bluuebunny/crossref_metadata_2025 huggingface dataset:
Planning Structure Transformation Strategies for Satellite Cities of the Minsk Agglomeration
Authors: Zholud’ N. I.
Published: October 2020

Determination of  strategies for the formation of satellite cities of Minsk is the basis for the development of a polycentric model of the metropolitan agglomeration. On the basis of the comparative analysis of design solutions for master plans, a concept for improving the planning structure and functional organization of satellite cities has been proposed in the paper. The concept is to adapt their planning structure to one of the promising economic profiles (industrial, scientific and industrial, agrarian and industrial, tourism and recreation). In accordance with the concept, there are four main types of the planning structure of satellite cities that correlate with their city-forming specifics: an urbanized planning structure (type У) – an industrial city, an urbanized-natural structure (type УП) – a scientific-industrial city, a natural-urbanized structure (type ПУ) – agricultural  and  industrial  city and a natural  structure (type П) – tourist and recreational  city.  The selected period (20–30 years). While developing master plans, it is necessary to distinguish two main directions of transformation: transformation and development. The implementation of the first direction is provided by two strategies – fragmentation and defragmentation as well as four varieties of each strategy. Spatial development strategies are consolidation, vector growth, sector growth, radial growth. Particular attention is paid to the analysis of possible options for the placement of functional zones, depending on the distance of the city from the core city. Taking into account the identified strategies for spatial development and analysis of the location of satellite cities in the Minsk agglomeration, twelve planning models have been developed that can be used to create urban planning projects to improve the functional planning organization of settlements in the Minsk agglomeration.
Intelligent Model of Potential Risks in Emergence of Man-Made Disaster
Authors: Gulay A. V. , Zaitsev V. M.
Published: October 2020

A man-made catastrophe is considered as an information display of catastrophic development of events in the management system, a peculiar projection of  a man-made catastrophe on the information plane. The paper presents an intellectual model, considers dynamics and ranges of emergency changes in management system parameters, assesses potential risks and  threats  of  catastrophe  emergence.  It  has been  shown  that  at  the  macro-structural  level  for  semantic   description of a catastrophe, it is quite effective to use a tree-like network of scenarios, which displays the conceptual scheme of the subject and problem areas of the catastrophe and is based on judgments of experts, their experience and intuition. This allows probabilistic methods  to  assess  potential  risks  of  a catastrophe using two quantitative indicators: risk (probability) level of  phenomenon occurrence at a certain control point of time and the volume of the expected material loss. It has been suggested that for assessment of possible microstate the fuzzy logic should be applied for each critical object parameter, tolerance limits and functions of affiliation with the fields of fail-safe object functioning should be set by expertise, migration trajectories of relative parameter values should be monitored and terms of their forced return to the working field of regular functioning should be duly provided. Quantitative indicators having imprecise origin have been introduced in the intelligent model of potential risks to assess dynamics of catastrophe threat. One of these indicators is the expert level of catastrophe occurrence during migration of a group of abnormally dangerous parameters of a technical object. The time interval has also been considered which is measured from the current moment to the expected moment of catastrophe occurrence at the preset maximum permissible level of catastrophe threat.
Patient autonomy in dentistry – demonstrating the role for shared decision making
Authors: Benecke Mareike , Kasper Jürgen , Heesen Christoph , Schäffler Nina , Reissmann Daniel R.
Published: October 2020

Background: Evidence-based practice, decision aids, patient preferences and autonomy preferences (AP) play an important role in making decisions with the patient. They are crucial in the process of a shared decision making (SDM) and can be incorporated into quality criteria for patient involvement in health care. However, there are few studies on SDM and AP in the field of dentistry. This study explored patients’ autonomy preferences in dentistry in comparison to other medical domains, comparing them with patient preferences in two other cohorts of patients with different conditions and in different health care settings.Methods: A sample of 100 dental patients attending 16 dentists was consecutively recruited in a university-based prosthodontic clinic. Patients’ and dentists’ preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions were compared using the Control Preference Scale (CPS). This was followed by cross sectional surveys to study autonomy preferences in three additional cohorts recruited from general practices (n=100), a multiple sclerosis clinic (n=109), and a university-based prosthodontic clinic (n=100). A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in the additional cohorts. Results: Dentists were less willing to give patients control than patients were willing to enact autonomy. However, decisions about management of tooth loss were considered relevant for a shared decision making by both parties. When comparing cohorts from different samples, the highest AP was expressed by people with multiple sclerosis and the lowest by patients in dentistry (means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p=.035). There were considerable intra-individual differences in autonomy preferences referring to different decision types (p<.001). In general, more autonomy was desired for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p<.001).Conclusion: There is an important role of patient participation in decision making in dentistry. Furthermore, PA should be considered with respect to specific medical decisions instead of assessing autonomy preferences in general implying a need for communication skills training of health care professionals.
Catalytic hydrolysis of CFC-12 over MoO3/ZrO2 -TiO2 solid acid
Authors: Li Zhiqian , Zhou Tong , Ren Guoqing , Tan Xiaofang , Jia Lijuan , Liu Tiancheng
Published: October 2020

