bluuebunny/crossref_metadata_2025 huggingface dataset:
Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: a retrospective study
Authors: Zhou Shenghu , Liu Jun , Zhen Ping , Shen Weiwei , Chang Yanfeng , Zhang Haoqiang , Zhu Qingsheng , Li Xusheng
Published: October 2019

Background

The treatment for unstable intertrochanteric fractures in the elderly has always been a controversial issue. The aim in this study was to compare the curative effects of proximal femoral nail anti-rotation (PFNA) and cementless bipolar hemiarthroplasty (CPH) on femoral intertrochanteric fracture in the elderly.

Methods

From March 2008 to December 2012, 108 elderly patients with femoral intertrochanteric fractures were treated by PFNA or CPH. There were 63 males and 45 females, aged 75.3–99.1 years [(83.7 ± 5.6) years]. The patients’ bone mineral density was routinely measured, and the fractures were classified according to Evans-Jensen. The patients were divided into CPH group and PFNA group. The differences in operation time, intraoperative bleeding, immobilization duration, hospitalization time, Harris scores and postoperative complications including deep venous thrombosis, lung and urinary infection were analyzed.

Results

All patients were followed for 12.5–36.2 months [(28.0 ± 6.3) months)]. The operation time was (53.7 ± 15.2) min and (77.5 ± 16.8) min in PFNA group and CPH group, respectively (P < 0.05); intraoperative bleeding was (132.5 ± 33.2) mL and (286.3 ± 43.2) mL, respectively (P < 0.05); immobilization duration was (28.2 ± 3.7) days and (3.1 ± 1.2) days, respectively (P < 0.05); hospitalization time was (7.6 ± 1.8) days and (6.9 ± 2.2) days, respectively (P > 0.05); and the Harris scores after 1 year were (87.7 ± 7.9) points and (88.3 ± 9.2) points, respectively (P > 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05).

Conclusion

Both PFNA and CPH are safe and effective treatments for femoral intertrochanteric fracture in elderly patients. Nonetheless, CPH allows faster mobilization and recovery.

Trial registration

Registration Number:ChiCTR1900022846.

Reg Date:2019-04-26 00:27:33

Retrospective registration
The APHIRM toolkit: an evidence-based system for workplace MSD risk management
Authors: Oakman Jodi , Macdonald Wendy
Published: October 2019

Musculoskeletal disorders (MSDs) continue as one of the largest occupational health and safety problems worldwide. One reason for this situation is that current workplace risk management practices fail to meet some important evidence-based requirements for effective reduction of MSD risk. In particular: they largely fail to address risk arising from psychosocial hazards; do not allow sufficient participation by workers; and often fail to control risk at its sources.

To address these deficiencies, A Participative Hazard Identification and Risk Management (APHIRM) toolkit has been formulated in accordance with both a framework developed by the World Health Organisation and implementation science principles. It comprises a set of online tools that include automated data analysis and reporting modules, and procedures to guide users through the five stages of the conventional risk management cycle. Importantly, it assesses both hazard and risk levels for groups of people doing a particular job, focusing on the job overall rather than only on tasks deemed to be hazardous. Its intended users are workplace managers and consultants responsible for occupational health and safety, with active participation from workers also. Resultant risk control interventions are customized to address the main physical and psychosocial hazards identified for the target job, and repetitions of the risk management cycle enables ongoing evaluation of outcomes in terms of both hazard and risk levels.
Comparison of the efficacy of a distal clavicular locking plate with and without a suture anchor in the treatment of Neer IIb distal clavicle fractures
Authors: Xu Hua , Chen Wen Jun , Zhi Xiao Cheng , Chen Shi Chang
Published: October 2019

Background

To compare the clinical outcomes between the use of a distal clavicular locking plate alone and the combined use of a plate and a coracoclavicular suture anchor in the treatment of Neer IIb distal clavicle fractures and to discuss the application procedure of suture anchors.

Methods

This is a retrospective study. Thirty-four patients with unilateral Neer IIb distal clavicle fractures who underwent open reduction and internal fixation with a distal clavicular locking plate only (16 patients) or with both a plate and a coracoclavicular suture anchor (18 patients) were evaluated. The main observation data included the Constant-Murley Shoulder Function Score (CMS), rate of postoperative complications, and union time.

Results

The distal clavicular locking plate and coracoclavicular suture anchor combination group had better outcomes in the Constant-Murley score (94.6 ± 4.5 vs. 90.1 ± 9.5) (P < 0.05) and a shorter union time (13.9 ± 2.3 vs. 16.1 ± 3.0) (P < 0.05) than the locking plate only group did, and the rate of complications showed no significant difference, 16.7% vs. 31.2% (5/16) (P>0.05).

