bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification and characterization of the TCA cycle genes in maize
Authors: Liu Yongming , Qu Jingtao , Zhang Ling , Xu Xiangyu , Wei Gui , Zhao Zhuofan , Ren Maozhi , Cao Moju
Published: December 2019

Background

The tricarboxylic acid (TCA) cycle is crucial for cellular energy metabolism and carbon skeleton supply. However, the detailed functions of the maize TCA cycle genes remain unclear.

Results

In this study, 91 TCA genes were identified in maize by a homology search, and they were distributed on 10 chromosomes and 1 contig. Phylogenetic results showed that almost all maize TCA genes could be classified into eight major clades according to their enzyme families. Sequence alignment revealed that several genes in the same subunit shared high protein sequence similarity. The results of cis-acting element analysis suggested that several TCA genes might be involved in signal transduction and plant growth. Expression profile analysis showed that many maize TCA cycle genes were expressed in specific tissues, and replicate genes always shared similar expression patterns. Moreover, qPCR analysis revealed that some TCA genes were highly expressed in the anthers at the microspore meiosis phase. In addition, we predicted the potential interaction networks among the maize TCA genes. Next, we cloned five TCA genes located on different TCA enzyme complexes, Zm00001d008244 (isocitrate dehydrogenase, IDH), Zm00001d017258 (succinyl-CoA synthetase, SCoAL), Zm00001d025258 (α-ketoglutarate dehydrogenase, αKGDH), Zm00001d027558 (aconitase, ACO) and Zm00001d044042 (malate dehydrogenase, MDH). Confocal observation showed that their protein products were mainly localized to the mitochondria; however, Zm00001d025258 and Zm00001d027558 were also distributed in the nucleus, and Zm00001d017258 and Zm00001d044042 were also located in other unknown positions in the cytoplasm. Through the bimolecular fluorescent complimentary (BiFC) method, it was determined that Zm00001d027558 and Zm00001d044042 could form homologous dimers, and both homologous dimers were mainly distributed in the mitochondria. However, no heterodimers were detected between these five genes. Finally, Arabidopsis lines overexpressing the above five genes were constructed, and those transgenic lines exhibited altered primary root length, salt tolerance, and fertility.

Conclusion

Sequence compositions, duplication patterns, phylogenetic relationships, cis-elements, expression patterns, and interaction networks were investigated for all maize TCA cycle genes. Five maize TCA genes were overexpressed in Arabidopsis, and they could alter primary root length, salt tolerance, and fertility. In conclusion, our findings may help to reveal the molecular function of the TCA genes in maize.
Anesthesiology and cognitive impairment: a narrative review of current clinical literature
Authors: Belrose Jillian C. , Noppens Ruediger R.
Published: December 2019

Background

The impact of general anesthesia on cognitive impairment is controversial and complex. A large body of evidence supports the association between exposure to surgery under general anesthesia and development of delayed neurocognitive recovery in a subset of patients. Existing literature continues to debate whether these short-term effects on cognition can be attributed to anesthetic agents themselves, or whether other variables are causative of the observed changes in cognition. Furthermore, there is conflicting data on the relationship between anesthesia exposure and the development of long-term neurocognitive disorders, or development of incident dementia in the patient population with normal preoperative cognitive function. Patients with pre-existing cognitive impairment present a unique set of anesthetic considerations, including potential medication interactions, challenges with cooperation during assessment and non-general anesthesia techniques, and the possibility that pre-existing cognitive impairment may impart a susceptibility to further cognitive dysfunction.

Main body

This review highlights landmark and recent studies in the field, and explores potential mechanisms involved in perioperative cognitive disorders (also known as postoperative cognitive dysfunction, POCD). Specifically, we will review clinical and preclinical evidence which implicates alterations to tau protein, inflammation, calcium dysregulation, and mitochondrial dysfunction. As our population ages and the prevalence of Alzheimer’s disease and other forms of dementia continues to increase, we require a greater understanding of potential modifiable factors that impact perioperative cognitive impairment.

Conclusions

Future research should aim to further characterize the associated risk factors and determine whether certain anesthetic approaches or other interventions may lower the potential risk which may be conferred by anesthesia and/or surgery in susceptible individuals.
Point-of-care versus central testing of hemoglobin during large volume blood transfusion
Authors: Herman Justin , Park Brian , Awsare Bharat , West Frances , Crittendon Denine , Evans Lilah , Harach Mary , Karp Julie , Peedin Alexis , LaNoue Marianna , Goldsmith Barbara , Warnick Eugene , Baram Michael
Published: December 2019

Background

Point-of-care (POC) hemoglobin testing has the potential to revolutionize massive transfusion strategies. No prior studies have compared POC and central laboratory testing of hemoglobin in patients undergoing massive transfusions.

