bluuebunny/crossref_metadata_2025 huggingface dataset:
Matching Ethical Climate to Nurses’ Service Behaviors in Public and Private Hospitals: A Cross-Sectional Study
Authors: Zhang Na , Li Jingjing , Bu Xing , Gong Zhenxing
Published: December 2020

Background: Workplace climate is great significant element that has impact on nurses’ behavior and practice; moreover, nurses’ service behavior contributes to the patients’ satisfaction and subsequently to the long-term success of hospitals. Few studies explore how different types of organizational ethical climate encourage nurses to engage in both in-role and extra-role service behaviors, especially in comparing the influencing process between public and private hospitals. This study aimed to compare the relationship between the five types of ethical climate and nurses’ in-role and extra-role service behaviors in public and private hospitals.Methods: This study conducted a cross-sectional survey on 559 nurses from China. All participants were investigated using the Ethical Climate Scale and Service Behavior Questionnaire. SPSS 22.0 was used for correlation analysis, t-test and analysis of variance test, and Mplus 7.4 was used for group comparison.Results: The law and code climate has a much greater influence on nurses’ in-role service behavior in private hospitals than on that in public hospitals (β = -.277; CI 95% = [-.452, -.075]; p < .01), and the instrumental climate has a stronger influence on nurses’ extra-role service behavior private hospitals than on that in public hospitals (β = -.352; CI 95% = [-.651, -.056]; p < .05). Meanwhile, the rules climate has a greater effect on nurses’ extra-role service behavior in public hospitals than it does in private hospitals (β = .397; CI 95% = [.120, .651]; p < .01). Conclusions: As the relationship between the five types of ethical climate and nurses’ in-role and extra-role service behaviors in public and private hospitals were different, the strategies used to foster and enhance the types of ethical climate are various from public to private hospitals. The caring and instrumental climate are the key to promote extra-role service behavior for nurses in private hospitals. And independent climate has great effect on extra-role service behaviors for nurses in public hospitals.
Utilizing Network Pharmacology to Explore the Possible Mechanism of Coptidis Rhizoma in Kawasaki Disease
Authors: Fan Xue , Guo Xin , Li Ying , Xu Mingguo
Published: December 2020

Background: Kawasaki disease (KD) is an acute self-limiting systemic vasculitis. In study, a randomized controlled trial regarding berberine (main component of Coptidis Rhizoma) function in treating KD was carried out and possible pharmacological mechanisms of Coptidis Rhizoma (CR) on KD therapy were investigated using an integrated network pharmacology approach. Methods: A total of 58 children with KD, younger than 5 years old, were enrolled in the study from October 2018 to May 2019. The patients were randomly divided into control group and BBR treatment group. The therapeutic indicators of the 2 groups before and after treatments were compared. Then, compounds and drug targets of CR from the Traditional Chinese Medicine Systems Pharmacology (TCMSP) database, the SWISS database, the SEA database and the STITCH database were collected, and targeted KD genes were retrieved from the DisGeNET databases, the DrugBank databases and the GeneCards databases. The network pharmacology approach involved network construction, target prediction, and module analysis. KEGG pathway and GO enrichment analysis were performed to investigate the molecular mechanisms and pathways related to CR for KD treatments. Results: The berberine group was able to reduce the values of CRP, NLR and PLR significantly. Also, the effect of berberine improved the resistance rate of intravenous injection of gamma globulin significantly. In total, 9 compounds and 369 relative drug targets were collected from TCMSP, SWISS, SEA and STITCH database and 624 KD target genes were collected in DisGeNET, DrugBank and GeneCards database. The network analysis revealed that 41 targets might be the therapeutic targets of CR on KD, among which ATK1, RELA, SRC, CASP3 and MTOR ranked in top 5. Gene ontology enrichment analysis revealed that the reaction to bacteria-derived molecules and to lipopolysaccharide and the apoptosis process were the key biological procedures for CR treating KD. The KEGG pathway enrichment analysis pointed out that the four signaling pathways closely related to CR treating KD including age-rage signaling pathway, fluid shear stress and atherosclerosis, TNF signaling pathway and Toll-like receptor signaling pathway in diabetic complications. Conclusions: we concluded that the introduction of routine treatment combined with berberine in treating KD has advantages than routine treatment and can be considered as a preferred approach in KD. Network pharmacology showed that CR exerted the effect of prevention KD by regulating multi-targets and multi-components.
ACE2-like carboxypeptidase B38-CAP protects from SARS-CoV-2-induced lung injury
Authors: Minato Takafumi , Hoshizaki Midori , Yamaguchi Tomokazu , An Jianbo , Niiyama Mayumi , Nirasawa Satoru , Asaka Masamitsu N , Chan Jasper Fuk-Woo , Imai Masaki , Takahashi Saori , Utsumi Daichi , Poon Vincent Kwok-Man , Yasuhara Atsuhiro , Chan Chris Chung-Sing , Motoyama Satoru , Nagata Satoshi , Penninger Josef M. , Kamada Haruhiko , Yuen Kwok-Yung , Kawaoka Yoshihiro , Yasutomi Yasuhiro , Imai Yumiko , Kuba Keiji
Published: December 2020

