bluuebunny/crossref_metadata_2025 huggingface dataset:
Patterns of access to reproductive health services in Ghana and Nigeria: results of a cluster analysis
Authors: Ogundele Oluwasegun Jko , Pavlova Milena , Groot Wim
Published: April 2020

Background

Inequalities in access to health care result in systematic health differences between social groups. Interventions to improve health do not always consider these inequalities. To examine access to reproductive health care services in Ghana and Nigeria, the patterns of use of family planning and maternal care by women in these countries are explored.

Methods

We used population-level data from the Ghana and Nigeria Demographic Health Surveys of 2014 and 2013 respectively. We applied a two-step cluster analysis followed by multinomial logistic regression analysis.

Results

The initial two-step cluster analyses related to family planning identified three clusters of women in Ghana and Nigeria: women with high, medium and poor access to family planning services. The subsequent two-step cluster analyses related to maternal care identified five distinct clusters: higher, high, medium, low and poor access to maternal health services in Ghana and Nigeria. Multinomial logistic regression showed that compared to women with secondary/higher education, women without education have higher odds of poor access to family planning services in Nigeria (OR = 2.54, 95% CI: 1.90–3.39) and in Ghana (OR = 1.257, 95% CI: 0.77–2.03). Compared to white-collar workers, women who are not working have increased odds of poor access to maternal health services in Nigeria (OR = 1.579, 95% CI: 1.081–2.307, p ≤ 0.01). This association is not observed for Ghana. Household wealth is strongly associated with access to family planning services and maternal health care services in Nigeria. Not having insurance in Ghana is associated with low access to family planning services, while this is not the case in Nigeria. In both countries, the absence of insurance is associated with poor access to maternal health services.

Conclusions

These differences confirm the importance of a focused context-specific approach towards reproductive health services, particularly to reduce inequality in access resulting from socio-economic status. Interventions should be focused on the categorization of services and population groups into priority classes based on needs assessment. In this way, they can help expand coverage of quality services bottom up to improve access among these vulnerable groups.
Social regulation activities in end-of-life: a qualitative study on completion of advance directives in Swiss nursing homes
Authors: Droz Mendelzweig M.
Published: April 2020

Background

In Switzerland as in many countries, steady trend is observed in nursing homes to promote writing of advanced directives (ADs). Implementation of ADs reflects the rise in public concern for the persons’ right to self-determination and informed decision. The issue of end-of-life conditions is particularly acute in situations with dementia. This article investigates how ADs interventions in nursing homes strive simultaneously to behave in line with the principles of care ethics and with the intention to respond to legally binding instructions. Healthcare to dying residents with dementia in nursing homes is interpreted in light of the Regulation theory.

Methods

Nursing home palliative care reference nurses were contacted through questionnaire. One hundred twenty-one addresses were reached, 69 responses were collected, giving a response rate of 57%. In order to deepen the understanding, 10 semi-directive interviews were conducted in 10 different nursing facilities with 12 palliative nurses.

Results

Presently, Swiss nursing homes are lacking a model of AD suitable to people with dementia. The study sheds light on dissimilarities in the purpose assigned to ADs’ procedure in the different facilities. Discrepancies in end-of-life care practices reveal more the influence of structural and organisational devices specific to each setting than conflicting views on end-of-life care principles. We analyse the interpretation of the Law and its implementation in the participating NHs as compromises that could be accounted for as a form of social regulation.

Conclusion

Dementia accentuates the uncertainty inherent to end-of-life trajectories. The implementation of standardised procedures aimed at collecting the wishes of the person deprived of his or her discernment is source of dissonances with regard to the multiple interests involved in these care situations. In this context, the drafting of ADs during end-of-life care in NH correspond to new normative constraints requiring new collective regulation actions.
Kinect and wearable inertial sensors for motor rehabilitation programs at home: state of the art and an experimental comparison
Authors: Milosevic Bojan , Leardini Alberto , Farella Elisabetta
Published: April 2020

Background

Emerging sensing and communication technologies are contributing to the development of many motor rehabilitation programs outside the standard healthcare facilities. Nowadays, motor rehabilitation exercises can be easily performed and monitored even at home by a variety of motion-tracking systems. These are cheap, reliable, easy-to-use, and allow also remote configuration and control of the rehabilitation programs. The two most promising technologies for home-based motor rehabilitation programs are inertial wearable sensors and video-based motion capture systems.

Methods

In this paper, after a thorough review of the relevant literature, an original experimental analysis is reported for two corresponding commercially available solutions, a wearable inertial measurement unit and the Kinect, respectively. For the former, a number of different algorithms for rigid body pose estimation from sensor data were also tested. Both systems were compared with the measurements obtained with state-of-the-art marker-based stereophotogrammetric motion analysis, taken as a gold-standard, and also evaluated outside the lab in a home environment.

Results

The results in the laboratory setting showed similarly good performance for the elementary large motion exercises, with both systems having errors in the 3–8 degree range. Usability and other possible limitations were also assessed during utilization at home, which revealed additional advantages and drawbacks for the two systems.

