bluuebunny/crossref_metadata_2025 huggingface dataset:
Facial distortion due to chronic inflammation of unknown cause in a cat
Authors: Johnson Lynelle R , Vidal Sarah A , Brust Kelsey D , Keel M Kevin , Steffey Michele A
Published: September 2020

Case summary

An 8-year-old neutered male indoor cat was presented for evaluation of a year-long history of swelling over the bridge of the nose that extended from the subcutaneous tissue of the right upper eyelid to the dorsum of the skull. Intermittent regression of the mass lesion was reported with antibiotic or corticosteroid therapy; however, progressive swelling, malaise and hiding behavior persisted. CT revealed an aggressive osteolytic mass lesion in the right and left nasal cavities and extending into the frontal sinuses. Rhinoscopy using a 2.8 mm rigid telescope revealed somewhat normal-appearing turbinates rostrally and ventrally on the left side, with turbinate destruction on the right. After obtaining a biopsy from the right side of the nasal cavity, thick material filling the entire nasal cavity was visible caudally and was extracted endoscopically from a rostral approach. Surgical biopsy of the dorsal nasal bridge resulted in protrusion of inspissated material from the incision site. Rhinoscopic exploration revealed that the material extended into both frontal sinuses. Following extensive debridement and medical therapy, marked resolution of facial asymmetry was achieved.

Relevance and novel information

Facial distortion is often considered suggestive of a neoplastic process; however, it can also be seen with fungal and mycobacterial infections, and, in this case, an inflammatory condition of unknown etiology. In this cat, aggressive intervention and debridement of necrotic debris resulted in substantial bony remodeling of the skull and return to normal activity levels.
Minimum 10-Year Outcomes After Revision Anatomic Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Instability
Authors: Berthold Daniel P. , Muench Lukas N. , Beitzel Knut , Archambault Simon , Jerliu Aulon , Cote Mark P. , Scheiderer Bastian , Imhoff Andreas. B. , Arciero Robert A. , Mazzocca Augustus D.
Published: September 2020

Background:

Revision surgery in cases of previously failed primary acromioclavicular (AC) joint stabilization remains challenging mainly because of anatomic alterations or technical difficulties. However, anatomic coracoclavicular ligament reconstruction (ACCR) has been shown to achieve encouraging biomechanical, clinical, and radiographic short-term to midterm results.

Purpose:

To evaluate the clinical and radiographic long-term outcomes of patients undergoing revision ACCR after failed operative treatment for type III through V AC joint injuries with a minimum 10-year follow-up.

Study Design:

Case series; Level of evidence, 4.

Methods:

A retrospective chart review was performed on prospectively collected data within an institutional shoulder registry. Patients who underwent revision ACCR for type III through V AC joint injuries between January 2003 and December 2009 were analyzed. Clinical outcome measures included the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE). The coracoclavicular distance (CCD) was measured for radiographic analysis immediately postoperatively and at last postoperative follow-up.

Results:

A total of 8 patients with a mean age at the time of surgery of 44.6 ± 10.6 years and a mean follow-up of 135.0 ± 17.4 months (range, 120-167 months) were eligible for inclusion in the study. The time from initial AC joint stabilization until revision surgery was 10.2 ± 12.4 months (range, 0.5-36 months); 62.5% of the patients had undergone more than 2 previous AC joint surgical procedures. The ASES score improved from 43.9 ± 22.4 preoperatively to 80.6 ± 28.8 postoperatively ( P = .012), the SST score improved from 4.4 ± 3.6 preoperatively to 11.0 ± 2.2 postoperatively ( P = .017), and the SANE score improved from 31.4 ± 27.3 preoperatively to 86.9 ± 24.1 postoperatively ( P = .018) at final follow-up. There was no significant difference in the CCD ( P = .08) between the first (7.6 ± 3.0 mm) and final (10.6 ± 2.8 mm) radiographic follow-up (mean, 50.5 ± 32.7 months [range, 18-98 months]).

Conclusion:

Patients undergoing revision ACCR after failed operative treatment for type III through V AC joint injuries maintained significant improvement in clinical outcomes at a minimum 10-year follow-up.
Differences in Strength, Patient-Reported Outcomes, and Return-to-Play Rates Between Athletes With Primary Versus Revision ACL Reconstruction at 9 Months After Surgery
Authors: Carolan David , King Enda , Richter Chris , Franklyn-Miller Andy , Moran Ray , Jackson Mark
Published: September 2020

Background:

Patient-reported outcomes and return-to-play (RTP) rates are inferior after revision anterior cruciate ligament reconstruction (ACLR) compared with primary ACLR. Physical properties such as maximal, explosive, and reactive strength influence reinjury and RTP rates after ACLR. No study has compared these outcomes between revision and primary ACLR.

Purpose:

To compare maximal, explosive, and reactive strength of the ACLR limb, as well as patient-reported outcomes and RTP rates between primary and revision ACLR at 9 months after surgery.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

A comparative study was performed at 9 months after surgery for 344 male athletes who had undergone ACLR (298 primary, 46 revision). Maximal strength of the ACLR limb was measured by means of isokinetic dynamometry. Explosive strength was measured by use of single-leg countermovement jump height, and reactive strength was measured by single-leg drop jump. Patient-reported outcomes and responses to RTP questionnaires were recorded for both groups.