The catalytic hydrolysis of Difluorodichloromethane(CFC-12) by solid acid of MoO3/ZrO2-TiO2 calcined at different temperature had been studied. The effects of catalytic hydrolysis temperature and water vapor concentration on catalytic hydrolysis of CFC-12were also studied. The results showed that catalytic hydrolysis rate of CFC-12 reached to 98.65% at 400 ℃ when the MoO3/ZrO2-TiO2 catalyst was calcined at 500 ℃ with a concentration of water vapor of 83.18%, and the main hydrolysis products were CO, CO2, HF and HCl. After 30 hours’ continuous reaction, the hydrolysis rate of CFC-12 was 65.34%. The XRD result reveals that the main phase of solid MoO3/ZrO2-TiO2 catalyst is the tetragonal Zr (MoO4)2 with doped TiO2 of anatase.
Dental implant care and trouble among dependent patients based on the questionnaire survey among Japanese dental practitioners
Authors: Sato Yuji , Koyama Shigeto , Ohkubo Chikahiro , Ogura Shin , Kamijo Ryutaro , Sato Soh , Aida Jun , Izumi Yuichi , Atsum Mihoko , Isobe Akio , Baba Shunsuke , Ikum Noriharu , Watanabe Fumihiko
Published: October 2020

BackgroundSelf-care and professional care of implants may prove difficult for elderly people who require nursing care. However, the actual state of care and problems remains unknown. In this study, we investigated the actual state of implant problems in elderly people living in their own home or in a nursing home who received visiting dental treatment. MethodsWe mailed questionnaire survey forms to 2339 representatives or specialists who were members of the Japanese Society of Oral Implantology, the Japanese Society of Gerodontology or the Japan Prosthodontic Society. We narrowed down the respondents to those who provided visiting dental treatment, and analyzed the actual state of implants observed during visiting dental treatment (type, care, problems, countermeasures, etc.). ResultsOf the 924 dentists who responded to the questionnaire survey, 291 (22%) provided visiting dental treatment. While the majority of implant types encountered in the previous 12 months were root-form implants, there were still a certain number of blade and subperiosteal implants. Daily implant care involved mostly cleaning with a toothbrush + auxiliary tools. The most frequent implant problems encountered in the past were difficulty in cleaning and peri-implantitis. Medication and antiphlogistic treatment were most frequently adopted as countermeasures to implant problems, followed by observation. When we classified the results into those for the dentists who provided implant treatment and those for the dentists who did not, we found that many of the dentists who did not provide implant treatment opted for observation or medication, while those who provided implant treatment also implemented removal of superstructure, retightening of screws, repair and so forth. Conclusions We found that many of the implant troubles encountered by dentists who provided visiting dental care were difficulty in cleaning or peri-implantitis, and that the actions taken against these troubles varied depending on the experience of the dentist performing the implant treatment. Our study also revealed that dentists who provide visiting dental care need to acquire knowledge and skills of implant treatment, to have actions prepared in case they encounter such cases, or to closely coordinate with dentists who specialize in implants.
Estimating restricted mean survival time and expected life-years lost in the presence of competing risks within flexible parametric survival models
Authors: Mozumder Sarwar Islam , Rutherford Mark , Lambert Paul
Published: October 2020

We present various measures, speciﬁcally the expected life-years list due to a cause of death, that can be predicted for a speciﬁc covariate pattern to facilitate interpretation in observational studies. These can also be summarised at the population-level using standardisation to obtain marginal measures. The restricted mean survival time (RMST) measure can be obtained in the presence of competing risks using Royston-Parmar ﬂexible parametric survival models (FPMs). Royston-Parmar FPMs can be ﬁtted on either the cause-speciﬁc hazards or cumulative incidence scale in the presence of competing risks. An advantage of modelling within this framework for competing risks data is the ease at which other alternative predictions to the (cause-speciﬁc or subdistribution) hazard ratio can be obtained. The RMST estimate is one such measure. This has an attractive interpretation, especially when the proportionality assumption is violated. In addition to this, compared to similar measures, fewer assumptions are required and it does not require extrapolation. Furthermore, one can easily obtain the expected number of life-years lost, or gained, due to a particular cause of death, which is a further useful prognostic measure. We describe estimation of RMST after ﬁtting a FPM on either the log-cumulative subdistribution, or cause-speciﬁc hazards scale. As an illustration of reporting such measures to facilitate interpretation of a competing risks analysis, models are ﬁtted to English colorectal data.
Performance of Mattis dementia rating scale-Chinese Version in patients with mild cognitive impairment and Alzheimer's disease
Authors: QIAN shuxia , CHEN keliang , GUAN qiaobing , Guo qihao
Published: October 2020