Conclusions

The two evaluated systems use different technology and algorithms, but have similar performance in terms of human motion tracking. Therefore, both can be adopted for monitoring home-based rehabilitation programs, taking adequate precautions however for operation, user instructions and interpretation of the results.
Outcome and risk of recurrence in a large cohort of idiopathic longitudinally extensive transverse myelitis without AQP4/MOG antibodies
Authors:   on behalf of the OFSEP, SFSEP, and NOMADMUS study groups, Maillart Elisabeth , Durand-Dubief Françoise , Louapre Céline , Audoin Bertrand , Bourre Bertrand , Derache Nathalie , Ciron Jonathan , Collongues Nicolas , de Sèze Jérome , Cohen Mikael , Lebrun-Frenay Christine , Hadhoum Nawel , Zéphir Hélène , Deschamps Romain , Carra-Dallière Clarisse , Labauge Pierre , Kerschen Philippe , Montcuquet Alexis , Wiertlewski Sandrine , Laplaud David , Runavot Gwenaëlle , Vukusic Sandra , Papeix Caroline , Marignier Romain
Published: April 2020

Background

Longitudinally extensive transverse myelitis (LETM) is classically related to aquaporin (AQP4)-antibodies (Ab) neuromyelitis optica spectrum disorders (NMOSD) or more recently to myelin oligodendrocyte glycoprotein (MOG)-Ab associated disease. However, some patients remain negative for any diagnosis, despite a large work-up including AQP4-Ab and MOG-Ab. Data about natural history, disability outcome, and treatment are limited in this group of patients.

We aimed to (1) describe clinical, biological, and radiological features of double seronegative LETM patients; (2) assess the clinical course and identify prognostic factors; and (3) assess the risk of recurrence, according to maintenance immunosuppressive therapy.

Methods

Retrospective evaluation of patients with a first episode of LETM, tested negative for AQP-Ab and MOG-Ab, from the French nationwide observatory study NOMADMUS.

Results

Fifty-three patients (median age 38 years (range 16–80)) with double seronegative LETM were included. Median nadir EDSS at onset was 6.0 (1–8.5), associated to a median EDSS at last follow-up of 4.0 (0–8). Recurrence was observed in 24.5% of patients in the 18 following months, with a median time to first relapse of 5.7 months. The risk of recurrence was lower in the group of patients treated early with an immunosuppressive drug (2/22, 9%), in comparison with untreated patients (10/31, 32%).

Conclusions

A first episode of a double seronegative LETM is associated to a severe outcome and a high rate of relapse in the following 18 months, suggesting that an early immunosuppressive treatment may be beneficial in that condition.
MAPK signaling determines lysophosphatidic acid (LPA)-induced inflammation in microglia
Authors: Plastira Ioanna , Bernhart Eva , Joshi Lisha , Koyani Chintan N. , Strohmaier Heimo , Reicher Helga , Malle Ernst , Sattler Wolfgang
Published: April 2020

Background

In the extracellular environment, lysophosphatidic acid (LPA) species are generated via autotaxin (ATX)-mediated hydrolysis of lysophospholipid precursors. Members of the LPA family are potent lipid mediators transmitting signals via six different G protein-coupled LPA receptors (LPAR1-6). The LPA signaling axis is indispensable for brain development and function of the nervous system; however, during damage of the central nervous system, LPA levels can increase and aberrant signaling events counteract brain function. Here, we investigated regulation of the ATX/LPA/LPAR axis in response to lipopolysaccharide-induced systemic inflammation in mice and potential neurotoxic polarization programs in LPA-activated primary murine microglia.

Methods

In vivo, LPAR1-6 expression was established by qPCR in whole murine brain homogenates and in FACS-sorted microglia. ELISAs were used to quantitate LPA concentrations in the brain and cyto-/chemokine secretion from primary microglia in vitro. Transcription factor phosphorylation was analyzed by immunoblotting, and plasma membrane markers were analyzed by flow cytometry. We used MAPK inhibitors to study signal integration by the JNK, p38, and ERK1/2 branches in response to LPA-mediated activation of primary microglia.

Results

Under acute and chronic inflammatory conditions, we observed a significant increase in LPA concentrations and differential regulation of LPAR, ATX (encoded by ENPP2), and cytosolic phospholipase A2 (encoded by PLA2G4A) gene expression in the brain and FACS-sorted microglia. During pathway analyses in vitro, the use of specific MAPK antagonists (SP600125, SB203580, and PD98059) revealed that JNK and p38 inhibition most efficiently attenuated LPA-induced phosphorylation of proinflammatory transcription factors (STAT1 and -3, p65, and c-Jun) and secretion of IL-6 and TNFα. All three inhibitors decreased LPA-mediated secretion of IL-1β, CXCL10, CXCL2, and CCL5. The plasma membrane marker CD40 was solely inhibited by SP600125 while all three inhibitors affected expression of CD86 and CD206. All MAPK antagonists reduced intracellular COX-2 and Arg1 as well as ROS and NO formation, and neurotoxicity of microglia-conditioned media.