Results:

The primary ACLR group had higher scores than the revision ACLR group for single-leg countermovement jump height ( P = .02) and single-leg drop jump reactive strength index ( P = .01) on the ACLR limb. No significant difference was observed between groups on maximal strength of the quadriceps or hamstring, and no significant difference in limb symmetry index was observed between groups on any strength or jump test. The primary ACLR group demonstrated higher scores on the Marx Activity Rating Scale ( P = .03) and the Anterior Cruciate Ligament–Return to Sport after Injury scale ( P < .001). Athletes in the primary ACLR group were more likely to have returned to sport ( P < .001).

Conclusion:

At 9 months after surgery, athletes who had undergone revision ACLR achieved maximal strength similar to that of athletes who had undergone primary ACLR. However, athletes who had revision ACLR demonstrated lower scores on explosive and reactive strength tests. Athletes who underwent revision ACLR had lower RTP rates at 9 months after surgery, potentially due to explosive and reactive strength deficits and lower perceived readiness for RTP.
Assessment and Comparative Evaluation of Self-Efficacy as a Function of Training Style
Authors: Bliss James P. , Hartzler Beth M. , Winner Jennifer , Hodge Douglas
Published: September 2020

As with civilian medicine, the Military Health System relies on medical manikins to supplement didactic training. Analyses of transfer-of-training and the calibration between self-efficacy (SE) and competence offer a robust look at training effectiveness; however, the logistics of collecting these data are complex. Self-reported SE is commonly used as a starting point to look at training effectiveness, and prior research has used it to compare didactic against simulation-based training options. Military medical training courses, however, often combine didactic and experiential (simulation-based) training. Little or no work has documented how SE is differentially affected in courses using both training approaches. Results reported here represent SE data from enlisted medical technicians completing pre-deployment readiness training. These data illustrate that SE gained through didactic training was maintained throughout the simulation training. We discuss possible reasons why this sample did not demonstrate further significant gains following simulation and we identify challenges associated with the study of individual constructs such as SE in the context of team-based training environments.
Informing the Design of Mental Health Smartphone Apps for Adolescents
Authors: Fausett Crystal , Lee Jenny , Godwin Eryn , Palmer Evan , Fouquet Sarah
Published: September 2020

The purpose of this work is to obtain a set of best practices for the design of mental health smartphone applications (MHSAs) for an adolescent user base. The authors carried out a systematic literature review combined with a bibliographic coupling analysis to identify relevant literature, and then a thematic analysis of the literature to identify core principles. These efforts led to a framework of nine general principles for the creation and design of MHSAs. The nine core principles identified were: Using evidence-based treatments, encouraging intrinsic motivation in users, using extrinsic behavior triggers, providing professional support, enabling social support, engaging users during the development process, using user-centered design principles, including a parental mode, and protecting patients’ privacy.
Treatment Burden: Gaps and Future Directions for Communication, Measurement and Training
Authors: Winner Jennifer , Papautsky Elizabeth Lerner
Published: September 2020

Focus on the patient at the center of the healthcare equation has increased over the recent decade. Not unlike patient ergonomics, treatment burden research is concerned with the work that patients do to manage chronic illness and ways of reducing its impact in service of better patient outcomes. In addition, it has focused on measurement approaches that can capture treatment burden across illness types yielding two validated instruments. In this paper, we provide a topical review of the treatment burden literature and its value to human factors; as well as discuss opportunities for subjective, objective, and surrogate measures, challenges in patient-clinician communication in detecting burden, and the role of the EHR in documentation and integration.
Developing an Industry-Focused Maturity Assessment Tool Based on Key Factors Critical to Quality and Success in FDA Human Factors Validation Projects – Overview
Authors: Rojas Katia M.
Published: September 2020

This work is Phase II of a research theme on the topic of human factors validation projects for medical devices and combination products. Initially, a review and analysis of the persisting concerns and also of the implications of failed FDA HF validation projects took place. One main problem delineated was that key stakeholders (namely procurers and providers of HF services) are lacking the necessary tools to adapt to current and future demands of a changing and evolving quality system regulation (QSR). Under the QSR, manufacturers are responsible for the assessment and control of critical suppliers, such as HF service providers. However, there is a need for tools that enable integration and alignment so that stakeholders can develop the necessary capabilities. To increase the quality and success of HF validation projects and help HF service providers meet the QSR, an industry-focused project management (PM) maturity assessment tool was proposed. Phase I consisted of a survey that gathered interesting information to help understand practices and key success factors in FDA HF validation projects. This Phase II summarizes the method and process followed to develop the PM maturity assessment tool. An overview and description of the tool and its resulting components is also presented.
Older Adult Shopping Persona Types and its Impact on Over-the-Counter Medication Misuse
Authors: Shah Shweta , Morris Ashley O. , Stone Jamie A. , Chui Michelle A.
Published: September 2020