Background: To identify the applicability of the Chinese Version of Mattis Dementia Rating Scale (DRS-CV).Methods: The DRS-CV was administered to 483 participants, including 136 normal controls, 167 patients with mild cognition impairment (MCI), and 180 patients with Alzheimer’s disease (AD). Receiver Operating Characteristic (ROC) curve was used to evaluate the sensitivity and specificity of the scale.Results: The scores of DRS-CV were ranked in the order of NC >MCI > mild AD > moderate AD group. Memory was the sensitive function affected at a relatively earlier stage of AD. ROC curve analysis indicated the DRS-CV total score and memory subscale showed excellent sensitivity and specificity in the discrimination between MCI from mild AD and mild AD from moderate AD, but poor sensitivity and specificity in the discrimination between MCI and NC.Conclusion: The DRS-CV is useful to the early diagnosis and severity of AD, not to the early identification of MCI.
The biological effects of microencapsulated organic acids and botanicals induces tissue-specific and dose-dependent changes to the Gallus gallus microbiota
Authors: Feye Kristina , Swaggerty Christina L. , Kogut Michael H. , Ricke Steven C. , Piva Andrea , Grilli Ester
Published: October 2020

Background: Microencapsulated organic acids and botanicals have the potential to develop into important tools for the poultry industry. A blend of organic acids and botanicals (AviPlus®P) has previously shown to reduce Salmonella and Campylobacter in chickens; however, changes to the microbiota of the jejunum and ileum have not been evaluated. Microbiota diversity is linked to, but not correlated with, the efficacy of natural products; therefore, understanding the effects on the microbiota is necessary for evaluating their potential as an antibiotic alternative. Results: Ileal and jejunal segments from control and supplement-fed chickens (300 and 500g/metric ton [MT]) were subjected to alpha diversity analysis including Shannon’s diversity and Pielou’s Evenness. In both analytics, the diversity in the ileum was significantly decreased compared to the jejunum irrespective of treatment. Similarly, beta diversity metrics including Bray-Curtis dissimilarity index and Weighted Unifrac Distance Matrix, were significant (Q<0.05) for both tissue and treatments comparisons. Alpha and beta diversity analytics indicated compartmentalization effects between the ileum and jejunum. Additionally, analysis of communities in the microbiota (ANCOM) analysis showed Lactobacilliaceae predominated the total operational taxonomic units (OTU), with a stepwise increase from 53% in the no treatment control (NTC) to 56% in the 300g/MT and 67% in the 500g/MT group. Staphylococcaceae were 2% in NTC and 2 and 0% in 300 and 500g/MT groups. Enterobacteriaceae decreased in the 500g/MT (31%) and increased in the 300g/MT (37%) compared to the NTC (35%). Aerococcaceae was 0% for both doses and 7% in NTC. Ruminococcaceae were 0% in NTC and 2% and 1% in the 300 and 500g/MT. These changes in the microbial consortia were statistically (Q<0.05) associated with treatment groups in the jejunum that were not observed in the ileum. Least discriminant analysis effect size (LEfSE) indicated different changes directly corresponding to treatment. Enterobacteriaceae demonstrated a stepwise decrease (from NTC onward) while Clostridiaceae, were significantly increased in the 500g/MT compared to NTC and 300g/MT (P<0.05).Conclusion: The bioactive site for the microencapsulated blend of organic acids and botanicals was the jejunum, and dietary inclusion enhanced the GIT microbiota and may be a viable antibiotic alternative for the poultry industry.
The Dignity of Burn Patients: A Qualitative Descriptive Study on Nurses, Family Caregivers, and Patients
Authors: Tehranineshat Banafsheh , Rakhshan Mahnaz , Torabizadeh Camellia , Fararouei Mohammad , Gillespie Mark
Published: October 2020

Background: As an ethical principle, showing respect to human dignity is considered as a professional duty of all nurses. The aggressive nature of severe burn injuries makes it hard to respect existential values and dignity of burn patients. However, only a few studies have been conducted on the preservation of the dignity of burn patients.Purpose: The purpose of the study was to determine the various aspects of the concept of burn patients’ dignity from the perspective of nurses, family caregivers, and burn patients themselves.Methods: The present study has a descriptive, qualitative research design. Moreover, data were collected using semi-structured, in-depth, individual interviews. Thereafter, data analysis was performed using conventional content analysis. The subjects of the present study were from nurses, family caregivers, and patients referred to the biggest burns hospital in the southeast of Iran. The participants were then selected via a purposeful sampling (n=25), which continued until reaching data saturation. This study lasted from October 2017 to August 2018. Results: Three main themes were extracted from the information obtained in the interviews, which were as follows: Creating an intimate atmosphere, showing respect, and providing comprehensive support.Conclusion: Burn patients need receiving appropriate care in a convivial atmosphere where they are looked after by empathetic caregivers who dedicate enough time to them as well as allowing them to express their feelings and concerns. In addition, patients' human values and beliefs should be respected and all aspects of their existence should be taken into account to preserve their dignity. In this regard, workshops designed based on the findings of the present study can help improving the quality of burn care nursing.
Learning curve of digital intraoral scanning – an in vivo study
Authors: Róth Ivett , Czigola Alexandra , Joós-Kovács Gellért Levente , Dalos Magdolna , Hermann Péter , Borbély Judit
Published: October 2020