Conclusion

In the present study, we show that systemic inflammation induces aberrant ATX/LPA/LPAR homeostasis in the murine brain. LPA-mediated polarization of primary microglia via MAPK-dependent pathways induces features reminiscent of a neurotoxic phenotype.
A hot-blast warming facility for simulating global warming in low-stature crop systems and its application case to assess elevated temperature effects on rice in Central China
Authors: Zhang Zuolin , Yang Zhiyuan , Fahad Shah , Zhang Tong , Xu Wenhao , Cui Kehui , Peng Shaobing , Huang Jianliang
Published: April 2020

Background

To study the impact of climate warming on crops, it is crucial to have a warming equipment suitable for their field environment. A facility is needed that can provide suitable combinations of different temperatures at reasonable cost for large plots.

Results

Here, an additional field warming facility option named the hot-blast warming facility (HBWF), which comprised heaters, blowers, wind breaks, and a control board was developed. An application case based on HBWF was carried out to assess elevated temperature effects on rice in Central China during 2015 and 2016. We tested four elevated temperature treatments on four rice cultivars under paddy field conditions and measured yield and its components. Heating convection air directly, the facility could increase the temperature of the rice canopy up to 1–2 °C, which could properly simulate global warming. Considering the costs, the HBWF reduced the operating costs because of its relatively lower power consumption (0.164 kW/m2), which was 80% lower than that of Free Air Temperature Increase. Our results demonstrate that the HBWF could build a 25 m2homogeneous heating area and had little effect on the relative humidity under a paddy field environment. Warming treatments significantly reduced the grain yield by 4.4–22.7% in 2015, and 30.8–61.9% in 2016, compared to the control. The main contribution to the significant decrease of the grain yields was the decrease in seed setting rate. Moreover, a reduction of 1000-grain weight led to the decline in grain yield. The increasing ranges of the temperature simulated by HBWF were stable in different years, however, whether the elevated treatments demonstrated significant difference on rice growth mainly decided by the basic atmospheric temperature (as the control) during the growth period.

Conclusions

The new warming facility is suitable for field trials to assess elevated temperature combinations and provides an extra equipment option for use in elevated temperature research in the future.
Proposal of a new shared payment model for healthcare financing in the United States: a hypothesis
Authors: Ziran Bruce H. , O’Pry E. Kathleen
Published: April 2020

The healthcare repayment system in America is highly flawed due to several factors such as uncontrolled costs, unequal access, varied reimbursement systems, and complex patient interfaces. In fact, it is rated the worst among the eleven developed nations analyzed in the Commonwealth Fund’s evaluation conducted every three years. We propose a novel three-tiered model for healthcare repayment designed to fulfill the needs of the patients, the providers, the payers and the nation as a whole. We hypothesized that our new plan may spread cost between multiple entities and offer better coverage and access to care. Our model uses a shared-cost approach wherein the total risk expenditure becomes the responsibility of various stakeholders including the government, insurance industry, hospitals, patients, providers as well as the nation’s economy. While there is no perfect solution to healthcare in America, we believe our three-tiered model can create an economically balanced solution to break deadlock between party lines and result in better outcomes and patient care.
Associations of CXCL1 gene 5’UTR variations with ovarian cancer
Authors: Guo Man , Xu Chao , Chen Yan-Zhe , Sun Qi-Wen , Zhao Xin-Ying , Liu Xin , Yang Yi , Hu Yi-Yan , Li Fei-Feng , Liu Shu-Lin
Published: April 2020

Background

There are about 2.4 hundred thousand new cases and 1.5 hundred thousand deaths of ovarian cancer (OC) annually in the world. Chronic inflammation is a risk factor for OC. C-X-C motif chemokine ligand 1 (CXCL1) defects may facilitate inflammation and transactivate EGFR in ovarian cancer, but the precise haplotypes associated with the potential diseases remained largely unknown. In this work, we characterized CXCL1 gene variations to elucidate their possible associations with OC.

Methods

We analyzed the CXCL1 gene for 300 OC patients with 400 healthy participants as controls. The statistical analyses and Hardy-Weinberg equilibrium tests of the patients and control populations were conducted using the SPSS software (version 19.0) and Plink (version 1.9).

Results

The variants rs11547681, rs201090116, rs199791199, rs181868085, rs4074 and rs1814092 within or near the CXCL1 gene were characterized. The genetic heterozygosity of rs11547681 and rs4074 was very high. Statistical analysis showed that the variant rs11547681 in the gene was closely associated with the risk of OC in the Chinese Han population, although this variant was not associated with FIGO stages or pathological grades of the patients.

Conclusions

Rs11547681 in CXCL1 gene was associated with the risk of OC in the Chinese Han population.
A caregiver-reported global severity assessment in pediatric atopic eczema: the Comano score
Authors: Giovannini Mattia , Geat Davide , Barlocco Gabriele , Pertile Riccardo , Mori Francesca , Filippeschi Cesare , Novembre Elio , Cristofolini Mario , Baldo Ermanno
Published: April 2020

Atopic eczema (AE) is the most common inflammatory skin disease in infancy and its prevalence is rising worldwide. It has a wide social impact on the affected children and their families’ lives. AE can have a chronic and heterogeneous course, with periods of remission and relapse of the clinical manifestations. For this reason, its severity assessment through standardized outcome measures becomes a fundamental guide for health professionals, who can manage AE following evidence-based medicine principles in their everyday clinical practice or in clinical trials.

