bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive performance along the migraine cycle: A negative exploratory study
Authors: Quadros Maria Ana , Granadeiro Marta , Ruiz-Tagle Amparo , Maruta Carolina , Gil-Gouveia Raquel , Martins Isabel Pavão
Published: August 2020

Migraine patients frequently report cognitive difficulties in the proximity and during migraine attacks. We performed an exploratory comparison of executive functioning across the four stages of the migraine cycle. Consecutive patients with episodic migraine undertook cognitive tests for attention, processing speed, set-shifting, and inhibitory control. Performance was compared between patients in different migraine stages, controlling for attack frequency and prophylactic medication. One hundred forty-three patients (142 women, average age 36.2 ± 9.9 years) were included, 28 preictal (≤48 h before the attack), 21 ictal (during the attack), 18 postictal (≤24 h after attack), and 76 interictal. Test performance (age and literacy adjusted z-scores) was not significantly different across migraine phases, despite a tendency for a decline before the attack. This negative study shows that cognitive performance fluctuates as patients approach the attack. To control for individual variability, this comparison needs to be better characterized longitudinally with a within-patient design.
Revealing the diversity of amber source plants from the Early Cretaceous Crato Formation, Brazil
Authors: Seyfullah Leyla J. , Roberts Emily A. , Schmidt Alexander R. , Ragazzi Eugenio , Anderson Ken B. , Rodrigues do Nascimento Daniel , Ferreira da Silva Filho Wellington , Kunzmann Lutz
Published: August 2020

Background

Amber has been reported from the Early Cretaceous Crato Formation, as isolated clasts or within plant tissues. Undescribed cones of uncertain gymnosperm affinity have also been recovered with amber preserved in situ. Here, we provide multiple lines of evidence to determine the botanical affinity of this enigmatic, conspicuous cone type, and to better understand the diversity of amber-source plants present in the Crato Formation and beyond.

Results

A new taxon of amber-bearing pollen coneAraripestrobus resinosusgen. nov. et sp. nov. is described here from complete cones and characteristic disarticulated portions. The best-preserved cone portion has both in situ amber infilling the resin canals inside the preserved microsporophyll tissues and pollen of theEucommiidites-type. This places this genus within the Erdtmanithecales, an incompletely known gymnosperm group from the Mesozoic.

FTIR analysis of the in situ amber indicates a potential araucariacean conifer affinity, although affinity with cupressacean conifers cannot be definitely ruled out. Pyr-GC-MS analysis of theAraripestrobus resinosusgen. nov. et sp. nov. in situ fossil resin shows that it is a mature class Ib amber, thought to indicate affinities with araucariacean and cupressacean, but not pinaceous, conifers. This is the first confirmed occurrence of this class of amber in the Crato Formation flora and in South America, except for an archaeological sample from Laguna Guatavita, Colombia.

Conclusions

The combined results of the cones’ novel gross morphology and the analyses of the in situ amber and pollen clearly indicate that the new taxon of resinous gymnosperm pollen cones from the Crato Formation is affiliated with Erdtmanithecales. The cone morphology is very distinct from all known pollen cone types of this extinct plant group. We therefore assume that the plant group that producedEucommiidites-type pollen is much more diverse in habits than previously thought. Moreover, the diversity of potential amber source plants from the Crato Formation is now expanded beyond the Araucariaceae and the Cheirolepidiaceae to include this member of the Erdtmanithecales. Despite dispersedEucommiiditespollen being noted from the Crato Formation, this is the first time macrofossils of Erdtmanithecales have been recognized from the Early Cretaceous of South America.
Hybrid transcriptome sequencing approach improved assembly and gene annotation in Cynara cardunculus (L.)
Authors: Puglia Giuseppe D. , Prjibelski Andrey D. , Vitale Domenico , Bushmanova Elena , Schmid Karl J. , Raccuia Salvatore A.
Published: August 2020