Background: The spread of digital technology in dentistry poses new challenges and sets new goals for dentists. The aim of the present in vivo study was to determine the learning curve of intraoral scanning described by (1) scanning time and (2) image number (count of images created by intraoral scanner during the scanning process).Methods: Ten dental students of Semmelweis University took part in the study. Dental students took digital study impressions using a 3Shape Trios 3® (3Shape, Copenhagen, Denmark) intraoral scanning device. Each student took 10 digital impressions on volunteers. Volunteer inclusion criteria included full dentition (except for missing third molars) and no prosthetic/restorative treatment. Digital impression taking was preceded by tuition consisting of both theoretical education and practical training. Digital impressions were taken of the upper and lower arches, and the bite was recorded according to the manufacturer's instructions. Total scanning times and image numbers were recorded.Results: The difference in scanning time between the first and the tenth digital impressions was significant (p=0.007). The average scanning time for the first impressions was 23 min 9 sec; for the tenth impressions, it was 15 min 28 sec. The difference between the scanning times of the first and the tenth procedures was 7 min 41 sec. The average image count for the first impressions was 1964.5; for the tenth impressions, it was 1468.6. The image count difference between the first and the tenth procedures was 495.9. The image count versus sequential number of measurement curve shows an initial decreasing tendency followed by a trough around the sixth measurement and a final increasing phase.Conclusion: Our results indicate an association between the sequential number of measurements and the outcome variables. The drop in scanning time is probably explained by a practice effect of repeated use, i.e. the students learned to move the scanning tip faster. The image count first showed a decreasing tendency, and after the sixth measurement, it increased; there was no consistent decline in mean scan count. Shorter scanning times are associated with poorer coverage quality, with the operator needing to make corrections by adding extra images; this manifests as the time function of image counts taking an increase after the sixth measurement.
Occupational risk factors for shoulder chronic tendinous pathology in the Spanish automotive manufacturing sector: a case-control study.
Authors: DIEZ-CABALLERO BEATRIZ RODRIGUEZ , Alfonso-Beltran Joaquin , Bautista Iker J. , Pitarque Carlos Barrios
Published: October 2020

Background: Musculoskeletal Diseases (MSDs) are among the most prevalent health problems encountered in the workforce in Europe. Multiple risk factors contribute to their onset. In the present study, different individual risk factors for chronic tendinous pathology affecting the shoulder were analysed in a sample of workers from the automotive manufacturing sector. Methods: An observational retrospective study was conducted with 73 cases of officially recognised and compensated occupational diseases and 94 aleatory cases of healthy workers from the same car assembly company. The experimental group comprised individuals with tendinous chronic pathology of the rotator cuff. Multiple variables that identified the risks present in the job were assessed along with participants clinical evaluation. Furthermore, two standardised guidelines for risk factors assessment were also used: the Spanish National Institute of Social Security (INSS) and the American Occupational Information Network (O*Net). Both descriptive statistical analysis and Odds ratios calculations considering the occupational disease as a dependent variable were performed. Results: The use of hand tools, exposure to mechanical pressure in the upper limbs and awkward postures were the most prevalent risk factors. Pressure on the palm of the hand and the hand tool impacting the hand were also important risk factors. Some psychosocial factors such as lack of autonomy and mental workload were also associated shoulder tendinous diseases. The association of age, load handling, and awkward postures were the core risk factors responsible for most of the tendinous chronic injuries of the shoulder in this sample of car assembly workers.Conclusions: Both ergonomic and psychosocial factors were present and increased the risk of developing occupational chronic tendinopathies at the shoulder in this sample of workers. Aging, load handling, and awkward postures showed the strongest predictive values. Greater knowledge of how risk factors interact would facilitate the design of better preventive workplace strategies.
Effectiveness of combined education to promote self efficacy and self-care oral health behaviors among students: A randomized controlled trial
Authors: Hashemi Zahra Sadat , khorsandi Mahboobeh , Shamsi Mohsen , Moradzadeh Rahmatollah
Published: October 2020

Background: In order to prevent oral diseases, the use of appropriate educational methods at childhood is one of the most important strategies for imrpving oral health knowledge. Therefore, the present study aimed to evaluate the effect of animations and games as a streagy for improving oral health self-efficacy and self-care behaviors among 6-12-aged students. Methods: In this interventional study, 82 students were selected based on cluster random sampling including 38 for the case and 44 for control group). The case group received four sessions of combined learning per week including animations and games while the control group received routine school education. The data were collected in six domains including demographics, self-care, knowledge, attitude, behavior and self-efficacy before and 5 months after the intervention using a questionnaire. SPSS version 20 was used for data analysis.Results: Five months after the intervention, the mean score of self-care, self-efficacy, behavior increased from 3.8 to 4.8, 36.8 to 48.9, and 17.07 to 18.29, respectively indicating a significant change (p < 0.05). However, no significant change was reported in these variables in the control group (p >0.05)Conclusion: The use of animation combiend with other stragies for oral health self-care education can positively influence the students' performance and self-efficacyIRCT registration number: This trial was registered at IRCT. IRCT2017042133565N1 Registration date: 2017-05-17 https://en.irct.ir/trial/25851Name of RCT: The effect of combine education methods on self efficacy and self-care oral health behavior among 6-12-aged school children.
A cross-sectional study on associations of physical symptoms, health self-efficacy and suicidal ideation among Chinese hospitalized cancer patients following diagnosis.
Authors: Xu Qingyi , Jia Shuhua , Fukasawa Maiko , Lin Lin , Na Jun , Mu Zhen , Li Bo , Li Ningning , Zhao Tong , Ju Zaishuang , He Meng , Yu Lianzheng , Kawakami Norito , Jiang Chao
Published: October 2020