Several scoring systems have been recognized to assess the clinical manifestations of AE, both from the physician’s and the patient’s point of view. Despite the scoring systems standardized for adults, there are very few published options about the expression of a patient/caregiver-centered global severity assessment specifically for pediatric AE. For this reason, the aim of our study was to evaluate a new, quick, user-friendly and feasible caregiver-reported global severity assessment for pediatric AE. Based on a 0–10 numerical rating scale in pediatric AE, we named this scoring system the Comano score.

We carried out a cross-sectional observational study enrolling a total of 867 patients aged from 1 to 16 years (males 49.5%, mean patient’s age 5.9 years, standard deviation ±3.6 years) with a previous doctor-confirmed diagnosis of AE, who underwent balneotherapy at Comano Thermal Center (Comano, Trentino, Italy). A strong correlation between Comano score and SCORing Atopic Dermatitis (SCORAD) was observed (r = 0.74, p < 0.0001).

According to our results, the Comano score may be a promising new tool for the expression of a caregiver-reported global severity assessment in pediatric AE. However, further data are needed to confirm our preliminary findings before health professionals can use this scoring system in their everyday clinical practice to manage pediatric AE. Still, as a patient-focused measure, the Comano score may facilitate delivering person-centered care so as to define a measure for a clinical impact that can be meaningful to the subject, which is gaining importance in modern medicine.
Proactive versus standard support of labour in nulliparous women; study protocol for a randomized, controlled trial
Authors: Brenne Fehn Møyfrid , Dahlø Raija , Nielsen Renate , Laache Ingebjørg , Vanky Eszter
Published: April 2020

Background

Prolonged latent phase of labour often results in a traumatic birth experience. Prolonged labour is associated with more operative deliveries, haemorrhage, fetal asphyxia and poor birth experience. Women with prolonged labour in a former pregnancy more often demand caesarean section in the next, due to their negative birth experience. “Proactive support of labour” is an alternative method, developed to counteract prolonged labour. There are little research and no randomized controlled study that compare proactive to standard labour support.

Methods/Design

A prospective, non-blinded, randomized, single-centre, clinical trial where we compare proactive support to standard support of labour in a university hospital setting.

Inclusion criteria: latent phase of labour, non-pathologic pregnancy. Robson group 1, with painful contractions, and fully effaced cervix, with 1–3 cm dilatation. Exclusion criteria: induction of labour, breech presentation, twin pregnancy, multi-parity, conditions that require extended surveillance before and/or during labour.

Primary outcome: spontaneous, uncomplicated vaginal delivery. After inclusion, women randomized to proactive support of labour will stay at the hospital and have one-to-one midwife support. If no progression during the next 1–2 hours, amniotomy and/or oxytocin stimulation will be started. The control group will adhere to the standard procedures for labour support: expectance until established regular contractions and 4–5 cm cervical dilatation, and then one-to-one midwife support.

Discussion

The idea of proactive support of labour is to initiate early intervention when there are signs of slow progress in order to avoid protracted labour with exhaustion of the mother, the uterus and prolonged stress of the foetus. Proactive support of labour may represent a useful method to improve labour support in nulliparous women. However, evidence based on randomized controlled trials are needed in order to know whether proactive support of labour is comparable or superior to standard care. A randomized, controlled trial is described; challenges and possible clinical implications are discussed.

Trial registration

The Proactive Support of Labor Study (PAF) ClinicalTrials, NCT03056313. Registered on February 17, 2017.
Efficacy of digital cognitive behavioural therapy for symptoms of generalised anxiety disorder: a study protocol for a randomised controlled trial
Authors: Gu J. , Miller C. B. , Henry A. L. , Espie C. A. , Davis M. L. , Stott R. , Emsley R. , Smits J. A. J. , Craske M. , Saunders K. E. A. , Goodwin G. , Carl J. R.
Published: April 2020

Background

Generalised anxiety disorder (GAD) is a chronic and disabling condition with considerable personal and economic impact. Cognitive behavioural therapy (CBT) is a recommended psychological therapy for GAD; however, there are substantial barriers to accessing treatment. Digital CBT, in particular smartphone-delivered CBT, has the potential to improve accessibility and increase dissemination of CBT. Despite the emerging evidence of smartphone-based psychological interventions for reducing anxiety, effect size scores are typically smaller than in-person interventions, and there is a lack of research assessing the efficacy of smartphone-delivered digital interventions specifically for GAD.

Methods

In the DeLTA trial (DigitaL Therapy for Anxiety), we plan to conduct a parallel-group superiority randomised controlled trial examining the efficacy of a novel smartphone-based digital CBT intervention for GAD compared to a waitlist control. We aim to recruit 242 adults (aged 18 years or above) with moderate-to-severe symptoms of GAD. This trial will be conducted entirely online and will involve assessments at baseline (week 0; immediately preceding randomisation), mid-intervention (week 3), post-intervention (week 6; primary end point) and follow-up (week 10). The primary objective is to evaluate the efficacy of the intervention on GAD symptom severity compared to a waitlist control at post-intervention. Secondary objectives are to examine between-group effects on GAD at follow-up, and to examine the following secondary outcomes at both post-intervention and follow-up: 1) worry; 2) depressive symptoms; 3) wellbeing; 4) quality of life; and 5) sleep difficulty.

