital estratégica da Prefeitura de São José dos Pinhais-PR, por meio de suas estratégias e serviços públicos disponibilizados digitalmente aos cidadãos e gestores públicos. O método de pesquisa consiste em estudo de caso com técnicas tanto quantitativas, pois expressam números, quanto qualitativas, ao analisarem os nomes e as temáticas municipais desses mesmos números, sendo pautado por um protocolo de pesquisa com 2 constructos e 10 variáveis. Os resultados auferidos demonstram que a administração pública municipal tem se preocupado com a adoção de iniciativas para facilitar a qualidade de vida dos cidadãos, pois possui 16 estratégias e 31 serviços públicos fornecidos por meio da tecnologia da informação. A conclusão indica que os subprojetos encontrados contribuem com a gestão municipal e possibilitam que São José dos Pinhais seja entendida como uma cidade digital estratégica, apesar da inexistência de um projeto formal.
A influência de características dos empregados nas despesas de pessoal dos bancos brasileiros
Authors: Deus Taís Lara Gimenes de , Silva César Augusto Tibúrcio
Published: October 2020

Análise sobre a influência das características dos empregados na despesa de pessoal dos bancos brasileiros no período de 2006 a 2017. A hipótese formulada considerou as expectativas a respeito da influência da escolaridade dos empregados na despesa de pessoal bancária, tendo como base as teorias do capital humano e da sinalização. Além disso, foi analisada a influência de outras características empregatícias, uma vez que há disponibilidade dessas informações na base de dados. Para tanto, foi utilizada a análise de correlação e a regressão linear múltipla, tendo a despesa de pessoal como variável dependente. De acordo com o modelo estimado, a quantidade de anos de estudo do empregado, a participação nos cargos de gerência e a taxa de rotatividade são características que influenciam a despesa de pessoal bancária tanto em conjunto quanto individualmente, ressaltando-se que a influência das duas primeiras é direta e a da terceira é inversamente proporcional. Os resultados da pesquisa mostraram que as características dos empregados influenciam a despesa de pessoal bancária, do que se depreende que seria possível alterar esse tipo de despesa e interferir no resultado da instituição, por meio de uma escolha eficiente das características dos funcionários que irão compor o quadro da empresa.
As empresas e seus valores: análise das declarações de valores das maiores empresas brasileiras
Authors: Sathler André Rehbein , Miranda Roberto Campos Rocha , Silva Murilo de Assis
Published: October 2020

O objetivo da pesquisa é traçar um perfil identitário das maiores empresas brasileiras com base na análise de suas declarações de valores. A estratégia foi qualitativa, com uso de técnicas de análise de conteúdo e de discurso, bem como software específico (Iramuteq). Os resultados indicaram que a maioria das empresas ostenta uma declaração de visão em seus sites (62,2%). Há uma média de 5,82 valores por empresa, similar à internacional. Os elementos semânticos mais predominantes sinalizam para uma dupla preocupação: ética e inovação. Os resultados demonstram que a técnica de elaboração e o uso de declarações de valores estão bem difundidos e aceitos no Brasil, inclusive apontando para declarações mais extensas de valores das empresas nacionais. O artigo identifica lacunas que sugerem estudos futuros, como a análise da aderência das pessoas aos valores organizacionais e a especificidade das empresas brasileiras em relação às internacionais.
Interpreting cost-effectiveness ratios in a cost-effectiveness analysis of risk-tailored prostate screening: A critique of Callender et al.
Authors: O'Mahony James F.
Published: October 2020

Callenderet al.recently published a model-based cost-effectiveness analysis of a risk-tailored approach to prostate cancer screening. It considers the costs and effects of prostate cancer screening offered to all men aged 55-69 without any risk selection and, alternatively, over a range of risk-tailored strategies in which screen eligibility is determined by a varying threshold of disease risk. The analysis finds that the strategy of screening men once they reach a 10-year absolute risk of disease of 5% or more is cost-effective in a UK context. I believe there are several problems with the study, mostly stemming from an incorrect interpretation of the cost-effectiveness estimates. I show that one reinterpretation of their results indicates that screening is much less cost-effective than the original analysis suggests, indicating that screening should be restricted to a much smaller group of higher risk men. More broadly, I explain the challenges of attempting to meaningfully reinterpret the originally published results due to the simulation of non-mutually exclusive intervention strategies. Finally, I consider the relevance of considering sufficient alternative screening intensities. This critique highlights the need for appropriate interpretation of cost-effectiveness results for policymakers, especially as risk stratification within screening becomes increasingly feasible.
External Financing and Customer Capital: A Financial Theory of Markups
Authors: Dou Winston Wei , Ji Yan
Published: October 2020

We develop a continuous-time industry equilibrium model of monopolistic competition to understand how product markups are determined in the presence of external financing costs and customer capital. Firms optimally set markups to balance the tradeoff between profiting from their existing customer base and developing their future customer base. We characterize how the equilibrium markups are determined by the interaction between the marginal value of corporate liquidity and the marginal value of customer base. Firms’ markups are more responsive to changes in their marginal value of corporate liquidity when the marginal value of customer base is higher. Moreover, the model predicts that greater product market threats lead to more conservative financial policies, which is supported by the data.

