bluuebunny/crossref_metadata_2025 huggingface dataset:
Period Doubling Phenomenon as the Origin of Electron Properties
Authors: Lehto Ari
Published: June 2020

It is proposed that the electrons have an intrinsic periodic property, which determines particle’s rest energy, electric charge, and magnetic moment. Numerical analysis shows that the correct periods are generated by a precise period doubling cascade starting at the Planck scale. Periods corresponding to the values of the intrinsic physical properties of the electron and positron belong to a subset of stable periods. The periodic structures of the rest energy and magnetic moment consist of three internal degrees of freedom, whereas the Coulomb energy of the electric charge consists of four. The number of period doublings for the elementary charge determines the value of the fine structure constant alpha.
Demystifying the Effects of Age at Marriage and Age at First Birth on Completed Family Size in Zambia
Authors: Moyo Nkuye , Nanyangwe-Moyo Tina , Qiao Xiaochun , Wu Jilei , Zheng Xiaoying
Published: June 2020

The link between age at marriage and first birth in explaining completed family size is not always direct, due to heterogeneity in circumstances, that compel individual women to marry or initiate childbearing at a particular age. We analyzed data for 1020 women aged 45-49 in 2014 of the 1965-1969 birth cohort from the 2013-14 ZDHS. We fitted a bivariate and multivariate multinomial logistic regression to establish the effect of mother’s age at first marriage and at first birth on completed family size (CFS). Chi-square test of proportions measuring differences in proportions and relative risk ratios (RRR) with confident intervals at 95% are reported. Our results show that the average CFS was 6.7 (95% CI: 6.5 – 6.9) among women completing their reproductive span in 2014 with mean age at first marriage and birth being 18.3 years (95% CI: 18.0 – 18.5) and 18.9 years (95% CI: 18.7 – 19.1) respectively. Women marrying at younger ages and having their first birth at younger ages were more likely (RRR: 0.262; 95% CI:0.126-0.547 and RRR: 0.176; 95% CI:0.068-0.497 respectively) to have higher CFS than their compatriots that initiated both marriage and childbearing at or after age 22. Having no education, being a rural resident and having a medium household wealth all increased the risk of having higher CFS. Women that marry before age 19 have a higher likelihood of having 6 or more children by the end of their reproductive period. The study concludes that apart from a woman’s age at first marriage and first birth, a complex network of factors interact to determined CFS.
The Effect of CCCP on Mitophagy in CD4+CD25+ Regulatory T Cells in Human Peripheral Blood
Authors: Yang Yu-Jie , Karim Md Rezaul , Yuan Jiang , Peng Xiao-Qian , Zeng Pei , Xu Yong , Lu Zu-Neng , Wang Yun-Fu
Published: June 2020

Objective: To investigate the effects and mechanisms of different concentrations of CCCP on mitophagy in human peripheral blood regulatory T cells. Methods: Tregs were isolated, identified and then grouped, treating with CCCP at a concentration of 2.5 μM, 5 μM, 10 μM, 20 μM and 40 μM for 24h in an incubator. Flow cytometry detected the reactive oxygen species (ROS), mitochondrial membrane potential (MMP), mitochondrial quality, and fluorescence microscopy observed the co-localization of mitochondria and lysosomes in each group. Results: The purity of CD4+CD25+Tregs was (93.36 ± 1.87) %. With the increase of CCCP concentration, the level of ROS gradually increased, while the MMP decreased gradually. About the mitochondria and lysosome fusion, the fluorescence intensity of orange (yellow) was the highest when the concentration of CCCP was in the range of 5-10 μM while decreased with the CCCP concentration continually increasing. The mitochondrial quality decreased with the increase of CCCP concentration. However, there was no significant difference between groups C, D and E. The mitochondrial quality of groups F and G were significantly lower than that of group E. Conclusions: With the concentration of CCCP gradually increased, the level of ROS in Treg cells increased, and MMP decreased, which promoted the mitophagy, mitochondrial quality maintains homeostasis; When ROS accumulated, and MMP decreased significantly, the mitophagy was inhibited, and the mitochondrial quality was significantly decreased.
Parental Influence on Students’ Academic Performance - A Case Study of Debre Berhan General Secondary School students, Debre Berhan, Ethiopia
Authors: Enbeyle Wegayehu , Desta Gebremedhin , Pandey Digvijay
Published: June 2020

Education plays an essential role in the acquisition of knowledge and skills. School is the place where children’ attitudes, interests, and habits are developed. More involved and supportive a parent is towards their adolescent the higher self-esteem they will gain allowing the adolescent to feel confident and focused during school. Parents therefore enroll their children in schools that can give them expected quality of lives. The main core objective for this study was to determine the parental influence on students’ academic performance - A case study of Debre Berhan General Secondary School. A total of 118 students were included in the present study using simple random sampling technique from the total students (2367). Cross-sectional design was appropriate for this study. Primary source of data was employed collected from students. Descriptive and inferential statistics were applied. For statistical analysis SPSS 20 was used at 5% level of signiﬁcance. Descriptive statistics results indicate that the average mark of students was with minimum and maximum value of 47 and 94 respectively. Multiple regression models showed that Income level, Rate of money given to satisfy basic and educational materials, Parent’s occupation, Family size, Parent’s educational level, and Parent’s way of giving motivation were found to be a significant effect on academic performance of students at 5% level of significance at study area. However, sex of students, age of students and grade level of students were not found to be significant effect to academic performance at study area. Overall model is statistically significance for the data. All the assumption of regression analysis was satisfied. Normality, Constant variance, absence of multicolinearity, linearity and absence of autocorrelation were satisfied due to formal tests and diagnostic plots. Study recommended the need for programs related to improvement of mother and father education for caring child in appropriate success of their education and also parents should allocate time to visit schools and establish good relationship and discussion about their children’s academic progress in according to way of motivation to learn actively in school.
An Exploratory Data Analysis on Certified Perovskite Devices Efficiency and I-V Metrics: Insights into Materials Engineering and Process Scaling Up
Authors: Ma Jialiu , Guo Da
Published: June 2020