Discussion

This trial will report findings on the initial efficacy of a novel digital CBT intervention for GAD. Results have the potential to contribute towards the evidence base for digital CBT for GAD and increase the dissemination of CBT.

Trial registration

ISRCTN, ISRCTN12765810. Registered on 11 January 2019.
Medium-chain fatty acids and monoglycerides as feed additives for pig production: towards gut health improvement and feed pathogen mitigation
Authors: Jackman Joshua A. , Boyd R. Dean , Elrod Charles C.
Published: April 2020

Ongoing challenges in the swine industry, such as reduced access to antibiotics and virus outbreaks (e.g., porcine epidemic diarrhea virus, African swine fever virus), have prompted calls for innovative feed additives to support pig production. Medium-chain fatty acids (MCFAs) and monoglycerides have emerged as a potential option due to key molecular features and versatile functions, including inhibitory activity against viral and bacterial pathogens. In this review, we summarize recent studies examining the potential of MCFAs and monoglycerides as feed additives to improve pig gut health and to mitigate feed pathogens. The molecular properties and biological functions of MCFAs and monoglycerides are first introduced along with an overview of intervention needs at different stages of pig production. The latest progress in testing MCFAs and monoglycerides as feed additives in pig diets is then presented, and their effects on a wide range of production issues, such as growth performance, pathogenic infections, and gut health, are covered. The utilization of MCFAs and monoglycerides together with other feed additives such as organic acids and probiotics is also described, along with advances in molecular encapsulation and delivery strategies. Finally, we discuss how MCFAs and monoglycerides demonstrate potential for feed pathogen mitigation to curb disease transmission. Looking forward, we envision that MCFAs and monoglycerides may become an important class of feed additives in pig production for gut health improvement and feed pathogen mitigation.
A feasibility study to investigate the utility of a home-based exercise intervention during and after neo-adjuvant chemotherapy for oesophago-gastric cancer—the ChemoFit study protocol
Authors: Chmelo J. , Phillips A. W. , Greystoke A. , Charman S. J. , Avery L. , Hallsworth K. , Welford J. , Sinclair R. C. F.
Published: April 2020

Background

Treatment of locally advanced oesophago-gastric adenocarcinoma usually entails neo-adjuvant chemotherapy (NAC) and surgery. Surgery is associated with high morbidity and mortality. Cardiopulmonary reserve of patients having major surgery is related to postoperative outcomes. Complications are associated with poorer quality of life and may affect prognosis. Preventing complications may be beneficial to both of these and have cost implications. Prehabilitation may improve recovery from surgery by increasing a patients’ fitness before surgery. Designing a potentially cost and resource effective regimen which improves cardiopulmonary reserve may have a beneficial impact on patient outcomes after surgery.

Methods

The ChemoFit study is a non-randomised, single-arm and single-centre pilot study designed to investigate the feasibility of a home-based prehabilitation exercise intervention for patients receiving neoadjuvant treatment prior to oesophago-gastric surgery. Forty patients will be recruited at a single high-volume centre. The simple, home-based exercise intervention involves patients increasing their daily step-count during and after NAC and in the weeks leading up to surgical resection of the cancer. Additionally, quality of life assessments (QLQ-C30 and QLQ-OG25), oncological treatment delivery and participant perceptions of the study assessed by focus groups and questionnaires will be performed. The primary outcomes are to assess feasibility of the exercise intervention. The secondary outcomes will evaluate changes in cardiopulmonary reserve, sarcopenia and fat composition.

Discussion

It is anticipated that during an important teachable moment, the diagnosis and treatment of cancer, our patients will be open to the possibility of improving their fitness during chemotherapy and before major cancer surgery. It is possible that the negative impact of NAC on cardiopulmonary fitness could be prevented by implementing a home-based prehabilitation programme during and after NAC, prior to surgery for oesophago-gastric adenocarcinoma.

Trial registration

This study has been approved by the Health Research Authority (REC 18/WA/0427). Newcastle upon Tyne Hospitals NHS Foundation Trust (NUTH) will act as the study sponsor and the work is funded by a grant awarded by The Jon Moulton Charitable Foundation, supported by a research post funded by the Sir Bobby Robson Foundation. Trial registration: Clinicaltrials.gov, NCT04194463. Registered 11th December 2019—retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04194463.
In-vitro cytotoxic effects of Solanum macranthum fruit. Dunal extract with antioxidant potential
Authors: Kalebar Vishal U. , Hoskeri Joy H. , Hiremath Shivaprakash V. , Hiremath Murigendra B.
Published: April 2020

Background

The current study undertaken to evaluate antioxidant property of Solanum macranthum fruit methanol extract and its in-vitro cytotoxic effects on breast cancer MDA-MB-231 and mice embryo fibroblast (MEF-L929) cell line.

Methods

The total alkaloids, phenols and flavonoids content in the methanol extract of S.macranthum fruit were estimated. The antioxidant activity was evaluated by FRAP assay, H2O2 scavenging assay and DPPH assay. Anti-inflammatory protein denaturation inhibition assay was carried out using bovine serum albumin. Anticancer property of the extract was evaluated against breast cancer MDA-MB-231 by MTT assay and comparative study was carried out on normal cells using MEF-L929 cell line.

