bluuebunny/crossref_metadata_2025 huggingface dataset:
Lateral Trochlear Inclination Angle: Measurement via a 2-Image Technique to Reliably Characterize and Quantify Trochlear Dysplasia
Authors: Joseph Sheeba M. , Cheng Chris , Solomito Matthew J. , Pace J. Lee
Published: October 2020

Background:

Trochlear dysplasia (TD) is a risk factor for patellar instability (PI). The Dejour classification categorizes TD but has suboptimal reliability. Lateral trochlear inclination (LTI) is a quantitative measurement of trochlear dysplasia on a single axial magnetic resonance imaging (MRI) scan.

Hypothesis:

A modified LTI measurement technique using 2 different axial MRI scans that reference the most proximal aspect of the trochlear cartilage on 1 image and the fully formed posterior condyles on the second image would be as reliable as and significantly different from the single-image measurement technique for LTI. Further, the 2-image LTI would adequately represent overall proximal trochlear morphologic characteristics.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

Patients aged 9 to 18 years treated for PI between 2014 and 2017 were identified. The Dejour classification was radiographically determined. Single-image LTI was measured on a single axial MRI scan at the most proximal aspect of visible trochlear cartilage. A 2-image LTI was measured from 2 separate MRI scans: 1 at the most proximal aspect of trochlear cartilage and the second at the fully formed posterior condyles. This 2-image LTI was repeated at 3 subsequent levels (the first measurement is referred to as LTI-1; repeated measurements are LTI-2, LTI-3, and LTI-4, moving distally). In total, 65 patients met the inclusion criteria, and 30 were randomly selected for reliability analysis.

Results:

Inter- and intrarater reliability trended toward more variability for single-image LTI (intraclass correlation coefficient [ICC], 0.86 and 0.88, respectively) than for 2-image LTI (ICC, 0.97 and 0.96, respectively). The Dejour classification had lower intra- and interrater reliability (ICC, 0.31 and 0.73, respectively). Average single-image LTI (9.2° ± 12.6°) was greater than average 2-image LTI-1 (4.2° SD ± 11.9°) ( P = .0125). Single-image LTI classified 60% of patients with PI as having TD, whereas the 2-image LTI classified 71% as having TD. The 2-image LTI was able to capture 91% of overall proximal trochlear morphologic characteristics.

Conclusion:

LTI has higher reliability when performed using a 2-image measurement technique compared with single-image LTI and Dejour classification. The strong correlation between 2-image LTI and average LTI shows that 91% of TD is represented on the most proximal axial image. Because the single-image measurement appears to underestimate dysplasia, previously described thresholds should be reexamined using this 2-image technique to appropriately characterize TD.
“Taking Care of Your Own”: Parochialism, Pride of Place, and the Drive to Diversify Teaching
Authors: Noonan James , Bristol Travis J.
Published: October 2020

As the student population in U.S. public schools becomes increasingly ethnoracially diverse, many school districts and hiring personnel have taken proactive approaches to recruiting teachers of color. The drive to diversify the teaching force is supported by a range of academic and nonacademic outcomes for students of color. Yet, many districts struggle with the recruitment and retention of teachers of color. One explanation for the slow pace of change, especially in districts with increasing diversity in its study body, is the presence of durable and parochial social networks in schools and districts that privilege the hiring of largely White alumni. Drawing on semistructured interviews with 65 participants in a small urban district and applying the analytic lens of bonding social capital, we examined these entrenched patterns of parochialism, and the extent to which parochial attitudes and behaviors intersect with race, to explain the incremental pace of change diversifying the teacher workforce.
Periorbital Entrapment in a Minimally Displaced Medial Wall Fracture
Authors: Hwang Kun
Published: October 2020

I experienced periorbital entrapment in a minimally displaced medial wall fracture. An 18-year male was hit in the left eye by a fist. He had decreased horizontal ocular motility with pain. Exophthalmometry of both eyes were same. Computed tomography (CT) demonstrated a minimally displaced medial wall fracture with herniation of orbital fat. Decreased horizontal ocular motility and pain persisted until the fifth post-trauma day. On exploration, entrapped soft tissue was found and dissected from the fractured site, but the bony displacement was minimal. After release, the forced duction test became normal and postoperative CT demonstrated reduced herniated orbital fat. In cases of a minimally displaced medial orbital wall fracture, if the patient feels pain while gazing horizontally, precise inspection of the CT scan is needed. If the pain persists for several days, despite the absence of diplopia, periorbital entrapment should be suspected and exploration can be considered.
Effects of flexing, optical density, and lamination on barrier and mechanical properties of metallized films and aluminum foil centered laminates prepared with polyethylene terephthalate and linear low density polyethylene
Authors: Ge Changfeng , Verma Suraj Singh , Burruto Jack , Ribalco Nazar , Ong Janice , Sudhahar K
Published: October 2020