Perovskite based solar cells have achieved tremendous progress reaching record efficiency in the past 5 years. Numerous new processes and chemistry have been reported and contribute to the perovskite rapid progress. Continuous efficiency improvements are still necessary for perovskite solar cells, and an exploratory data analysis on devices performance over multiple studies could boost the technology development. Such analysis could identify patterns or provide insights that are not obvious in a single study. Here we present a high quality dataset containing only independently certified Pb-based perovskite solar cells summarizing their efficiency, relevant I-V metrics, manufacturing processes and materials used. Analysis over the dataset provides insights on how aperture size, perovskite deposition methods and materials used in each functional layer affect the final solar cell efficiency and I-V metrics. Future directions are also suggested for efficiency improvements.
A Novel Family of Quadrupole-Orbitrap Mass Spectrometers for a Broad Range of Analytical Applications
Authors: Hauschild Jan-Peter , Peterson Amelia Corinne , Couzijn Erik , Denisov Eduard , Chernyshev Denis , Hock Christian , Stewart Hamish , Hartmer Ralf , Grinfeld Dmitry , Thoeing Christian , Reitemeier Bastian , Kreutzmann Arne , Lange Oliver , Balschun Wilko , Venckus Aivaras , Kanngiesser Sebastian , Kholomeev Alexander , Quiring Gregor , Czemper Frank , Wouters Eloy , Belford Michael , Mueller Mathias , Grote Jens , Arrey Tabiwang N. , Kraegenbring Julia , Strupat Kerstin , Mohring Siegrun , Crone Catharina , Harder Alexander , Robitaille Aaron , Gajadhar Aaron , Motamed Khatereh , Liu Yang , Lopez Ferrer Daniel , Damoc Nicolaie Eugen , Criscuolo Angela , Srzentic Kristina , George Ed , Yang Charles , Ntai Ioanna , Souza Amanda , Wieghaus Andreas , Makarov Alexander
Published: June 2020

The rapidly increasing adoption of high-resolution accurate-mass methods in analytical laboratories has fueled demand for instruments that combine high performance and reliability with small size and greater ease-of-use. This paper presents the major design principles that are driving the evolution of the hybrid quadrupole-Orbitrap instrument architecture to enable a greater range of applications and users. These principles may be summarized as follows: better usage of physical space and better access for service by means of size reduction of pumping and ion optics; expanded use of technologies from electronics in ion-optical design; flexibility in performance via modularity of design of the hardware and software components; and, harmonization of interfaces with other instruments to facilitate sharing and transferability of analytical workflows. The design of a novel family of hybrid mass spectrometers is described in detail, and performance evaluation is carried out on a wide variety of samples for its three representatives: the Orbitrap Exploris 120, Orbitrap Exploris 240 and Orbitrap Exploris 480 mass spectrometers.The new instrument family is shown to offer compelling potential not only for high-end proteomics and biopharmaceutical applications, but also for screening, trace, targeted and clinical analysis by liquid chromatography/mass spectrometry methods.
Effect of 24/7 attending coverage in the Neonatal Intensive Care Unit on fellow education.
Authors: Sahni Mitali , Mowes Anja
Published: June 2020

Background There is a current change in type of attending coverage in the Neonatal Intensive Care Unit (NICU) from home calls to 24/7 in House. Effects of this increased attending physician presence on education of NICU fellows has not been studied. The objective of this study is to evaluate the fellows’ perception of in house attending coverage on their education and evaluate its effect on their perceived autonomy.Methods A secure, anonymous, web-based survey was designed using using RedCap. The web-based survey was sent via the section of Neonatal Perinatal Medicine of the American Academy of Pediatrics, to all members of Training & Early Career Neonatologists. Chi-square tests were used to compare groups on dichotomous outcomes, with Fisher Exact tests used when the expected cell frequencies were small.Results One hundred and twenty-three surveys were analyzed, that included responses from 82 fellows & 41 early career neonatologists. 52% reported having 24/7 attending in-house (IH) coverage. 30 of the 123 respondents experienced a change in model of attending coverage during their training. Among these 30, only 26.6% preferred the model of attending IH coverage. The respondents currently working in IH models, when compared to those in non-IH coverage models felt IH attending coverage was beneficial for fellow education (p <0.05) but was less likely to give fellows autonomy for decision making (p=0.02). Conclusion In our survey respondents with in house attending, had a more favorable view of its benefit on fellow education. Institutions practicing or considering IH attending coverage should consider use of adequate measures to balance fellow supervision and education.
Is Leishmaniasis adequately notified in Sri Lanka? A survey among doctors from an endemic district, Sri Lanka.
Authors: Hewawasam Chandana , Weerakoon Hema S , Thilakan Vyshnavi , Lelwala Tishni , Prasanka Kalana , Rathnayaka Amila S , Gamage Shanika , Agampodi Suneth
Published: June 2020