Conclusions

Both methods achieved good results in the treatment of Neer IIb distal clavicle fractures; however, the use of both locking plates and coracoclavicular suture anchors can provide more stability in the early stage after operation than can the use of locking plates alone, which can make the sped of union quicker and result in better clinical outcomes. For elderly patients with comminuted Neer IIb distal clavicle fractures, a locking plate combined with a suture anchor is recommended to provide more stability in the early stage after the operation.
Diabetes insipidus and panhypopituitarism as a first presentation of silent adenocarcinoma of lung: a case report and literature review
Authors: Sirinvaravong Sirinart , Vibhatavata Peeradon , Chunharojrith Paweena , Cheunsuchon Pornsuk , Sriussadaporn Sutin
Published: October 2019

Background

Pituitary metastasis is a rare condition with a poor prognosis. Very few patients with pituitary metastasis are symptomatic. It is often associated with presence of co-existing metastases to other organs. Isolated pituitary metastasis as the first presentation of primary malignancy is uncommon.

Case presentation

A 72-year-old woman presented with a 2-month history of polyuria, increasing thirst and unexplained weight loss. Esophagogastroduodenoscopy (EGD) was scheduled as part of the investigation. She was keptnilper osfor 10 h prior to EGD, after which she developed alteration of consciousness. Further investigation revealed hypernatremia with sodium level of 161 mmol/L and low urine osmolality of 62 mOsm/kg. Her urine output was 300 mL per hour. Diabetes insipidus (DI) was diagnosed based on evidence of polyuria, hypernatremia, and low urine osmolality. Her urine output decreased and urine osmolality increased to 570 mOsm/kg in response to subcutaneous desmopressin acetate, confirming central DI. Pituitary magnetic resonance imaging showed a heterogeneous gadolinium enhancing lesion at the sellar and suprasellar regions, measuring 2.4 × 2.6 × 3.9 cm compressing both the hypothalamus bilaterally and the inferior aspect of optic chiasm as well as displacing the residual pituitary gland anteriorly. The posterior pituitary bright spot was absent. These MRI findings suggested pituitary macroadenoma. There were also multiple small gadolinium-enhancing lesions up to 0.7 cm in size with adjacent vasogenic brain edema at the subcortical and subpial regions of the left frontal and parietal areas, raising the concern of brain metastases. Pituitary hormonal evaluation was consistent with panhypopituitarism. Histopathological and immunohistochemical studies of the pituitary tissue revealed an adenocarcinoma, originating from the lung. Computed tomography of the chest and abdomen was subsequently performed, showing a 2.2-cm soft tissue mass at the proximal part of right bronchus. There was no evidence of distant metastases elsewhere. The final diagnosis was adenocarcinoma of the lung with pituitary metastasis manifesting as panhypopituitarism and central DI. Palliative care along with hormonal replacement therapy was offered to the patient. She died 4 months after diagnosis.

Conclusion

Diagnosis of pituitary metastasis is challenging, especially in patients with previously undiagnosed primary cancer. It should be considered in the elderly patients presenting with new-onset central DI with or without anterior pituitary dysfunction.
Online reported women’s experiences of symptomatic pelvic organ prolapse after vaginal birth
Authors: Mirskaya Maria , Lindgren Eva-Carin , Carlsson Ing-Marie
Published: October 2019

Background

Pelvic organ prolapse (POP) is a major public health problem with a relative high lifetime risk of surgery. The main risk factor for developing POP is vaginal birth. Many women become symptomatic later in life and most of the existing research on symptomatic pelvic organ prolapse (sPOP) predominantly concentrates on the effects of the condition on postmenopausal women. However bothersome symptoms of POP can be reported as early as in women’s 20s and may occur shortly after vaginal birth. Limited studies provide an insight into daily life of fertile women with sPOP. Thus, we aimed to explore fertile women’s experiences of symptomatic pelvic organ (sPOP) after vaginal birth.

Methods

An inductive, text-driven approach was taken by selecting thread posts from an internet forum written by 33 Swedish fertile women who had experienced sPOP after vaginal birth.

Results

The overarching theme “being irreparably damaged” was identified as representing an experience of being disabled by sPOP after vaginal birth. The fertile women experienced that their lives were ruined because of physical and psychological limitations caused by this unexpected, unfamiliar and unexplained condition. Living with sPOP impinged on sexual health, restricted daily and sports activities and affected the women’s ability to fulfill everyday parental duties. This in turn compromised women’s psychological health. In addition, the negligence of healthcare professionals who tended to trivialize and normalize the symptoms led to the belief that there were no sustainable treatments and that women would have to live with bothersome symptoms of POP for rest of their lives.

Conclusions

This study found that sPOP had a significant negative impact on fertile women’s lives. The women indicated that they had not had the opportunity to voice their concerns and had not been taken seriously by healthcare professionals. It is of the utmost importance to acknowledge this problem and develop guidelines for prevention and management of sPOP to improve the quality of life for women.
Improving students’ learning environment by DREEM: an educational experiment in an Iranian medical sciences university (2011–2016)
Authors: Bakhshialiabad Hamid , Bakhshi Golnaz , Hashemi Zahra , Bakhshi Amirhosein , Abazari Faroukh
Published: October 2019

Background

Students’ perception of the educational setting is an important source for improving and applying changes to the educational environment. In this study, we reassessed undergraduate students’ perception of the educational environment at two colleges of RUMS-Iran in the academic years of 2011 and 2016.