Methods

We retrospectively compared the results of our point-of-care hemoglobin test (EPOC®) to our core laboratory complete blood count (CBC) hemoglobin test (Sysmex XE-5000™) in patients undergoing massive transfusion protocols (MTP) for hemorrhage. One hundred seventy paired samples from 90 patients for whom MTP was activated were collected at a single, tertiary care hospital between 10/2011 and 10/2017. Patients had both an EPOC® and CBC hemoglobin performed within 30 min of each other during the MTP. We assessed the accuracy of EPOC® hemoglobin testing using two variables: interchangeability and clinically significant differences from the CBC. The Clinical Laboratory Improvement Amendments (CLIA) proficiency testing criteria defined interchangeability for measurements. Clinically significant differences between the tests were defined by an expert panel. We examined whether these relationships changed as a function of the hemoglobin measured by the EPOC® and specific patient characteristics.

Results

Fifty one percent (86 of 170) of paired samples’ hemoglobin results had an absolute difference of ≤7 and 73% (124 of 170) fell within ±1 g/dL of each other. The mean difference between EPOC® and CBC hemoglobin had a bias of − 0.268 g/dL (p = 0.002). When the EPOC® hemoglobin was < 7 g/dL, 30% of the hemoglobin values were within ±7, and 57% were within ±1 g/dL. When the measured EPOC® hemoglobin was ≥7 g/dL, 55% of the EPOC® and CBC hemoglobin values were within ±7, and 76% were within ±1 g/dL. EPOC® and CBC hemoglobin values that were within ±1 g/dL varied by patient population: 77% for cardiac surgery, 58% for general surgery, and 72% for non-surgical patients.

Conclusions

The EPOC® device had minor negative bias, was not interchangeable with the CBC hemoglobin, and was less reliable when the EPOC® value was < 7 g/dL. Clinicians must consider speed versus accuracy, and should check a CBC within 30 min as confirmation when the EPOC® hemoglobin is < 7 g/dL until further prospective trials are performed in this population.
The prevalence, awareness, management and control of hypertension in men and women in Benin, West Africa: the TAHES study
Authors: Desormais Ileana , Amidou Salimanou Ariyoh , Houehanou Yessito Corine , Houinato Stephan Dismand , Gbagouidi Gwladys Nadia , Preux Pierre Marie , Aboyans Victor , Lacroix Philippe
Published: December 2019

Background

Due to epidemiological transitions, Sub-Saharan Africa is facing a growing burden of non-communicable diseases, including cardiovascular diseases (CVDs). Among their risk factors, hypertension is a major determinant of CVDs, but the prevalence and level of awareness and management of this condition are poorly studied in African populations. The aim of this study was to determine the prevalence of hypertension and identify its associated risk factors as well as the awareness and management of this condition in a community-dwelling cohort in Benin.

Methods

A cross-sectional door-to-door study was conducted in the population over the age of 25 years in Tanve, a rural setting in Benin. The questionnaire and anthropometric measurements of the World Health Organization STEPWISE survey were used. Blood pressure was measured using standard procedures.

Results

The sample included 1777 subjects (60.9% females, mean age was 42.5 ± 16.5 years). The prevalence of hypertension was 32.9%, similar in men (32.8%) and women (33.0%, p = 0.9342). Age and obesity were significantly associated with hypertension. Less than half (42%) of hypertensive people were aware about their condition and only 46.3% of them were treated. Awareness ratios differed between men and women (respectively 32.9% vs. 47.5%; p = 0.0039) and was not influenced by age, education, occupation, marital status or income. Female sex was the only factor associated with better controlled HTN, independent of socio-economic parameters.

Conclusion

This large population-based study confirms the high prevalence, low awareness, and low control of hypertension in men and women in sub-Saharan Africa. Only half of the populations with hypertension are aware of their hypertension, indicating a high burden of undiagnosed and un-controlled high blood pressure in these populations.
First-degree relatives with similar phenotypic characterisation of acute myocardial infarction: a case report and review of the literature
Authors: Hao Yi-Dan , Ohene Bright Eric , Yang Shi-Wei , Zhou Yu-Jie
Published: December 2019

Background

Genetic susceptibility to the development of coronary artery disease (CAD) and myocardial infarction (MI) is well established. However, lack of replication, and difficulty in the identification of specific genes that underlie impressive linkage peaks remain challenges at the molecular level due to the heterogeneity of phenotype and their associated genotypes. We present two cases of first-degree family members of acute myocardial infarction (AMI) having similar clinical and angiographic features of obstructive coronary lesions at same anatomic locations.

Case presentation

The father presented with significant chest discomfort and loss of consciousness. The electrocardiogram (ECG) showed an acute anterior ST-segment–elevation myocardial infarction (STEMI). Coronary angiogram demonstrated a subtotal occlusion in the mid-left anterior descending (LAD) coronary artery. One week later, the son presented after an in-hospital cardiac arrest with pulseless electric activity preceded by significant chest pain and loss of consciousness. His ECG also showed an acute anterior STEMI. Catheterization revealed strikingly similar angiographic characteristics with his father: subtotal occlusion in the proximal to mid-LAD coronary artery.