Background: Leishmaniasis is a notifiable disease in Sri Lanka since 2008. Previous studies show a gap in the notification of leishmaniasis. Purpose of the present study was to determine the Knowledge, attitudes and practice of medical officers regarding leishmaniasis.Methods: A cross-sectional study was conducted in the Anuradhapura district which reported the highest case load of leishmaniasis. Medical officers from public and private health care institutes in the area filled a self-administered questionnaire in the presence of the investigators.Results: One hundred and eighty-eight (188) medical officers completed the questionnaire. Of them, 95.7% were aware of leishmaniasis as a parasitic infection and 84.7% correctly identified Leishmania donovani as the causative organism in Sri Lanka. From the respondents, 181 (96.8%) knew that the vector of leishmaniasis is sand fly. Cutaneous leishmaniasis was reported as the most prevalent form of leishmaniasis in the country by 176 (94.1%). Nearly half of the respondents (98, 54.1%) were aware of the fact that the Anuradhapura district has the highest disease burden. Many of them had the idea that leishmaniasis is an emerging disease (155, 84.3%,) and early diagnosis is important in controlling the disease (163, 89.1%). Although about three fourth (123, 73.7 %,) of the participants mentioned that leishmaniasis should be notified at first clinical suspicion, only 74 (42.5%) were aware that it is a legal requirement. Some medical officers (39, 22%) believed that the current notification system in the country is not effective. Unavailability of notification forms (60, 36.8%) heavy workload (85, 50.3%) and inadequate supportive staff (55, 35.1%) were reported as barriers for timely notification. Even though 105 (58.0%) of medical officers had suspected leishmaniasis during last eight years period only 35 (19.4%) had notified.Conclusions: Even though more than 90% of the participants had good theoretical knowledge about leishmaniasis; notification of leishmaniasis is considerably inadequate. This study emphasizes the need for greater efforts to improve the notification of leishmaniasis in Sri Lanka.
Gradient Boosting for Parkinson’s Disease Diagnosis from Voice Recordings
Authors: Karabayir Ibrahim , Goldman Samuel , Pappu Suguna , Akbilgic Oguz
Published: June 2020

Background: Parkinson’s Disease (PD) is a clinically diagnosed neurodegenerative disorder that affects both motor and non-motor neural circuits. Speech deterioration (hypokinetic dysarthria) is a common symptom, which often presents early in the disease course. Machine learning can help movement disorders specialists improve their diagnostic accuracy using non-invasive and inexpensive voice recordings.Method: We used “Parkinson Dataset with Replicated Acoustic Features Data Set” from the UCI-Machine Learning repository. The dataset included 44 speech-test based acoustic features from patients with PD and controls. We analyzed the data using various machine learning algorithms including Light and Extreme Gradient Boosting, Random Forest, Support Vector Machines, K-nearest neighborhood, Least Absolute Shrinkage and Selection Operator Regression, as well as logistic regression. We also implemented a variable importance analysis to identify important variables classifying patients with PD. Results: The cohort included a total of 80 subjects: 40 patients with PD (55% men) and 40 controls (67.5% men). Disease duration was 5 years or less for all subjects, with a mean Unified Parkinson’s Disease Rating Scale (UPDRS) score of 19.6 (SD 8.1), and none were taking PD medication. The mean age for PD subjects and controls was 69.6 (SD 7.8) and 66.4 (SD 8.4), respectively. Our best-performing model used Light Gradient Boosting to provide an AUC of 0.951 with 95% confidence interval 0.946-0.955 in 4-fold cross validation using only seven acoustic features.Conclusions: Machine learning can accurately detect Parkinson’s disease using an inexpensive and non-invasive voice recording. Light Gradient Boosting outperformed other machine learning algorithms. Such approaches could be used to inexpensively screen large patient populations for Parkinson’s disease.
Molecular epidemiology and clinical characteristics of hepatitis delta virus (HDV) infected patients with elevated transaminases in Shanghai, China
Authors: Wu Shanshan , Zhang Yi , Tang Yuyan , Yao Ting , Lv Mengjiao , Tang Zhenghao , Zang Guoqing , Yu Yongsheng , Chen Xiaohua
Published: June 2020

Background: Patients coinfected with HBV and hepatitis D virus (HDV) have a greater risk of HCC and cirrhosis. The current study was undertaken to assess HDV genotype distribution and determine clinical characteristics of hepatitis delta virus (HDV) among HBsAg positive individuals in Shanghai.Method: This retrospective study involved 225 serum samples from HBsAg positive hospitalized patients from October 2010 to April 2013. HDV-specific RT-nested PCR was used to amplify HDV RNA. HDV genotypes were characterized by Next-generation sequencing (NGS), followed by phylogenetic analyses. HDV/HBV co-infected patients and HBV mono-infected patients were compared clinically and virologically.Results: Out of the 225 HBsAg-positive serum samples with elevated transaminases, HDV-RNA was identified in 11 (4.9%) HBsAg positive patients. The HBV loads in the HDV positive group were significantly lower than the HDV negative HBV-infected patients. The aminotransferase enzymes were significantly higher in HDV/HBV co-infected compared to HDV negative patients (P<0.05). Phylogenetic analyses indicated that HDV-2 genotype being the predominant genotype, other HDV genotypes were not observed. HDV/HBV patients were significantly associated with a rather unfavourable clinical outcomeConclusion： In summary, our study showed that the prevalence of HDV infection in patients with elevated transaminases is not low and the predominance of HDV genotype 2 infection in Shanghai. This finding helps us to better understand the correlation of HDV/HBV co-infection. Moreover, Next-generation sequencing (NGS) technologies provide a rapid, precise method for generating HDV genomes to define infecting genotypes.
Exosomes derived from human umbilical cord MSCs rejuvenate aged MSCs and enhance their functions for myocardial repair
Authors: Zhang Ning , Zhu JinYun , Ma QunChao , Zhao Yun , Wang YingChao , Hu XinYang , Chen JingHai , Zhu Wei , Han ZhongChao , Yu Hong
Published: June 2020