Background: Epidemiological studies have shown elevated suicide risk in cancer patients compare with the general population. This study was performed to examine the association between physical symptoms and suicidal ideation among Chinese hospitalized cancer patients and test the modifying effect of health self-efficacy on this association. Methods: A cross-sectional study was conducted among 544 cancer patients from oncology settings in two general hospitals in northeast China via face-to-face interviews. Suicidal ideation was measured by using four items from the Yale Evaluation of Suicidality scale, dichotomized into a positive and negative score. Multivariable logistic regression was applied to examine the impact of physical symptoms, health self-efficacy and their interactions on suicidal ideation.Results: We found a suicidal ideation rate of 26.3% in patients following cancer diagnosis. Logistic regression showed that insomnia (aOR=1.84, 95% CI 1.13 to 3.00, p =0.015), lack of appetite (aOR=2.14, 95% CI 1.26 to 3.64, p =0.005) were positively associated with suicidal ideation, low health self-efficacy showed a marginally significant exaggerating effect on the association between pain and suicidal ideation (aOR = 2.77, 95% CI 0.99 to 7.74, p =0.053), even after controlling for significant socio-demographic, clinical characteristics and depression. Conclusions: These findings demonstrate the associations between insomnia、lack of appetite and suicidal ideation and highlight the potential moderating role of health self-efficacy in the identification and prevention of suicide among cancer patients.
Does the IOFix implant Improve Union Rates?
Authors: segal david , Ohana Nissim , Nyska Meir , Palmanovich Ezequiel
Published: October 2020

BACKGROUNDFirst metatarso-phalangeal joint fusion is the current gold standard for severe hallux rigidus. Data regarding the union rate and the re-operation rate when IOFix (an Intra-osseous fixation device, Extremity medical, New Jersey, USA) is used for hallux rigidus fusion is limited but promising. The aim of this study was to review our outcomes with the IOFix implant. METHODSWe have conducted a retrospective chart review, following the approval of the hospital IRB committee. Exclusion criteria included bilateral operations on the same patient, multiple surgeries, charcot foot or other structural foot abnormalities (except hallux valgus), rheumatoid arthritis and a recent foot trauma. We collected demographic data, physical examination documentation, functional score evaluations (AOFAS), and Plain radiographic studies. RESULTS Thirty patients were included in the study. The mean age was 60.36±9.12 (range 36 to 77) years, 18 (60%) female patients and 12 (40%) male. Fourteen (53.33%) were left side pathologies. The average follow up period was 36.2±12.31 (range 12 to 54) months. Union was obtained in 28 (93.33%) patients, of whom none had requested a hardware removal due to a prominent hardware during a minimum of 2 year follow up period. The mean postoperative AOFAS score was 80.5±10.87 (range 35 to 90). A more stringent inclusion criteria and fusion definitions would have led to an exclusion of two more patients and a dropout of two patients from the “fused” group, which would have led to a fusion rate of 85.71%.CONCLUSIONSThis is the largest series of hallux rigidus patients that were operated with an IOFix device. The rates of fusion and hardware removal in MTPJ1 arthrodesis performed with an IOFix implant were found to be similar at most when compared to previously described rates that were obtained with other cheaper and more simple fixation devices.
The Binding Behaviors between Cyclopentanocucurbit[6]uril and Three Amino Acids in the Solid and the Solution Phases
Authors: Cheng Si Yuan , Zhao Wei Wei , Yang Xi Nan , Wei Lian Tong , Tao Zhu , Ma Peihua
Published: October 2020

Binding behaviors between CyP 6 Q[6] and three amino acids have been investigated by means of X-ray crystallography, proton nuclear magnetic resonance ( 1 H NMR) spectroscopy, amino acids and isothermal titration calorimetry (ITC). The results showed that CyP 6 Q[6] forms a 1:2 inclusion complex with glycine, but 1:1 complexes with both leucine and lysine. Whereas the carboxyl group of glycine can enter the interior of the cavity of CyP 6 Q[6], only the alkyl chains of leucine and lysine can enter this cavity. Interestingly, leucine can adopt two different self-assembly modes upon its interaction with cucurbituril, depending on the external conditions, whereas glycine and lysine do not exhibit such behavior.
Explanation and Prediction of Clinical Data with Imbalanced Class Distribution based on Pattern Discovery and Disentanglement
Authors: Zhou Peiyuan , Wong Andrew K.C.
Published: October 2020