Older adult selection and use of over-the-counter (OTC) medications is informed by a range of motivations and rationales-forming different older adult personas. Holden et al. (2019) categorized older adults seeking OTC medications into two personas: habit followers and deliberators. The goal of this paper is to 1) operationalize and expand on the persona types proposed by Holden et al. 2) use these definitions to characterize the types of older adult personas and 3) explore the relationship between over the counter medication misuse and persona type. Our preliminary analysis identified 3 persona types with differing rates of misuse: 1) deliberators (m=1.8 (range 0-3) instances of misuse), 2) habit followers- formal source dependent (m=0 instances of misuse), 3) habit followers- informal source dependent (m=2.1 (range 1-3) instances of misuse). Information about safe medication choices, provided by physician or pharmacist recommendation, was seen to be critical in safe decision-making about OTC medication selection and use.
IVCO2 Training Effectiveness Study
Authors: Tremoulet Patrice , Clark Katie , McManus Michael , Baronov Dimitar
Published: September 2020

Etiometry’s Lead Clinical Specialist and a Human Factors Psychology Professor conducted a study to assess the effectiveness of training on how to use a new risk index, IVCO2, at The Hospital for Sick Children in Toronto, Ontario. Ten clinicians were each separately trained by the Lead Clinical Specialist and afterward the Human Factors Professor administered a ten question assessment. Immediately following the assessment, the professor interviewed each clinician, to obtain feedback about T3 which may be used to inform future enhancements user interface design changes, and/or training changes. Assessment results indicate that a majority of clinical users who are trained using existing materials will be able to interpret and use T3’s new IVCO2 Index safely and effectively. However, 30% of the study participants answered at least one assessment question wrong. This suggests that IVCO2 training should be enhanced. Meanwhile, interview data revealed that all study participants believe that Etiometry’s software provides users with relevant, clinically useful information and capabilities. However, the study’s results also suggest that users must climb a steep learning curve before they can use it effectively. It may helpful to train novice users in phases, so that they have multiple opportunities to learn about some of the features that they may not use immediately could find helpful as they start to use Etiometry’s software more.
Cognitive Work Analysis Models of Neuro-Critical Care
Authors: Üreten Ece , McCredie Victoria , Burns Catherine
Published: September 2020

Neuro-critical care is a complex environment where clinicians have to deal with a great variety and amount of data on a daily basis. The different types of medical equipment and software often pose challenges to clinicians as they are separate systems and lack long data storage which is necessary to trend patient health over time. An observational study has been conducted, followed by the first step of a Cognitive Work Analysis approach to understand and visualize key components of this field in more depth. This so-called Work Domain Analysis shows findings for relations between the different abstract levels of neuro-critical care monitoring and treatment, as well as the nervous system and cognition. The abstract representation shapes the basis of designing an Ecological Interface.
Organizational considerations from HFE to speed up the adoption of AI-related technology in medical diagnostics
Authors: Elkefi Safa , Wang Hongwei , Asan Onur
Published: September 2020

Diagnostic errors contribute to hospital complications that can lead to death. It is essential to create a favorable environment for implementing AI-related technologies to improve medical diagnostics. This study aims to present the different categories of A.I. diagnostic applications, as well as the organizational factors and policies, inﬂuencing the best adoption and implementation of A.I. applications. We conducted an online database search to identify peer-reviewed papers published between Jan 2009 and May 2019 that were related to A.I. applications in medical diagnostics. Papers were included as indexed in database PubMed if they contain any one of the following: (1) the research used Artificial Intelligence or Machine Learning or Deep Learning to perform medical diagnostics, and (2) the research conducted validation analysis or clinical trial. Additionally, we explored whether the study can promisingly improve social welfare or achieve cost-savings by improving clinical outcomes. 197 selected papers were explored that covered the following topics: types of diagnostic technology, medical application scenario, clinical outcome measurement, potential beneﬁt, and how the AI-related diagnostics is improving the clinical outcome and produce economic value.
Flattening the Curve of Cognitive Decline: A Survey of Cognitive Interventions for People Living with Dementia
Authors: Zhang Bella (Yigong) , Chignell Mark H.
Published: September 2020

In our aging societies, slowing and managing cognitive decline has become a significant challenge for older people, caregivers, andhealthcare providers. In the past decade, there has been an explosion in productsaimed at providing cognitive interventions for the elderly in response to the growing market need. In thispaper, we present a framework for thinking about cognitive interventions, and a product typology based onthe level of technology used and the amount of tangibility/physical interactivity that products have. Weshow how current products fit within the proposed product typology framework. We also note shortfallsthat exist in validating products in terms of their claimed cognitive interventions, and in regions of theproduct technology space that deal withproducts that have low technology and low physical interactivity.
Family-Specific Social Support at Work: The Role of Open and Trustworthy Communication
Authors: Schulz-Knappe Charlotte , Ter Hoeven Claartje
Published: September 2020