Background: Age and other cardiovascular risk factors have been reported to impair the activities of mesenchymal stem cells (MSCs), which will affect the efficacy of stem cell transplantation. The objective of the study is to investigate whether exosomes derived from human umbilical cord MSCs (UMSCs) could enhance the activities of bone marrow MSCs from old person (OMSCs), and improve their capacity for cardiac repair. Methods: Exosomes extracted from conditioned medium of UMSCs were used to treat OMSCs to generate OMSCsExo. The key molecule in the exosomes that have potential to rejuvenate aged MSCs were screened, and the role of OMSC was tested in the mouse model of mycardiac infarction(MI). Results: We found the activity of senescence-associated β-galactosidase and the expression of aging-related factors such as p53, p21, and p16 were significantly higher in OMSCs than those in UMSCs. After treatment with UMSC exosomes, these senescence phenotypes of OMSCs were remarkably reduced. The proliferation, migration, differentiation, anti-apoptotic and paracrine effect were increased in OMSCsExo. In vivo study, mice with cardiac infarction had significantly better cardiac function, less fibrosis, and more angiogenesis after they were injected with OMSCsExo as compared with those with OMSC. There was more miR-136 expression in UMSCs and OMSCsExo than in OMSCs. Upregulation of miR-136 by transfection of miR-136 mimic into OMSCs significantly attenuated the apoptosis and senescence of OMSCs. Apoptotic peptidase activating factor (Apaf1) was found to be the downstream gene that is negatively regulated by miR-136 via directly targeting at its 3’UTR. Conclusion: Our data suggest that exosomes from young MSCs can improve activities of aged MSCs and enhance their function for myocardial repair by transferring exosomal miR-136 and downregulating Apaf1.
Transitions in Adolescent Boys and Young Men’s High-Risk Sexual Behaviour in India
Authors: Sharma Santosh Kumar , Vishwakarma Deepanjali
Published: June 2020

Background: The sexual behaviour of adolescents is of importance due to the engagement in risky sexual activity at a too early age, which may be associated with the adverse outcomes. The study aims to understand the transitions in adolescent boys and young men’s high-risk sexual behaviour in India using two rounds of Indian demographic health survey, NFHS-3 (2005-06) and NFHS-4 (2015-16).
Methods: A total of 25,538 in NFHS-3 (2005-06) and 35,112 in NFHS-4 (2015-16) men were considered for the analysis. Men have been divided into two age groups as 15-19 years (adolescent) and 20-24 (young men) for comparison purposes. Descriptive and multivariate statistics have been used.
Results: Overall, high-risk sexual behaviour has increased among adolescent boys (64% to 70%) and young men (18% to 27%) from 2005-06 to 2015-16. The trend of live-in relationship has increased among adolescent boys of rural areas (0.6% to 6.0%) as well as in urban areas (3.1% to 10.9%) over the last ten years. Adolescent boys having 10 th and above years of schooling (AOR=1.98; p<0.01), residing in urban areas (AOR=2.23; p<0.01), and belonging to the affluent class of households (AOR=1.41; p<0.05) were more likely to engage in high-risk sexual activity than the young men in India. The odds of high-risk sexual behaviour was higher among alcohol-using adolescent boys (AOR= 1.82; p<0.01) and young men (AOR=2.38; p<0.01) in 2015-16.
Conclusions: The study concludes that early sexual debut, lower prevalence of condom use at first sexual experience, tendency of live-in-relationship, and alcohol consumption indicate the hazardous interconnection between such behaviours among adolescent boys over the last decade which put them at higher-risky sexual behaviour as compared to young men. Adolescent’ sexual behaviours have both short-term and long-term consequences, and interventions that focus on multiple domains of risk may be the most effective in helping to promote broad reproductive health among young adults.
Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016
Authors: Wu Zhenzhu , Chen Yi , Xiao Tingting , Niu Tianshui , Shi Qingyi , xiao yonghong
Published: June 2020