Flex barrier and optical density (OD) are two unique properties for metallized films and aluminum foil. This study investigated the effect of flexing on barrier properties of a laminate comprising metallized films and aluminum foil, as well as OD and adhesive lamination process on the overall multilayer laminate performance. Three (3) barrier layers, namely aluminum foil, metallized polyethylene terephthalate (met OPET) film with a high OD, and standard metallized PET film(met OPET), were laminated with the same printing layer OPET and sealing layer linear low density polyethylene (LLDPE), into OPET/adhesive/foil/adhesive/LLDPE and OPET/adhesive/met OPET/adhesive/LLDPE structures. The oxygen transmission rate (OTR) and water vapor transmission rate (WVTR) were measured before and after flexing. The aluminum foil centered laminate had an excellent oxygen barrier after the 20-cycle flexing test and failed to retain its oxygen barrier after the 270-cycle flexing. Compared to the aluminum foil centered laminate, the metallized film centered laminates were less affected by the flexing on the oxygen barrier. For all laminates, the water vapor barrier was less severely affected by flexing than the oxygen barrier. This study suggests that the ASTMF392 Gelbo D (20- cycle flexing) can determine if aluminum foil and metallized film centered laminates are resistant to flex-formed pinhole failures. A higher OD, a thicker film thickness and lamination process improved laminate’s actual barrier, resulting in lower measured transmission rates versus that predicted using Henry's solubility law and Fick's diffusion law. The laminate’s water vapor transmission rate is 55–74% lower than predicted. The oxygen transmission rate is 15–31% lower than predicted.
Lung Ultrasonography: An Emerging Practice
Authors: Kuchenmeister Melissa
Published: October 2020

Objective:

Sonography of the chest has traditionally been focused on chest wall and pleural space. Over time, clinicians have developed a practice of bedside lung ultrasonography (LUS) to supplement physical examination. In the wake of the SARS-COV-2 (COVID-19) pandemic, clinicians have increasingly turned to LUS as a tool to assess a patient’s condition.

Methods:

A literature search was performed using Google Scholar with access to articles through a major Midwestern university.

Results:

Computed tomography (CT) and radiographs are not always available in all treatment centers. While LUS may be limited, it is important to correlate findings with compatible imaging modalities. This review summarizes lung pathologies and the sonographic appearance of lung abnormalities.

Conclusions:

Radiology professionals have largely questioned the practice and findings of LUS. However, now, as the most qualified experts in the use of ultrasound, sonographers and radiologists have a duty to be educated in the use of LUS.
Application of transthoracic shear-wave ultrasound elastography in lung lesions
Authors: Kuo Yao-Wen , Chen Yen-Lin , Wu Huey-Dong , Chien Ying-Chun , Huang Chun-Kai , Wang Hao-Chien
Published: October 2020

Introduction

Tissue stiffness information may help in the diagnosis of lung lesions. This study aimed to investigate and validate the application of transthoracic two-dimensional shear-wave ultrasound elastography in differentiating malignant from benign subpleural lung lesions.

Methods

This study involved one retrospective observational derivation cohort from January 2016 to December 2017 and one prospective observational validation cohort from December 2017 to December 2019. The inclusion criterion was radiographic evidence of pulmonary lesions. The patients were categorised into air bronchogram and hypoechoic groups based on B-mode grayscale images. The elasticity of subpleural lung lesions with acceptable shear-wave propagation was measured. Diagnoses were made on the basis of pathology, microbiological studies or following up the clinical course for at least 6 months.

Results

A total of 354 patients were included. Among the 121 patients in the derivation cohort, a receiver operating characteristic curve was constructed and the cut-off point to differentiate benign from malignant lesions was 65 kPa with a Youden index of 0.60 and an accuracy of 84.3%. Among the 233 patients in the validation cohort, the diagnostic performance was maintained, with a Youden index of 0.65 and an accuracy of 86.7%. Upon applying the cut-off point to the air bronchogram group, the Youden index was 0.70 and the accuracy was 85.0%.

Conclusions

This study validated the application of transthoracic shear-wave ultrasound elastography for assessing lung malignancy. A cut-off point of 65 kPa is suggested for predicting lung malignancy. Furthermore, for pulmonary air bronchogram lesions with high elasticity, tissue proofing should be considered because of the high possibility of malignancy.
Diaphragmatic excursion correlates with exercise capacity and dynamic hyperinflation in COPD patients
Authors: Shiraishi Masashi , Higashimoto Yuji , Sugiya Ryuji , Mizusawa Hiroki , Takeda Yu , Fujita Shuhei , Nishiyama Osamu , Kudo Shintarou , Kimura Tamotsu , Chiba Yasutaka , Fukuda Kanji , Tohda Yuji
Published: October 2020

Background

Although the pathophysiological mechanisms involved in the development of dyspnoea and poor exercise tolerance in patients with COPD are complex, dynamic lung hyperinflation (DLH) plays a central role. Diaphragmatic excursions can be measured by ultrasonography (US) with high intra- and interobserver reliability. The objective of this study was to evaluate the effect of diaphragmatic excursions as assessed by US on exercise tolerance and DLH in patients with COPD.

Methods

Patients with COPD (n=20) and age-matched control subjects (n=20) underwent US, which was used to determine the maximum level of diaphragmatic excursion (DEmax). Ventilation parameters, including the change in inspiratory capacity (ΔIC), were measured in the subjects during cardiopulmonary exercise testing (CPET). We examined the correlations between DEmaxand the ventilation parameters.