Family-friendly organizational policies are important for employees to manage work and family responsibilities. Besides formal policies, research has emphasized the importance of informal social support by organizational actors. The positive effects of organizational and supervisor support are already known, but findings are limited regarding family-specific support by coworkers. Taking a communicative perspective, this study tests the assumption that social support is contingent on trustworthy and open communication. To test this, 724 German employees participated in an online survey. Results confirm the relationship between family-specific support and the outcomes job satisfaction, policy use, and work-family conflict, through open and trustworthy communication. Additionally, the study illuminates the distinct roles of organizational actors’ (i.e., coworker, supervisor, organization) support on employee outcomes in the German context.
Ethics and Economics of the COVID-19 Pandemic in the United States
Authors: Hilsenrath Peter , Borders Tyrone
Published: September 2020

The Covid-19 experience provides a natural experiment in personal and social ethics. Difficult decisions are routinely made to optimize lives and livelihoods. This commentary provides background and insight into the ethical and economic foundations underpinning dilemmas of this historic pandemic.
Biologic Treatment of 4 HIV-Positive Patients: A Case Series and Literature Review
Authors: Myers Bridget , Thibodeaux Quinn , Reddy Vidhatha , Chan Stephanie , Brownstone Nicholas , Liao Wilson , Bhutani Tina
Published: September 2020

Background:

The management of psoriatic disease in HIV-positive patients is challenging. Psoriasis in HIV-positive patients is often severe, progressive, and resistant to first- and second-line therapies, including topical treatments, phototherapy, highly active antiretroviral therapy (HAART), and oral retinoids. Other systemic agents used to treat psoriasis, such as methotrexate and cyclosporine, are immunosuppressants and thus many dermatologists may not feel comfortable prescribing them to HIV-positive patients who are already immunocompromised. Biologic agents, which target specific aspects of overactive immune pathways in psoriasis, have revolutionized the management of moderate-to-severe psoriasis. However, data are limited regarding their safety and efficacy in HIV-positive patients.

Objective:

Report 4 cases of HIV-positive patients managed on biologic therapy and summarize the cases of psoriasis in HIV-positive patients managed on biologic therapy that have been published in dermatologic literature to date.

Methods:

We searched PubMed and Embase databases using the terms HIV and psoriasis or HIV and psoriatic arthritis combined with one of the 11 biologics currently approved for treating psoriasis.

Results:

We identified 48 cases of anti-psoriasis biologic therapy (including adalimumab, infliximab, etanercept, ustekinumab, and guselkumab) in HIV-positive patients and added 4. While data are limited, the evidence available suggests biologic agents are safe and efficacious in moderate-to-severe psoriasis and may even have a favorable effect on CD4 and HIV viral counts when used with concomitant HAART.

Conclusion:

Further research would be helpful to establish practical guidelines for the use of anti-psoriasis biologic therapy in the HIV population, including that of newer agents.
Panobinostat and decitabine prior to donor lymphocyte infusion in allogeneic stem cell transplantation
Authors: Kalin Burak , van Norden Yvette , van Gelder Michel , Breems Dimitri , Maertens Johan , Jongen-Lavrencic Mojca , Broers Annoek E. C. , Braakman Eric , Grob Tim , Zeijlemaker Wendelien , Ossenkoppele Gert J. , Meijer Ellen , Cornelissen Jan J.
Published: September 2020

Outcome after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is adversely affected by relapse to a considerable degree. To exploit the graft-versus-leukemia effect more effectively, we assessed the feasibility of early initiation of epigenetic therapy with panobinostat and decitabine after allo-HSCT and before donor lymphocyte infusion (DLI) in poor-risk patients with acute myeloid leukemia (AML) or refractory anemia with excess blasts with International Prognostic Scoring System score ≥1.5. A total of 140 poor-risk patients with AML aged 18 to 70 years were registered, and 110 proceeded to allo-HSCT. Three dose levels were evaluated for dose-limiting toxicities, including panobinostat monotherapy 20 mg at days 1, 4, 8, and 11 of a 4-week cycle (PNB mono group) and panobinostat combined with either decitabine 20 mg/m2 (PNB/DAC20 group) or decitabine 10 mg/m2 (PNB/DAC10 group) at days 1 to 3 of every 4-week cycle. After phase 1, the study continued as phase 2, focusing on completion of protocol treatment and treatment outcome. PNB mono and PNB/DAC10 were feasible, whereas PNB/DAC20 was not related to prolonged cytopenia. Sixty of 110 patients who underwent transplantation were eligible to receive their first DLI within 115 days after allo-HSCT. Grade 3 and 4 adverse events related to panobinostat and decitabine were observed in 23 (26%) of the 87 patients, and they received epigenetic therapy. Cumulative incidence of relapse was 35% (standard error [SE] 5), and overall survival and progression-free survival at 24 months were 50% (SE 5) and 49% (SE 5). Post–allo-HSCT epigenetic therapy with panobinostat alone or in combination with low-dose decitabine is feasible and is associated with a relatively low relapse rate. The trial was registered at the European Clinical Trial Registry, https://www.clinicaltrialsregister.eu, as ECT2012-003344-74.
3D Visualization and Volume-Based Quantification of Rice Chalkiness In Vivo by Using High Resolution Micro-CT
Authors: Su Yi , Xiao Lang-Tao
Published: September 2020

Background

Rice quality research attracts attention worldwide. Rice chalkiness is one of the key indexes determining rice kernel quality. The traditional rice chalkiness measurement methods only use milled rice as materials and are mainly based on naked-eye observation or area-based two-dimensional (2D) image analysis and the results could not represent the three-dimensional (3D) characteristics of chalkiness in the rice kernel. These methods are neither in vivo thus are unable to analyze living rice seeds for high throughput screening of rice chalkiness phenotype.