Methods

In the present prospective study, the DREEM inventory consisted of seven courses for undergraduate paramedical and nursing-midwifery students (n = 982). After the first stage, educational seminars and workshops were set up for academic members and faculty staff on deficiencies and the ideal climate for optimizing the educational environment. The results of students’ responses in 2011 were compared with those assessed in 2016. For the data analysis, the independent t-test and the one-way ANOVA were utilized.

Results

In the academic year of 2010–2011, the DREEM inventory scored 115.33/200 (57.66%); it also scored 123.47/200 (60.7%) in the academic year of 2015–2016 (p ≤ 0.01). There was an interesting feeling about the first-year education, and female students felt a more positively perceived learning environment during all courses than male students at both stages of the study. There were significant positive differences (2 to 7%) in all domains of the components of DREEM in all courses between the academic year of 2010–2011 and the academic year of 2015–2016, showing that the DREEM score had changed and increased (p < 0.05), in the latter case.

Conclusions

Positive differences were observed in DREEM scores between the two stages of the study. DREEM helped reduce the areas of deficiencies in students’ perception of many aspects of the educational environment. It also helped identify problematic areas in the improvement. In addition, DREEM could be used to optimize and make modifications to the educational environment.
Decision curve analysis apropos of choice of preferable treatment positioning during breast irradiation
Authors: Rárosi Ferenc , Boda Krisztina , Kahán Zsuzsanna , Varga Zoltán
Published: October 2019

Background

Radiotherapy is a standard treatment option for breast cancer, but it may lead to significant late morbidity, including radiation heart damage. Breast irradiation performed individually in the supine or prone position may aid in minimizing the irradiation dose to the heart and LAD coronary artery. A series of CT scans and therapy plans are needed in both positions for the ‘gold standard’ decision on the preferable treatment position. This method is expensive with respect to technology and physician workload.

Our ultimate goal is to develop a predictive tool to identify the preferable treatment position using easily measurable patient characteristics. In this article, we describe the details of how model building and consequently validation of the best model are done.

Methods

Different models were used: both logistic regression and multiple linear regressions were used to estimate the LAD mean dose difference (the difference between the mean dose to the LAD in the supine position versus prone position); predicted dose differences were analysed compared to the ‘gold standard’ values, and the best model was selected accordingly. The final model was checked by random cross-validation. In addition to generally used measures (ROC and Brier score), decision curves were employed to evaluate the performance of the models.

Results

ROC analysis demonstrated that none of the predictors alone was satisfactory. Multiple logistic regression models and the linear regression model lead to high values of net benefit for a wide range of threshold probabilities. Multiple linear regression seemed to be the most useful model. We also present the results of the random cross-validation for this model (i.e. sensitivity of 80.7% and specificity of 87.5%).

Conclusions

Decision curves proved to be useful to evaluate our models. Our results indicate that any of the models could be implemented in clinical practice, but the linear regression model is the most useful model to facilitate the radiation treatment decision. In addition, it is in use in everyday practice in the Department of Oncotherapy, University of Szeged, Hungary.
The effect of self-management education through weblogs on the quality of life of diabetic patients
Authors: Rasoul Amal Mohammad , Jalali Rostam , Abdi Alireza , Salari Nader , Rahimi Mehrali , Mohammadi Masoud
Published: October 2019

Background

Self-management education of diabetes which is one of the most important noncommunicable diseases worldwide involves facilitating knowledge, skills, and ability required for self-care in these patients. Concerning the progressive growth of use of Internet for educating patients and absence of different studies about education through use of weblogs in patients with diabetes in Iran, the present study was conducted with the aim of determining the effect of self-management education through weblogs on the quality of life of affect the patients.

Methods

This study was performed as intervention on patients referring to diabetes clinic of Talghani hospital in Kermanshah in winter 2018 and spring 2019. The samples consisted of 98 patients with diabetes chosen through available sampling and randomly assigned into study and control groups. For data collection, diabetes quality of life (DQOL) short form clinical questionnaire, Persian version, was used. The intervention involved training self-management conducted through 60 sessions via a designed weblog. The obtained information was introduced into SPSS 21, and analyzed through Mann-Whitney, t-test, and paired t-test.

Results

According to the results of this study, the mean age of the examined patients was 32.1 ± 4.9 years, where the major participants were male (n = 52 in the test group, 52.5%). The results showed that after the intervention, the test and control groups were different in terms of anthropometric variables and metabolic indicators; the mean waist circumference in the test and control groups was 98.6 ± 9.8 and 101.5 ± 7.8, respectively; the mean FBS following the intervention in the test and control groups was 131.08 ± 16.04 and 238.2 ± 40, respectively; and the mean BMI postintervention in the test and control groups was obtained as 27.3 ± 3.4 and 30.1 ± 3.8 respectively, where these differences were significant according to independent t-test (p < 0.05). The mean score of quality of life postintervention in the test and control groups was obtained as 56.1 and 49.9 respectively; according to Mann-Whitney test, the difference between the two groups was significant (p < 0.05).