Background: To explore the trends in epidemiology and the risk factors related to the prognosis of infective endocarditis in a tertiary hospital over the past ten years.Methods: A retrospective cohort study was performed. A total of 407 consecutive patients who were admitted with infective endocarditis were included. The clinical characteristics and the risk factors related to the prognosis of infective endocarditis during this period were analyzed. Results: A total of 407 patients with infective endocarditis were included, the average age was 48 ±16 years old with an increasing trend and in-hospital mortality rate was 10.6% and one-year mortality rate was 11.3%. Among patients with underlying heart disease, congenital heart disease was the most common(25.8%), followed by rheumatic heart disease(17.0%) which showed a decreased trend during this period (P<0.001). There were 222(54.5%) patients with positive blood cultures results and Streptococci (24.6%) was the main pathogens with an increasing trend. There were 403 patients (99%) with surgical indications, but only 235 patients (57.7%) received surgical treatment. Hemodialysis (P = 0.041, OR = 4.697, 95% CI 1.068-20.665), pulmonary hypertension (P = 0.001, OR = 5.308, 95% CI 2.034-13.852), Pitt score ≥ 4 (P <0.001, OR = 28.594, 95% CI 5.561-148.173) and vegetation length＞30mm (P = 0.011, OR = 13.754, 95% CI 1.832-103.250) were independent risk factors for in-hospital mortality.Conclusions: There were no significant changes in the overall incidence of infective endocarditis, but the clinical features of infective endocarditis had slightly changed during the past ten years. Streptococci infective endocarditis was still the predominant. Patients with hemodialysis, pulmonary hypertension, Pitt score ≥ 4 and vegetation length＞30mm had an worse in-hospital outcome.
The correlation between imaging expression of P16 and S100 in hypertrophic ligamentum flavum
Authors: Hu Wei , Liu Yidong , Kan Shunli , Zhang Tengfei , Jiang Zehua , Zhu Rusen
Published: June 2020

Background: Lumbar spinal stenosis (LSS) is a common degenerative disease, which can lead to neurological dysfunction and requires surgical treatment. In the previous study, we used H&E staining and immunohistochemistry to qualitatively analyze the expression of S100 and P16 in the pathological process of ligamentum flavum (LF) hypertrophy in patients with LSS. To further explore the relationship between P16, S100 and LF hypertrophy in patients with LSS, we quantitatively detected S100 and P16 and their expressed products based on molecular biology techniques, and analyzed their imaging correlation.Methods: Before posterior lumbar surgery, LF thickness was measured by Magnetic Resonance Imaging (MRI). Through the operation, we obtained the specimens of LF from 120 patients, all of whom were L4/5 LF. They were designated: simple lumbar disc herniation (LDH), single-segment spinal stenosis (SLSS), and double-segment LSS (DLSS). The detection of each side of LF was assessed. S100 and P16 and their expression products were detected by western blot and quantitative polymerase chain reaction (qPCR).Results: The dorsal mRNA expression of P16 in DLSS group was significantly higher than that in SLSS group. On the dorsal and dural side of LF, the expression of P16 mRNA and proteins in the LDH group was significantly lower than that in SLSS and DLSS groups. We found a correlation between the thickness of LF and the expression of P16. However, there was no significant difference in the expression of S100 mRNA and S100 protein on both sides of the ligament and among the three groups, and no significant correlation between the expression of S100 and the thickness of LF.Conclusions: P16 is involved in the process of LF hypertrophy in patients with LSS, and the imaging thickness of LF is related to the expression of P16. No obvious evidence proves that S100 may be related to the hypertrophy of LF in patients with LSS.
Improving the surgical consenting process for patients with acute hip fractures: a pilot quality improvement project
Authors: Singh Kirit , Assaf Ali , Bayley Morgan , Gillespie Gordon
Published: June 2020

Background: Consenting patients for trauma procedures following hip fracture is a key stage in the treatment pathway from admission to the operating theatre. Errors in this process can result in delayed procedures which may negatively impact patient recovery. The aim of this project was to identify and reduce errors in our consenting process for patients with capacity. Methods: Consent forms for all adult patients with capacity admitted for surgical repair of traumatic hip fracture were reviewed over a 4-week period. The baseline measurement (n=24), identified errors in three key process measures: clarity of documentation, failure to record procedure-specific risks and not offering a copy of the consent form to the patient. Pre-printed stickers and targeted teaching were then introduced as quality improvement measures. Their impact was evaluated over subsequent 4-week review of the same patient demographic, with further refinement of these interventions being carried out and re-evaluated for a final cycle.Results: Cycle 1 (n=26) following targeted teaching demonstrated a reduction in abbreviations from 38% to 20%, while doubling the documentation of discussion of procedure-specific risks from 31% to 72%. More patients were offered a copy of their consent form, rising from 12% to 48%. Cycle 2 (n=24) saw the introduction of pre-printed “risk of procedure” stickers. Although clarity measures continued to improve, quality of pre-procedure risk documentation remained static while the number of forms being offered to patients fell to 8%.Conclusions: Our project would suggest that while pre-printed stickers can be useful memory aids, specific teaching on consenting produces the greatest benefit. The usage of such tools should therefore be limited, as adjuncts only to specific training.
Pre-labor Cesarean delivery or induction of labor in twin gestation
Authors: Dougan Claire , Gotha Lara , Melamed Nir , Aviram Amir , Asztalos Elizabeth , Anabusi Saja , Willan Andy , Barrett Jon , Mei-Dan Elad
Published: June 2020