Results

The DEmaxof patients with COPD was significantly lower than that of the controls (45.0±12.8 mmversus64.6±6.3 mm, respectively; p<0.01). The perception of peak dyspnoea (Borg scale) was significantly negatively correlated with DEmaxin patients with COPD. During CPET, oxygen uptake/weight (V′O2/W) and minute ventilation (V′E) were significantly positively correlated with DEmax, whileV′E/V′O2andV′E/carbon dioxide output (V′CO2) were significantly negatively correlated with DEmaxin patients with COPD. DEmaxwas also significantly positively correlated with ΔIC, reflecting DLH, and withV′O2/W, reflecting exercise capacity.

Conclusion

Reduced mobility of the diaphragm was related to decreased exercise capacity and increased dyspnoea due to dynamic lung hyperinflation in COPD patients.
miRNA-23b as a biomarker of culture-positive neonatal sepsis
Authors: Fatmi Ahlam , Rebiahi Sid Ahmed , Chabni Nafissa , Zerrouki Hanane , Azzaoui Hafsa , Elhabiri Yamina , Benmansour Souheila , Ibáñez-Cabellos José Santiago , Smahi Mohammed Chems-Eddine , Aribi Mourad , García-Giménez José Luis , Pallardó Federico V.
Published: October 2020

Background

Neonatal sepsis remains an important cause of morbidity and mortality. The ability to quickly and accurately diagnose neonatal sepsis based on clinical assessments and laboratory blood tests remains difficult, where haemoculture is the gold standard for detecting bacterial sepsis in blood culture. It is also very difficult to study because neonatal samples are lacking.

Methods

Forty-eight newborns suspected of sepsis admitted to the Neonatology Department of the Mother-Child Specialized Hospital of Tlemcen. From each newborn, a minimum of 1–2 ml of blood was drawn by standard sterile procedures for blood culture. The miRNA-23b level in haemoculture was evaluated by RT-qPCR.

Results

miR-23b levels increased in premature and full-term newborns in early onset sepsis (p < 0.001 and p < 0.005 respectively), but lowered in late onset sepsis in full-term neonates (p < 0.05) compared to the respective negative controls. miR-23b levels also increased in late sepsis in the negative versus early sepsis negative controls (p < 0.05). miR-23b levels significantly lowered in the newborns who died from both sepsis types (p < 0.0001 and p < 0.05 respectively). In early sepsis, miR-23b and death strongly and negatively correlated (correlation coefficient = − 0.96, p = 0.0019). In late sepsis, miRNA-23b and number of survivors (correlation coefficient = 0.70, p = 0.506) positively correlated.

Conclusions

Lowering miR-23b levels is an important factor that favours sepsis development, which would confirm their vital protective role, and strongly suggest that they act as a good marker in molecular diagnosis and patient monitoring.
High conservation combined with high plasticity: genomics and evolution of Borrelia bavariensis
Authors: Becker Noémie S. , Rollins Robert E. , Nosenko Kateryna , Paulus Alexander , Martin Samantha , Krebs Stefan , Takano Ai , Sato Kozue , Kovalev Sergey Y. , Kawabata Hiroki , Fingerle Volker , Margos Gabriele
Published: October 2020

Background

Borrelia bavariensis is one of the agents of Lyme Borreliosis (or Lyme disease) in Eurasia. The genome of the Borrelia burgdorferi sensu lato species complex, that includes B. bavariensis, is known to be very complex and fragmented making the assembly of whole genomes with next-generation sequencing data a challenge.

Results

We present a genome reconstruction for 33 B. bavariensis isolates from Eurasia based on long-read (Pacific Bioscience, for three isolates) and short-read (Illumina) data. We show that the combination of both sequencing techniques allows proper genome reconstruction of all plasmids in most cases but use of a very close reference is necessary when only short-read sequencing data is available. B. bavariensis genomes combine a high degree of genetic conservation with high plasticity: all isolates share the main chromosome and five plasmids, but the repertoire of other plasmids is highly variable. In addition to plasmid losses and gains through horizontal transfer, we also observe several fusions between plasmids. Although European isolates of B. bavariensis have little diversity in genome content, there is some geographic structure to this variation. In contrast, each Asian isolate has a unique plasmid repertoire and we observe no geographically based differences between Japanese and Russian isolates. Comparing the genomes of Asian and European populations of B. bavariensis suggests that some genes which are markedly different between the two populations may be good candidates for adaptation to the tick vector, (Ixodes ricinus in Europe and I. persulcatus in Asia).

Conclusions

We present the characterization of genomes of a large sample of B. bavariensis isolates and show that their plasmid content is highly variable. This study opens the way for genomic studies seeking to understand host and vector adaptation as well as human pathogenicity in Eurasian Lyme Borreliosis agents.
Going web or staying paper? The use of web-surveys among older people
Authors: Kelfve Susanne , Kivi Marie , Johansson Boo , Lindwall Magnus
Published: October 2020

Background

Web-surveys are increasingly used in population studies. Yet, web-surveys targeting older individuals are still uncommon for various reasons. However, with younger cohorts approaching older age, the potentials for web-surveys among older people might be improved. In this study, we investigated response patterns in a web-survey targeting older adults and the potential importance of offering a paper-questionnaire as an alternative to the web-questionnaire.

Methods

We analyzed data from three waves of a retirement study, in which a web-push methodology was used and a paper questionnaire was offered as an alternative to the web questionnaire in the last reminder. We mapped the response patterns, compared web- and paper respondents and compared different key outcomes resulting from the sample with and without the paper respondents, both at baseline and after two follow-ups.