Results

Here, we introduced a novel method for 3D visualization and accurate volume-based quantification of rice chalkiness in vivo by using X-ray microcomputed tomography (micro-CT). This approach not only develops a novel volume-based method to measure the 3D rice chalkiness index, but also provides a high throughput solution for rice chalkiness phenotype analysis by using living rice seeds.

Conclusions

Our method could be a new powerful tool for rice chalkiness measurement, especially for high throughput chalkiness phenotype screening using living rice seeds. This method could be used in chalkiness phenotype identification and screening, and would greatly promote the basic research in rice chalkiness regulation as well as the quality evaluation in rice production practice.
Metagenomic analysis through the extended Burrows-Wheeler transform
Authors: Guerrini Veronica , Louza Felipe A. , Rosone Giovanna
Published: September 2020

Background

The development of Next Generation Sequencing (NGS) has had a major impact on the study of genetic sequences. Among problems that researchers in the field have to face, one of the most challenging is the taxonomic classification of metagenomic reads, i.e., identifying the microorganisms that are present in a sample collected directly from the environment. The analysis of environmental samples (metagenomes) are particularly important to figure out the microbial composition of different ecosystems and it is used in a wide variety of fields: for instance, metagenomic studies in agriculture can help understanding the interactions between plants and microbes, or in ecology, they can provide valuable insights into the functions of environmental communities.

Results

In this paper, we describe a new lightweight alignment-free and assembly-free framework for metagenomic classification that compares each unknown sequence in the sample to a collection of known genomes. We take advantage of the combinatorial properties of an extension of the Burrows-Wheeler transform, and we sequentially scan the required data structures, so that we can analyze unknown sequences of large collections using little internal memory. The tool LiME (Lightweight Metagenomics via eBWT) is available at https://github.com/veronicaguerrini/LiME.

Conclusions

In order to assess the reliability of our approach, we run several experiments on NGS data from two simulated metagenomes among those provided in benchmarking analysis and on a real metagenome from the Human Microbiome Project. The experiment results on the simulated data show that LiME is competitive with the widely used taxonomic classifiers. It achieves high levels of precision and specificity – e.g. 99.9% of the positive control reads are correctly assigned and the percentage of classified reads of the negative control is less than 0.01% – while keeping a high sensitivity. On the real metagenome, we show that LiME is able to deliver classification results comparable to that of MagicBlast. Overall, the experiments confirm the effectiveness of our method and its high accuracy even in negative control samples.
Genotypic similarities among the parthenogenetic Darevskia rock lizards with different hybrid origins
Authors: Tarkhnishvili David , Yanchukov Alexey , Şahin Mehmet Kürşat , Gabelaia Mariam , Murtskhvaladze Marine , Candan Kamil , Galoyan Eduard , Arakelyan Marine , Iankoshvili Giorgi , Kumlutaş Yusuf , Ilgaz Çetin , Matur Ferhat , Çolak Faruk , Erdolu Meriç , Kurdadze Sofiko , Barateli Natia , Anderson Cort L.
Published: September 2020

Background

The majority of parthenogenetic vertebrates derive from hybridization between sexually reproducing species, but the exact number of hybridization events ancestral to currently extant clonal lineages is difficult to determine. Usually, we do not know whether the parental species are able to contribute their genes to the parthenogenetic vertebrate lineages after the initial hybridization. In this paper, we address the hypothesis, whether some genotypes of seven phenotypically distinct parthenogenetic rock lizards (genusDarevskia) could have resulted from back-crosses of parthenogens with their presumed parental species. We also tried to identify, as precise as possible, the ancestral populations of all seven parthenogens.

Results

We analysed partial mtDNA sequences and microsatellite genotypes of all seven parthenogens and their presumed ansectral species, sampled across the entire geographic range of parthenogenesis in this group. Our results confirm the previous designation of the parental species, but further specify the maternal populations that are likely ancestral to different parthenogenetic lineages. Contrary to the expectation of independent hybrid origins of the unisexual taxa, we found that genotypes at multiple loci were shared frequently between different parthenogenetic species. The highest proportions of shared genotypes were detected between (i)D. sapphirinaandD. bendimahiensisand (ii)D. dahliandD. armeniaca, and less often between other parthenogens. In case (ii), genotypes at the remaining loci were notably distinct.