Angiotensin-converting enzyme 2 (ACE2) is a receptor for cell entry of SARS-CoV-2, and recombinant soluble ACE2 protein inhibits SARS-CoV-2 infection as a decoy. ACE2 is the carboxypeptidase to degrade angiotensin II (Ang II) to angiotensin 1-7 and improves the pathologies of cardiovascular disease and acute lung injury. To address whether the carboxypeptidase enzymatic activity of ACE2 is protective against COVID-19, we investigated the effects of B38-CAP, an ACE2-like enzyme, on SARS-CoV-2-induced lung injury. Expression of ACE2 protein was significantly downregulated in the lungs of SARS-CoV-2-infected hamsters. Recombinant S1 domain or receptor-binding domain (RBD) of the SARS-CoV-2 Spike protein also directly downregulated ACE2 expression and elevated Ang II levels and considerably worsened acid-induced lung injury in hamsters. Treatment with B38-CAP downregulated Spike RBD-induced high Ang II levels, severe inflammation and pulmonary edema through its ACE2-like enzymatic activity. Consistently, elevated cytokine mRNA levels and impaired lung functions were improved by B38-CAP treatment. Moreover, in SARS-CoV-2-infected humanized ACE2 transgenic mice, B38-CAP significantly improved the pathologies of lung injury, alleviated the cytokine storms and downregulated viral RNA levels. These results provide the first experimental in vivo evidence that increasing ACE2-like enzymatic activity is a potential and powerful therapeutic strategy for lung pathologies in COVID-19.
Routine Point of Care Ultrasound (POCUS) Assessment of Gastric Antral Contents in Traumatic Emergency Surgical Patients for Prevention of Aspiration Pneumonitis: A Randomized Clinical Trial 
Authors: Shorbagy Mohamed S. , Kasem Amr A. , Eldin Ahmed A. Gamal , Mahrose Ramy
Published: December 2020

Background: Polytrauma patients are at a higher risk of delayed gastric emptying. To assess gastric volume, a reliable diagnostic tool is needed to prevent the occurrence of aspiration pneumonia, which remains a serious complication associated with anesthesia. Gastric antral ultrasound can provide reliable information about the size of the gastric antrum in traumatized patients undergoing emergency surgery.Methods: A prospective observational study of 45 polytrauma patients undergoing emergency surgery under general anesthesia. Prior to induction of anesthesia in the emergency department, gastric ultrasound was performed to allow qualitative and quantitative assessment of gastric antrum in a supine position and right lateral decubitus (RLD) position. Followed by routine placement of nasogastric tube to aspirate and calculate the volume of the stomach contents.Results: Forty-five polytrauma patients who underwent gastric ultrasound examination showed that the risk assessment of aspiration and anesthesia technique changed in 14 patients (31.1%) after the ultrasound examination.A very good relationship existed between the expected stomach volume at the RLD position and the suction volume in the nasogastric tube. In all cases, no aspirations were documented.Conclusion: Ultrasound examination of the stomach in polytrauma patients allows assessing the size and type of stomach contents. The data obtained can influence the choice of anesthesia technique while inducing anesthesia and reduce the risk of aspiration pneumonia.Trial registration: This trial was registered at ClinicalTrials.gov. Registry number: NCT04083677.
The Efficacy and Safety of Nabufen and Sufentanil in the Prevention of Visceral Pain After Gynecological Laparoscopic Surgery: A Randomised Controlled Trial
Authors: Gu Xiaoxia , Wang Jingjing , Liao Huihua , Mo Jian , Huang Weiming , Lu Yue , Pang Ping , Tan XiuJuan , Zhang Liangqing
Published: December 2020

Background: To compare the efficacy and safety of different compatibility schemes in the prevention of visceral pain after gynecological laparoscopic surgery. Methods: from April 2019 to April 2020, patients undergoing elective gynecological laparoscopic surgery in our hospital were randomly divided into four groups: group A: sufentanil 3 μ g / kg; group B: low-dose nalbuphine group: 0.1 mg / kg of nabufen + 3 μ g / kg of sufentanil; group C: medium dose of nabufen group: 1 mg / kg of nabufen + 2 μ g / kg of sufentanil; group D: high-dose nabufen 2 There were 30 cases in each group. The degree of pain and the number of adverse reactions at 2, 4, 8, 12, 24 and 48 hours after operation were observed and recorded. The number and dosage of morphine used as a remedial analgesic were recorded. The pain degree was assessed by visual analogue scale (VAS). The total amount of analgesic pump used, the total number of times of pressing and the effective times of pressing were recorded. The adverse reactions included respiratory depression, nausea and vomiting, drowsiness, restlessness and skin The skin itches. Results: the analgesic effect of group B was similar to that of group A, and there was no significant difference in the number of invalid pressing, total pressing times and rescue analgesia rate (P > 0.05), while the invalid pressing times, total pressing times and remedial analgesia rate of group C and group D were significantly lower than those of group A (P < 0.05). There was no significant difference between group C and group D in the number of invalid compressions, the total number of compressions and the rate of remedial analgesia (P > 0.05), suggesting that increasing the dose of nalbuphine could not significantly increase the analgesic effect. The incidence of postoperative nausea and vomiting, skin pruritus, lethargy and Ramsay Sedation score in group B and group C were significantly lower than those in group A (P < 0.05). Ramsay Sedation score and incidence of drowsiness were lower than those in group D, which indicated that the incidence of adverse reactions was higher in group D than group B and group C.Conclusion: the combination of 1 mg / kg nabufen and 2 μ g / kg sufentanil is a safe and effective combination scheme for the prevention of visceral pain after gynecological laparoscopic surgery with small adverse reactions.Trial registration: http://www.chictr.org.cn/showproj.aspx?proj=40635Registration number：ChiCTR1900025076 . Prospectively registered on 10 August 2019.
DDX23 is a Metabolic Regulator in Hepatocellular Carcinoma
Authors: Zhou Jianlong , Wang Xiaoming , Liang Jing , Tan Chaohui , Chen Changnan , Lin Yunxiao , Xie Feng , Chen Zhong , Huang Wenhua
Published: December 2020