Results

Paper-respondents, that is, those that did not answer until they got a paper questionnaire with the last reminder, were more likely to be female, retired, single, and to report a lower level of education, higher levels of depression and lower self-reported health, compared to web-respondents. The association between retirement status and depression was only present among web-respondents. The differences between web and paper respondents were stronger in the longitudinal sample (after two follow-ups) than at baseline.

Conclusions

We conclude that a web-survey might be a feasible and good alternative in surveys targeting people in the retirement age range. However, without offering a paper-questionnaire, a small but important group will likely be missing with potential biased estimates as the result.
Case report: Candida krusei spondylitis in an immunocompromised patient
Authors: Overgaauw Audrey J. C. , de Leeuw David C. , Stoof Susanne P. , van Dijk Karin , Bot Joost C. J. , Hendriks Eef J.
Published: October 2020

Background

Invasive infections with Candida krusei are uncommon and rarely complicated by spondylitis. Previous described cases were solely treated with antimycotic therapy, despite guidelines recommending surgical interventions.

Case presentation

We describe a case of C. krusei spondylitis in a patient treated with chemotherapy for acute myeloid leukemia. After induction chemotherapy, the patient developed a candidemia, which was treated with micafungin. One month after the candidemia, the patient was admitted with severe lumbar pain. Spondylitis of the L4 and L5 vertebra was diagnosed on MR-imaging, with signs suggesting an atypical infection. The patient was treated with anidulafungin combined with voriconazole. Despite maximal conservative management symptoms gradually worsened eventually requiring surgical intervention.

Conclusions

In contrast to previous case reports, antimycotic treatment alone could be insufficient in treating C. krusei spondylitis.
Prevalence of and socioeconomic gradient in low birth weight in Ethiopia: further analysis of the 2016 demographic and health survey data
Authors: Shibre Gebretsadik , Tamire Mulugeta
Published: October 2020

Background

Evidence suggests appearance of socioeconomic gradient in the probability of low birth weight (LBW). Such evidence, however, is scanty in Ethiopia. The study aimed to examine the prevalence of and socioeconomic gradient in LBW in Ethiopia.

Method

Data for the study were drawn from the Ethiopia Demographic and Health Survey conducted in 2016. The 2016 EDHS is the fourth wave in the series of nationally representative household surveys carried out in the country to deliver up-to-date health and demographic indicators for the Ethiopian population. Women aged 15 to 49 years were the main focus of the survey, with data also gathered from men aged 15 to 59 years and under five children. The study pursued complex sampling strategy to draw samples representative at national as well as at urban and rural levels. The data are available to the public domain and were accessed from the MEASURE DHS following registration. Multivariable logistic regression model and marginal standardization were used to estimate socioeconomic gradient in the probability of LBW. We performed sensitivity analysis to evaluate variation of LBW according to different categories of socioeconomic position. Maternal education and household wealth were used as measures of the socioeconomic position in the study.

Results

13.2% (95% confidence interval = 10.73, 15.65) of births were complicated by LBW. The findings showed that socioeconomic gradient was evident between maternal education and LBW; as education increases from no education to secondary education, the probability of occurrence of LBW consistently declined. However, no gradient in LBW was detected for household wealth.

Conclusions

We have identified education gradient in LBW, with the highest burden of LBW occurring among the non-educated women. To redress the observed education disparity in LBW, targeted interventions need to be implemented with greater emphasis placed on illiterate women.
Improving infant sleep safety via electronic health record communication: a randomized controlled trial
Authors: Canty Ethan A. , Fogel Benjamin N. , Batra Erich K. , Schaefer Eric W. , Beiler Jessica S. , Paul Ian M.
Published: October 2020

Background

With increased use of telehealth, interventions to improve infant sleep environments have not been explored. This study sought to assess the feasibility and efficacy of using electronic health record patient portals to transmit photographs of infant sleep between mothers and healthcare professionals as part of an intervention to promote sleep environments consistent with AAP guidelines.

Methods

One hundred eighty-four mother-newborn dyads consented to participate in a randomized trial requiring patient portal registration within 1 month of delivery. We first assessed feasibility as measured by a) the proportion of consented mothers enrolling in the portal and b) maternal adherence to prompts to submit photographs of their infant sleeping to the research team through the patient portal. Intervention group mothers were prompted at 1 and 2 months; controls were prompted only at 2 months. Efficacy was determined via research assistant review of submitted photographs. These assistants were trained to detect sudden unexplained infant death risk factors utilizing AAP guidelines. Standardized feedback was returned to mothers through the patient portal. We used Fisher’s Exact test to assess group differences in guideline adherence at 2 months.

Results

One hundred nine mothers (59%) enrolled in the patient portal and were randomized to intervention (N = 55) and control (N = 54) groups. 21 (38, 95% CI 25–52%) intervention group participants sent photographs at 1 month and received personalized feedback. Across both groups at 2 months, 40 (37, 95% CI 28–46%) sent photographs; 56% of intervention group participants who submitted photographs met all safe sleep criteria compared with 46% of controls (difference 0.10, 95% CI − 0.26 to 0.46, p = .75). Common reasons for guideline non-adherence were sleeping in a room without a caregiver (43%), loose bedding (15%) and objects (8%) on the sleep surface.