Conclusions

We suggest that both observations (i-ii) can be explained by two parthenogenetic forms tracing their origin to a single initial hybridization event. In case (ii), however, occasional gene exchange between the unisexual and the parental bisexual species could have taken placeafterthe onset of parthenogenetic reproduction. Indeed, backcrossed polyploid hybrids are relatively frequent inDarevskia, although no direct evidence of recent gene flow has been previously documented. Our results further suggest that parthenogens are losing heterozygosity as a result of allelic conversion, hence their fitness is expected to decline over time as genetic diversity declines. Backcrosses with the parental species could be a rescue mechanism which might prevent this decline, and therefore increase the persistance of unisexual forms.
A small dose of dezocine suppresses remifentanil-induced cough in general anesthesia induction: a prospective, randomized, controlled study
Authors: Ma Rui , Wei Yu , Xu Zifeng
Published: September 2020

Background

The aim of this prospective randomized controlled study was to evaluate whether pretreatment with a small dose of dezocine could prevent remifentanil-induced cough in general anesthesia induction.

Trial design

a prospective, randomized, controlled study.

Methods

A total of 210 patients receiving elective operative hysteroscopy from December 2018 to April 2019 were enrolled in the present study. They were randomly equally separated into dezocine group (n = 105) and control group (n = 105). Patients were intravenously pre-administrated with dezocine 0.03 mg/kg (diluted to 5 mL) or the same volume of normal saline 1 min prior to remifentanil infusion. One minute later, intravenous injection of propofol 1.5 mg/kg and cisatracurium 0.1 mg/kg were given to all patients for induction of general anesthesia. The counts of coughs occurred during the anesthesia induction period were recorded and the severity of cough was scaled.

Results

There were 7 cases of mild cough in dezocine group and 18 cases of mild cough, 12 cases of moderate cough and 4 cases of severe cough in control group. The incidence rate of cough was significantly lower and the severity of cough was obviously relieved in dezocine group compared to control group (6.67% vs. 32.38%,P <  0.001). The two groups were not significantly different in heart rate and mean arterial pressure before the induction, before and after the intubation, and in operating time and postoperative visual analog scale pain scores.

Conclusion

This study recommends the efficacy and safety of a pretreatment with a small dose of dezocine in reducing remifentanil-induced cough during general anesthesia.

Trial Registration

ChiCTR2000032035.

Date of registration: Retrospectively registered on 2020/04/18.
Protruded duodenal tumor arising from Santorini’s duct of the pancreas: a rare case of intraductal papillary mucinous neoplasm mimicking a duodenal polypoid tumor
Authors: Komatsubara Haruna , Kato Hiroyuki , Noguchi Daisuke , Gyoten Kazuyuki , Hayasaki Aoi , Iizawa Yusuke , Fujii Takehiro , Tanemura Akihiro , Murata Yasuhiro , Kuriyama Naohisa , Kishiwada Masashi , Sakurai Hiroyuki , Mizuno Shugo
Published: September 2020

Background

We experienced a rare case of intraductal papillary mucinous neoplasm arising from Santorini’s duct (SD) forming a tumor protruding into the duodenum .

Case presentation

A 71-year-old woman was incidentally diagnosed with a 3 cm type Isp polypoid tumor in the second portion of the duodenum at another hospital. Enhanced CT and endoscopic ultrasound revealed that the origin of this protruding tumor was arising from SD and that the tumor mimicked a pedunculated duodenal tumor. Our preoperative diagnosis was a malignant pancreatic tumor arising from SD with invasion into the duodenum. She underwent a subtotal stomach-preserving pancreaticoduodenectomy, and the resected specimen showed a 25 mm tumor protruding into the duodenum with a villous surface. The pathological findings revealed that the tumor was intraductal papillary mucinous adenoma (IPMA) arising from SD.

Conclusions

To the best of our knowledge, this is the first case of IPMA protruding into the duodenal lumen from SD, although most of the tumors arising from SD have been reported to be malignant.
Fungal peritonitis in children on peritoneal dialysis at a tertiary care Centre
Authors: Alsuhaibani Mohammed , Aldosari Egab , Rahim Khawla A. , Alzabli Saeed , Alshahrani Dayel
Published: September 2020

Background

Fungal peritonitis (FP) is an infrequent but serious complication in children undergoing peritoneal dialysis (PD). This study aimed to explore the risk factors, clinical manifestations, causative organisms, fungal susceptibility findings, and outcomes of FP in children from Saudi Arabia.

Methods

In this case–control study, the medical records and laboratory results of paediatric patients aged 0–14 years who underwent PD were reviewed for FP episodes. All FP episodes were matched with PD-related bacterial peritonitis episodes (1:4 ratio).

Results

A total of 194 episodes of PD-related peritonitis occurred between 2007 and 2017, among which 11 were FP episodes (5.6%), representing a rate of 0.03 episodes per patient-year. Of these 11 episodes, 9 were caused by Candida species (82%). Compared with the bacterial peritonitis group, the FP group had a higher proportion of patients with congenital/infantile nephrotic syndrome (p = 0.005) and those younger than 5 years of age (p = 0.001). We observed a higher rate of catheter removal in the FP group than in the bacterial peritonitis group (p <  0.001); however, 1 patient died despite catheter removal. Moreover, 75% of Candida species isolates were susceptible to fluconazole.