Background: Although biochemical activities of RNA helicases have been well-studied, physiological meaning of those factors in both normal and disease condition remained to be clarified.Methods: RNA sequencing (RNA-seq) in HCC cells indicated DDX23 are highly expressed in HCC and high expression of DDX23 is responsible for poor survival of HCC patients. Next, The expression of DDX23 was establish for subsequent investigation. The roll of DDX23 in HCC was identified by RNA-seq, RT-qPCR, LC-MS, OCR, ECAR. The effect of DDX23 on proliferative, Cloning information as well as tumorigenicity of transfected cells in mice was examined using loss-of-function experiments.Results: Here, we investigated a new role of RNA helicase in a member of the DEAD box protein family, DDX23 in hepatocellular carcinoma (HCC). RNA level of DDX23 are highly expressed in HCC and high expression of DDX23 is responsible for poor survival of HCC patients. In addition, we demonstrated that DDX23 expression is important for in vitro and in vivo tumorigenesis. RNA sequencing (RNA-seq) in HCC cells indicated that metabolism is the most affected pathway by the DDX23 and most abundant DDX23-interacting RNA are involved in metabolism in HCC, especially glycolysis. Conclusions: These findings provide new insights on the unexpected HCC-related role of DDX23, an opportunities for the development of the therapeutic target which is a master regulator of genes involved in HCC-favorable metabolic reprogram at the RNA level.
Energy Delivery Guided by Indirect Calorimetry in Critically Ill Patients: a Systematic Review and Meta-analysis
Authors: Duan Jing-Yi , Zheng Wen-He , Zhou Hua , Xu Yuan , Huang Hui-bin
Published: December 2020

Background: The use of indirect calorimetry (IC) is increasing due to its precision in resting energy expenditure (REE) measurement in critically ill patients. Thus, we aimed to evaluate the clinical outcomes of an IC-guided nutrition therapy compared to predictive equations strategy in such a patient population.Methods: We searched PubMed, EMBASE, and Cochrane library databases up to Oct 25, 2020. Randomized controlled trials (RCTs) were included if they focused on energy delivery guided by either IC or predictive equations in critically ill adults. We used the Cochrane risk-of-bias tool to assess the quality of the included studies. Short-term mortality was the primary outcome. The meta-analysis was performed with the fixed-effect model or random-effect model according to the heterogeneity. Results: Eight RCTs with 991 adults met the inclusion criteria. The overall quality of the included studies was moderate. Significantly higher mean energy delivered per day was observed in the IC group, as well as percent delivered energy over REE targets, than the control group. IC-guided energy delivery significantly reduced short-term mortality compared with the control group (risk ratio=0.77; 95% CI, 0.60 to 0.98; I2=3%, P=0.03). IC-guided strategy did not significantly prolong the duration of mechanical ventilation (mean difference [MD]=0.61 days; 95% CI, -1.08 to 2.29; P=0.48), length of stay in ICU (MD=0.32 days; 95% CI, -2.51 to 3.16; P=0.82) and hospital (MD=0.30 days; 95% CI, -3.23 to 3.83; P=0.87). Additionally, adverse events were similar between the two groups. Conclusions: This meta-analysis indicates that IC-guided energy delivery significantly reduces short-term mortality in critically ill patients. This finding encourages the use of IC-guided energy delivery during critical nutrition support. But more high-quality studies are still needed to confirm these findings.
Outcomes of Combined Percutaneous Tracheostomy and Endoscopic Gastrostomy Tube Placement in COVID-19 Patients
Authors: Oberg Catherine , Keyes Colleen , Panchabhai Tanmay , Ali Sajawal , Oh Scott , Grogan Tristan , Mojica James , Auchincloss Hugh , Pulido Natalie , Brait Kelsey , Folch Erik
Published: December 2020