Conclusions

Utilizing the patient portal to individualize safe infant sleep is possible, however, we encountered numerous barriers in this trial to assess its effects on promoting safe infant sleep. Photographs of infants sleeping showed substantial non-adherence to AAP guidelines, suggesting further needs for improvement to promote safe infant sleep practices.

Trial registration

Name: Improving Infant Sleep Safety With the Electronic Health Record; Clinicaltrials.gov: NCT03662048; Date of Registration: September 7, 2018;

Data Sharing Statement: None
Correlation of medical students' situational motivation and performance of non-technical skills during simulation-based emergency training
Authors: Schulte-Uentrop Leonie , Cronje Jonathan S. , Zöllner Christian , Kubitz Jens C. , Sehner Susanne , Moll-Khosrawi Parisa
Published: October 2020

Background

Non-technical skills (NTS) are an indispensable element of emergency care and need to be prevalent alongside with good technical skills. Though, questions of how to teach (instructional design) and improve NTS effectively remain unresolved. One adjustment screw to enhance performance of NTS, which is detached from instructional designs and learning efforts might be motivation. Theoretical models and observational studies suggest that high levels of intrinsic (situational) motivation result in better performance and better learning. Therefore, this study analyzed the influence of motivation on performance of NTS, by exploring if high levels of intrinsic motivation lead to better performance of NTS in medical students.

Methods

In this prospective cross-sectional cohort study, the authors assessed the correlation of situational motivation and performance of NTS within a cohort of 449 undergraduates in their 1st to 4th year of medical studies, in a total of 101 emergency simulation trainings. Situational motivation was measured with the validated Situational Motivation Scale (SIMS), which was completed by every undergraduate directly before each simulation training. The NTS were evaluated with the Anesthesiology Students´ Non-Technical skills (AS-NTS) rating tool, a validated taxonomy, especially developed to rate NTS of undergraduates.

Results

Student situational motivation was weakly correlated with their performance of NTS in simulation-based emergency trainings.

Conclusion

Although motivation has been emphasized as a determining factor, enhancing performance in different fields and in medicine in particular, in our study, student situational motivation was independent from their performance of NTS in simulation-based emergency trainings (SBET).
How to enhance and assess reflection in specialist training: a mixed method validation study of a new tool for global assessment of reflection ability
Authors: Lillevang Gunver , Ibsen Helle , Prins Søren Hast , Kjaer Niels Kristian
Published: October 2020

Background

In Danish GP training we had the ambition to enhance and assess global reflection ability, but since we found no appropriate validated method in the literature, we decided to develop a new assessment tool. This tool is based on individual trainee developed mind maps and structured trainer-trainee discussions related to specific complex competencies. We named the tool Global Assessment of Reflection ability (GAR) and conducted a mixed method validation study. Our goal was to investigate whether it is possible to enhance and assess reflection ability using the tool.

Methods

In order to investigate acceptability, feasibility, face validity, and construct validity of the tool we conducted a mixed method validation study that combined 1) qualitative data obtained from 750 GP trainers participating in train-the-trainer courses, 2) a questionnaire survey sent to 349 GP trainers and 214 GP trainees and 3) a thorough analysis of eight trainer-trainee discussions.

Results

Our study showed an immediate high acceptance of the GAR tool. Both trainers and trainees found the tool feasible, useful, and relevant with acceptable face validity. Rating of eight audio recordings showed that the tool can demonstrate reflection during assessment of complex competencies.

Conclusions

We have developed an assessment tool (GAR) to enhance and assess reflection. GAR was found to be acceptable, feasible, relevant and with good face- and construct validity. GAR seems to be able to enhance the trainees’ ability to reflect and provide a good basis for assessment in relation to complex competencies.
Integration of palliative care in services for children with life-limiting neurodevelopmental disabilities and their families: a Delphi study
Authors: Guerin Suzanne , Kiernan Gemma , Courtney Eileen , McQuillan Regina , Ryan Karen
Published: October 2020

Background

The aim of this study was to explore expert professionals’ opinions on service provision to children under six with life-limiting neurodevelopmental disabilities (LLNDD), including the goals of care and the integration and coordination of palliative care in general and specialist services.

Methods

A Delphi design was used with three questionnaire rounds, one open-ended and two closed response rounds. Primary data collected over a six-month period from expert professionals with five years’ (or more) experience in pediatric, intellectual disability and/or palliative care settings. Ratings of agreement and prioritization were provided with agreement expressed as a median (threshold = 80%) and consensus reported as interquartile ranges. Stability was measured using non-parametric tests.

Results

Primary goals of care were achievement of best possible quality of life, effective communication and symptom management. Service integration and coordination were considered inadequate, and respondents agreed that areas of deficiency included palliative care. Improvement strategies included a single care plan, improved communication and key worker appointments.

Conclusions

The findings suggest that services do not serve this group well with deficiencies in care compounded by a lack of information on available services and sub-optimal communication between settings. Further research is needed to develop an expert-based consensus regarding the care of children with LLNDD.
Development, implementation and evaluation of an online course on evidence-based healthcare for consumers
Authors: Han Genie , Mayer Musa , Canner Joseph , Lindsley Kristina , Datar Reva , Le Jimmy , Bar-Cohen Annette , Bowie Janice , Dickersin Kay
Published: October 2020

Background

Evidence-based healthcare (EBHC) principles are essential knowledge for patient and consumer (“consumer”) engagement as research and research implementation stakeholders. The aim of this study was to assess whether participation in a free, self-paced online course affects confidence in explaining EBHC topics. The course comprises six modules and evaluations which together take about 6 h to complete.