BACKGROUND: We aimed to compare neonatal and maternal outcomes of twin gestations without spontaneous onset of labor, which underwent induction of labor or pre-labor cesarean section.METHODS: In the Twin Birth Study (TBS), women at 320/7-386/7 weeks of gestation, in whom the first twin was in cephalic presentation, were randomized to planned vaginal delivery or cesarean section. In this secondary analysis of the TBS we focused on the outcomes of the subset of women who did not have a spontaneous onset of labor. We compared those who had an induction of labor with those who had a pre-labor cesarean section. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity. Secondary outcome was a composite of maternal morbidity and mortality.RESULTS: Of the 2,804 women included in the TBS, a total of 1,347 (48%) women did not have a spontaneous onset of labor: 568 (42%) in the planned vaginal delivery arm and 779 (58%) in the planned cesarean arm. Induction of labor was attempted in 409 (30%), and 938 (70%) had a pre-labor cesarean section. The rate of intrapartum cesarean section in the induction of labor group was 41.3%. The rate of the primary outcome was comparable between the pre-labor cesarean section and induction of labor groups (1.65% vs. 1.97%; p=0.61; OR 0.83; 95% CI 0.43-1.62). The maternal composite outcome was found to be lower with pre-labor cesarean section compared to induction of labor (7.25% vs. 11.25%; p=0.01; OR 0.61; 95% CI 0.41-0.91).CONCLUSION: In women with twin gestation between 320/7-386/7 weeks of gestation with the first twin in cephalic presentation, induction of labor and pre-labor cesarean section have similar neonatal outcomes. Pre-labor cesarean section is associated with favorable maternal outcomes.
Non-alcoholic steatohepatitis and progression of carotid atherosclerosis in patients with type 2 diabetes: a Korean cohort study
Authors: Lee Hyeok-Hee , Cho Yongin , Choi Young Ju , Huh Byung Wook , Lee Byung-Wan , Kang Eun Seok , Park Seok Won , Cha Bong-Soo , Lee Eun Jig , Lee Yong-ho , Huh Kap Bum
Published: June 2020

Background: There is increasing concern regarding cardiovascular risk in individuals with non-alcoholic fatty liver disease. This study was conducted to evaluate whether hepatic steatosis with or without fibrosis is associated with the progression of carotid atherosclerosis in patients with type 2 diabetes.Methods: From a longitudinal cohort, we enrolled 1,120 patients with type 2 diabetes who underwent repeated carotid artery ultrasonography every 1-2 years. Ultrasonographic findings at baseline and after 6-8 years were compared. Presence of hepatic steatosis was mainly assessed by abdominal ultrasonography; patients with hepatic steatosis were further evaluated for hepatic fibrosis according to fibrosis-4 index. We investigated the association between liver status and atherosclerosis progression.Results: Of 1,120 patients, 636 (56.8%) were classified as having hepatic steatosis at baseline. After 6-8 years, 431 (38.5%) showed atherosclerosis progression. Hepatic steatosis was significantly associated with atherosclerosis progression (adjusted odds ratio[AOR]: 1.370, 95% CI: 1.025-1.832; p < 0.05). Among patients with hepatic steatosis, only individuals with fibrosis showed significant association with atherosclerosis progression (AOR: 1.615, 95% CI: 1.005-2.598; p < 0.05). The association between hepatic fibrosis and atherosclerosis progression was significant in all metabolic subgroups regardless of age, body mass index, presence of metabolic syndrome, or insulin sensitivity (all p < 0.05). Furthermore, subjects with hepatic steatosis & fibrosis and ≥ 4 components of metabolic syndrome criteria showed markedly increased risk of atherosclerosis progression (AOR: 2.430, 95% CI: 1.087-5.458; p < 0.05).Conclusions: Hepatic steatosis with fibrosis is independently associated with the progression of carotid atherosclerosis in patients with type 2 diabetes.
Management of Oligosymptomatic Patients with Respiratory Infection in the Era of SARS-Cov2. Experience from Rural German General Practitioners and Proposition of a New Screening Model
Authors: Wernhart Simon , Förster Tim Henning , Weihe Eberhard
Published: June 2020

Background: Covid-19 is causing a pandemic and forces physicians to restructure their daily work. We want to share our successful experience in the outpatient management of potentially infected patients with colleagues from other countries.Methods: We analyzed all patients with respiratory symptoms reporting to our three rural general practioner (GP) offices in North Rhine Westphalia, Germany, from 27.01-20.04.2020 (n=489 from a total of 6090 patients). A history of symptoms was taken at the doorstep following a specific questionnaire. Patients with respiratory symptoms were examined in a separated isolation area, while the others were allowed to enter the office. Results: Eighty patients (16.36%, mean age: 47.03years+-18.08) were sent to a nasopharyngeal smear following the screening algorithm of the Robert-Koch Institute, Berlin, Germany. 5 patients (6.25%) turned out to be positive, 4 of which had established risk factors for COVID-19. Overall, the most common symptoms were cough (83.75%), sore throat (71.25%), as well as myalgia and fatigue (66.25%). The most common diagnoses were rhinopharyngitis (37.22%) and acute bronchitis (30.27%). Clinically, it was impossible to differentiate ordinary respiratory infections from COVID-19 patients in our low-risk population, although a sore throat was more common in positively tested patients (80% vs. 12%). None of our employees called in sick during this period, which emphasizes the efficacy and safety of our screening methods. We suggest a novel risk score integrating patient history, symptoms, pulmonary ultrasound and environmental risks to stratify patients as candidates for SARS-Cov2-PCR.Conclusion: A clinical distinction between ordinary respiratory infections and COVID-19 is not possible in a low-risk population. Our model to prevent unprotected physical contact, screen patients in front of the office with protective equipment, and to examine respiratory infections in separated areas works in the GP setting without overt health risks for employees. Thus, this approach should be used as a GP standard to uphold patient care without major health risks for the personnel. We introduce a new combinatorial scoring model to assess COVID-19 probability in the GP setting.
Genome-wide identification and expression analysis of chitin-binding gene family in Brassica oleracea L. reveals its role in different disease resistance
Authors: Zhu Mingzhao , Kong Congcong , Zhuang Mu , Zhang Yangyong , Lv Honghao , Ji Jialei , Hou Xilin , Fang Zhiyuan , Wang Yong , Yang Limei
Published: June 2020