Background:A significant number of patients with severe respiratory failure related to COVID-19 require prolonged mechanical ventilation. Minimal data exists regarding the timing, safety, and efficacy of combined bedside percutaneous tracheostomy and endoscopy gastrostomy tube placement in these patients. The safety for healthcare providers is also in question. This study’s objective was to evaluate the effectiveness and safety of combined bedside tracheostomy and gastrostomy tube placement in COVID-19 patients.Methods:This is a single arm, prospective cohort study in patients with COVID-19 and acute respiratory failure requiring prolonged mechanical ventilation who underwent bedside tracheostomy and percutaneous endoscopic gastrostomy tube placement. Detailed clinical and procedural data were collected. Descriptive statistics were employed and time to event curves were estimated and plotted using the Kaplan Meier method for clinically relevant pre-specified endpoints.Results:Fifty-eight patients were included. Nearly 90% of the patients received pronation therapy and 52% of patients underwent extracorporeal membrane oxygenation evaluation. The median total intensive care unit length of stay was 29 days (24.7-33.3) with a median of 10 days (6.3-13.7) post-procedure. Nearly 88% of patients were weaned from mechanical ventilation post-procedure at a median of 9 days (6-12); 94% of these were decannulated. Sixty-day mortality was 10.3%. Almost 90% of patients were discharged alive from the hospital. No transfer out of the intensive care unit was required and a median of 3 healthcare personnel per procedure were present.Conclusions:This study shows that survival of critically ill COVID-19 patients after tracheostomy and gastrostomy was nearly 90%. The time-to-event curves are encouraging regarding time to weaning, downsizing, decannulation and discharge. A combined procedure minimizes the risk of virus transmission to healthcare providers in addition to decreasing the number of anesthetic episodes, transfusions, and transfers patients must undergo.
Awake Prone Positioning in Non-intubated Patients With Acute Hypoxemic Respiratory Failure Due to COVID-19: a Systematic Review and Meta-analysis
Authors: Pavlov Ivan , He Hangyong , McNicholas Bairbre , Perez Yonatan , Tavernier Elsa , Trump Matthew W. , Jackson Julie A. , Zhang Wei , Rubin Daniel S. , Spiegel Thomas , Hung Anthony , Estrada Miguel Ángel Ibarra , Roca Oriol , Vines David L. , Cosgrave David , Mirza Sara , Laffey John G. , Rice Todd W. , Ehrmann Stephan , Li Jie
Published: December 2020

Background: Awake prone positioning (APP) has been advocated to improve oxygenation and prevent intubations of patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19). This paper aims to synthesize the available evidence on the efficacy of APP. Methods: We performed a prospective systematic review and meta-analysis of observational studies to compare in-hospital intubation and mortality rates in patients treated with APP or with standard care.Results: A total of 46 published and 4 unpublished observational studies that included 2994 patients were included. The intubation rate was 27% (95%CI, 19 to 37%) in the 870 patients treated with APP, as compared to 30% (95%CI, 20 to 42%) in the 852 patients treated with usual care (p=0.71). The mortality rate was 11% (95CI%, 6 to 20%) in the 767 patients treated with APP, as compared to 22% (95%CI, 13 to 36%) in those treated with usual care. This difference was not statistically significant (p=0.10). APP was associated with significant improvement of various oxygenation parameters in 19 studies (n=381) that reported this outcome.Conclusions: In this prospective meta-analysis of observational studies of patients with acute hypoxemic respiratory failure due to COVID-19, APP did not result in lower intubation or mortality rates, despite reported improvements in oxygenation parameters. Data from randomized controlled trials are needed. Routine implementation of APP outside of a clinical trial is not supported by current evidence. Registered on PROSPERO on August 3d, 2020, CRD42020201947.
An Appraisal of Respiratory System Compliance In Mechanically Ventilated Covid-19 Patients
Authors: Bassi Gianluigi Li , Suen Jacky , Dalton Heidi , White Nicole , Shrapnel Sally , Fanning Jonathon P. , Liquet Benoit , Hinton Samuel , Vuorinem Aapeli , Booth Gareth , Millar Jonathan , Forsyth Simon , Panigada Mauro , Laffey John , Brodie Daniel , Fan Eddy , Torres Antoni , Chiumello Davide , Corley Amanda , Elhazmi Alyaa , Hodgson Carol , Ichiba Shingo , Luna Carlos , Murthy Srinivas , Nichol Alistair , Yeung Pauline , Ogino Mark , Pesenti Antonio , Trieu Huynh Trung , Fraser John
Published: December 2020

Background

Heterogeneous respiratory system static compliance (CRS) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous small-case series or studies conducted at a national level.
Methods

We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe the impact of CRS on the ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide.
Results

We enrolled 318 COVID-19 patients enrolled into the study from January 14th through September 31th, 2020 in 19 countries and stratified into two CRS groups. CRS was calculated as: tidal volume/[airway plateau pressure-positive end-expiratory pressure (PEEP)] and available within 48 h from commencement of MV in 318 patients. Patients were mean ± SD of 58.0 ± 12.2, predominantly from Europe (54%) and males (68%). Median CRS (IQR) was 34.1 mL/cmH2O (26.5–45.5) and PaO2/FiO2 was 119 mmHg (87.1–164) and was not correlated with CRS. Female sex presented lower CRS than in males (95% CI: -13.8 to -8.5 P < 0.001) and higher body mass index (34.7 ± 10.9 vs 29.1 ± 6.0, p < 0.001). Median (IQR) PEEP was 12 cmH2O (10–15), throughout the range of CRS, while median (IQR) driving pressure was 12.3 (10–15) cmH2O and significantly decreased as CRS improved (p < 0.001). No differences were found in comorbidities and clinical management between CRS strata. In addition, 28-day ICU mortality and hospital mortality did not differ between CRS groups.
Conclusions