Methods

Consumers United for Evidence-based Healthcare (CUE) designed, tested and implemented a free, online course for consumers, Understanding Evidence-based Healthcare: A Foundation for Action (“Understanding EBHC”). The course is offered through the Johns Hopkins Bloomberg School of Public Health. Participants rated their confidence in explaining EBHC topics on a scale of 1 (lowest) to 5 (highest), using an online evaluation provided before accessing the course (“Before”) and after (“After”) completing all six course modules. We analyzed data from those who registered for the course from May 31, 2007 to December 31, 2018 (n = 15,606), and among those persons, the 11,522 who completed the “Before” evaluation and 4899 who completed the “After” evaluation. Our primary outcome was the overall mean of within-person change (“overall mean change”) in self-reported confidence levels on EBHC-related topics between “Before” and “After” evaluations among course completers. Our secondary outcomes were the mean within-person change for each of the 11 topics (mean change by topic).

Results

From May 31, 2007 to December 31, 2018, 15,606 individuals registered for the course: 11,522 completed the “Before” evaluation, and 4899 of these completed the “After” evaluation (i.e., completed the course). The overall mean change in self-reported confidence levels (ranging from 1 to 5) from the “Before” to “After” evaluation was 1.27 (95% CI, 1.24–1.30). The mean change by topic ranged from 1.00 (95% CI, 0.96–1.03) to 1.90 (95% CI, 1.87–1.94).

Conclusion

Those who seek to involve consumer stakeholders can offer Understanding EBHC as a step toward meaningful consumer engagement. Future research should focus on long-term impact assessment of online course such as ours to understand whether confidence is retained post-course and applied appropriately.
Identification of African swine fever virus-like elements in the soft tick genome provides insights into the virus’ evolution
Authors: Forth Jan H. , Forth Leonie F. , Lycett Samantha , Bell-Sakyi Lesley , Keil Günther M. , Blome Sandra , Calvignac-Spencer Sébastien , Wissgott Antje , Krause Johannes , Höper Dirk , Kampen Helge , Beer Martin
Published: October 2020

Background

African swine fever virus (ASFV) is a most devastating pathogen affecting swine. In 2007, ASFV was introduced into Eastern Europe where it continuously circulates and recently reached Western Europe and Asia, leading to a socio-economic crisis of global proportion. In Africa, where ASFV was first described in 1921, it is transmitted between warthogs and soft ticks of the genus Ornithodoros in a so-called sylvatic cycle. However, analyses into this virus’ evolution are aggravated by the absence of any closely related viruses. Even ancient endogenous viral elements, viral sequences integrated into a host’s genome many thousand years ago that have proven extremely valuable to analyse virus evolution, remain to be identified. Therefore, the evolution of ASFV, the only known DNA virus transmitted by arthropods, remains a mystery.

Results

For the identification of ASFV-like sequences, we sequenced DNA from different recent Ornithodoros tick species, e.g. O. moubata and O. porcinus, O. moubata tick cells and also 100-year-old O. moubata and O. porcinus ticks using high-throughput sequencing. We used BLAST analyses for the identification of ASFV-like sequences and further analysed the data through phylogenetic reconstruction and molecular clock analyses. In addition, we performed tick infection experiments as well as additional small RNA sequencing of O. moubata and O. porcinus soft ticks.

Conclusion

Here, we show that soft ticks of the Ornithodoros moubata group, the natural arthropod vector of ASFV, harbour African swine fever virus-like integrated (ASFLI) elements corresponding to up to 10% (over 20 kb) of the ASFV genome. Through orthologous dating and molecular clock analyses, we provide data suggesting that integration could have occurred over 1.47 million years ago. Furthermore, we provide data showing ASFLI-element specific siRNA and piRNA in ticks and tick cells allowing for speculations on a possible role of ASFLI-elements in RNA interference-based protection against ASFV in ticks. We suggest that these elements, shaped through many years of co-evolution, could be part of an evolutionary virus-vector ‘arms race’, a finding that has not only high impact on our understanding of the co-evolution of viruses with their hosts but also provides a glimpse into the evolution of ASFV.
LDL-C: lower is better for longer—even at low risk
Authors: Penson Peter E. , Pirro Matteo , Banach Maciej
Published: October 2020

Background

Low-density lipoprotein cholesterol (LDL-C) causes atherosclerotic disease, as demonstrated in experimental and epidemiological cohorts, randomised controlled trials, and Mendelian randomisation studies.

Main text

There is considerable inconsistency between existing guidelines as to how to effectively manage patients at low overall risk of cardiovascular disease (CVD) who have persistently elevated levels of LDL-C.

We propose a step-by-step practical approach for the management of cardiovascular risks in individuals with low (< 1%) 10-year risk of CVD, and elevated (> 140 mg/dL, 3.6 mmol/L) LDL-C. The strategy proposed is based on the level of adherence to lifestyle interventions (LSI), and in case of non-adherence, stepwise practical management, including lipid-lowering therapy, is recommended to achieve a target LDL-C levels (< 115 mg/dL, 3.0 mmol/L).