Background

The investigation of transcriptome profiles using short reads in non-model organisms, which lack of well-annotated genomes, is limited by partial gene reconstruction and isoform detection. In contrast, long-reads sequencing techniques revealed their potential to generate complete transcript assemblies even when a reference genome is lacking. Cynara cardunculus var. altilis (DC) (cultivated cardoon) is a perennial hardy crop adapted to dry environments with many industrial and nutraceutical applications due to the richness of secondary metabolites mostly produced in flower heads. The investigation of this species benefited from the recent release of a draft genome, but the transcriptome profile during the capitula formation still remains unexplored. In the present study we show a transcriptome analysis of vegetative and inflorescence organs of cultivated cardoon through a novel hybrid RNA-seq assembly approach utilizing both long and short RNA-seq reads.

Results

The inclusion of a single Nanopore flow-cell output in a hybrid sequencing approach determined an increase of 15% complete assembled genes and 18% transcript isoforms respect to short reads alone. Among 25,463 assembled unigenes, we identified 578 new genes and updated 13,039 gene models, 11,169 of which were alternatively spliced isoforms. During capitulum development, 3424 genes were differentially expressed and approximately two-thirds were identified as transcription factors including bHLH, MYB, NAC, C2H2 and MADS-box which were highly expressed especially after capitulum opening. We also show the expression dynamics of key genes involved in the production of valuable secondary metabolites of which capitulum is rich such as phenylpropanoids, flavonoids and sesquiterpene lactones. Most of their biosynthetic genes were strongly transcribed in the flower heads with alternative isoforms exhibiting differentially expression levels across the tissues.

Conclusions

This novel hybrid sequencing approach allowed to improve the transcriptome assembly, to update more than half of annotated genes and to identify many novel genes and different alternatively spliced isoforms. This study provides new insights on the flowering cycle in an Asteraceae plant, a valuable resource for plant biology and breeding in Cynara and an effective method for improving gene annotation.
Association of TIM-3 expression with glucose metabolism in Jurkat T cells
Authors: Lee Mi Jin , Yun Su Jin , Lee Bokyoung , Jeong Eun , Yoon Gyesoon , Kim Kyongmin , Park Sun
Published: August 2020

Background

T cell activation is associated with increase in glycolysis and glutaminolysis. T cell immunoglobulin and mucin domain containing protein-3 (TIM-3), a T cell surface molecule, downregulates T cell activation and leads to insufficient immunity in cancer and chronic infection. TIM-3 regulates T cell activation possibly through alterations in metabolism; however, the relationship between TIM-3 expression and T cell metabolic changes has not been well studied.

Results

We investigated the association between TIM-3 expression and metabolic changes by analyzing glucose metabolism, glutamine metabolism, and mitochondrial function in TIM-3 overexpressing or knockout Jurkat T cell lines relative to their control cell lines. Glucose uptake and consumption, and lactate release were downregulated by TIM-3 expression but upregulated by TIM-3 knockout. Concomitantly, the expression of the glucose transporter, Glut1, but not Glut2, 3, or 4 was altered by TIM-3 expression. However, TIM-3 expression alone could not account for the change in glutamine consumption, glutamate release, and mitochondrial mass, ROS production or membrane potential in these cell lines.

Conclusion

Our results show the association of TIM-3 expression with T cell glucose metabolism. These results are significant in chronic infections and cancers where it is necessary to control TIM-3 expressing T cells.
Novel variant in NSDHL gene associated with CHILD syndrome and syndactyly- a case report
Authors: Hettiarachchi D. , Panchal Hetalkumar , Lai P. S. , Dissanayake V. H. W.
Published: August 2020

Background

Congenital hemidysplasia with ichthyosiform erythroderma and limb defects also known as CHILD syndrome is an X-linked dominant, male lethal genodermatosis with a prevalence of 1 in 100,000 live births. Mutations in NSDHL gene located at Xq28 potentially impair the function of NAD(P) H steroid dehydrogenase-like protein and is responsible for its pathogenesis.