Conclusion

The results of the present study revealed the positive effect of weblog based self-management on the quality of life of patients with diabetes following the intervention. Further, reduced levels of FBS, BMI, as well as systolic and diastolic blood pressure were also observed, which could be due to increased awareness of patients about their abilities, its risks, as well as the ways to control and treat it.
Representative sample survey on factors determining the Czech physicians’ awareness of generic drugs and substitution
Authors: Maly J. , Zimcikova E. , Babica J. , Kubena A. A. , Kostriba J. , Mala-Ladova K.
Published: October 2019

Background

Generic drugs and generic substitution belong to the tools by which healthcare costs may be reduced. However, low awareness and reluctance among healthcare professionals towards generic drugs may negatively affect the rational use of generic substitution.

Methods

The study aimed to analyze opinions and attitudes towards generic drugs and generic substitution among Czech physicians including their understanding of generic substitution legislative rules and the physicians´ previous experience in this field. Using random allocation, 1551 physicians practicing in the Czech Republic were asked to participate in the sociological representative survey conducted from November to December 2016, through face-to-face structured interviews comprising 19 items. Factor analysis as well as reliability analysis of items focused on legal rules in the context of physicians’ awareness were applied with p-value of < 0.05 as statistically significant.

Results

Of a total of 1237 (79.8%) physicians (43.7% males; mean age 47.5 ± 11.6 years, 46.3% general practitioners) 24.8% considered generic drugs to be less safe, especially those with specialized qualification (p < 0.01). However, only 4.4% of the physicians noticed any drug-related problems, including adverse drug reactions associated with generic substitution. The majority of physicians felt neutrally about performing generic substitution in pharmacies, nor they expressed any opinion on characteristics of generics, even though a better understanding of the legislation and higher need of accordance of substituted drugs were associated with more positive attitudes towards generic substitution (p < 0.05). Physicians showed low knowledge score of legislative rules (mean 3.9 ± 1.6 from maximum 9), nevertheless they overestimated the law, as they considered some rules valid, even if the law does not require them. Cronbach alpha of all legislative rules that regulate generic substitution increased from 0.318 to 0.553 if two optional rules (physician consent and strength equivalence) would be taken into account.

Conclusions

There is no sufficient awareness of generic drugs and generic substitution related issues among Czech physicians, although a deeper knowledge of legislation improves their perception about providing generic substitution.
Effects of a mandatory DRG payment system in South Korea: Analysis of multi-year nationwide hospital claims data
Authors: Choi Jae Woo , Kim Seung-Ju , Park Hye-Ki , Jang Sung-In , Kim Tae Hyun , Park Eun-Cheol
Published: October 2019

Background

In 2002, a voluntary diagnosis-related groups (DRGs) payment system was introduced in South Korea for seven disease groups, and participation in the DRGs was mandated for all hospitals beginning in 2013. The primary aim of this study was to compare results reflective of patient care between voluntary participation hospitals (VPHs) and mandatory participation hospitals (MPHs) governed by either the DRGs or fee-for-service (FFS) payment system.

Methods

We collected DRGs and FFS inpatient records (n=3,038,006) from the Health Insurance Review and Assessment for the period of July 2011 to July 2014 and compared length-of-stay, total medical costs, shifting services to an outpatient setting, and readmission rates according to payment system, time of DRGs implementation, and hospital type. We analyzed the effects of mandatory introduction in DRGs payment system on results for patient care and used generalized estimating equations with difference-in-difference methodology.

Results

Most notably, patients at MPHs had significantly shorter LOS and lower readmission rates than VPH patients after mandatory introduction of the DRGs. Shifting services to an outpatient setting was similar between the groups.

Conclusions

Our findings suggest that the DRGs payment policy in Korea has decreased LOS and readmission rates. These findings support the continued implementation and enlargement of the DRGs payment system for other diseases in South Korea, given its potential for curbing unnecessary resource usage encouraged by FFS. If the Korean government deliberates on expansion of the DRGs to include other diseases with higher rates of complications, policymakers need to monitor deterioration of health care quality caused by fixed pricing.
A path analysis on the direct and indirect effects of the unit environment on eating dependence among cognitively impaired nursing home residents
Authors: Palese Alvisa , Grassetti Luca , Bressan Valentina , Decaro Alessandro , Kasa Tea , Longobardi Melania , Hayter Mark , Watson Roger
Published: October 2019

Background

This study aims to estimate the direct and indirect effects of the unit environment alongside individual and nursing care variables on eating dependence among residents who are cognitively impaired and living in a nursing home.

Method

A multicentre observational study was carried out in 2017: 13 Italian nursing homes were involved in data collection. Included residents were aged > 65 at baseline, living in the considered facility for the last 6 months and during the entire study period and having received at least one comprehensive assessment. Data were collected (a) at the individual level: eating dependence using the Edinburgh Feeding Evaluation in Dementia Scale and other clinical variables; (b) at the nursing care level with daily interventions to maintain eating independence assessed with a checklist; and (c) at the nursing home level, using the Therapeutic Environment Screening Survey for Nursing Homes.