Background: Statistical data analysis, especially the advanced machine learning (ML) methods, have attracted considerable interest in clinical practices. We are looking for interpretability of the diagnostic/prognostic results that will bring confidence to doctors, patients and their relatives in therapeutics and clinical practice. When datasets are imbalanced in diagnostic categories, we notice that the ordinary ML methods might produce results overwhelmed by the majority classes diminishing prediction accuracy. Hence, we need methods that could produce explicit transparent and interpretable results in decision-making, without sacrificing accuracy, even for data with imbalanced groups. Methods: In order to interpret the clinical patterns and conduct diagnostic prediction of patients with high accuracy, we develop a novel method, Pattern Discovery and Disentanglement for Clinical Data Analysis (cPDD), which is able to discover patterns (correlated traits/indicants) and use them to classify clinical data even if the class distribution is imbalanced. In the most general setting, a relational dataset is a large table such that each column represents an attribute (trait/indicant), and each row contains a set of attribute values (AVs) of an entity (patient). Compared to the existing pattern discovery approaches, cPDD can discover a small succinct set of statistically significant high-order patterns from clinical data for interpreting and predicting the disease class of the patients even with groups small and rare.Results: Experiments on synthetic and thoracic clinical dataset showed that cPDD can 1) discover fewer patterns compared to other existing pattern discovery methods; 2) allow the users to interpret succinct sets of patterns coming from uncorrelated sources, even the groups are rare/small; and 3) obtain better performance in prediction compared to other interpretable classification approaches. Conclusions: In conclusion, cPDD discovers fewer patterns with greater comprehensive coverage to improve the interpretability of patterns discovered. Experimental results on synthetic data validated that cPDD discovers all patterns implanted in the data, displays them precisely and succinctly with statistical support for interpretation and prediction, a capability which the traditional ML methods lack. The success of cPDD as a novel interpretable method in solving the imbalanced class problem shows its great potential to clinical data analysis for years to come.
Association of Patient-Centered Medical Home designation and quality indicators within HRSA-funded community health center delivery sites
Authors: Bell Nathaniel , Wilkerson Rebecca , Mayfield-Smith Kathy , Fede Ana Lòpez-De
Published: October 2020

Background: Patient-Centered Medical Home (PCMH) adoption is an important strategy to help improve primary care quality within Health Resources and Service Administration (HRSA) community health centers (CHC), but evidence of its effect thus far remains mixed. A limitation of previous evaluations has been the inability to account for the proportion of CHC delivery sites that are designated medical homes.Methods: Retrospective cross-sectional study using HRSA Uniform Data System (UDS) and certification files from the National Committee for Quality Assurance (NCQA) and the Joint Commission (JC). Datasets were linked through geocoding and an approximate string-matching algorithm. Predicted probability scores were regressed onto 11 clinical performance measures using 10% increments in site-level designation using 10% increments in site designation and regressed onto 11 clinical performance measures using beta logistic regression.Results: The geocoding and approximate string-matching algorithm identified 2,615 of the 6,851 (41.8%) delivery sites included in the analyses as having been designated through the NCQA and/or JC. In total, 74.7% (n=777) of the 1,039 CHCs that met the inclusion criteria for the analysis managed at least one NCQA- and/or JC-designated site. A proportional increase in site-level designation showed a positive association with adherence scores for the majority of all indicators, but primarily among CHCs that designated at least 50% of its delivery sites. Once this threshold was achieved, there was a stepwise percentage point increase in adherence scores, ranging from 1.9% to 11.8% improvement, depending on the measure.Conclusion: Geocoding and approximate string-matching techniques offer a reliable approach for monitoring the association between site-level PCMH designation and clinical performance within HRSA’s CHC delivery sites. The model also offers preliminary evidence of a stepwise increase in quality metrics once half of a CHC’s delivery sites become designated medical homes.
Homology analysis between clinically isolated extraintestinal and enteral Klebsiella pneumoniae among Neonates
Authors: Chen Chun-mei , Wang Min , Li Xian-ping , Li Peng-ling , Tian Jing-jing , Zhang Kan , Luo Can
Published: October 2020

Background: Klebsiella pneumoniae is a leading cause of hospital-associated (HA) infections . It has been reported that gastrointestinal colonization (GI) is likely to be a common and significant reservoir for the transmission and infections of K. pneumoniae in both adults and neonates. However, the homologous relationship between clinically isolated extraintestinal and enteral K. pneumoniae in neonates hasn’t been characterized yet. Results: 43 isolates from 21 neonatal patients were collected in this study. The proportion of carbapenem resistance was 62.8%. There were 12 patients (12/21, 57.4%) whose antibiotic resistance phenotypes, genotypes, and ST types (STs) were concordant. Six sequence types were detected using MLST, with ST37 and ST54 being the dominant types. The results of MLST were consist with the results of PFGE. Conclusions: These data showed that there might be a close homologous relationship between EXKP and EKP in neonates，indicating that the K. pneumoniae from the GI tract is possibly to be a significant reservoir for causing extraintestinal infections.
Relaxometric learning: a pattern recognition method for T2 relaxation curves based on machine learning supported by an analytical framework
Authors: Date Yasuhiro , Wei Feifei , Tsuboi Yuuri , Ito Kengo , Sakata Kenji , Kikuchi Jun
Published: October 2020