This multicentre report provides a comprehensive account of CRS in COVID-19 patients on MV – predominantly males or overweight females, in their late 50 s – admitted to ICU during the first international outbreaks. Phenotypes associated with different CRS upon commencement of MV could not be identified. Trial documentation: Available at https://www.covid-critical.com/study.
Trial registration
ACTRN12620000421932.
THETA: Machine-learning Algorithm for Evaluating Hybrid Operation Theater Entry of Trauma Patients
Authors: Senda Atsushi , Endo Akira , Kinoshita Takahiro , Otomo Yasuhiro
Published: December 2020

Background

The clinical benefits of hybrid operating rooms are recognized globally. However, appropriate conditions for entry into such rooms must be urgently established, because they exclusively benefit few patients under severe trauma while requiring a significant amount of resources. This paper presents an algorithm to triage trauma patients into a hybrid operating room.
Methods

This retrospective observational study was conducted using the Japan Trauma Data Bank database comprising information collected between January 2004 and December 2018. A machine-learning-based triage algorithm is developed using the baseline demographics, injury mechanisms, and vital signs obtained from the database. The analysis dataset comprised information regarding 117,771 trauma patients with abbreviated injury scale (AIS) > 3. The performance of the proposed model was compared against those of other statistical models (logistic regression and classification and regression tree [CART] models) while considering the status quo entry condition (systolic blood pressure < 90 mmHg).
Results

The proposed trauma hybrid-suite entry algorithm (THETA) outperforms other algorithms (PR-AUC: THETA [0.59], logistic regression model [0.22], and CART [0.20]; AUROC: THETA [0.93], logistic regression model [0.88], and CART [0.86]), thereby facilitating appropriate triaging of patients who would potentially benefit from resuscitation performed using angiographic percutaneous techniques and operative resuscitation suites.
Conclusions

An accurate machine-learning-based algorithm is developed to triage patient entry into hybrid operating rooms via a web application, thereby enabling emergency doctors to utilize limited medical resources more efficiently.
Local Ecological Knowledge Networks in Tropical Artisanal Shrimp Fisheries
Authors: Castro Rafael Barros de , Fabré Nidia Noemi , Oliveira Aldo da Silva , Júnior José Gilmar Cavalcante de Oliveira , Batista Vandick da Silva
Published: December 2020

BackgroundLocal ecological knowledge (LEK) in fishing communities is generated through interactions between fishers and the exploited resources. It is transmitted through social networks, interdisciplinary structures that drives the dynamics of socio-ecological systems (SES). LEK variability is supposed to depend on the quality and quantity of ecological information flow among different stakeholders. To assess what is driving LEK themes, we hypothesized that the formation of LEK clusters among fishers is determined by network articulation, fisher experience and the commercial value of the exploited species. MethodsThe study area comprises three fishing communities in the Western South Atlantic, in the tropical coastal zone of Brazil where artisanal shrimp fisheries (on Penaeus schmitti, P. subtilis and Xiphopenaeus kroyeri) are a major activity. Data collection took place between March, April, and November 2019. To test our hypothesis, linear regression and bipartite network analyses were performed to visualize the interactions between fishermen groups and LEK themes. The connectivity, nesting, modularity, and centrality parameters in this social network were calculated to test the hypothesis. ResultsOur results indicate that experienced fishers enhance LEK in their networks on the themes of food, mortality, and growth. Furthermore, there are subgroups of fishers with dissimilar knowledge about the exploited shrimp species, one old on the fishery with wide knowledge, other less experienced, just knowing about reproduction and migration themes. ConclusionWe conclude that there is a spatial similarity in the connectivity of fisher’s LEK, mainly concerning the reproductive and migratory dynamics of the target species, but also differences permeated by fishers’ experience and local interests. Managers initiating co-management agreements using reproduction and migration referential variables as benchmarks will be more successful if they incorporate LEK into decision-making. Regional knowledge similarities favor the implementation of management policies at a regional scale potentially reducing conflicts within fishing communities and increasing resource use efficiency.
Influence of Participation in a Quality Improvement Collaborative on Staff Perceptions of Organizational Sustainability
Authors: II James H Ford , Gilson Aaron
Published: December 2020

Background: Sustainability capacity (SC), which is an organization’s ability to implement and maintain change, is influenced by internal attributes, environmental contextual influencers, and intervention attributes. Temporal changes in staff SC perceptions, as well as the influence of quality improvement collaborative (QIC) participation, has generally not been explored. This project addresses this gap, measuring staff SC perceptions at four time points (baseline and every 9 months) for clinics participating in an intervention – the Network for the Improvement of Addiction Treatment QIC initiative (called NIATx200).Methods: A mixed linear model repeated measures analysis was applied to matched staff members (n=908, representing 2,329 total cases) across the evaluation timeframe. Three separate statistical models assessed potential predictors of SC perceptions: Time (Models I-III); NIATx200 intervention, staff job function, and tenure (Models II &III); and NIATx200 participation hours and four organizational variables (Model III).Results: For Model I, staff perceptions of total SC increased throughout most of the study (t1,4=-6.74, p<.0001; t2,4=-3.100, p<.036; t3,4=-0.23, p=ns). Model II did not change Model I’s overall Time effect, but combined NIATx200 services (t=-2.23, p=.026), staff job function (t=-3.27, p=.001), and organizational administrators (t=-3.50, p=.001) were also significantly associated with greater perceptions of total SC. Inclusion of additional variables in Model III demonstrated the importance of a higher participation level (t=-3.09, p<.002) and being in a free-standing clinic (t=-2.06, p<.04) on staff perceptions of total SC. Conclusion: Although staff exposure to sustainability principals was minimal in NIATx200, staff perceptions about their organization’s SC significantly differed over time. However, an organization’s participation level in a QIC became the principal predictor of staff SC perceptions, regardless of other factors’ influence. Given these findings, it is possible to develop and introduce specific sustainability content within the structure of a QIC to assess the impact on staff SC perceptions over time and the sustainment of organizational change.Trial Registration: ClinicalTrials.gov, NCT00934141 Registered July 6, 2009. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT00934141
The Fermented Soy Beverage Q-CAN® Plus Induces Beneficial Changes in the Oral and Intestinal Microbiome
Authors: Dioletis Evangelos , Paiva Ricardo , Kaffe Eleanna , Secor Eric R. , Weiss Theresa R. , Fields Maxine R. , Ouyang Xinshou , Ali Ather
Published: December 2020