Case presentation

The proband was a 9-month-old twin (T2) girl with a healthy twin sister (T1) of Sri Lankan origin born to non-consanguineous parents. She presented with right sided continuous icthyosiform erythroderma and ipsilateral limb defects and congenital hemidysplasia since birth. Notably the child had ipsilateral hand hypoplasia and syndactyly. There were other visceral abnormalities. We performed whole exome sequencing and found a novel heterozygous variant (NSDHL, c.713C > A, p.Thr238Asn).

Conclusion

We report a novel missense variant in the NSDHL gene that resides in a highly-conserved region. This variant affects the NAD(P) H steroid dehydrogenase-like protein function via reduction in the number of active sites resulting in the CHILD syndrome phenotype and syndactyly.
Use of terlipressin in critically ill children with liver disease
Authors: Saxena Romit , Anand Aravind , Deep Akash
Published: August 2020

Background

Terlipressin, a long-acting synthetic analogue of vasopressin has been used in the adult population for various indications including hepatorenal syndrome (HRS-AKI), esophageal variceal hemorrhage (EVH) and shock, but its use in pediatrics is still limited to individualized cases and data on safety and efficacy is scant.

Methods

We reviewed the patient records of children with liver disease and Acute Kidney Injury requiring terlipressin admitted to the Paediatric Intensive Care Unit (PICU) of King’s College Hospital, London from January 2010–December 2017, with special emphasis on its effect on renal parameters and adverse event profile.

Results

Twenty-one terlipressin administration records in a total of 16 patients (median) (IQR) 10 years (6.1–14.4) were included. The drug was initially given as a bolus dose in all cases, followed by either bolus or infusion with median dosage being 5.2 (3.8–6.7) mcg/kg/hour. After administration, a sustained increase of mean arterial pressure was observed. There was an improvement in serum creatinine (Cr) (at 24 h; p = 0.386) and increase in urine output (UO), especially in the hepatorenal syndrome subgroup (HRS-AKI). We found minimal evidence of gastrointestinal side effects including feeding intolerance and vasoconstrictive side effects including cyanosis / ischaemia of extremities.

Conclusion

Terlipressin was found to be safe in critically sick children with liver disease with positive impact on renal parameters which might be taken as a surrogate marker of HRS reversal, though effects on outcomes are difficult to ascertain. It is important to be aware of all its side-effects and actively watch for them. Future prospective studies are warranted to validate these findings.
Pain trajectories of dorsomedial prefrontal intermittent theta burst stimulation versus sham treatment in depression
Authors: Malm Erika , Struckmann Wiebke , Persson Jonas , Bodén Robert
Published: August 2020

Background

Prefrontal repetitive transcranial magnetic stimulation is an established add-on treatment for major depressive disorder and is increasingly feasible with protocols of short duration, such as intermittent theta burst stimulation (iTBS). The most common and limiting side effect is pain at the site of application. Our objective was to investigate how pain develops over time in patients with depression receiving iTBS compared to sham stimulation.

Methods

This is a subsample from a randomized clinical trial. Patients received daily sessions of 2400 pulses of dorsomedial prefrontal iTBS or sham stimulation with transcutaneous electric stimulation during 2 to 3 weeks. After unmasking of treatment allocation, patients receiving sham treatment were offered active iTBS in an open phase. Patients rated pain on a scale from 0 to 10 after the last train of stimulation on the first, fifth and final treatment day. A Mann-Whitney U-test was conducted to test for group differences and related-samples Friedman’s tests to analyze changes in pain ratings over time.

Results

The scalp pain in the group receiving iTBS was rated higher than sham treatment on the first (U = 263.5, p = 0.035) and fifth day (U = 271.0, p = 0.020) but not on the final day (U = 210.5, p = 0.121). The pain decreased mainly during the first 5 days of treatment (χ2 = 0.875, p = 0.040). In the open phase the pain decreased from the first day to the final day (χ2 = 1.194, p = 0.001).