Nuclear magnetic resonance (NMR)-based relaxometry is widely used in various fields of research because of its advantages such as simple sample preparation, easy handling, and relatively low cost compared with metabolomics approaches. However, there have been no reports on the application of the T2 relaxation curves in metabolomics studies involving the evaluation of metabolic mixtures, such as geographical origin determination and feature extraction by pattern recognition and data mining. In this study, we describe a data mining method for relaxometric data (i.e., relaxometric learning). This method is based on a machine learning algorithm supported by the analytical framework optimized for the relaxation curve analyses. In the analytical framework, we incorporated a variable optimization approach and bootstrap resampling-based matrixing to enhance the classification performance and balance the sample size between groups, respectively. The relaxometric learning enabled the extraction of features related to the physical properties of fish muscle and the determination of the geographical origin of the fish by improving the classification performance. Our results suggest that relaxometric learning is a powerful and versatile alternative to conventional metabolomics approaches for evaluating fleshiness of chemical mixtures in food and for other biological and chemical research requiring a nondestructive, cost-effective, and time-saving method.
A novel ELISA method to determine human MrgX2 in chronic urticaria
Authors: Ding Yuanyuan , Zhang Tao , Liu Rui , Che Delu , Wang Nan , He Langchong
Published: October 2020

BACKGROUND: Mas-related G-protein coupled receptor member X2 (MrgX2) directly mediates drug-induced pseudo allergic reactions. Skin mast cell MrgX2 is upregulated in severe chronic urticaria (CU). Mast cells and leukocytes are key effector cells in allergic reactions and undergo degranulation upon stimulation. It is unknown whether circulating MrgX2 expression can be detected occurs in the whole blood of CU patients and reflects pseudo-allergic reaction. There is no effective method for its detection. Therefore, an enzyme-linked immuno-sorbent assay (ELISA) for MrgX2 was developed.METHODS: Monoclonal and polyclonal MrgX2 specific antibodies were obtained from rabbits and mice immunized by MrgX2 peptides prepared. Indirect ELISA and Dot blot were used to determine antibody titers before a sandwich ELISA for MrgX2 was established. The whole blood from healthy subjects and CU patients was used to detect MrgX2 concentrations. The use of feasibility of this MrgX2-ELISA as a clinical detection tool was explored and diagnostic purposes was assessed.RESULTS: The sandwich antibody ELISA method for MrgX2 was established with good linearity regression (R2 = 0.9910). The lowest detection limit was 3.125 ng/mL. The quantification limit was 6.25 ng/mL. The sandwich ELISA for MrgX2 have good stability and high specificity. The initial truncation value of MrgX2 was 60.91 ng/mL (95% confidence interval). The whole blood MrgX2 concentrations in CU patients (median 98.01 ± 4.317 ng/mL, n = 75) was significantly increased compared to healthy subjects (58.09 ± 1.418 ng/mL, n = 75), with significant difference (p <0.0001) and higher accuracy of (AUC = 0.8795). Comprehensive the frequency analysis of MrgX2 expression in 75 CU patients reference frequency distribution and ROC curve analysis, determined the threshold for CU patients as 71.23 ng/mL, with 81.33% sensitivity and 90.67% specificity.CONCLUSION: MrgX2-ELISA provides a useful and convenient method for detecting MrgX2 in whole blood samples. The MrgX2-ELISA will help improve the understanding of the role of MrgX2 in regulating chronic urticaria.
Measuring the quality of nursing clinical placements. Development of the Placement Evaluation Tool (PET): A mixed methods co-design project
Authors: Cooper Simon , Cant Robyn , Waters Donna , Luders Elise , Henderson Amanda , Willetts Georgina , Tower Marion , Searl Kerry Reid , Ryan Colleen , Hood Kerry
Published: October 2020

Background: The quality of nursing clinical placements has been found to vary. Placement evaluation tools for nursing students are available but lack contemporary reviews of clinical settings. Therefore, the aim of this study was to develop a feasible, valid and reliable clinical placement evaluation tool applicable to nursing student placements in Australia.Methods: An exploratory mixed methods co-design project. Phase 1 included a literature review; expert rating of potential question items and Nominal Group Technique meetings with a range of stakeholders for item development. Phase 2 included on-line pilot testing of the Placement Evaluation Tool (PET) with 1,263 nursing students, across all year levels at six Australian Universities and one further education college in 2019-20, to confirm validity, reliability and feasibility.Results: The PET included 19-items (rated on a 5-point agreement scale) and one global satisfaction rating (a 10-point scale). Placements were generally positively rated. The total scale score (19 items) revealed a median student rating of 81 points from a maximum of 95 and a median global satisfaction rating of 9/10. Criterion validity was confirmed by item correlation: Intra-class Correlation Co-efficient ICC = .709; scale total to global score r = .722; and items to total score ranging from .609 to .832. Strong concurrent validity was demonstrated with the Clinical Learning Environment and Supervision Scale (r= .834). Internal reliability was identified and confirmed in two subscale factors: Clinical Environment (Cronbach’s alpha = .94) and Learning Support (alpha = .96). Based on the short time taken to complete the survey (median 3.5 minutes) and students’ comments, the tool was deemed applicable and feasible.Conclusions: The PET was found to be valid, reliable and feasible. Use of the tool as a quality assurance measure is likely to improve education and practice in clinical environments. Further international evaluation of the instrument is required to fully determine its psychometric properties.
Smartphone application for celiac patients: assessing its effect on gastrointestinal symptoms in a randomized controlled clinical trial
Authors: Nikniaz Zeinab , Shirmohammadi Masood , Maserrat Elham , Namvar Zahra Akbari
Published: October 2020