Conclusions

Further studies are necessary to answer the questions on the long-term efficacy, safety, and cost-effectiveness of the suggested approach. This is critical, considering the ever-increasing numbers of such low-risk patients seen in clinical practice.
RETRACTED ARTICLE: Aging-related tumor associated fibroblasts changes could worsen the prognosis of GBM patients
Authors: Song Hongwang , Fu Xiaojun , Wu Chenxing , Li Shouwei
Published: October 2020

Background

Glioblastoma multiforme (GBM) is the most malignant tumor in human brain, with highly heterogeneity among different patients. Age could function as an incidence and prognosis risk factor for many tumors.

Method

A series of bioinformatic experiments were conducted to evaluate the differences of incidence, differential expressed genes, enriched pathways with the data from Surveillance, Epidemiology, and End Results (SEER) program, the cancer genome atlas (TCGA) and Chinese glioma genome atlas (CGGA) project.

Results

We discovered in our present study that distinct difference of incidence and prognosis of different aged GBM patients. By a series of bioinformatic method, we found that the tumor associated fibroblasts (TAFs) was the most crucial tumor microenvironment (TME) component that led to this phenomenon. Epithelial-mesenchymal transition (EMT) could be the mechanism by which TAFs regulate the progression of GBM.

Conclusion

We have proposed a close correlation between age and GBM incidence and prognosis, and propose the underlying mechanism behind this correlation by mining different databases, which laid the foundation for future research.
Researchers’ perceptions of malaria eradication: findings from a mixed-methods analysis of a large online survey
Authors: Brew Joe , Pradhan Menno , Broerse Jacqueline , Bassat Quique
Published: October 2020

Background

The value of malaria eradication, the permanent reduction to zero of the worldwide incidence of malaria infection caused by human malaria parasites, would be enormous. However, the expected value of an investment in an intended, but uncertain, outcome hinges on the probability of, and time until, its fulfilment. Though the long-term benefits of global malaria eradication promise to be large, the upfront costs and uncertainty regarding feasibility and timeframe make it difficult for policymakers and researchers to forecast the return on investment.

Methods

A large online survey of 844 peer-reviewed malaria researchers of different scientific backgrounds administered in order to estimate the probability and time frame of eradication. Adjustments were made for potential selection bias, and thematic analysis of free text comments was carried out.

Results

The average perceived likelihood of global eradication among malaria researchers approximates the number of years into the future: approximately 10% of researchers believe that eradication will occur in the next 10 years, 30% believe it will occur in the next 30 years, and half believe eradication will require 50 years or more. Researchers who gave free form comments highlighted systemic challenges and the need for innovation as chief among obstacles to achieving global malaria eradication.

Conclusions

The findings highlight the difficulty and complexity of malaria eradication, and can be used in prospective cost–benefit analyses to inform stakeholders regarding the likely return on eradication-specific investments.
Age-dependent carriage of alleles and haplotypes of Plasmodium falciparum sera5, eba-175, and csp in a region of intense malaria transmission in Uganda
Authors: Agwang Constance , Erume Joseph , Okech Brenda , Olobo Joseph , Egwang Thomas G.
Published: October 2020

Background

The development of malaria vaccines is constrained by genetic polymorphisms exhibited by Plasmodium falciparum antigens. The project the age-dependent distribution of alleles or haplotypes of three P. falciparum malaria vaccine candidates, Circumsporozoite Protein (csp), Erythrocyte Binding Antigen 175 (eba-175) and Serine Repeat Antigen 5 (sera5) in a region of intense malaria transmission in Uganda.

Methods

A cross-sectional study was carried out between August and November 2009 in which 250 study participants were selected from a population of 600. Finger prick blood samples were collected after informed consent from participants below 5 years, 5–10 years, and above 10 years of age. Blood was used for microscopy, RDT and dried blood spots. Plasmodium falciparum DNA was extracted by chelex method. Alleles of sera5 and eba-175 were determined by polymerase chain reaction (PCR) amplification followed by resolution of products by agarose gel electrophoresis. Allele calling was done using gel photographs from ethiduim bromide stained gels. Haplotypes of csp were identified by sequencing 63 PCR products using the P. falciparum 7G8 laboratory strain sequence as a reference. The data were analysed using SPSS 16, EQX for windows and Chi-square test was used to calculate associations (P-values), Excel was used to generate graphs. The BioEdit and NCBI blast software programs were used to analyse the sequences from which csp haplotypes map was constructed.

Results

Eba-175 FCR3 (48/178) and CAMP (16/178) alleles were observed, the FCR3 (24/67) allele being predominant among children aged below 5 years old while the CAMP (12/67) allele was predominant among older participants. Sera5 alleles ORI (6/204) and ORII (103/204) were observed in the population, ORII was more prevalent and was significantly associated with age (P values < 0.0001), parasite density (P-value < 0.0001) and clinical outcomes (P value = 0.018). There was marked csp diversity in the Th2/Th3 region. Out of 63 sequences, 16 conformed to the reference strain and one (1/16) was similar to a West African haplotype and the majority (14/16) of the haplotypes were unique to this study region. There was an age-dependent distribution of csp haplotypes with more haplotypes being harbored by children < 5-year of age, (10/16) compared to adults (2/16). Interestingly, the csp haplotype corresponding to 3D7 whose prototypical sequence is identical to the sequence of the leading malaria vaccine candidate RTS, S was not observed.