Results

Phytochemical estimation revealed that total alkaloid content was measurable high (13.6 g/100 g of extract), where as the total phenolics and flavonoids content was 115.5 mg/GAE and 142.6 mg/QE. Further, the antioxidant effect of methanol extract by H2O2 assay showed considerably higher scavenging activity with 99.6% at 400 μg/ml, where as by FRAP assay the relative reducing power was estimated to be 39.1% at 400 μg/ml and in case of DPPH assay it was found to be 47.9% at 400 μg/ml. EC50 value of anti-inflammatory assay was found to be 112.96 μg/ml. Anticancer studies showed that the IC50 value was found to be 373.77 μg /ml against MDA-MB-231 breast cancer cell line, where as the methanol extract showed negligible cytotoxic effect against normal cells (MEF -L929 cell line), indicating its cancer specific effect.

Conclusion

Based on the results obtained, methanol extract of Solanum macranthum fruit was found to possess significant antioxidant properties and also showed potential anticancer property against MDA-MB-231 breast cancer cell line with negligible cytotoxic effect on normal cells revealing its potential application as an anticancer agent.
Barcelona: municipalist policy entrepreneurship in a centralist refugee reception system
Authors: Garcés-Mascareñas Blanca , Gebhardt Dirk
Published: April 2020

This article is a case study of Barcelona’s policy entrepreneurship in innovating refugee reception. In a context of a highly centralised and increasingly dysfunctional Spanish refugee reception system, it traces how Barcelona, after declaring itself a city of refuge, aimed to change refugee reception into a more decentralised and bottom-up system with a major role of cities. Following Minstrom and Norman, the article reconstructs the city’s policy entrepreneurship and shows how the city 1) led by example in developing innovative local policies; 2) developed political arguments for change from a municipalist stance in coalition with other cities at national and EU level; and 3) worked its arguments into more technical discussions on the future of integration funding in the EU. On the basis of these developments, the article reaches two main conclusions. First, while the different registers of policy entrepreneurship cannot be directly connected to any concrete change of the multi-level setup of refugee reception, they do represent a significant step forward in cities’ self-organisation beyond ideological lines and a factor contributing to a stronger recognition of cities in refugee reception in Europe. Second, while the literature on multilevel governance has an in-built bias towards more coordinated and harmonious relationships across tiers, the case of Barcelona shows that more attention should be paid to conflict and change.
Is it time to review NICE guidelines on family therapy for anorexia in young people?
Authors: Woo Esther
Published: April 2020

Family therapy is recommended by the National Institute for Health and Care Excellence (NICE) for the management of anorexia nervosa in children and young people, but there is limited evidence to back this recommendation. The Cochrane Review under consideration evaluates the efficacy of different family therapy approaches compared with other treatments for anorexia nervosa, and this commentary puts the findings into clinical perspective.
Diagnosis and Management of Squamous Cell Carcinoma of Unknown Primary in the Head and Neck: ASCO Guideline
Authors: Maghami Ellie , Ismaila Nofisat , Alvarez Adriana , Chernock Rebecca , Duvvuri Umamaheswar , Geiger Jessica , Gross Neil , Haughey Bruce , Paul Doru , Rodriguez Cristina , Sher David , Stambuk Hilda E. , Waldron John , Witek Matt , Caudell James
Published: April 2020

PURPOSE

To provide evidence-based recommendations to practicing physicians and other health care providers on the diagnosis and management of squamous cell carcinoma of unknown primary in the head and neck (SCCUP).

METHODS

The American Society of Clinical Oncology convened an Expert Panel of medical oncology, surgery, radiation oncology, radiology, pathology, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2008 through 2019. Outcomes of interest included survival, local and regional disease control, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations.

RESULTS

The literature search identified 100 relevant studies to inform the evidence base for this guideline. Four main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate pathology techniques, and adjuvant therapy.

RECOMMENDATIONS

Evidence-based recommendations were developed to address preoperative evaluation for patients with a neck mass, surgical diagnostic and therapeutic procedures, appropriate treatment options in unilateral versus bilateral SCCUP. Additional information is available at www.asco.org/head-neck-cancer-guidelines .
Successful Implementation of a Perioperative Data Warehouse Using Another Hospital’s Published Specification From Epic’s Electronic Health Record System
Authors: Epstein Richard H. , Hofer Ira S. , Salari Valiollah , Gabel Eilon
Published: April 2020

BACKGROUND:

Many hospitals have replaced their legacy anesthesia information management system with an enterprise-wide electronic health record system. Integrating the anesthesia data within the context of the global hospital information infrastructure has created substantive challenges for many organizations. A process to build a perioperative data warehouse from Epic was recently published from the University of California Los Angeles (UCLA), but the generalizability of that process is unknown. We describe the implementation of their process at the University of Miami (UM).

METHODS:

The UCLA process was tested at UM, and performance was evaluated following the configuration of a reporting server and transfer of the required Clarity tables to that server. Modifications required for the code to execute correctly in the UM environment were identified and implemented, including the addition of locally specified elements in the database.