Conclusions

This study revealed that FP is associated with a significant risk of peritoneal membrane failure among children undergoing PD. Therefore, early diagnosis and prompt management are essential. We also found that congenital/infantile nephrotic syndrome and young age (5 years old or younger) were risk factors for FP in children undergoing PD.
Development and validation of oral chemotherapy self-management scale
Authors: Peng Qi , Wu Wanying
Published: September 2020

Background

With the increase of oral chemotherapy drugs, patients receiving cancer treatment prefer oral chemotherapy versus intravenous, given equal efficacy and toxicity. However, they need to take an active part in their care, which is vital with home-based oral therapy, therefore the self-management is important for patients with oral chemotherapy. Unfortunately, the development of self-management assessment tools for oral chemotherapy still lags behind.

Methods

The OCSMS item pool was formulated based on literature review and semi-structured interviews, An initial scale containing 5 dimensions and 38 items was constructed through research seminar, Delphi survey and pilot testing. To assess the validity and reliability, We recruited 261 patients from cancer hospital in China.

Results

A 36-item scale was developed with five dimensions identified through factor analysis: daily life management, symptom management, medication management, emotional cognitive management and social support. Cronbach’s coefficient Alpha, split-half coefficient, test-retest reliability and S-CVI/UA scores were 0.929, 0.773, 0.966 and 0.833, respectively, indicating that OCSMS has good reliability and validity.

Conclusions

The OCSMS is a valid, reliable measurement method of the self-management ability of patients with oral chemotherapy. The OCSMS shows potential as a tool to ensure the safety of patients with cancer. The OCSMS may help evaluate the effectiveness of interventions to improve the self-management ability of patients.
Impact of attitudes and beliefs on antiretroviral treatment adherence intention among HIV-positive pregnant and breastfeeding women in Zambia
Authors: Nutor Jerry John , Slaughter-Acey Jaime C. , Marquez Shannon P. , DiMaria-Ghalili Rose Ann , Momplaisir Florence , Oladimeji Kelechi Elizabeth , Jemmott Loretta S.
Published: September 2020

Objective

The aim of this study was to investigate if attitudes or behavioral beliefs about antiretroviral therapy (ART) influence ART adherence intention among pregnant and breastfeeding women in Zambia.

Methods

We recruited 150 HIV-positive women receiving ART in urban (Lusaka) and rural (Sinazongwe) districts of Zambia. Generalized modified Poisson regression models were used to assess the extent to which adherence intention was influenced by attitude toward ART or behavioral beliefs about ART.

Results

Intention to adhere to ART differed significantly by income, knowledge about HIV transmission, attitudes, and behavioral beliefs (all Ps < .05). In addition, strong intention to adhere to ART differed by urban (69%) and rural (31%) place of residence (P ≤ .01). In adjusted models, women in the weak adherence intention group were more likely to be older, have less knowledge about HIV transmission, and have a more negative attitude toward ART (PR 0.74; 95% CI 0.67–0.82). Behavioral belief about ART, however, was significant in unadjusted model (PR 0.85; 95% CI 0.76–0.94) but not significant after adjusting for covariates such as age, knowledge of transmission, and district locality.

Conclusion

Compared to behavioral beliefs, attitudes about ART were more influential for intention to adhere. This knowledge will help inform effective and appropriate ART counseling for pregnant and breastfeeding women at different points along their ART time course.
The effect of neuropalliative care on quality of life and satisfaction with quality of care in patients with progressive neurological disease and their family caregivers: an interventional control study
Authors: Bužgová Radka , Kozáková Radka , Bar Michal
Published: September 2020

Background

It is recommended that patients with progressive neurological disease (PND) receive general and specialized palliative care. The purpose of this study was to determine the effect of neuropalliative care on quality of life (QoL) and satisfaction with provided care in both patients with PND in advanced stages of disease and their family caregivers.

Methods

The sample consisted of 151 patients with PND and 140 family caregivers. The PNDQoL questionnaire was used for data collection. Patients and family caregivers completed the questionnaires both before and 3 months after the intervention.

Results

Before intervention, there were no statistically significant differences in the individual domains of QoL in patients and family caregivers in either the intervention or the control group. After intervention, differences were identified in the sample of patients in the domains ofsymptoms burden(p < 0.001),emotional(p < 0 .001),social functioning(p = 0.046),spiritual area (nonreligious)(p = 0.050), and inQoL. In the sample of family caregivers, there were differences in the domains ofsymptoms burden(p < 0.001),emotional functioning(p = 0.016),spiritual area (nonreligious)(p = 0.042), and in theassessment of health(p = 0.002), andQoL(p = 0.002). Patients and family caregivers from the intervention group evaluated their satisfaction with the quality of care provided significantly more positively in all five analyzed domains.

Conclusion

The provision of neuropalliative care to patients with advanced stages of PND helped to maintain and slightly improve their QoL, and symptoms burden, and resulted in a more positive assessment of satisfaction with the quality of care provided.
The efficiency and effectiveness of surgery information systems in Iran
Authors: Abbasi Faezeh , Khajouei Reza , Mirzaee Moghaddameh
Published: September 2020

Background

Despite the prevalent use and advantages of information systems in hospitals, some have failed to meet their predefined objectives. Surgery information system (SIS) is a sub-system of a hospital information system. Its effective and efficient operation could enhance patient care in the busy environment of operating rooms with multiple tasks. The objective of this study was to evaluate the effectiveness and efficiency of SIS in three educational hospitals.