Conclusions

The subjective pain perception of active dorsomedial iTBS was higher than sham treatment but decreased over time, indicating an analgesic effect, or habituation. The result from this study can be used to inform patients about what to expect regarding pain during an iTBS treatment course.

Trial registration

Clinicaltrials.gov, NCT02905604. Registered 19 September 2016.
Twin pregnancy complicated with congenital Hemivertebra: report of two cases and literature review
Authors: Xu Tingting , Wang Xiaodong , Yu Haiyan , Zhao Fumin
Published: August 2020

Background

Hemivertebra deformity, involving one or multiple vertebral bodies, is one of the important causes of congenital scoliosis. Congenital fetal hemivertebrae could be diagnosed by ultrasonography and confirmed by fetal magnetic resonance imaging during pregnancy. However, reports of hemivertebrae in twins during the perinatal period are very rare.

Case presentation

We report two cases of congenital fetal hemivertebrae, each affecting one fetus in a dichorionic diamniotic (DCDA) twin pregnancy. We have also conducted a literature review of its prenatal screening, diagnosis, management, and outcomes. These two cases of congenital fetal hemivertebrae in one fetus of a DCDA twin were both initially found by ultrasonography and confirmed by fetal magnetic resonance imaging (MRI). One couple chose selective termination of the hemivertebrae fetus after they were extensively counseled by the multidisciplinary team regarding the treatment and prognosis of the hemivertebrae twin, and a healthy baby weighing 2320 g was delivered at the 37+ 1 gestational week. The other couple decided to continue the twin pregnancy and gave birth to two living newborns weighing 2580 g and 2060 g at 37+ 1 gestational weeks. These three babies were all in good health during follow-up.

Conclusions

Based on our center’s experience, comprehensive ultrasonography is necessary for early prenatal diagnosis of this condition. In addition, fetal MRI will confirm the diagnosis of hemivertebrae and provide parents with helpful information for their decision about the fate of the affected fetus.
Randomized double-blind clinical trial comparing safety and efficacy of the biosimilar BCD-022 with reference trastuzumab
Authors: Alexeev Sergey M. , Khorinko Andrey V. , Mukhametshina Guzel Z. , Shelepen Konstantin G. , Burdaeva Olga N. , Kulik Sergey A. , Satheesh Chiradoni Thugappa , Srivastava Kirti , Vikranth Mummaneni , Kryukov Fedor , Paltusova Anastasia N. , Shustova Mariya S. , Ivanov Roman A.
Published: August 2020

Background

BCD-022 is a trastuzumab biosimilar which was shown to be equivalent to reference trastuzumab in a wide panel of physicochemical studies as well as preclinical studies in vitro and in vivo. International multicenter phase III clinical trial was conducted to comparatively assess efficacy and safety of BCD-022 and reference trastuzumab in combination with paclitaxel used as the therapy of metastatic HER2(+) breast cancer. Pharmacokinetics and immunogenicity were also studied.

Methods

Patients with no previous treatment for metastatic HER2(+) breast cancer were randomly assigned 1:1 to BCD-022 or reference trastuzumab and were treated with trastuzumab + paclitaxel. Therapy continued for 6 cycles of therapy (every 3 weeks), until progression of the disease or unbearable toxicity. Primary study endpoint was overall response rate. Study goal was to prove equivalent efficacy of BCD-022 and reference trastuzumab. Equivalence margins for 95% CI for difference in overall response rates were set at [− 20%; 20%].

Results

In total 225 patients were enrolled into the study, 115 in BCD-022 arm and 110 in reference trastuzumab arm. Overall response rate was 49.6% in BCD-022 arm and 43.6% in reference trastuzumab arm. Limits of 95% CI for difference of overall response rates between arms were [(− 8.05)-19.89%], thus, they lied within predetermined equivalence margins [− 20%; 20%]. Profile of adverse events was similar between groups (any AEs were reported in 93.81% of patients in BCD-022 arm and 94.55% of patients in reference arm). No unexpected adverse reactions were reported throughout the study. No statistically significant differences regarding antibody occurrence rate (either BAb or NAb) was found between BCD-022 (n = 3; 2.65%) and comparator (n = 4; 3.64%). Both drug products are characterized with low occurrence rate and short life of anti-trastuzumab antibodies. Pharmacokinetics assessment after 1st and 6th study drug injection also demonstrated equivalent PK parameters by all outcome measures: AUC0–504, Сmах, Тmax, T1/2. Analysis of Ctrough did not reveal any significant inter-group differences as well.