Conclusions

More considerations should be given to patients with similar phenotypic characterization in genetic studies of CAD/MI in the future.
The frequency and impact of admission hyperglycemia on short term outcome of acute stroke patients admitted to Tikur Anbessa Specialized hospital, Addis Ababa, Ethiopia: a cross-sectional study
Authors: Zewde Yared Zenebe , Mengesha Abenet Tafesse , Gebreyes Yeweynhareg Feleke , Naess Halvor
Published: December 2019

Background

Admission hyperglycemia (HG) has been associated with worse outcomes among acute stroke patients. A better understanding and awareness of the potentially adverse influence of hyperglycemia on the clinical outcome of acute stroke patients would help to provide guidance for acute stroke management and prevention of its adverse outcomes. We aimed to assess the frequency of admission hyperglycemia and its impact on short term (30-days) morbidity and mortality outcomes of stroke in adult Ethiopian patients in an urban setting.

Methods

A prospective, cross-sectional study was conducted among acute stroke patients admitted to Tikur Anbessa Specialized Hospital (TASH), within 72 h of symptom onset, from July to December 2016. Socio-demographic data, neuroimaging findings and capillary blood glucose values were obtained on admission. Hyperglycemia was defined as > 140 mg/dl. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the baseline stroke severity and the 30-days post-stroke outcome, respectively.

Results

A total of 103 first-ever acute stroke patients were included (mean age = 55.5 + 15.3 years, 64.1% male and 65% under the age of 65 years) and 51 (49.5%) were hyperglycemic at time of admission. The median admission NIHSS score was worse in the hyperglycemic patients 14 (IQR 10–19) compared to normoglycemic patients 11 (IQR 8–15). Among stroke survivors, patients with hyperglycemia were 3.83 times (95% CI, 1.99–6.19) more likely to be functionally impaired (mRS = 3–5) at 30-days compared to normoglycemic patients (P = 0.041).Older age (≥ 65 years) (P = 0.017) and stroke severity (NIHSS > 14) (P = 0.006) at admission were both significantly associated with poor functional recovery at 30-day. Among patients who died at 30-day, two-third (66.7%) were hyperglycemic but they failed to show any significant association.

Conclusions

Hyperglycemia is prevalent among Ethiopian stroke patients at the time of presentation and it is associated with significantly poor functional recovery at 30th-day of follow up. This finding provides a rationale for achieving normal blood glucose in the course of acute stroke management which could have a favorable impact on the neurological outcome and quality of life for patients.
Predicting the serum digoxin concentrations of infants in the neonatal intensive care unit through an artificial neural network
Authors: Yao Shu-Hui , Tsai Hsiang-Te , Lin Wen-Lin , Chen Yu-Chieh , Chou Chiahung , Lin Hsiang-Wen
Published: December 2019

Background

Given its narrow therapeutic range, digoxin’s pharmacokinetic parameters in infants are difficult to predict due to variation in birth weight and gestational age, especially for critically ill newborns. There is limited evidence to support the safety and dosage requirements of digoxin, let alone to predict its concentrations in infants. This study aimed to compare the concentrations of digoxin predicted by traditional regression modeling and artificial neural network (ANN) modeling for newborn infants given digoxin for clinically significant patent ductus arteriosus (PDA).

Methods

A retrospective chart review was conducted to obtain data on digoxin use for clinically significant PDA in a neonatal intensive care unit. Newborn infants who were given digoxin and had digoxin concentration(s) within the acceptable range were identified as subjects in the training model and validation datasets, accordingly. Their demographics, disease, and medication information, which were potentially associated with heart failure, were used for model training and analysis of digoxin concentration prediction. The models were generated using backward standard multivariable linear regressions (MLRs) and a standard backpropagation algorithm of ANN, respectively. The common goodness-of-fit estimates, receiver operating characteristic curves, and classification of sensitivity and specificity of the toxic concentrations in the validation dataset obtained from MLR or ANN models were compared to identify the final better predictive model.

Results

Given the weakness of correlations between actual observed digoxin concentrations and pre-specified variables in newborn infants, the performance of all ANN models was better than that of MLR models for digoxin concentration prediction. In particular, the nine-parameter ANN model has better forecasting accuracy and differentiation ability for toxic concentrations.

Conclusion

The nine-parameter ANN model is the best alternative than the other models to predict serum digoxin concentrations whenever therapeutic drug monitoring is not available. Further cross-validations using diverse samples from different hospitals for newborn infants are needed.
Reasons and multilevel factors associated with unscheduled contraceptive use discontinuation in Ethiopia: evidence from Ethiopian demographic and health survey 2016
Authors: Weldemariam Kibrom Taame , Gezae Kebede Embaye , Abebe Haftom Temesgen
Published: December 2019

Background

Contraceptive discontinuations for reasons other than the desire for pregnancy are a public health concern because of their negative effect on reproductive health outcomes. In Ethiopia, the contraceptive discontinuation rate is increasing; however the factors associated are poorly understood. So this study was aimed at assessing reasons and multilevel factors for unscheduled contraceptive use discontinuation.

Methods

This is a cross-sectional study of Ethiopian women who participated in the Ethiopian demographic health survey from January 18, 2016, to June 27, 2016. Ever using any contraceptive with in the calendar of the survey were an inclusion criteria for which 3835 women were found eligible. The data were analyzed using multilevel binary logistic regression in STATA version 14. Variables with p-value less than 0.05 were considered as statistically significant, and reported using adjusted odds ratio and 95% confidence interval. Median odds ratio and interval odds ratio, to quantify the magnitude of the general and specific contextual effect respectively, were used. Receiver operating characteristics curve and akaike’s information criterion were used for model comparison.