Methods

Data were collected using a questionnaire completed by 82 users of SIS. This questionnaire contains three parts: 1) participants’ demographic information, 2) questions regarding the efficiency of SIS, and 3) questions about its effectiveness. An independent sample t-test was used to compare the efficiency and effectiveness among systems. Chi-squared and Fisher tests were used to determine the relationship between the participants’ demographics and efficiency and effectiveness as well as the relationship between efficiency and effectiveness.

Results

About 23% of the participants rated the system’s efficiency as low, 29% as medium, and 48% as high. Besides, 24% of the participants considered the effectiveness of the system as low, 31% as medium, and 45% as high. There was a significant correlation between the efficiency and effectiveness of SIS (p ≤ 0.0001).

Conclusion

Based on the perspective of most participants (44%)the efficiency and effectiveness of both surgery information systems were acceptable. The results suggest that these systems should be designed in a way that facilitate user’s interaction and reduce the time takes to complete tasks. The results could be useful for developing and designing an efficient and effective system.
Willingness of community based health insurance uptake and associated factors among urban residents of Oromia regional state, Oromia, Ethiopia, a cross-sectional study
Authors: Deksisa Alem , Abdo Meyrema , Mohamed Ebrahim , Tolesa Daniel , Garoma Sileshi , Zewdie Abate , Lami Melese , Irena Dinka , Abdena Dereje , Lemi Hunde
Published: September 2020

Background

Globally, Millions of people cannot use health services because of the fear of payment for the service at the time of service delivery. From the agenda of transformation and the current situation of urbanization as well as to ensure universal health coverage implementing this program to the urban resident is mandatory. The aim of this study is to assess the willingness of community-based health insurance (CBHI) uptake and associated factors among urban residents of Oromia regional state, Oromia, Ethiopia, 2018.

Methods

A community-based cross-sectional study was conducted. From the total of eighteen towns; six towns which account for 33% of the total were selected randomly for the study. One population proportion formula was employed to get a total of 845 households. A pre-tested, semi-structured interviewer-administered questionnaire was used to collect the required data. Double-Bounded Dichotomous Choice Variant of the contingent valuation method was used to assess the maximum willingness to pay for the scheme, and a multiple logistic regression model was used to determine the effect of various factors on the willingness to join and willingness to pay for the households.

Result

About 839 (99.3%) of the respondents participated. The mean ages of the respondents were 40.44(SD ± 11.12) years. 621 (74.1%) ever heard about CBHI with 473 (56.3%) knowing the benefits package. Out of 839, 724 (86.3%) were willing to uptake CBHI of which 704 (83.9%) were willing to pay if CBHI established in their town.

Conclusion

If CBHI established about 86.3% of the households would enroll in the scheme. Having education, with a family size between 3 & 6, having difficulty in paying for health care and less than 20mins it took to reach the nearest health facility were the independent predictors of the willingness of CBHI uptake. The Oromia and Towns Health Bureau should consider the availability of health facilities near to the community and establishing CBHI in the urban towns.
Approaches of integrating the development of guidelines and quality indicators: a systematic review
Authors: Langendam Miranda W. , Piggott Thomas , Nothacker Monika , Agarwal Arnav , Armstrong David , Baldeh Tejan , Braithwaite Jeffrey , Castro Martins Carolina , Darzi Andrea , Etxeandia Itziar , Florez Ivan , Hoving Jan , Karam Samer G. , Kötter Thomas , Meerpohl Joerg J. , Mustafa Reem A. , Muti-Schünemann Giovanna E. U. , van der Wees Philip J. , Follmann Markus , Schünemann Holger J.
Published: September 2020

Background

Guidelines and quality indicators (for example as part of a quality assurance scheme) aim to improve health care delivery and health outcomes. Ideally, the development of quality indicators should be grounded in evidence-based, trustworthy guideline recommendations. However, anecdotally, guidelines and quality assurance schemes are developed independently, by different groups of experts who employ different methodologies. We conducted an extension and update of a previous systematic review to identify, describe and evaluate approaches to the integrated development of guidelines and related quality indicators.

Methods

On May 24th, 2019 we searched in Medline, Embase and CINAHL and included studies if they reported a methodological approach to guideline-based quality indicator development and were published in English, French, or German.

Results: Out of 16,034 identified records, we included 17 articles that described a method to integrate guideline recommendations development and quality indicator development. Added to the 13 method articles from original systematic review we included a total 30 method articles. We did not find any evaluation studies. In most approaches, guidelines were a source of evidence to inform the quality indicator development. The criteria to select recommendations (e.g. level of evidence or strength of the recommendation) and to generate, select and assess quality indicators varied widely. We found methodological approaches that linked guidelines and quality indicator development explicitly, however none of the articles reported a conceptual framework that fully integrated quality indicator development into the guideline process or where quality indicator development was part of the question formulation for developing the guideline recommendations.

Conclusions

In our systematic review we found approaches which explicitly linked guidelines with quality indicator development, nevertheless none of the articles reported a comprehensive and well-defined conceptual framework which integrated quality indicator development fully into the guideline development process.