RESULTS:

The UCLA code to build the base tables in the perioperative data warehouse executed correctly after minor modifications to match the local server and database architecture at UM. The 26 stored procedures in the UCLA process all ran correctly using the default settings provided and populated the base tables. After modification of the item lists to reflect the UM implementation of Epic (eg, medications, laboratory tests, physiologic monitors, and anesthesia machine parameters), the UCLA code ran correctly and populated the base tables. The data from those tables were used successfully to populate the existing perioperative data warehouse at UM, which housed data from the legacy anesthesia information management system of the institution. The time to pull data from Epic and populate the perioperative data warehouse was 197 ± 47 minutes (standard deviation [SD]) on weekdays and 260 ± 56 minutes (SD) on weekend days, measured over 100 consecutive days. The longer times on weekends reflect the simultaneous execution of database maintenance tasks on the reporting server. The UCLA extract process has been in production at UM for the past 18 months and has been invaluable for quality assurance, business process, and research activities.

CONCLUSIONS:

The data schema developed at UCLA proved to be a practical and scalable method to extract information from the Epic electronic health system database into the perioperative data warehouse in use at UM. Implementing the process developed at UCLA to build a comprehensive perioperative data warehouse from Epic is an extensible process that other hospitals seeking more efficient access to their electronic health record data should consider.
The Venoarterial Extracorporeal Membrane Oxygenation Weaning Checklist
Authors: Mihalj Maks , Rehfeldt Kent H. , Carrel Thierry , Stueber Frank , Luedi Markus M.
Published: April 2020

Venoarterial extracorporeal membrane oxygenation (vaECMO) is a well-established treatment option for severe cardiogenic shock of various etiologies. Although trials have explored weaning strategies, a brief and conclusive overview is lacking. We present the different aspects of weaning and provide an evidence- and experienced-based guide for clinicians managing patients under vaECMO in the preweaning, weaning, and postweaning phases.
Prophylactic Physostigmine for Extreme and Refractory Adult Emergence Delirium, Aimed at Increasing Patient Safety and Reducing Health Care Workplace Violence: A Case Report
Authors: Gutman David A. , Hassid Marc , Jeanes Zachary , Redding Amanda T. , Romeo Deborah
Published: April 2020

Emergence delirium is a well-known phenomenon that may be encountered after general anesthesia. A common approach to this issue is to risk stratify patients preoperatively and treat them postoperatively if emergence delirium occurs. We present the case of a patient with Barrett esophagus and a history of severe and refractory emergence delirium, who was successfully treated prophylactically with physostigmine, resulting in decreased risk of harm to the patient, trauma to the perioperative staff, and a safer and more positive recovery.
Development and Implementation of a Nonclinical Professional Development Rotation
Authors: Fowler Leslie C. , Ehrenfeld Jesse M. , McEvoy Matthew D.
Published: April 2020

Residency programs often struggle with strategies to formally teach leadership and communications skills. To provide a catalyst for professional development, Vanderbilt University Medical Center implemented a curriculum aimed at addressing this gap. Starting in 2014, the authors implemented a 2-week professional development rotation for first-year anesthesiology residents. Experts provided a series of didactic and experiential sessions focused on various professional development topics. Outcomes were assessed using pre- and postrotation surveys. Sixty-nine residents completed the rotation over a 4-year period, and 82% (54 of 66) strongly agreed that nonclinical professional development should be a component of training.
The Severed Head as Public Sculpture in Late Medieval England
Authors: Drimmer Sonja
Published: April 2020

Chronicles of fifteenth-century England teem with severed heads. Frequently, these texts focus less on the event of decapitation than on its enduring result: namely, the modified and adorned head of the deceased, spiked and exhibited in a prominent public venue. This article concentrates on textual descriptions of such sights in order to propose that the head was not simply a byproduct of the premodern state’s judicial cruelty or merely evidence of the deceased’s damnation; rather, the displayed head was a visual phenomenon in its own right, one that was often more available for public inspection than the act of execution that preceded it. Severed heads thus assumed the role of public sculpture: they were likened to and in dialogue with figural representations in stone that inhabited the civic landscape, and manipulated by their creators to speak specific statements through their material properties, visual form, and conspicuous display.
Competing Humanisms
Authors: Mori Giuliano
Published: April 2020

Leonardo Bruni’s Dialogi ad Petrum Paulum Histrum has long been studied as a manifesto of the humanist divergence from medieval culture. This article reconsiders the role of Bruni’s Dialogi in the development of Italian humanism and especially in the development of the humanists’ awareness of their cultural identity as a group. The essay argues that Bruni’s principal aim was not to distance himself from previous traditions, but rather to mark a distinction between two concurrent conceptions of humanism that prevailed in his own time. Through the Dialogi, Bruni criticizes Niccolò Niccoli’s cultural extremism and advances a moderate ideal of humanism that seeks to revise and incorporate nonhumanist traditions instead of rejecting them outright. In doing so, Bruni also intends to shield his ideal of humanism from the attack of the traditionalist sector of Renaissance culture.
Unbinding the Maternal Body in Lucy Hutchinson’s Order and Disorder
Authors: Lesser Madeline
Published: April 2020