Background: Soy products are associated with many beneficial health consequences, but their effects on the human intestinal microbiome are poorly characterized. Objectives: To identify the changes in the oral and fecal microbiome in lean and obese participants due to consumption of Q-CAN®, and to assess the expected consequences of these changes based on the published literature. Methods: Prospective study of lean (10) and obese (9) participants consuming Q-CAN® twice daily for 4 weeks with 8 weeks follow-up. Microbial DNA was extracted from saliva and stool samples, amplified against the V4 region of the 16S ribosomal RNA gene and data analyzed using QIIME 1.9.1 bioinformatics. 440 samples were collected in total, 424 of which were productive and yielded good quality data. Results: STOOL. In the lean population Bifidobacteria and Blautia show a significant increase while taking Q-CAN®, and there was a trend for this in the obese population. ORAL. There were relatively fewer major changes in the oral microbiome with an increase in the family Veillonellaceae in the lean population while on Q-CAN®. Conclusion: Q-CAN® consumption induced a number of significant changes in the fecal and oral microbiome. Most notably an increase in the stool microbiome of Bifidobacteria and Blautia, both of which are associated with positive health benefits, and in the saliva an increase in Veillonellaceae. Trial registration: This trial was registered with Clinicaltrials.gov on January 14th 2016. ClinicalTrials.gov Identifier: NCT02656056
A mixed-methods evaluation of the impact of a person-centered family planning intervention for community health workers on family planning outcomes in India
Authors: Diamond-Smith Nadia , McDonell Claire , Sahu Ananta Basudev , Roy Kali Prasad , Giessler Katie
Published: December 2020

Background: Person-centered quality for family planning has been gaining increased attention, yet few interventions have focused on this, or measured associations between person-centered quality for family planning and family planning outcomes (uptake, continuation, etc.). In India, the first point of contact for family planning is often the community health care worker, in this case, Accredited Social Health Activists (ASHAs). Methods: In this study, we evaluate a training on person-centered family planning as an add-on to a training on family planning provision for urban ASHAs in Varanasi, India in 2019 using mixed methods. We first validate a scale to measure person-centered family planning in a community health worker population and find it to be valid. Higher person-centered family planning scores are associated with family planning uptake. Results: Comparing women who saw intervention compared to control ASHAs, we find that the intervention had no impact on overall person-centered family planning scores. Women in the intervention arm were more likely to report that their ASHA had a strong preference about what method they choose, suggesting that the training increased provider pressure. However, qualitative interviews with ASHAs suggest that they value person-centered care for their interactions and absorbed the messages from the intervention.Conclusions: More research is needed on how to intervene to change behaviors related to person-centered family planning. This study received IRB approval from the University of California, San Francisco (IRB # 15-25950) and was retrospectively registered at clinicaltrials.gov (NCT04206527)
Improving the transition process to independent living for adolescents with profound intellectual disabilities. Experiences of parents and employees.
Authors: Roos Eirik , Sondenaa Erik
Published: December 2020

Background The transition process from the family home to independent living for young adults with profound intellectual disability (PID) becomes delayed. Those families face challenges that exceed those of typical families such as higher objective and subjective burden, more frequent psychological distress and lower social support. The aim of this study was to explore the collaboration process between parents and employees and identify factors that improve the transition with less burden. Methods A descriptive qualitative study was undertaken with 18 persons (9 parents and 9 employees) interviewed individually and in groups. In accordance with the municipality`s guidelines, families with a child with PID should apply for housing, when the child turns 16. The purpose is to ensure interdisciplinary collaboration, information flow and coordinated services according to family’s needs. The main question in the interviews was ‘What was your experience with cooperation in the transition process, and what would you do to improve this process?’ The interviews were analysed with a thematic approach using systematic text condensation.Results The parents experienced a lack of general information about the ‘housing waiting list’, level of services, and the plan for time of moving from the family home, and how to choose where and whom to live with. Parents described an unsustainable burden of care during the waiting period, and a family crisis caused the allocation of an apartment in a group house. Employees shared challenges to meet families’ wishes, as there were too few group homes. They experienced good collaboration with families and said they offered respite care, due to reduce parents’ burden of care. Employees experienced that PID adolescents developed skills, mastery and degrees of independence after completing a residency at the Folk High School. Conclusions To improve the transition process from family home to independent living for young adults with PID, the informants highlighted some factors to reduce the burden of care on families: 1) Systematic follow-up program for families to observe their needs at an early stage; 2) More available group houses; 3) Information about the housing priorities of the services and; 4) Educational preparation programs for families.
The Feasibility of Emotion-Focused Therapy for Binge-Eating Disorder: A Pilot Randomised Waitlist Control Trial
Authors: Glisenti Kevin , Strodl Esben , King Robert , Greenberg Leslie
Published: December 2020