Conclusion

This data suggest that the eba-175 FCR3 allele, sera5 ORII allele, and csp haplotypes are targets of host immunity and under immune selection pressure in Apac District. These molecules could provide alternative malaria vaccine candidates as sub-unit vaccines.
Malaria serology data from the Guiana shield: first insight in IgG antibody responses to Plasmodium falciparum, Plasmodium vivax and Plasmodium malariae antigens in Suriname
Authors: Labadie-Bracho Mergiory Y. , van Genderen Farah T. , Adhin Malti R.
Published: October 2020

Background

Suriname has accomplished a steep decline in malaria burden, even reaching elimination levels. Plasmodium serology data are not available for Suriname and even extremely scarce within the region, therefore malaria serology testing was introduced, country customized cut-off values were determined and a study was performed to explore the antibody status for Plasmodium falciparum, Plasmodium vivax and Plasmodium malariae.

Methods

A cross-sectional survey was conducted between July 2017 and March 2018 in two areas of the interior with different malaria settings: Stoelmanseiland, representing Maroon villages and Benzdorp, a gold mining area, with mostly Brazilian miners. Dried blood spots (DBS) were collected (n = 197) and antibody presence against seven Plasmodium antigens was detected using a multiplex bead-based, IgG antibody assay. Demographic information was gathered through a questionnaire. Country customized cut-off values were generated from a Surinamese malaria-naïve reference population (n = 50).

Results

Serological analysis for the reference population revealed cut-off values ranging from 14 MFI for LSA-1 to 177 MFI for PmMSP-119. Seroprevalence against any of the three MSP-119 antibodies was similar in both regions and surpassed 75%. Single seropositivity against PfMSP-119 antibodies was higher in Stoelmanseiland (27.0%) than Benzdorp (9.3%), in line with the historical malaria burden of Stoelmanseiland, while the reverse was observed for PvMSP-119 antibodies. Despite sporadic reports of P. malariae infections, PmMSP-119 antibody presence was 39.6%. A more detailed examination of P. falciparum serology data displayed a higher seroprevalence in villagers (90.7%) than in Brazilians (64.6%) and a highly diverse antigenic response with 22 distinct antibody combinations.

Conclusions

The results on the malaria antibody signature of Maroon villagers and Brazilian miners living in Suriname displayed a high Plasmodium seroprevalence, especially for P. falciparum in villagers, still reflecting the historical malaria burden. The seroprevalence data for both regions and the observed combinations of P. falciparum antibodies provided a valuable dataset from a historically important region to the international malaria serology knowledge. First insight in malaria serology data for Suriname indicated that the use of other target groups and assessment of age-dependent seroprevalence are required to successfully use malaria serology as tool in the national elimination strategy.
Spatial distribution of iron rich foods consumption and its associated factors among children aged 6–23 months in Ethiopia: spatial and multilevel analysis of 2016 Ethiopian demographic and health survey
Authors: Tiruneh Sofonyas Abebaw , Ayele Belete Achamyelew , Yitbarek Getachew Yideg , Asnakew Desalegn Tesfa , Engidaw Melaku Tadege , Gebremariam Alemayehu Digssie
Published: October 2020

Background

Micronutrient deficiencies are the most prevalent nutritional deficiencies that cause serious developmental problems in the globe. The aim of this study was to assess the spatial distribution of iron rich foods consumption and its associated factors among children aged 6–23 months in Ethiopia.

Methods

The data retrieved from the standard Ethiopian Demographic and Health Survey 2016 dataset with a total sample size of 3055 children aged 6–23 months. Spatial scan statistics done using Kuldorff’s SaTScan version 9.6 software. ArcGIS version 10.7 software used to visualize spatial distribution for poor consumption of iron rich foods. Multilevel mixed-effects logistic regression analysis employed to identify the associated factors for good consumption of iron-rich foods. Level of statistical significance was declared at a two-sided P-value < 0.05.

Results

Overall, 21.41% (95% CI: 19.9–22.9) of children aged 6–23 months had good consumption of iron rich foods in Ethiopia. Poor consumption of iron rich foods highly clustered at Southern Afar, Southeastern Amhara and Tigray, and the Northern part of Somali Regional States of Ethiopia. In spatial scan statistics, children aged 6–23 months living in the most likely cluster were 21% more likely vulnerable to poor consumption of iron rich foods than those living outside the window (RR = 1.21, P-value < 0.001). Child aged 12–17 months (AOR = 1.90, 95% CI: 1.45–2.49) and 18–23 months (AOR = 2.05, 95% CI: 1.55–2.73), primary (AOR = 1.42, 95% CI:1.06–1.87) and secondary and above (AOR = 2.26, 95% CI: 1.47–3.46) mother’s education level, rich (AOR = 1.49, 95% CI: 1.04–2.13) and middle (AOR = 1.83, 95% CI: 1.31–2.57) household wealth status, Amhara (AOR = 0.24, 95% CI: 0.09–0.60), Afar (AOR = 0.38, 95% CI: 0.17–0.84), and Harari (AOR = 2.11, 95% CI: 1.02–4.39) regional states of Ethiopia were statistically significant factors for good consumption of iron rich foods.

Conclusion

Overall, the consumption of iron rich foods was low and spatially non-random in Ethiopia. Federal Ministry of Health and other stakeholders should give prior attention to the identified hot spot areas to enhance the consumption of iron rich foods among children aged 6–23 months.