Results

One thousand twenty-seven residents were included with an average age of 85.32 years old (95% CI: 84.74–85.89), mainly female (781; 76%). The path analysis explained the 57.7% variance in eating dependence. Factors preventing eating dependence were: (a) at the individual level, increased functional dependence measured with the Barthel Index (β − 2.374); eating in the dining room surrounded by residents (β − 1.802) as compared to eating alone in bed; and having a close relationship with family relatives (β − 0.854), (b) at the nursing care level, the increased number of interventions aimed at promoting independence (β − 0.524); and (c) at the NH level, high scores in ‘Space setting’ (β − 4.446), ‘Safety’ (β − 3.053), ‘Lighting’ (β − 2.848) and ‘Outdoor access’ (β − 1.225). However, environmental factors at the unit level were found to have also indirect effects by influencing the degree of functional dependence, the occurrence of night restlessness and the number of daily interventions performed by the nursing staff.

Conclusion

Eating dependence is a complex phenomenon requiring interventions targeting individual, nursing care, and environmental levels. The NH environment had the largest direct and indirect effect on residents’ eating dependence, thus suggesting that at this level appropriate interventions should be designed and implemented.
Efficacy of umeclidinium/vilanterol versus umeclidinium and salmeterol monotherapies in symptomatic patients with COPD not receiving inhaled corticosteroids: the EMAX randomised trial
Authors: Maltais François , Bjermer Leif , Kerwin Edward M. , Jones Paul W. , Watkins Michael L. , Tombs Lee , Naya Ian P. , Boucot Isabelle H. , Lipson David A. , Compton Chris , Vahdati-Bolouri Mitra , Vogelmeier Claus F.
Published: October 2019

Background

Prospective evidence is lacking regarding incremental benefits of long-acting dual- versus mono-bronchodilation in improving symptoms and preventing short-term disease worsening/treatment failure in low exacerbation risk patients with chronic obstructive pulmonary disease (COPD) not receiving inhaled corticosteroids.

Methods

The 24-week, double-blind, double-dummy, parallel-group Early MAXimisation of bronchodilation for improving COPD stability (EMAX) trial randomised patients at low exacerbation risk not receiving inhaled corticosteroids, to umeclidinium/vilanterol 62.5/25 μg once-daily, umeclidinium 62.5 μg once-daily or salmeterol 50 μg twice-daily. The primary endpoint was trough forced expiratory volume in 1 s (FEV1) at Week 24. The study was also powered for the secondary endpoint of Transition Dyspnoea Index at Week 24. Other efficacy assessments included spirometry, symptoms, heath status and short-term disease worsening measured by the composite endpoint of clinically important deterioration using three definitions.

Results

Change from baseline in trough FEV1 at Week 24 was 66 mL (95% confidence interval [CI]: 43, 89) and 141 mL (95% CI: 118, 164) greater with umeclidinium/vilanterol versus umeclidinium and salmeterol, respectively (both p < 0.001). Umeclidinium/vilanterol demonstrated consistent improvements in Transition Dyspnoea Index versus both monotherapies at Week 24 (vs umeclidinium: 0.37 [95% CI: 0.06, 0.68], p = 0.018; vs salmeterol: 0.45 [95% CI: 0.15, 0.76], p = 0.004) and all other symptom measures at all time points. Regardless of the clinically important deterioration definition considered, umeclidinium/vilanterol significantly reduced the risk of a first clinically important deterioration compared with umeclidinium (by 16–25% [p < 0.01]) and salmeterol (by 26–41% [p < 0.001]). Safety profiles were similar between treatments.

Conclusions

Umeclidinium/vilanterol consistently provides early and sustained improvements in lung function and symptoms and reduces the risk of deterioration/treatment failure versus umeclidinium or salmeterol in symptomatic patients with low exacerbation risk not receiving inhaled corticosteroids. These findings suggest a potential for early use of dual bronchodilators to help optimise therapy in this patient group.
A metabolic reconstruction of Lactobacillus reuteri JCM 1112 and analysis of its potential as a cell factory
Authors: Kristjansdottir Thordis , Bosma Elleke F. , Branco dos Santos Filipe , Özdemir Emre , Herrgård Markus J. , França Lucas , Ferreira Bruno , Nielsen Alex T. , Gudmundsson Steinn
Published: October 2019

Background

Lactobacillus reuteri is a heterofermentative Lactic Acid Bacterium (LAB) that is commonly used for food fermentations and probiotic purposes. Due to its robust properties, it is also increasingly considered for use as a cell factory. It produces several industrially important compounds such as 1,3-propanediol and reuterin natively, but for cell factory purposes, developing improved strategies for engineering and fermentation optimization is crucial. Genome-scale metabolic models can be highly beneficial in guiding rational metabolic engineering. Reconstructing a reliable and a quantitatively accurate metabolic model requires extensive manual curation and incorporation of experimental data.

Results

A genome-scale metabolic model of L. reuteri JCM 1112T was reconstructed and the resulting model, Lreuteri_530, was validated and tested with experimental data. Several knowledge gaps in the metabolism were identified and resolved during this process, including presence/absence of glycolytic genes. Flux distribution between the two glycolytic pathways, the phosphoketolase and Embden–Meyerhof–Parnas pathways, varies considerably between LAB species and strains. As these pathways result in different energy yields, it is important to include strain-specific utilization of these pathways in the model. We determined experimentally that the Embden–Meyerhof–Parnas pathway carried at most 7% of the total glycolytic flux. Predicted growth rates from Lreuteri_530 were in good agreement with experimentally determined values. To further validate the prediction accuracy of Lreuteri_530, the predicted effects of glycerol addition and adhE gene knock-out, which results in impaired ethanol production, were compared to in vivo data. Examination of both growth rates and uptake- and secretion rates of the main metabolites in central metabolism demonstrated that the model was able to accurately predict the experimentally observed effects. Lastly, the potential of L. reuteri as a cell factory was investigated, resulting in a number of general metabolic engineering strategies.