Conclusions

Thus, results of this study have demonstrated therapeutic equivalence of trastuzumab biosimilar BCD-022 and referent trastuzumab drug.

Trial registration

The trial was registered with ClinicalTrials.gov (Study Number NCT01764022). The date of registration was January 9, 2013.
MEIS1 promotes expression of stem cell markers in esophageal squamous cell carcinoma
Authors: Zargari Selma , Negahban Khameneh Shabnam , Rad Abolfazl , Forghanifard Mohammad Mahdi
Published: August 2020

Background

MEIS1 (Myeloid ecotropic viral integration site 1) as a homeobox (HOX) transcription factor plays regulatory roles in a variety of cellular processes including development, differentiation, survival, apoptosis and hematopoiesis, as well as stem cell regulation. Few studies have established pluripotency and self-renewal regulatory roles for MEIS1 in human esophageal squamous cell carcinoma (ESCC), and our aim in this study was to evaluate the functional correlation between MEIS1 and the stemness markers in ESCC patients and cell line KYSE-30.

Methods

Expression pattern of MEIS1 and SALL4 gene expression was analyzed in different pathological features of ESCC patients. shRNA in retroviral vector was used for constantly silencing of MEIS1 mRNA in ESCC line (KYSE-30). Knockdown of MEIS1 gene and the expression pattern of selected stemness markers including SALL4, OCT4, BMI-1, HIWI, NANOG, PLK1, and KLF4 were evaluated using real-time PCR.

Results

Significant correlations were observed between MEIS1 and stemness marker SALL4 in different early pathological features of ESCC including non-invaded tumors, and the tumors with primary stages of progression. Retroviral knockdown of MEIS1 in KYSE-30 cells caused a noteworthy underexpression of both MEIS1 and major involved markers in stemness state of the cells including SALL4, OCT4, BMI-1, HIWI and KLF4.

Conclusions

The results highlight the important potential role of MEIS1 in modulating stemness properties of ESCCs and cells KYSE-30. These findings may confirm the linkage between MEIS1 and self-renewal capacity in ESCC and support probable oncogenic role for MEIS1 in the disease.
Study protocol: functioning curves and trajectories for children and adolescents with cerebral palsy in Brazil – PartiCipa Brazil
Authors: Chagas Paula S. C. , Drumond Carolyne M. , Toledo Aline M. , de Campos Ana Carolina , Camargos Ana Cristina R. , Longo Egmar , Leite Hércules R. , Ayupe Kênnea M. A. , Moreira Rafaela S. , Morais Rosane L. S. , Palisano Robert J. , Rosenbaum Peter ,   on Behalf of PartiCipa Brazil Research Group
Published: August 2020

Background

Gross motor development curves for children with Cerebral Palsy (CP), grouped by Gross Motor Function Classification System (GMFCS) levels, help health care professionals and parents to understand children’s motor function prognosis. Although these curves are widely used in Brazil to guide clinical decision-making, they were developed with Canadian children with CP. Little is known about how these patterns evolve in children and adolescents with CP in low-income countries like Brazil. The PARTICIPA BRAZIL aims to: (i) to identify and draw a profile of functioning and disability of Brazilian children and adolescents with CP by classifying them, for descriptive purposes, with all five valid and reliable functional classifications systems (gross motor function, manual ability, communication function, visual and eating and drinking abilities); (ii) to create longitudinal trajectories capturing the mobility capacity of Brazilian children and adolescents with CP for each level of the GMFCS; (iii) to document longitudinal trajectories in the performance of activities and participation of Brazilian children and adolescents with CP across two functional classification systems: GMFCS and MACS (Manual Abilities Classification System); (iv) to document longitudinal trajectories of neuromusculoskeletal and movement-related functions and exercise tolerance functions of Brazilian children and adolescents with CP for each level of the GMFCS; and (v) to explore interrelationships among all ICF framework components and the five functional classification systems in Brazilian children and adolescents with CP.