Background: Research into psychotherapy for binge-eating disorder (BED) has focused mainly on cognitive behavioural therapies, but efficacy, failure to abstain, and dropout rates continue to be problematic. The experience of negative emotions is among the most accurate predictors for the occurrence of binge eating episodes in BED, suggesting benefits to exploring psychological treatments with a more specific focus on the role of emotion. The present study aimed to explore the feasibility of individual emotion-focused therapy (EFT) as a treatment for BED by examining the outcomes of a pilot randomised wait-list controlled trial. Methods: Twenty-one participants were assessed using a variety of feasibility measures relating to recruitment, credibility and expectancy, therapy retention, objective binge episodes and days, and binge eating psychopathology outcomes. The treatment consisted of 12 weekly one-hour sessions of EFT for maladaptive emotions over three months. A mixed model approach was utilised with one between effect (group) using a one-way analysis of variance (ANOVA) to test the hypothesis that participants immediately receiving the EFT treatment would demonstrate a greater degree of improvement on outcomes relating to objective binge episodes and days, and binge eating psychopathology, compared to participants on the EFT wait-list; and one within effect (time) using a repeated-measures ANOVA to test the hypothesis that participation in the EFT intervention would result in significant improvements in outcome measures from pre to post-therapy and then maintained at follow-up. Results: Recruitment, credibility and expectancy, therapy retention outcomes indicated EFT is a feasible treatment for BED. Further, participants receiving EFT demonstrated a greater degree of improvement in objective binge episodes and days, and binge eating psychopathology compared to EFT wait-list control group participants. When participants in the EFT wait-list control group then received treatment and outcomes data were combined with participants who initially received the treatment, EFT demonstrated significant improvement in objective binge episodes and days, and binge eating psychopathology for the entire sample. Conclusions: These findings provide further preliminary evidence for the feasibility of individual EFT for BED and support more extensive randomised control trials to assess efficacy. Trial registration: The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000563965) on 14 May 2020 https://www.anzctr.org.au/ACTRN12620000563965.aspx
A gene-based risk score model for predicting recurrence-free survival in patients with hepatocellular carcinoma
Authors: Wang Wenhua , Wang Lingchen , Xie Xinsheng , Yan Yehong , Li Yue , Lu Quqin
Published: December 2020

Background Hepatocellular carcinoma (HCC) remains the most frequent liver cancer, accounting for approximately 90% of primary liver cancers worldwide. The recurrence-free survival (RFS) of HCC patients is a critical factor in devising a personal treatment plan. Thus, it is necessary to accurately forecast the prognosis of HCC patients in clinical practice.Methods Using The Cancer Genome Atlas (TCGA) dataset, we identified genes associated with RFS. A robust likelihood-based survival modeling approach was used to select the best genes for the prognostic model. Then, the GSE76427 dataset was used to evaluate the prognostic model’s effectiveness. Results We identified 1331 differentially expressed genes associated with RFS. Seven of these genes were selected to generate the prognostic model. The validation in both the TCGA cohort and GEO cohort demonstrated that the 7-gene prognostic model can predict the RFS of HCC patients. Meanwhile, the results of the multivariate Cox regression analysis showed that the 7-gene risk score model could function as an independent prognostic factor. In addition, according to the time-dependent ROC curve, the 7-gene risk score model performed better in predicting the RFS of the training set and the external validation dataset than the classical TNM staging and BCLC. Furthermore, these seven genes were found to be related to the occurrence and development of liver cancer by exploring three other databases. Conclusion Our study identified a seven-gene signature for HCC RFS prediction that can be used as a novel and convenient prognostic tool. These seven genes might be potential target genes for metabolic therapy and the treatment of HCC.
The effects of management of infection source of echinococcosis in Linzhi, Tibet autonomous region of China
Authors: Wang Ying , Ma Bing-Cheng , Wang Liying , Quzhen Gongsang , Pang Hua-Sheng
Published: December 2020