Conclusion

We have constructed a manually curated genome-scale metabolic model of L. reuteri JCM 1112T that has been experimentally parameterized and validated and can accurately predict metabolic behavior of this important platform cell factory.
Simultaneous and sequential based co-fermentations of Trichoderma asperellum GDFS1009 and Bacillus amyloliquefaciens 1841: a strategy to enhance the gene expression and metabolites to improve the bio-control and plant growth promoting activity
Authors: Karuppiah Valliappan , Vallikkannu Murugappan , Li Tingting , Chen Jie
Published: October 2019

Background

The consequence of simultaneous and sequential inoculation ofT. asperellumandB. amyloliquefacienscultures with respect to growth rate, differential expression of vital genes and metabolites were examined.

Results

The competition was observed betweenT. asperellumandB. amyloliquefaciensunder co-cultivation. The proliferation ofTrichodermawas reduced in the simultaneous inoculation (TB1) method, possibly due to the fastest growth ofBacillus. BothT. asperellumandB. amyloliquefacienswere proliferated in sequential inoculation method (TB2). The sequential inoculation method (TB2) upregulated the expression of metabolites and vital genes (sporulation, secondary metabolites, mycoparasitism enzymes and antioxidants) inTrichodermaand downregulated inBacillusand vice versa in co-inoculation method (TB1). The metabolic changes in the co-culture promoted the maize plant growth and defense potential under normal and biotic stress conditions.

Conclusion

The metabolites produced by the co-culture ofT. asperellumandB. amyloliquefaciensimproved the maize plant growth and defense potential under normal and biotic stress conditions.
Validation and reproducibility of a new iodine specific food frequency questionnaire for assessing iodine intake in Norwegian pregnant women
Authors: Næss Synnøve , Aakre Inger , Kjellevold Marian , Dahl Lisbeth , Nerhus Ive , Midtbø Lisa Kolden , Markhus Maria Wik
Published: October 2019

Background

Iodized salt is not mandatory in Norway, and the permitted level of iodine in table salt is low (5 μg/g). Thus, milk and dairy products, fish and eggs are the main dietary sources of iodine in Norway. Mild-to-moderate iodine deficiency in pregnant women has been described in several European countries, including Norway. There are few validated tools available to assess iodine intake in an efficient manner. The aim of the current study was to assess the validity and reproducibility of a new iodine-specific food frequency questionnaire (I-FFQ) in Norwegian pregnant women.

Methods

An I-FFQ consisting of a total of 60 food items and the use of supplements was developed to assess iodine intake and was administrated to 137 pregnant women at gestational week 18–19. Reference methods were a structured 6-days iodine specific food diary, urinary iodine concentration (UIC) (pooled sample of spot UIC from six consecutive days), and thyroid function tests. Correlation analyses, Cohen’s weighted kappa, Bland-Altman plots, and linear regression analyses were used to assess validity. Reproducibility of the I-FFQ was assessed in a subgroup (n = 47) at gestational week 35–36.

Results

There was a strong correlation between estimated iodine intake from the I-FFQ and food diary (r = 0.62,P < 0.001) and an acceptable correlation between the I-FFQ and UIC (r = 0.21,P = 0.018). There was no significant association between the I-FFQ and thyroid function tests. The I-FFQ estimated higher iodine intake compared to the food diary with a mean absolute difference 33 μg/day. The limits of agreement from the Bland-Altman plots were large, however few participants fell outside the limits of agreement (5.2–6.5%). There was no difference between the estimated iodine intake from the I-FFQ assessed at gestational week 18–19, and gestational week 35–36 (P = 0.866), and there was a strong correlation between the two time points (r = 0.63,P < 0.001).

Conclusion

In summary, this study suggests that the I-FFQ can be used as a valid tool to estimate and rank iodine intake among Norwegian pregnant women. We further suggest that this I-FFQ may also be valid in other populations with similarly dietary patterns and where salt is not iodized.

Trial registration

The study is registered inClinicalTrials.gov(NCT02610959).
Automatic sleep stage classification based on subcutaneous EEG in patients with epilepsy
Authors: Gangstad Sirin W. , Mikkelsen Kaare B. , Kidmose Preben , Tabar Yousef R. , Weisdorf Sigge , Lauritzen Maja H. , Hemmsen Martin C. , Hansen Lars K. , Kjaer Troels W. , Duun-Henriksen Jonas
Published: October 2019

Background

The interplay between sleep structure and seizure probability has previously been studied using electroencephalography (EEG). Combining sleep assessment and detection of epileptic activity in ultralong-term EEG could potentially optimize seizure treatment and sleep quality of patients with epilepsy. However, the current gold standard polysomnography (PSG) limits sleep recording to a few nights. A novel subcutaneous device was developed to record ultralong-term EEG, and has been shown to measure events of clinical relevance for patients with epilepsy. We investigated whether subcutaneous EEG recordings can also be used to automatically assess the sleep architecture of epilepsy patients.