Background

Chitinase, a category of pathogenesis-related proteins, is thought to play an important role in defending external stress in plants. However, comprehensive analysis of chitin-binding gene family has not yet been reported in cabbage (Brassica oleracea L.), especially their roles in response to different diseases.
Result

in this study, A total of 20 chitinase genes were identified using a genome-wide search method. Phylogenetic analysis classified these genes into two groups. They were distributed unevenly across six chromosomes in cabbage, and all of them contained few introns (≤ 2). The results of colinear analysis showed that the cabbage genome contained 1–5 copies of each chitinase gene (excluding Bol035470) found in Arabidopsis. The heatmap of the chitinase gene family showed that these genes were expressed in various tissues and organs. In addition, under four different stresses of Fusarium wilt, powdery mildew, black spot and downy mildew, we detected 9, 5, 8 and 8 genes with different expression, respectively.
Conclusions

Our results provide insights for further understanding the role of chitinase in host plants response to different diseases.
The impact of disease-related immobilization on thigh muscle mass and strength in frail older hospitalized patients
Authors: Rommersbach Nikola , Wirth Rainer , Lueg Gero , Klimek Christiane , Schnatmann Mirja , Liermann Dieter , Janssen Gregor , Müller Manfred James , Pourhassan Maryam
Published: June 2020

Background
We assessed the quantitative changes in muscle mass and strength during two weeks of hospitalization in immobile and mobile acutely ill hospitalized older adults.
Methods
41 patients (82.4 ± 6.6 years, 73.0% females) participated in this prospective longitudinal observational study. Mobility status was defined according to walking ability as described in the Barthel-Index. Functional status, including handgrip strength and isometric knee-extension strength, and mid-thigh magnetic resonance imaging measurements of cross-sectional area (CSA) were conducted on admission and at discharge.
Results
Twenty-two participants (54%) were immobile and 19 (46%) mobile. In all, 54.0% and 12.0% were at risk of malnutrition and malnourished, respectively. The median time between baseline and follow-up for MRI scans were 13 days in mobile and immobile participants (P = 0.072). Mid-thigh muscle and subcutaneous fat CSA significantly decreased by 3.9 cm2 (5.0%, P = 0.002) and 5.3 cm2 (5.7%, P = 0.036) during hospitalization whereas intermuscular fat remained unchanged in immobile subjects. No significant changes were observed in mobile patients. In a regression analysis, mobility was the major independent risk factor for changes in mid-thigh muscle CSA as a percentage of initial muscle area (P = 0.022) whereas other variables such as age (P = 0.584), nutritional status (P = 0.835) and inflammation (P = 0.291) were not associated with muscle mass changes. There was a significant decrease in isometric knee extension strength (P = 0.002) and no change in handgrip strength (P = 0.167) in immobile patients whereas both parameters increased significantly over time in mobile patients (P = 0.048 and P = 0.012, respectively).
Conclusions
Two weeks of disease-related immobilization result in a significant loss of thigh muscle mass and muscle strength. Concomitantly, there was a significant reduction of subcutaneous adipose tissue whereas no changes were observed in intermuscular fat in frail older hospitalized patients.
Notes on home birth: Safety, interventionism and satisfaction
Authors: Cruellas Marc , Soler Fina Martinez , Tortosa Avelina , Gimenez-Bonafe Pepita
Published: June 2020

Background: Home birth is still considered an unusual situation on most developed countries, where it accounts between 0.2 and 25 percent of all births depending of the country. However, the safety of the process and whether it should be offered as a choice makes it a controversial topic with strong opinions on both sides. This review aims to describe the situation of home birth in several developed countries and debate its safety and mothers’ satisfaction, by reviewing studies that compare home vs. hospital births.Methods: A systematic research has been done using different search engines to find publications that portray the current situation on this topic. Protocols and historical facts were selected using no filters, while publications reporting maternal and birth outcomes, as well as levels of satisfaction, were selected using filters that limited the search to articles that had been published in the last 10 years. A total of 45 articles were selected and reviewed.Results: Home birth in each country depends on many factors, including historical and cultural. Some countries have either developed good practice guidelines or included home birth on the already existing ones, while some other countries still do not recognize it as a safe option. While most studies do not show significant differences on neonatal mortality APGAR score and intensive care admissions, they do describe slightly better maternal outcomes on home birth due to lower interventionism. Studies also show that between 13 and 29 percent of home births require transferring the woman or the fetus to the hospital. Satisfaction levels also appear to be higher in women who had a planned home birth.Conclusions: Home birth appears to be a safe choice for women with low risk pregnancies, due to a lower rate of interventionism. However, safety depends on many factors, from professional accreditation, to the presence of protocols and good practice guidelines. Satisfaction also appears to be higher on women who had a planned home birth, although it depends on personal considerations and circumstances.
Onodera’s prognostic nutritional index is a strong prognostic indicator for patients with hepatocellular carcinoma after initial hepatectomy, especially patients with preserved liver function
Authors: Tanemura Akihiro , Mizuno Shugo , Hayasaki Aoi , Gyoten Kazuyuki , Fujii Takehiro , Iizawa Yusuke , Kato Hiroyuki , Murata Yasuhiro , Kuriyama Naohisa , Kishiwada Masashi , Sakurai Hiroyuki , Isaji Shuji
Published: June 2020