This article addresses Lucy Hutchinson’s Order and Disorder, an epic, twenty-canto retelling of Genesis. Scholars have often considered Hutchinson’s poem an inferior version of Paradise Lost insofar as it does not transgress biblical narrative. Attending to the poem’s portrayal of childbearing in relation to seventeenth-century birthing prayers and affect theory, this article demonstrates how Hutchinson’s figuration of the body belies any notion of her poem as “Christian cliché.” The article argues that the political value of Order and Disorder stems not from Hutchinson’s depiction of motherhood as a prototype of self-possessed, liberal political agency, but from her account of affective feeling as unbinding woman from any fixed position or category. Finally, the article shows how Hutchinson’s depiction of childbearing, as an ongoing process rather than a teleological event, parallels her understanding of both poetry and providence.
Cdc24 interacts with septins to create a positive feedback loop during bud site assembly in yeast
Authors: Chollet Julian , Dünkler Alexander , Bäuerle Anne , Vivero-Pol Laura , Mulaw Medhanie A. , Gronemeyer Thomas , Johnsson Nils
Published: April 2020

Yeast cells select the position of their new bud at the beginning of each cell cycle. The recruitment of septins to this prospective bud site is one of the critical events in a complex assembly pathway that culminates in the outgrowth of a new daughter cell. During recruitment, septin rods follow the high concentration of Cdc42GTP that is generated by the focused localization of the Cdc42 guanine-nucleotide-exchange factor Cdc24. We show that, shortly before budding, Cdc24 not only activates Cdc42 but also transiently interacts with Cdc11, the septin subunit that caps both ends of the septin rods. Mutations in Cdc24 that reduce affinity to Cdc11 impair septin recruitment and decrease the stability of the polarity patch. The interaction between septins and Cdc24 thus reinforces bud assembly at sites where septin structures are formed. Once the septins polymerize to form the septin ring, Cdc24 is found at the cortex of the bud and directs further outgrowth from this position.
En bloc TGN recruitment of Aspergillus TRAPPII reveals TRAPP maturation as unlikely to drive RAB1-to-RAB11 transition
Authors: Pinar Mario , Peñalva Miguel A.
Published: April 2020

Transport protein particle (TRAPP) complexes regulate membrane traffic. TRAPPII and TRAPPIII share a core hetero-heptamer, also denoted TRAPPI. In fungi TRAPPIII and TRAPPII mediate GDP exchange on RAB1 and RAB11, respectively, regulating traffic across the Golgi, with TRAPPIII also activating RAB1 in autophagosomes. Our finding that Aspergillus nidulans TRAPPII can be assembled by addition of a TRAPPII-specific subcomplex onto core TRAPP prompted us to investigate the possibility that TRAPPI and/or TRAPPIII already residing in the Golgi matures into TRAPPII to determine a RAB1-to-RAB11 conversion as Golgi cisternae progress from early Golgi to TGN identity. By time-resolved microscopy, we determine that the TRAPPII reporter Trs120 (the homolog of metazoan TRAPPC9) is recruited to existing trans-Golgi network (TGN) cisternae slightly before RAB11 arrives, and resides for ∼45 s on them before cisternae tear off into RAB11 secretory carriers. Notably, the core TRAPP reporter Bet3 (the homolog of metazoan TRAPPC3) was not detectable in early Golgi cisternae, being instead recruited to TGN cisternae simultaneously with Trs120, indicating en bloc recruitment of TRAPPII to the Golgi and arguing strongly against the TRAPP maturation model.
Associations between Range of Motion and Tissue Stiffness in Young and Older People
Authors: HIRATA KOSUKE , YAMADERA RYOSUKE , AKAGI RYOTA
Published: April 2020

Purpose

The purpose of this study was to investigate differences in the associations between passive ankle dorsiflexion range of motion (ROM) and stiffness of the triceps surae, sciatic nerve, and deep fascia located in the posterior leg between young and older people.

Methods

Twenty young and twenty older males were recruited and were placed in a prone position with their hip and knee fully extended. Passive ankle dorsiflexion ROM was determined based on the onset of pain during passive dorsiflexion at 1°·s−1 using an isokinetic dynamometer. Shear wave speeds (as a stiffness index) of the triceps surae, the sciatic nerve, and the deep fascia in the posterior leg were evaluated by ultrasound shear wave elastography.

Results

The shear wave speeds of the medial and lateral gastrocnemius measured at 15° dorsiflexion correlated negatively with passive ROM in young but not in older participants. The shear wave speed of the sciatic nerve measured at 15° dorsiflexion correlated negatively with passive ROM only in older participants. No association was observed between passive ROM and shear wave speed of the deep fascia in the posterior leg. For data measured at maximal dorsiflexion angle (as an index of stretch tolerance), shear wave speeds of the triceps surae and passive joint torque correlated positively with passive ROM in both groups.

Conclusion

These results suggest that the tissues limiting passive ankle dorsiflexion ROM are muscle and nerve for young and older people, respectively, whereas stretch tolerance influences passive ROM for both groups. This implies that the relative contribution of nonmuscular tissues to joint flexibility become stronger than that of muscles with age.