Method

Four adult inpatients with probable or definite temporal lobe epilepsy were monitored simultaneously with long-term video scalp EEG (LTV EEG) and subcutaneous EEG. In total, 11 nights with concurrent recordings were obtained. The sleep EEG in the two modalities was scored independently by a trained expert according to the American Academy of Sleep Medicine (AASM) rules. By using the sleep stage labels from the LTV EEG as ground truth, an automatic sleep stage classifier based on 30 descriptive features computed from the subcutaneous EEG was trained and tested.

Results

An average Cohen’s kappa of $$\kappa = 0.78\pm 0.02$$

κ
=
0.78
±
0.02

was achieved using patient specific leave-one-night-out cross validation. When merging all sleep stages into a single class and thereby evaluating an awake–sleep classifier, we achieved a sensitivity of 94.8% and a specificity of 96.6%. Compared to manually labeled video-EEG, the model underestimated total sleep time and sleep efficiency by 8.6 and 1.8 min, respectively, and overestimated wakefulness after sleep onset by 13.6 min.

Conclusion

This proof-of-concept study shows that it is possible to automatically sleep score patients with epilepsy based on two-channel subcutaneous EEG. The results are comparable with the methods currently used in clinical practice. In contrast to comparable studies with wearable EEG devices, several nights were recorded per patient, allowing for the training of patient specific algorithms that can account for the individual brain dynamics of each patient. Clinical trial registered at ClinicalTrial.gov on 19 October 2016 (ID:NCT02946151).
Predicting poverty. Data mining approaches to the health and demographic surveillance system in Cuatro Santos, Nicaragua
Authors: Källestål C. , Blandón Zelaya E. , Peña R. , Peréz W. , Contreras M. , Persson L. Å. , Sysoev O. , Ekholm Selling K.
Published: October 2019

Background

In order to further identify the needed interventions for continued poverty reduction in our study area Cuatro Santos, northern Nicaragua, we aimed to elucidate what predicts poverty, measured by the Unsatisfied Basic Need index. This analysis was done by using decision tree methodology applied to the Cuatro Santos health and demographic surveillance databases.

Methods

Using variables derived from the health and demographic surveillance update 2014, transferring individual data to the household level we used the decision tree framework Conditional Inference trees to predict the outcome “poverty” defined as two to four unsatisfied basic needs using the Unsatisfied Basic Need Index. We further validated the trees by applying Conditional random forest analyses in order to assess and rank the importance of predictors about their ability to explain the variation of the outcome “poverty.” The majority of the Cuatro Santos households provided information and the included variables measured housing conditions, assets, and demographic experiences since the last update (5 yrs), earlier participation in interventions and food security during the last 4 weeks.

Results

Poverty was rare in households that have some assets and someone in the household that has a higher education than primary school. For these households participating in the intervention that installed piped water with water meter was most important, but also when excluding this variable, the resulting tree showed the same results. When assets were not taken into consideration, the importance of education was pronounced as a predictor for welfare. The results were further strengthened by the validation using Conditional random forest modeling showing the same variables being important as predicting the outcome in the CI tree analysis. As assets can be a result, rather than a predictor of more affluence our results in summary point specifically to the importance of education and participation in the water installation intervention as predictors for more affluence.

Conclusion

Predictors of poverty are useful for directing interventions and in the Cuatro Santos area education seems most important to prioritize. Hopefully, the lessons learned can continue to develop the Cuatro Santos communities as well as development in similar poor rural settings around the world.
Effects of health insurance integration on health care utilization and its equity among the mid-aged and elderly: evidence from China
Authors: Li Chaofan , Tang Chengxiang , Wang Haipeng
Published: October 2019

Background

The fragmentation of health insurance schemes in China has undermined equity in access to health care. To achieve universal health coverage by 2020, the Chinese government has decided to consolidate three basic medical insurance schemes. This study aims to evaluate the effects of integrating Urban and Rural Residents Basic Medical Insurance schemes on health care utilization and its equity in China.

Methods

The data for the years before (2013) and after (2015) the integration were obtained from the China Health and Retirement Longitudinal Study. Respondents in pilot provinces were considered as the treatment group, and those in other provinces were the control group. Difference-in-difference method was used to examine integration effects on probability and frequency of health care visits. Subgroup analysis across regions of residence (urban/rural) and income groups and concentration index were used to examine effects on equity in utilization.

Results

The integration had no significant effects on probability of outpatient visits (β = 0.01, P > 0.05), inpatient visits (β = 0.01, P > 0.05), and unmet hospitalization needs (β =0.01, P > 0.05), while it had significant and positive effects on number of outpatient visits (β = 0.62, P < 0.05) and inpatient visits (β = 0.39, P < 0.01). Moreover, the integration had significant and positive effects on number of outpatient visits (β = 0.77, P < 0.05) and inpatient visits (β = 0.49, P < 0.01) for rural residents but no significant effects for urban residents. Furthermore, the integration led to an increase in the frequency of inpatient care utilization for the poor (β = 0.78, P < 0.05) among the piloted provinces but had no significant effects for the rich (β = 0.25, P > 0.05). The concentration index for frequency of inpatient visits turned into negative direction in integration group, while that in control group increased by 0.011.