Background Several inflammation-based scores are used to assess the surgical outcomes of hepatocellular carcinoma (HCC). The aim of the present study was to elucidate the prognostic value of the prognostic nutritional index (PNI) in HCC patients who underwent hepatectomy with special attention to preoperative liver functional reserve.Methods Preoperative demographic and tumor-related factors were analyzed in 189 patients with HCC undergoing initial hepatectomy from August 2005 to May 2016 to identify significant prognostic factors.Results Multivariate analysis for overall survival (OS) revealed that female gender (p=0.005), tumor size (p<0.001) and PNI (p=0.001) were independent prognostic factors. Compared to the High PNI group (PNI ≥37, n=172), the Low PNI group (PNI <37, n=17) had impaired liver function and significantly poorer OS (13% vs. 67% in 5-year survival, p=0.001) and recurrence-free survival (RFS) (8 vs. 25 months in median survival time, p=0.002). In the subgroup of patients with a preserved liver function of LHL15 ≥0.9, PNI was also independent prognostic factor, and OS (21% vs. 70% in 5-year survival, p=0.008) and RFS (8 vs. 28 months in median survival time, p=0.018) were significantly poorer in the Low PNI group than the High PNI group.Conclusions PNI was an independent prognostic factor for HCC patients who underwent hepatectomy. Patients with PNI lower than 37 were at high risk for early recurrence and poor patient survival, especially in the patients with preserved liver function of LHL ≥0.9.
Gene regulatory network analysis of Trichoderma reesei grown on glucose-lactose mixtures suggests links between development and cellulase production
Authors: Pirayre Aurélie , Duval Laurent , Blugeon Corinne , Firmo Cyril , Perrin Sandrine , Jourdier Etienne , Margeot Antoine , Bidard Frédérique
Published: June 2020

Background: The degradation of cellulose and hemicellulose molecules into simpler sugars such as glucose is part of the second generation biofuel production process. Hydrolysis of lignocellulosic substrates is usually performed by enzymes produced and secreted by the fungus Trichoderma reesei . Studies identifying transcription factors involved in the regulation of cellulase production have been conducted but no overview of the whole regulation network is available. A transcriptomic approach with mixtures of glucose and lactose, used as a substrate for cellulase induction, was used to help us decipher missing parts in the network.Results: Experimental results confirmed the impact of sugar mixture on the enzymatic cocktail composition. The transcriptomic study shows a temporal regulation of the main transcription factors and a lactose concentration impact on the transcriptional profile. A gene regulatory network built using the BRANE Cut software reveals three sub-networks related to i) a positive correlation between lactose concentration and cellulase production, ii) a particular dependence of the lactose onto the β-glucosidase regulation and iii) a negative regulation of the development process and growth.Conclusions: This work is the first investigating a transcriptomic study regarding the effects of pure and mixed carbon sources in a fed-batch mode. Our study expose a co-orchestration of xyr1 , clr2 and ace3 for cellulase and hemicellulase induction and production, a fine regulation of the β-glucosidase and a decrease of growth in favor of cellulase production. These conclusions provide us with potential targets for further genetic engineering leading to better cellulase-producing strains.
Impact of Free Newborn Care Service package on Out of Pocket Expenditure-Evidence from a multicentric study in Nepal.
Authors: Sunny Avinash K , Basnet Omkar , Acharya Ankit , Paudel Prajwal , Målqvist Mats , KC Ashish
Published: June 2020

Background
Sustainable Development Goal (SDG) aspires to improve universal health coverage through reduction of Out of Pocket Expenditure (OOPE) and improving the quality of care. In the last two decades, there have been several efforts to reduce the OOPE for maternal and newborn care. In this paper, we evaluate the change in the OOPE for treatment of sick newborn at hospital before and after implementation of a free newborn care (FNC) program in hospitals of Nepal.
Methods
Ministry of Health and Population implemented a free newborn care program which reimbursed the cost of treatment for sick newborns admitted in public referral hospitals in Nepal after October 2017. We conducted this study with three months of pre-implementation and 12 months of post-implementation of the program in 12 hospitals of Nepal. Logistic regression analysis was conducted for categorical variables and Mann-Whitney test was applied for continuous variables to determine statistically significant differences between pre- and post- intervention period.
Results
A total of 353 sick newborns were admitted into these hospitals before implementation of the FNC program while 1122 sick newborns were admitted after the implementation. Before implementation, 17% of mothers paid for sick newborn care while after implementation 15.3% mothers (p-value = 0.59) paid for care. The OOPE for treatment of sick newborn at hospital before implementation was Mean ± SD: US dollar 14.3 + 12.1 and after implementation was Mean ± SD: USD 13.0 ± 9.6 (p-value = 0.71). There were no significant differences in neonatal morbidity after the implementation of the FNC program. The stay in a hospital bed (in days) decreased after the implementation of FNC program (p-value < 0.001) while the cost for medicine increased (p-value = 0.02). The duration of hospital stay (in days) of sick newborns significantly decreased for Hypoxic Ischemic Encephalopathy (HIE) (p-value = 0.04) and neonatal sepsis (p-value < 0.001) after the FNC program was implemented.
Conclusion
We found no change in the OOPE for sick newborn care following implementation of the FNC Program. There is a need to revisit the FNC program by the type of morbidity and duration of stay. Further studies will be required to explore the health system adequacy to implement such a financing strategy in hospitals of Nepal.