Result

The prevalence of unscheduled contraceptive use discontinuation was 46.18% for the principal reason of method related problems (Side effects-45.3%, needing better method-33.6%, and inconvenience-21.1%,). Women heading a household (AOR = 1.281, 95%CI 1.079–1.520), women who had no work (AOR = 0.812, 95%CI 0.673, 0.979) compared to professionals, living in poorest house hold income (AOR = 0.753, 95%CI 0.567, 0.997) compared to middle, residing in community with low contraceptive utilization rate (AOR = 1.945, 95%CI 1.618, 2.339), residing in poor community (AOR = 0.763, 95%CI 0.596–0.997), and having more children, and region were found to be significant predictors of unscheduled contraceptive use discontinuation.

Conclusion

Method related problems were found to contribute for more than half of the contraceptive use discontinuation. Both individual and community level factors were found to significantly influence the Unscheduled contraceptive use discontinuation. The outcome was common in groups who could have more social interactions and knowledge on which myths and rumors are common. So strengthening the efforts to reduce contraceptive use discontinuation and quality of contraceptive service provision could be important.
Non-invasive skin autofluorescence, blood and urine assays of the advanced glycation end product (AGE) pentosidine as an indirect indicator of AGE content in human bone
Authors: Kida Yoshikuni , Saito Mitsuru , Shinohara Akira , Soshi Shigeru , Marumo Keishi
Published: December 2019

Background

Bone mineral density (BMD) measurements are widely used to assess fracture risk. However, the finding that some fracture patients had high BMD together with the low contribution of drugs to osteoporosis suggests that bone strength factors other than BMD contribute to bone quality. We evaluated the amount of advanced glycation end products (AGEs) by non-invasive assays of serum and urine as well as by skin autofluorescence to measure the levels of a representative AGE, pentosidine, to investigate whether pentosidine can serve as an indirect indicator of AGEs formation in bone collagen.

Methods

A total of 100 spinal surgery patients without fragility fracture (54 males and 46 females) treated at our hospital were enrolled. The amount of pentosidine in blood, urine, skin and bone (lumbar lamina) samples from these patients was measured. AGE accumulation was assessed by measuring skin autofluorescence. We examined the correlation between pentosidine content in tissues and body fluid, as well as skin AGEs with age, height, body weight, BMI, and estimated glomerular filtration rate (eGFR).

Results

A significant age-related increase in pentosidine levels in tissues was observed, while there was a significant negative correlation between tissue pentosidine and eGFR. The amount of skin pentosidine was significantly and positively correlated with pentosidine content of the bone in those under 50 years of age. Urine pentosidine also correlated positively with bone pentosidine and skin pentosidine, but only in females. The total amount of AGEs in skin did not correlate with bone pentosidine.

Conclusion

In this study, the strong correlation between the pentosidine content in each sample and eGFR may indicate that renal dysfunction with advancing age increases oxidative stress and induces AGEs formation in collagen-containing tissues. The correlation of skin pentosidine concentration and eGFR, with AGEs formation in bone collagen suggests that pentosidine would be a useful indirect index of decreased bone quality. Skin AGEs estimated by autofluorescence in clinical situations may not be suitable as an indirect assessment of bone quality. Because urine pentosidine correlated positively with bone pentosidine and skin pentosidine in females, urine pentosidine may be a candidate for an indirect assessment of bone quality.
The association of circulating irisin with metabolic risk factors in Chinese adults: a cross-sectional community-based study
Authors: Tang Lizhi , Tong Yuzhen , Zhang Fang , Chen Guilin , Zhang Yun Cong , Jobin John , Tong Nanwei
Published: December 2019

Background

Irisin is a myokine that leads to increased energy expenditure by stimulating the browning of white adipose tissue. We aimed to investigate the association of serum irisin levels with metabolic parameters in middle aged Chinese population.

Methods

The study was based on a cross-sectional analysis of data from 524 nondiabetic subjects aged 40~65. All participants were recruited from a screening survey for Metabolic Syndrome in a community in Southwest China, including 294 subjects categorized as overweight (defined as BMI≧25 kg/m2) and 230 subjects as normal control (defined as 18.5≦BMI < 25 kg/m2). Serum irisin concentration was quantified by enzyme linked immunosorbent assay (ELISA). The relationship of irisin with metabolic factors was determined by Pearson correlation. Multivariate linear regression was used to analyze the association of irisin with insulin resistance. Logistic regression was performed to assess the association of irisin with odds of overweight.