Conclusions

The findings suggest that the integration of fragmented health insurance schemes could promote access to and improve equity in health care utilization. Successful experiences of consolidating health insurance schemes in pilot provinces can provide valuable lessons for other provinces in China and other countries with similar fragmented schemes.
Time-varying associations between prenatal metal mixtures and rapid visual processing in children
Authors: Levin-Schwartz Yuri , Gennings Chris , Schnaas Lourdes , del Carmen Hernández Chávez María , Bellinger David C. , Téllez-Rojo Martha Maria , Baccarelli Andrea A. , Wright Robert O.
Published: October 2019

Background

Humans are exposed to mixtures of chemicals across their lifetimes, a concept sometimes called the “exposome.” Mixtures likely have temporal “critical windows” of susceptibility like single agents and measuring them repeatedly might help to define such windows. Common approaches to evaluate the effects of chemical mixtures have focused on their effects at a single time point. Our goal is to expand upon these previous techniques and examine the time-varying critical windows for metal mixtures on subsequent neurobehavior in children.

Methods

We propose two methods, joint weighted quantile sum regression (JWQS) and meta-weighted quantile sum regression (MWQS), to estimate the effects of chemical mixtures measured across multiple time points, while providing data on their critical windows of exposure. We compare the performance of both methods using simulations. We also applied both techniques to assess second and third trimester metal mixture effects in predicting performance in the Rapid Visual Processing (RVP) task from the Cambridge Neuropsychological Test Automated Battery (CANTAB) assessed at 6–9 years in children who are part of the PROGRESS (Programming Research in Obesity, GRowth, Environment and Social Stressors) longitudinal cohort study. The metals, arsenic, cadmium (Cd), cesium, chromium, lead (Pb) and antimony (Sb) were selected based on their toxicological profile.

Results

In simulations, JWQS and MWQS had over 80% accuracy in classifying exposures as either strongly or weakly contributing to an association. In real data, both JWQS and MWQS consistently found that Pb and Cd exposure jointly predicted longer latency in the RVP and that second trimester exposure better predicted the results than the third trimester. Additionally, both JWQS and MWQS highlighted the strong association Cd and Sb had with lower accuracy in the RVP and that third trimester exposure was a better predictor than second trimester exposure.

Conclusions

Our results indicate that metal mixtures effects vary across time, have distinct critical windows and that both JWQS and MWQS can determine longitudinal mixture effects including the cumulative contribution of each exposure and critical windows of effect.
Does the oxidative stress play a role in the associations between outdoor air pollution and persistent asthma in adults? Findings from the EGEA study
Authors: Havet Anaïs , Li Zhen , Zerimech Farid , Sanchez Margaux , Siroux Valérie , Le Moual Nicole , Brunekreef Bert , Künzli Nino , Jacquemin Bénédicte , Varraso Raphaëlle , Matran Régis , Nadif Rachel
Published: October 2019

Background

Evidences that oxidative stress plays a role in the associations between outdoor air pollution and asthma are growing. We aimed to study the role of plasma fluorescent oxidation products levels (FlOPs; an oxidative stress-related biomarker), as potential mediators, in the associations between outdoor air pollution and persistent asthma.

Methods

Analyses were conducted in 204 adult asthmatics followed up in the French case-control and family study on asthma (EGEA; the Epidemiological study of the Genetic and Environmental factors of Asthma). Persistent asthma was defined as having current asthma at EGEA2 (baseline, 2003–2007) and EGEA3 (follow-up, 2011–2013). Exposures to nitrogen dioxide, nitrogen oxides, road traffic, particulate matter with a diameter ≤ 10 μm (PM10) and ≤ 2.5 μm were estimated by ESCAPE models (2009–2010), and ozone (O3) by IFEN models (2004). We used a mediation analysis to assess the mediated effect by FlOPs levels and the interaction between FlOPs levels and air pollution.

Results

FlOPs levels increased with PM10and O3(adjusted β = 0.04 (95%CI 0.001–0.08), aβ = 0.04 (95%CI 0.009–0.07) per 10 μg/m3, respectively), and the risk of persistent asthma increased with FlOPs levels (aOR = 1.81 (95%CI 1.08–3.02)). The risk of persistent asthma decreased with exposures to NO2, NOx and PM2.5(aOR ranging from 0.62 to 0.94), and increased with exposures to PM10, O3, O3-summerand road traffic, the greater effect being observed for O3(aOR = 1.78, 95% CI 0.73–4.37, per 10 μg/m3). Using mediation analysis, we observed a positive total effect (aOR = 2.16, 95%CI 0.70–11.9), a positive direct effect of O3on persistent asthma (OR = 1.68, 95%CI 0.57–7.25), and a positive indirect effect mediated by FIOPs levels (aOR = 1.28 (95%CI 1.01–2.29)) accounting for 41% of the total effect.

Conclusions

Our results add insights on the role of oxidative stress in the association between air pollution and persistent asthma.