Methods

We propose a multi-center, longitudinal, prospective cohort study with 750 Brazilian children and adolescents with CP from across the country. Participants will be classified according to five functional classification systems. Contextual factors, activity and participation, and body functions will be evaluated longitudinally and prospectively for four years. Nonlinear mixed-effects models for each of the five GMFCS and MACS levels will be created using test scores over time to create prognosis curves. To explore the interrelationships among ICF components, a multiple linear regression will be performed.

Discussion

The findings from this study will describe the level and nature of activities and levels of participation of children and youth with CP in Brazil. This will support evidence-based public policies to improve care to this population from childhood to adulthood, based on their prognosis.
Superdiversity, migration and use of internet-based health information – results of a cross-sectional survey conducted in 4 European countries
Authors: Samkange-Zeeb Florence , Borisova Liubov , Padilla Beatriz , Bradby Hannah , Phillimore Jenny , Zeeb Hajo , Brand Tilman
Published: August 2020

Background

Studies of factors associated with the use of Internet-based health information generally focus on general, rather than migrant populations. This study looked into the reasons why Internet-based health information is used and the effects of migration-related factors, other socio-demographic characteristics and health-related factors on the tendency to consult the Internet.

Methods

In a cross-sectional survey conducted in eight superdiverse neighbourhoods - two each in Birmingham, United Kingdom; Bremen, Germany; Lisbon, Portugal and Uppsala, Sweden - participants were presented with six scenarios and asked to indicate the resources they most relied on when addressing a health concern from a given list. The scenarios included establishing the underlying causes of a health concern and seeking information about prescription drugs, treatments and services available as part of the public healthcare system. The list of resources included the public healthcare system, alternative medicine, family and friends, and the Internet. Frequencies for which the Internet was consulted for each different scenario were calculated and compared across the participating cities. The association between consulting Internet-based health information and migration-related factors, and further socio-demographic characteristics as well as health-related factors such as self-reported health and health literacy was assessed using multivariable logistic regressions.

Results

Of the 2570 participants from all four cities who were included in the analyses, 47% had a migrant background and 35% originated from non-EU countries. About a third reported relying on Internet-based health information for at least one of the given scenarios. The two most frequently chosen scenarios were to find out about other possible treatments and prescription drugs. Generally, using Internet-based health information was negatively associated with being a first generation migrant (OR 0.65; 95% CI 0.46–0.93), having poor local language competency (OR 0.25; 95% CI 0.14–0.45), older age (≥60 years, OR 0.21; 95% CI 0.15–0.31), low education (OR 0.35; 95% CI 0.24–0.50) and positively associated with low trust in physicians (OR 2.13; 95% CI 1.47–3.10).

Conclusion

Our findings indicate the need to consider migration background and language competency when promoting the provision of healthcare services via the Internet so that information and services are widely accessible.
The high prevalence of intestinal parasitic infections is associated with stunting among children aged 6–59 months in Boricha Woreda, Southern Ethiopia: a cross-sectional study
Authors: Yoseph Amanuel , Beyene Hunachew
Published: August 2020

Background

Prior studies reported controversial results about the association between intestinal parasitic infections and childhood under-nutrition. We investigated the association of intestinal parasitic infections with under-nutrition among children aged 6–59 months in Boricha Woreda, Southern Ethiopia.