Background: We aimed to study the effectiveness of information provided via smartphone application on gastrointestinal symptoms in patients with celiac disease (CD).Methods: In the present randomized controlled clinical trial, 60 patients with CD were randomly assigned to receive education through a smartphone application (n=30) or conventional clinical education (n=30). The patients were asked to use it for obtaining the required information for three months. We assessed gastrointestinal symptoms using the gastrointestinal symptom rating scale (GSRS) questionnaire at baseline and three months after interventions. The GSRS total score, celiac disease GSRS (CD-GSRS) score, abdominal pain, reflux, diarrhea, constipation, and indigestion scores were calculated.Results: Out of 60 randomized patients, 58 patients completed the study. The mean age of the participants was 37.49±9.32 years, and the mean disease duration was 4.57±3.36 years. There were no significant differences between the two groups regarding the baseline values. In comparison to baseline, the mean CD-GSRS score (p=0.001) and indigestion subscore score (p<0.001) were significantly decreased in the intervention group. The results of the between-group comparisons showed that although the mean GSRS and CD-GSRS total scores were lower in the intervention group than in the standard care group, the differences were not statistically significant. In terms of GSRS subscores, there was a significant difference between the two groups only in the mean score of indigestion (P=0.002).Conclusion: According to the results, using smartphone application for providing information to patients with celiac disease had only a significant positive effect on indigestion symptoms compared with routine clinic education, and we did not observe any significant differences in GSRS and CD-GSRS scores between the two groups.Trial registration: The protocol of the study was registered in the Iranian registry of clinical trials (IRCT code: IRCT20170117032004N2). trial registry webpage: https://www.irct.ir/user/trial/40187/view. Trial registry date: 2019.6.26
Enhanced differentiation of human pluripotent stem cells into pancreatic endocrine cells in 3D culture by inhibition of focal adhesion kinase
Authors: Liu Xiaofang , Qin Jinhua , Chang Mingyang , Wang Shuyong , Li Yali , Pei Xuetao , Wang Yunfang
Published: October 2020

Background: Generation of insulin-producing cells from human pluripotent stem cells (hPSCs) in vitro would be useful for drug discovery and cell therapy in diabetes. Three-dimensional (3D) culture is important for the acquisition of mature insulin-producing cells from hPSCs, but the mechanism by which it promotes β cell maturation is poorly understood.Methods: We established a stepwise method to induce high-efficiency differentiation of human embryonic stem cells (hESCs) into mature monohormonal pancreatic endocrine cells (PECs), with the last maturation stage in 3D culture. To comprehensively compare two-dimensional (2D) and 3D culture, we examined gene expression, pancreas-specific markers and functional characteristics in 2D culture-induced PECs and 3D culture-induced PECs. The mechanisms were considered from the perspectives of cell-cell and cell-extracellular matrix interactions which are fundamentally different between 2D and 3D culture.Results: The expression of the pancreatic endocrine-specific transcription factors PDX1, NKX6.1, NGN3, ISL1, and PAX6 and the hormones INS, GCG, and SST was significantly increased in 3D culture-induced PECs. 3D culture yielded monohormonal endocrine cells, while 2D culture-induced PECs co-expressed INS and GCG or INS and SST or even expressed all three hormones. We found that focal adhesion kinase (FAK) phosphorylation was significantly downregulated in 3D culture-induced PECs, and treatment with the selective FAK inhibitor PF-228 improved the expression of β cell-specific transcription factors in 2D culture-induced PECs. We further demonstrated that 3D culture may promote endocrine commitment by limiting FAK-dependent activation of the SMAD2/3 pathway. Moreover, the expression of the gap junction protein Connexin 36 was much higher in 3D culture-induced PECs than in 2D culture-induced PECs, and inhibition of the FAK pathway in 2D culture increased Connexin 36 expression.Conclusion: We developed a strategy to induce differentiation of monohormonal mature PECs from hPSCs and found limited FAK-dependent activation of the SMAD2/3 pathway and unregulated expression of Connexin 36 in 3D culture-induced PECs. This study has important implications for the generation of mature, functional β cells for drug discovery and cell transplantation therapy for diabetes, and sheds new light on the signalling events that regulate endocrine specification.