Results

Serum irisin levels were significantly lower in nondiabetic overweight subjects compared with control (11.46 ± 4.11vs14.78 ± 7.03 μg/mL, p = 0.02). Circulating irisin was positively correlated with quantitative insulin sensitivity check index (QUICKI, r = 0.178, p = 0.045) and triglycerides (r = 0.149, p = 0.022); while irisin was negatively correlated with waist circumference (WC, r = − 0.185, p = 0.037), waist-to-hip ratio (WHR, r = − 0.176, p = 0.047), fasting insulin (r = − 0.2, p = 0.024), serum creatinine (r = − 0.243, p = 0.006), homeostasis model assessment for insulin resistance (HOMA-IR, r = − 0.189, p = 0.033). Multiple linear regression showed that irisin was inversely associated with HOMA-IR (β = − 0.342 ± 0.154, p = 0.029). Higher irisin was associated with decreased odds of being overweight (OR = 0.281, β = − 1.271, p = 0.024).

Conclusions

We found that serum irisin levels were lower in overweight subjects. Moreover, serum irisin levels were inversely correlated with adverse metabolic parameters including WC, WHR, creatinine, HOMA-IR and fasting insulin, suggesting that irisin may play a role in obesity related insulin resistance.
Screening with the double surprise question to predict deterioration and death: an explorative study
Authors: Veldhoven C. M. M. , Nutma N. , De Graaf W. , Schers H. , Verhagen C. A. H. H. V. M. , Vissers K. C. P. , Engels Y.
Published: December 2019

Background

Early identification of palliative patients is challenging. The Surprise Question (SQ1; Would I be surprised if this patient were to die within 12 months?) is widely used to identify palliative patients. However, its predictive value is low. Therefore, we added a second question (SQ2) to SQ1: ‘Would I be surprised if this patient is still alive after 12 months?’ We studied the accuracy of this double surprise question (DSQ) in a general practice.

Methods

We performed a prospective cohort study with retrospective medical record review in a general practice in the eastern part of the Netherlands. Two general practitioners (GPs) answered both questions for all 292 patients aged ≥75 years (mean age 84 years).

Primary outcome was 1-year death, secondary outcomes were aspects of palliative care.

Results

SQ1 was answered with ‘no‘ for 161/292 patients. Of these, SQ2 was answered with ‘yes’ in 22 patients. Within 12 months 26 patients died, of whom 24 had been identified with SQ1 (sensitivity: 92%, specificity: 49%). Ten of them were also identified with SQ2 (sensitivity: 42%, specificity: 91%). The latter group had more contacts with their GP and more palliative care aspects were discussed.

Conclusions

The DSQ appears a feasible and easy applicable screening tool in general practice. It is highly effective in predicting patients in high need for palliative care and using it helps to discriminate between patients with different life expectancies and palliative care needs. Further research is necessary to confirm the findings of this study.
The last week of life of nursing home residents with advanced dementia: a retrospective study
Authors: Toscani Franco , Finetti Silvia , Giunco Fabrizio , Basso Ines , Rosa Debora , Pettenati Francesca , Bussotti Alessandro , Villani Daniele , Gentile Simona , Boncinelli Lorenzo , Monti Massimo , Spinsanti Sandro , Piazza Massimo , Charrier Lorena , Di Giulio Paola
Published: December 2019

Background

Barriers to palliative care still exist in long-term care settings for older people, which can mean that people with advanced dementia may not receive of adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The aim of this multicentre study was to assess the clinical interventions and care at end of life in a cohort of nursing home (NH) residents with advanced dementia in a large Italian region.

Methods

This retrospective study included a convenience sample of 29 NHs in the Lombardy Region. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the 7 days before death.

Results

Most residents (97.1%) died in the NH. In the 7 days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs were prescribed. Fifty-seven percent of residents had an acknowledgement of worsening condition recorded in their clinical records, a median of 4 days before death.

Conclusions

Full implementation of palliative care was not achieved in our study, possibly due to insufficient acknowledgement of the appropriateness of some drugs and interventions, and health professionals’ lack of implementation of palliative interventions. Future studies should focus on how to improve care for NH residents.
Mento’s change model in teaching competency-based medical education
Authors: Banerjee Yajnavalka , Tuffnell Christopher , Alkhadragy Rania
Published: December 2019

Background

Resistance to change is customary and is expected in any organization. However, most of the downsides of change can be avoided if the organization/individual prepares for the change by acknowledging guided strategies. In healthcare, change is the state of nature, which has also translated to medical education (ME). ME in the current era has undergone a shift from a traditional content-based curriculum to a competency-based curriculum. Recently, however, the broader social-accountability movement has accelerated this rate of transformation. One of the key challenges to educators harbingering this transformation to competency-based medical education (CBME) is to redesign the processes of teaching.

Aim

Here we define a framework designed using Mento’s model of change that will totally agree with introducing positive change in teaching in an institution undergoing transformation from a traditional content-based curriculum to a competency-based curriculum.

Methodology

Using Schein’s “unfreezing” as a guide term we critically reflected on the popular change-management models, to home in on Kotter’s model of change to transform organizations. However, Kotter’s change-model draws from Situational and Contingency Leadership Theories, which may not agree with academic organizations involved in ME. As such organizations adhere to Transactional and Transformational Leadership archetypes, where Leadership is constructively executed by “The Leader Team”, we decided to adopt Mento’s change-model for our study. Mento’s model not only draws from the precepts of Kotter’s model, but also incorporates axioms of Jick’s and GE’s change-models.