Methods

This community-based prospective cross-sectional study was carried out from January 1–30, 2019 among 622 children aged 6–59 months. A two-stage stratified sampling procedure was used. Data were collected using a structured, face-to-face interviewer-administered questionnaire and standard anthropometric measurements. The stool specimens were collected using standard technique and examined for the existence and species of intestinal parasites using direct wet mount, Kato Katz and staining technique. We have entered data using Epi Data 3.1 and WHO Anthro software and all analyses were conducted using SPSS version 20. The descriptive analyses were done to find descriptive measures for the socio-demographic and other important variables. Multivariable logistic regression analysis was used to identify factors associated with under-nutrition. Adjusted odds ratios (AORs) with a 95% confidence interval (CI) were computed to assess the presence and strength of associations.

Results

The total prevalence of intestinal parasitic infection was 48.7% (95% CI, 44.77–52.62). Approximately one-fourth (22%) of the children were infected with moderate intensity infections. Prevalence of stunting, underweight, wasting were 39.3, 24 and 11.6%, respectively. The prevalence of stunting among children infected with the intestinal parasite (59.4%) was significantly higher than the prevalence in non-infected children (20.6%) (p < 0.001). The absence of sanitation facility, living in medium and large family size, lack of shoes wearing practice, consuming raw vegetables and fruits were positively associated with intestinal parasitic infections. The presence of intestinal parasitic infections was positively associated with stunting (AOR = 2.18, 95% CI: 1.36–3.50) but not with wasting (AOR = 0.58, 95% CI: 0.3–1.13) and underweight (AOR: 0.92, 95% CI = 0.55–1.54).

Conclusions

Under-nutrition and intestinal parasitic infections were serious public health concerns. Consolidating the prevailing water, sanitation and hygiene packages and routine deworming of children aged 6–59 months may aid to decrease the burden of both stunting and intestinal parasitic infection in children. Also, improving modern contraceptive methods utilization to reduce family size is recommended.
Blessings or burdens: an Interpretative Phenomenological Analysis (IPA) study on the motivations and their impact on end-of-life caregiving among Asian family caregivers
Authors: Tan-Ho Geraldine , Choo Ping Ying , Patinadan Paul Victor , Low Casuarine Xinyi , Ho Andy Hau Yan
Published: August 2020

Background

While the impact of family caregiving has been well-documented, many of such studies center on investigating external factors such as socioeconomic status, accessibility to resources and availability of social support as the primary causation of caregiver wellbeing outcomes. This paper explores the motivations that drive family caregivers in supporting their family members at the end-of-life, and critically examines how internal appraisal processes of such motivations can both positively and negatively impact their wellbeing.

Methods

This study adopted an interpretative phenomenological analysis (IPA) to investigate the motivations and internal appraisal processes of Asian family caregivers in Singapore who were tending to a dying family member. Qualitative dyadic interview data (N = 20) was drawn from a larger Randomized Controlled Trial for a novel Family Dignity Intervention (FDI) for palliative care patients and their families. The sampling population consisted of participants aged 21 and above who were identified to be the primary caregivers of older palliative care patients with a prognosis of less than 12 months. Data collection was conducted in the homes of patients and family caregivers.

Results

Findings revealed six themes that could either nurture or diminish caregiver wellbeing: 1) Honoring Fidelity (caregivers were motivated to commit to their caregiving roles in order to avoid regret), 2) Alleviating Suffering (caregivers were motivated to relieve their family member’s pain), 3) Enduring Attachment (caregivers were motivated to spend time together with their family member), 4) Preserving Gratitude (caregivers were motivated to express their appreciation to their family member by caregiving), 5) Navigating Change (caregivers were motivated to adapt accordingly to changes in the illness trajectory) and 6) Reconciling with Mortality (caregivers were motivated to respond accordingly to their family member’s prognosis). The final theme of the Wellbeing Determinant is posited as an indication of self-determination, and is conjectured to influence how caregiving motivations are appraised by the caregiver.