This paper was accepted by Gustavo Manso, finance.
As ciências da vida e o mundo pós-pandemia
Authors: Da Silva Vinícius Carvalho , Portocarrero Vera , Da Costa Wigson Rafael
Published: October 2020

Atendendo aos apelos dos seguidores e estimulado pelo fatídico cenário pandêmico que se impôs, durante os dias 17 e 19 de junho, o Canal no Youtube intitulado Café com Nietzsche, fundado e administrado pelo mestrando Wigson Rafael Silva da Costa, realizou duas livestreaming que traziam como temática central “As ciências da vida e o mundo pós-pandemia”. Para tanto, quatro entrevistados foram convidados a fomentar reflexões e problemáticas que possibilitariam, sobretudo ao grande público, o acesso a uma discussão multidisciplinar e acessível sobre a pandemia da covid-19 e suas implicações científicas, políticas, sociais e econômicas.
Caracterização clínico-epidemiológica da comorbidade tuberculose/diabetes mellitus: revisão integrativa
Authors: Sousa Giana Gislanne da Silva de , Pascoal Lívia Maia , Ferreira Adriana Gomes Nogueira , Rolim Isaura Letícia Tavares Palmeira , Santos Lívia Fernanda Siqueira , Santos Neto Marcelino
Published: October 2020

Objetivo: sintetizar as evidências científicas acerca de características sociodemográficas, indicadores epidemiológicos de morbidade e manifestações clínicas dos casos associados de tuberculose e diabetes mellitus. Método: revisão integrativa da literatura com buscas realizadas nas bases Scopus, Literatura Latino Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval System Online e nos portais National Library of Medicine, Biblioteca Virtual em Saúde Brasil e Scientific Eletronic Library Online, sendo a amostra final foi composta por dezesseis estudos. Resultados: observou-se que a alta prevalência de diabetes contribui para o aumento dos casos de tuberculose. Os pacientes com a comorbidade tendem a apresentar idade avançada, serem do sexo feminino e possuírem renda familiar mais baixa. O diabetes afeta negativamente a gravidade da tuberculose pulmonar, provocando sintomas mais graves. Conclusão: as evidências apontadas têm potencial para guiar as intervenções em saúde e possibilitam a implementação de ações de saúde mais efetivas.
Minimum ten-year follow-up of a randomized trial comparing acetabular component fixation of two porous in-growth surfaces using radiosteriometric analysis
Authors: Rahman Luthfur , Ibrahim Mazin S. , Somerville Lyndsay , Teeter Matthew G. , Naudie Douglas D. , McCalden Richard W.
Published: October 2020

Aims

To compare the in vivo long-term fixation achieved by two acetabular components with different porous ingrowth surfaces using radiostereometric analysis (RSA).

Methods

This was a minimum ten-year follow-up of a prospective randomized trial of 62 hips with two different porous ingrowth acetabular components. RSA exams had previously been acquired through two years of follow-up. Patients returned for RSA examination at a minimum of ten years. In addition, radiological appearance of these acetabular components was analyzed, and patient-reported outcome measures (PROMs) obtained.

Results

In all, 15 hips were available at ten years. There was no statistically significant difference in PROMS between the two groups; PROMs were improved at ten years compared to preoperative scores. Conventional radiological assessment revealed well-fixed components. There was minimal movement for both porous surfaces in translation (X, Y, Z, 3D translation in mm (median and interquartile range (IQR)), StikTite (Smith and Nephew, Memphis, Tennessee, USA): 0.03 (1.08), 0.12 (0.7), 0.003 (2.3), 0.37 (0.30), and Roughcoat (Smith and Nephew): -0.6 (0.59),–0.1 (0.49), 0.1 (1.12), 0.48 (0.38)), and rotation (X, Y, Z rotation in degrees (median and IQR), (Stiktite: -0.4 (3), 0.28 (2), -0.2 (1), and Roughcoat: - 0.4 (1),–0.1 (1), 0.2 (2)). There was no statistically significant difference between the two cohorts (p-value for X, Y, Z, 3D translation - 0.54, 0.46, 0.87, 0.55 and for X, Y, Z rotation - 0.41, 0.23, 0.23 respectively) at ten years. There was significant correlation between two years and ten years 3D translation for all components ( r = 0.81(p =< 0.001)).

Conclusion

Both porous ingrowth surfaces demonstrated excellent fixation on plain radiographs and with RSA at ten years. Short-term RSA data are good predictors for long-term migration data.