Results

Using Mento’s model a framework was blueprinted to implement active learning (AL) strategies in CBME. Here we have elaborated on the framework using the exemplar of flipped teaching. The development of this framework required the design and execution of a faculty development program, and a step by step guidance plan to chaperon, instruct and implement change in teaching to harbinger CBME. Further, we have also reflected on the change process using Gravin’s framework.

Conclusion

To our knowledge this is the first report of the use of Mento’s model of change in medical education. Also, the blueprinted framework is supported by acknowledged leadership theories and can be translated to implement any curricular change in CBME.
Medical students’ resilience: a protective role on stress and quality of life in clerkship
Authors: Lin Yung Kai , Lin Chia-Der , Lin Blossom Yen-Ju , Chen Der-Yuan
Published: December 2019

Background

Resilience refers to the ability to be flexible and adaptive in response to challenges. Medical students in clerkship who are transitioning from medical studies to clinical practice face a variety of workplace demands that can lead to negative learning experiences and poor quality of life. This study explored whether medical students’ resilience plays a protective role against the stresses incurred during workplace training and on their professional quality of life during clerkships.

Methods

This was a 1-year prospective web-based questionnaire study comprising one cohort of medical students in their fifth year who were working as clerks as part of their 6-year medical education programme at one medical school in Taiwan between September 2017 and July 2018. Web-based, validated, structured, self-administered questionnaires were used to measure the students’ resilience at the beginning of the clerkship and their perceived training stress (i.e. physical and psychological demands) and professional quality of life (i.e. burnout and compassion satisfaction) at each specialty rotation. Ninety-three medical students who responded to our specialty rotation surveys at least three times in the clerkship were included and hierarchical regressions were performed.

Results

This study verified the negative effects of medical students’ perceived training stress on burnout and compassion satisfaction. However, although the buffering (protective) effects of resilience were observed for physical demands (one key risk factor related to medical students’ professional quality of life), this was not the case for psychological demands (another key risk factor). In addition, through the changes in R square (∆R2) values of the hierarchical regression building, our study found that medical students’ perceived training stresses played a critical role on explaining their burnout but their resilience on their compassion satisfaction.

Conclusions

Medical students’ resilience demonstrated a buffering effect on the negative relationship between physical demands and professional quality of life during clerkships. Moreover, different mechanisms (predictive paths) leading to medical students’ professional quality of life such as burnout and compassion satisfaction warrant additional studies.
Preferences for HIV testing services among young people in Nigeria
Authors: Nwaozuru Ucheoma , Iwelunmor Juliet , Ong Jason J. , Salah Sawsan , Obiezu-Umeh Chisom , Ezechi Oliver , Tucker Joseph D.
Published: December 2019

Background

Despite high HIV incidence rates among young people in Nigeria, less than 24% of this population have ever tested for HIV. These low HIV testing rates suggest that current testing services may not align with their testing preferences. To address this gap, the objective of this study was to assess preferences for HIV testing options among young people in Nigeria.

Methods

We conducted a cross-sectional study using survey to assess preferences for HIV testing options among 113 youth aged 14–24 years residing in Nigeria. The survey included a series of hypothetical HIV testing options, comprised of six characteristics centered around HIV testing service (i.e. location of testing, test administrator, mode of pre-test, mode of post-test counseling, type of HIV test, and cost of HIV test). For each characteristic, participants were asked to select one of the options that they prefer or indicate none of the above. A descriptive analysis of the preferences made by participants was conducted, summarizing proportions of participants who selected different options for HIV testing.

Results

The mean age of study participants was 19.5 years old (SD = 2.7). Most youth (73, 64.6%) had at least a secondary school degree. There was pronounced heterogeneity in HIV testing preferences among young people. Although most youth preferred free HIV testing, 14 (16.7%) reported preferring paying a small amount compared to free testing. More youth preferred blood-based HIV self-testing 39(48.8%) compared to facility-based HIV testing and oral HIV self-testing.

Conclusions

Our finding suggest that young people have a range of HIV testing preferences in Nigeria. This suggests that a “one-size-fits-all” approach to delivering services to youth may be challenging in this context. HIV testing services can be optimized to reach young people if a variety options are provided to meet their unique preferences.
Prognostic nomograms for predicting cause-specific survival and overall survival of stage I–III colon cancer patients: a large population-based study
Authors: Zhou Zheng , Mo Shaobo , Dai Weixing , Xiang Wenqiang , Han Lingyu , Li Qingguo , Wang Renjie , Liu Lu , Zhang Long , Cai Sanjun , Cai Guoxiang
Published: December 2019

Background

The purpose of this study was to build functional nomograms based on significant clinicopathological features to predict cause-specific survival (CSS) and overall survival (OS) in patients with stage I–III colon cancer.

Methods

Data on patients diagnosed with stage I–III colon cancer between 2010 and 2015 were downloaded from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox analyses were used to identify independent prognostic factors, which were used to construct nomograms to predict the probabilities of CSS and OS. The performance of the nomogram was assessed by C-indexes, receiver operating characteristic (ROC) curves and calibration curves. Decision curve analysis (DCA) was used to compare clinical usage between the nomogram and the tumor–node–metastasis (TNM) staging system.