Background Echinococcosis is highly endemic in western and northern China, Tibet Autonomous Region ( TAR) is the most serious prevalent area . Linzhi is located in southeastern part of TAR. Dogs are the main infection source for the transmission of echinococcosis to humans. A control and prevention campaign based on dog management has been conducted in the past three years. This study is to evaluate the effects of dog management on infection rate of dogs.Methods Data of dog population, registration and de-worming of seven counties/district in Linzhi were collected from the annual prevention and control report. Domestic dog fecal samples were collected from each endemic town of seven counties/district in Linzhi in 2019 to determine the infection of domestic dogs using coproantigen ELISA. Data analysis was processed using SPSS statistics to compare dog infection rate between 2016 and 2019 by chi-square test, and maps were mapped using ArcGIS.Results In Linzhi, domestic dog population has decreased from 17407 in 2017, 16512 in 2018, to 12663 in 2019, while the registration rate has increased from 75.9% in 2017, 95.5% in 2018, to 98.6% in 2019. Similarly, stray dog population has decreased from 14336 in 2017, 13067 in 2018, to 11837 in 2019, while sheltered rate has increased from 84.6% in 2017, 92.3% in 2018, to 96.6% in 2019. Dog de-worming frequency has increased from four times per annum in 2017 to 12 times in 2019, indicating that approximately every dog was dewormed monthly. A total number of 2715 dog fecal samples were collected for coproantigen ELISA assay. The dog infection rate was 2.8% (77/2715) in 2019, which was significantly lower than7.3% (45/618) in 2016 (P<0.05).Conclusions Increased dog registration, decreased dog population, and increased dog de-worming frequency contributed to significantly decreased dog infection rate in Linzhi, TAR. Control and prevention campaign based on dog management can significantly decrease dog infection with Echinococcus spp in echinococcosis endemic areas.
27-Gauge trocar-assisted sutureless intraocular lens fixation.
Authors: Jujo Tatsuya , Kogo Jiro , Sasaki Hiroki , Sekine Reio , Sato Keiji , Ebisutani Sakura , Toyoda Yasuhiro , Kitaoka Yasushi , Takagi Hitoshi
Published: December 2020

Backgrounds: However there have been numerous investigations of intrascleral intraocular lens (IOL) fixation techniques, there is room for improvement in terms of simplifying complicated techniques and reducing the high levels of skill required. This study aimed to report a novel technique for sutureless intrascleral fixation of the IOL using retinal forceps with a 27-gauge trocar.Methods: Nineteen eyes of 18 patients underwent intrascleral fixation of the IOL from July 2018 to September 2019 were enrolled in this study. A 27-gauge trocar formed 3-mm scleral tunnels positioned at 4 and 10 o’clock, 2 mm from the corneal limbus. We used a 3-piece IOL haptic grasped by a 27-gauge retinal forceps and pulled from the 27-gauge trocar. The IOL was fixed by making a flange. Main outcome measures were visual acuity, corneal endothelial cell density, IOL tilt, decentration, predicted error of refraction and complications.Results: The 19 eyes were followed up for 1 month. The mean pre- and postoperative logMAR uncorrected visual acuity (UCVA) was 1.06 ± 0.63 and 0.40 ± 0.26, respectively (p<0.01), while the mean pre- and postoperative logMAR best corrected visual acuity (BCVA) was 0.27 ± 0.51 and 0.06 ± 0.15, respectively (p=0.09). The mean corneal endothelial cell density was 2406 ± 625 to 2004 ± 759 cells/mm2 at 1 month (p=0.13). The mean IOL tilt was 3.52 ± 3.00°, and the mean IOL decentration was 0.39 ± 0.39 mm. There was no correlation among IOL tilt, decentration and BCVA (p>0.05). The mean prediction error of the target refraction was –0.03 ± 0.93 D. The complications were vitreous hemorrhage (3 eyes), hyphema (1 eye), IOP elevation (1 eye), iris capture of the IOL (1 eye) and hypotony (2 eyes). No IOL dislocation occurred.Conclusions: IOL intrascleral fixation with a flange achieved good IOL fixation and visual outcome in the scleral tunnels created with the 27-gauge trocar.
Decreased MicroRNA-155 in Behcet’s disease leads to defective control of autophagy thereby stimulating excessive proinflammatory cytokine production 
Authors: Liang Liang , Zhou Qingyun , Feng Lujia , Yang Peizeng
Published: December 2020

Background: Earlier we reported that the microRNA (miR)-155 expression in dendritic cells (DCs) from Behcet’s disease (BD) patients was decreased and affected cytokine production of DCs. In this study, we investigated the mechanisms whereby miR-155 regulates cytokine production by DCs.Methods: The formation of autophagosomes in DCs was detected by transmission electron microscopy. Western blotting was used to detect the protein levels of LC3, Beclin-1, P62, p-mTOR and p-Akt in DCs. TNF-α, IL-6 and IL-1β expression were investigated by ELISA. MiR-155 mimics were transfected to DCs to evaluate its effects on autophagy and cytokine production. RNA interference was used to downregulate the expression of TAB2.Results: The formation of autophagosomes was found in DCs of active BD patients. The expressions of LC3-Ⅱ, Beclin-1and P62 were significantly increased in DCs of active BD patients compared to that of inactive BD patients and healthy controls. The expressions of IL-6, IL-1β and TNF-α were significantly increased in DCs of active BD patients compared to that of healthy controls. The autophagy promoter (3-MA) and inhibitor (rapamycin) significantly decreased or increased the expression of TNF-α, IL-6 and IL-1β by DCs. The expression of LC3-Ⅱand Beclin-1 were significantly increased, but the expression of P62 proteins was decreased in DCs transfected with miR-155 mimics or after TAB2 was downregulated. The expression of TNF-α, IL-6 and IL-1β were decreased in DCs after miR-155 was upregulated or TAB2 was downregulated. The ratios of p-Akt/Akt and p-mTOR/mTOR were decreased in DCs after miR-155 was upregulated. Conclusions: These results suggest that miR-155 affects the production of TNF-α, IL-6 and IL-1β by DCs through activation of the Akt/mTOR signaling pathway and by affecting the process of autophagy.