Results

Based on the univariate and multivariate analyses, features that correlated with survival outcomes were used to establish nomograms for CSS and OS prediction. The nomograms showed favorable sensitivity at predicting 1-, 3-, and 5-year CSS and OS, with a C-index of 0.78 (95% confidence interval (CI) 0.77–0.80) for CSS and 0.74 (95% CI 0.73–0.75) for OS. Calibration curves and ROC curves revealed excellent predictive accuracy. The clinically and statistically significant prognostic performance of the nomogram generated with the entire group of patients and risk scores was validated by a stratified analysis. DCA showed that the nomograms were more clinically useful than TNM stage.

Conclusion

Novel nomograms based on significant clinicopathological characteristics were developed and can be used as a tool for clinicians to predict CSS and OS in stage I–III colon cancer patients. These models could help facilitate a personalized postoperative evaluation.
Impact of vector control interventions on malaria transmission intensity, outdoor vector biting rates and Anopheles mosquito species composition in Tororo, Uganda
Authors: Musiime Alex K. , Smith David L. , Kilama Maxwell , Rek John , Arinaitwe Emmanuel , Nankabirwa Joaniter I. , Kamya Moses R. , Conrad Melissa D. , Dorsey Grant , Akol Anne M. , Staedke Sarah G. , Lindsay Steve W. , Egonyu James P.
Published: December 2019

Background

Long-lasting insecticidal nets (LLINs) and indoor residual spraying of insecticide (IRS) are widely recommended for the prevention of malaria in endemic regions. Data from human landing catches provide information on the impact of vector control on vector populations. Here, malaria transmission indoors and outdoors, before and after mass deployment of LLINs and IRS in Uganda was compared.

Methods

The study took place in Tororo district, a historically high transmission area where universal LLIN distribution was conducted in November 2013 and May 2017 and 6 rounds of IRS implemented from December 2014 to July 2018. Human landing catches were performed in 8 houses monthly from October 2011 to September 2012 (pre-intervention period) and every 4 weeks from November 2017 to October 2018 (post-intervention period). Mosquitoes were collected outdoors from 18:00 to 22:00 h and indoors from 18:00 to 06:00 h. Female Anopheles were tested for the presence of Plasmodium falciparum sporozoites and species identification performed using gross dissection and polymerase chain reaction (PCR).

Results

The interventions were associated with a decline in human biting rate from 19.6 to 2.3 female Anopheles mosquitoes per house per night (p < 0.001) and annual entomological inoculation rate from 129 to 0 infective bites per person per year (p < 0.001). The proportion of mosquitoes collected outdoors increased from 11.6 to 49.4% (p < 0.001). Prior to the interventions the predominant species was Anopheles gambiae sensu stricto (s.s.), which comprised an estimated 76.7% of mosquitoes. Following the interventions, the predominant species was Anopheles arabiensis, which comprised 99.5% of mosquitoes, with almost complete elimination of An. gambiae s.s. (0.5%).

Conclusions

Mass distribution of LLINs and 6 rounds of IRS dramatically decreased vector density and sporozoite rate resulting in a marked reduction in malaria transmission intensity in a historically high transmission site in Uganda. These changes were accompanied by a shift in vector species from An. gambiae s.s. to An. arabiensis and a relative increase in outdoor biting.
Analyzing brain structural differences associated with categories of blood pressure in adults using empirical kernel mapping-based kernel ELM+
Authors: Yu Xinying , Peng Bo , Xue Zeyu , Rad Hamidreza Saligheh , Cai Zhenlin , Shi Jun , Zhu Jianbing , Dai Yakang
Published: December 2019

Background

Hypertension increases the risk of angiocardiopathy and cognitive disorder. Blood pressure has four categories: normal, elevated, hypertension stage 1 and hypertension stage 2. The quantitative analysis of hypertension helps determine disease status, prognosis assessment, guidance and management, but is not well studied in the framework of machine learning.

Methods

We proposed empirical kernel mapping-based kernel extreme learning machine plus (EKM–KELM+) classifier to discriminate different blood pressure grades in adults from structural brain MR images. ELM+ is the extended version of ELM, which integrates the additional privileged information about training samples in ELM to help train a more effective classifier. In this work, we extracted gray matter volume (GMV), white matter volume, cerebrospinal fluid volume, cortical surface area, cortical thickness from structural brain MR images, and constructed brain network features based on thickness. After feature selection and EKM, the enhanced features are obtained. Then, we select one feature type as the main feature to feed into KELM+, and the rest of the feature types are PI to assist the main feature to train 5 KELM+ classifiers. Finally, the 5 KELM+ classifiers are ensemble to predict classification result in the test stage, while PI is not used during testing.

Results

We evaluated the performance of the proposed EKM–KELM+ method using four grades of hypertension data (73 samples for each grade). The experimental results show that the GMV performs observably better than any other feature types with a comparatively higher classification accuracy of 77.37% (Grade 1 vs. Grade 2), 93.19% (Grade 1 vs. Grade 3), and 95.15% (Grade 1 vs. Grade 4). The most discriminative brain regions found using our method are olfactory, orbitofrontal cortex (inferior), supplementary motor area, etc.

Conclusions

Using region of interest features and brain network features, EKM–KELM+ is proposed to study the most discriminative regions that have obvious structural changes in different blood pressure grades. The discriminative features that are selected using our method are consistent with the existing neuroimaging studies. Moreover, our study provides a potential approach to take effective interventions in the early period, when the blood pressure makes minor impacts on the brain structure and function.
Socio-economic inequality in malnutrition among children in India: an analysis of 640 districts from National Family Health Survey (2015–16)
Authors: Singh Shrikant , Srivastava Swati , Upadhyay Ashish Kumar
Published: December 2019

Background

Despite a fast-growing economy and the largest anti-malnutrition programme, India has the world’s worst level of child malnutrition. Despite India’s 50% increase in GDP since 1991, more than one third of the world’s malnourished children live in India. Among these, half of the children under age 3 years are underweight and a third of wealthiest children are over-nutrient. One of the major causes for malnutrition in India is economic inequality. Therefore, using the data from the fourth round of National Family Health Survey (2015–16), present study aims to examine the socio-economic inequality in childhood malnutrition across 640 districts of India.

Method

Concentration curve and generalized concentration index were used to examine the socioeconomic inequalities in malnutrition. However, regression-based decomposition methodology was used to decomposes the causes of inequality in childhood malnutrition.

Result

Result shows that about 38% children in India were stunted and 35% were underweight during 2015–16. Prevalence of stunting and underweight children varies considerably across Indian districts (13 to 65% and 7 to 67% respectively). Districts having the higher share of undernourished children is coming from the particular regions like central, east and west part of the country. On an average about 35% of household in a district having the access of safe drinking water and 42% of household in a district exposed to open defecation. The study found the inverse relationship between district’s economic development with childhood stunting and underweight. The concentration of stunted as well as underweight children were found in least developed districts of India. Decomposition approach found that practice of open defecation is positively influenced the inequality in stunting and underweight. Further, inequality in undernutrition is accelerated by the height and education of the mother, and availability of safe drinking water in a district.

Conclusions

The districts that lied out in a spectrum of developmental diversity are required some specific set of information’s that covering socio-economic, demographic and health-related quality of life of people in those backward districts. More generally, policies to avail improved water and sanitation facility to public and female literacy should be continued. It is also important to see that the benefits of both infrastructure and more general economic development are spread more evenly across districts.
Intelligence gain and social cost savings attributable to environmental lead exposure reduction strategies since the year 2000 in Flanders, Belgium
Authors: Remy Sylvie , Hambach Ramona , Van Sprundel Marc , Teughels Caroline , Nawrot Tim S. , Buekers Jurgen , Cornelis Christa , Bruckers Liesbeth , Schoeters Greet
Published: December 2019

Background

Recent lead (Pb) exposure reduction strategies enabled to lower children’s blood lead levels (B-Pb) worldwide. This study reports the estimated intelligence gain and social cost savings attributable to recent exposure reduction based on reported B-Pb levels observed in adolescents sampled within the framework of the Flemish Environment and Health Studies (FLEHS, Belgium), i.e. in 2003–2004 (FLEHSI), in 2008–2009 (FLEHSII), and in 2013–2014 (FLEHSIII).

Methods

Intelligence Quotient (IQ) loss per 100,000 individuals - attributable to B-Pb above 20 μg/L - was estimated based on widely accepted dose response functions between children’s B-Pb and IQ (− 1.88 IQ points for a duplication in B-Pb from 20 μg/L onwards; 95% Confidence Interval (CI): − 1.16;-2.59) and B-Pb exposure distribution parameters of FLEHS studies. The results were translated to the Flemish population of 15-year-olds. Given a 3-year time gap between subsequent sampling periods, the exposure distribution of each study was assumed 3 years prior to the study as well. Economic impact was estimated based on expected decrease in lifetime earnings (€ 19,464 per decreasing IQ point in 2018).

Results

The percentage of the adolescent population exceeding a B-Pb of 20 μg/L decreased from 57% (FLEHSI) to 23% (FLEHSII), and even further to 2.5% (FLEHSIII). The estimated IQ loss per 100,000 individuals was 94,280 (95% CI: 58,427-130,138) in FLEHSI, 14,993 (95% CI: 9289-20,695) in FLEHSII, and 976 (95% CI: 604–1347) in FLEHSIII. This translates into a total loss of 378,962 (95%CI: 234,840-523,091) IQ points within the Flemish population of 15-year-olds between 2000 and 2014. Assuming that current exposure levels do not reincrease, the expected IQ loss during the subsequent period of 15 years is estimated to be maximally 10,275 (95%CI: 6363-14,182) points.

Conclusions

7176 (95%CI: 4447-9905) million € of social cost savings were achieved by Pb reduction strategies in Flanders over 15 years. If current exposure levels further reduce to B-Pb below 20 μg/L for the whole population, social cost savings may increase up to 7376 (95%CI: 4571-10,181) million €. Given the relatively low lead contamination in Flanders, the global impact of ongoing reduction strategies is expected to be tremendous.