Conclusion

Fulfilling and enhancing one’s sense of self-determination appears central to infusing one’s caregiving motivations with positive meaning, and consequently nurturing one’s wellbeing in the end-of-life caregiving journey. These findings are discussed with recommendations for healthcare professionals working with family caregivers of palliative care patients.
Establishment of a sentinel surveillance network for sexually transmissible infections and blood borne viruses in Aboriginal primary care services across Australia: the ATLAS project
Authors: Bradley Clare , Hengel Belinda , Crawford Katy , Elliott Salenna , Donovan Basil , Mak Donna B. , Nattabi Barbara , Johnson David , Guy Rebecca , Fairley Christopher K. , Wand Handan , Ward James ,   and the Centre of Research Excellence in Aboriginal Sexual Health investigator group, Lewis David , Bowden Frank , Selvey Christine , Bastian Lisa , Smallwood Gracelyn
Published: August 2020

Background

Sexually transmissible infection (STI) and blood-borne virus (BBV) diagnoses data are a core component of the Australian National Notifiable Diseases Surveillance System (NNDSS). However, the NNDSS data alone is not enough to understand STI and BBV burden among priority population groups, like Aboriginal and Torres Strait Islander people, because it lacks testing, treatment and management data. Here, we describe the processes involved in establishing a STI and BBV sentinel surveillance network representative of Aboriginal Community-Controlled Health Services (ACCHS)—known as the ATLAS network—to augment the NNDSS and to help us understand the burden of disease due to STI and BBV among Aboriginal and Torres Strait Islander peoples.

Methods

Researchers invited participation from ACCHS in urban, regional and remote areas clustered in five clinical hubs across four Australian jurisdictions. Participation agreements were developed for each clinical hub and individual ACCHS. Deidentified electronic medical record (EMR) data relating to STI and BBV testing, treatment and management are collected passively from each ACCHS via the GRHANITEtm data extraction tool. These data are analysed centrally to inform 12 performance measures which are included in regular surveillance reports generated for each ACCHS and clinical hub.

Results

The ATLAS network currently includes 29 ACCHS. Regular reports are provided to ACCHS to assess clinical practice and drive continuous quality improvement initiatives internally. Data is also aggregated at the hub, jurisdictional and national level and will be used to inform clinical guidelines and to guide future research questions. The ATLAS infrastructure can be expanded to include other health services and potentially linked to other data sources using GRHANITE.

Conclusions

The ATLAS network is an established national surveillance network specific to Aboriginal and Torres Strait Islander peoples. The data collected through the ATLAS network augments the NNDSS and will contribute to improved STI and BBV clinical care, guidelines and policy program-planning.
Use of low-value pediatric services in the Military Health System
Authors: Koehlmoos Tracey Pérez , Madsen Cathaleen , Banaag Amanda , Li Qiong , Schoenfeld Andrew J. , Weissman Joel S.
Published: August 2020

Background

Low-value care (LVC) is understudied in pediatric populations and in the Military Health System (MHS). This cross-sectional study applies previously developed measures of pediatric LVC diagnostic tests, procedures, and treatments to children receiving care within the direct and purchased care environments of the MHS.

Methods

We queried the MHS Data Repository (MDR) to identify children (n = 1,111,534) who received one or more of 20 previously described types of LVC in fiscal year 2015. We calculated the proportion of eligible children and all children who received the service at least once during fiscal year 2015. Among children eligible for each measure, we used logistic regressions to calculate the adjusted odds ratios (AOR) for receiving LVC at least once during fiscal year 2015 in direct versus purchased care.

Results

All 20 measures of pediatric LVC were found in the MDR. Of the 1,111,534 eligible children identified, 15.41% received at least one LVC service, and the two most common procedures were cough and cold medications in children under 6 years and acid blockers for infants with uncomplicated gastroesophageal reflux. Eighteen of the 20 measures of pediatric LVC were eligible for comparison across care environments: 6 were significantly more likely to be delivered in direct care and 10 were significantly more likely to be delivered in purchased care. The greatest differences between direct and purchased care were seen in respiratory syncytial virus testing in children with bronchiolitis (AOR = 21.01, 95% CI = 12.23–36.10) and blood tests in children with simple febrile seizure (AOR = 24.44, 95% CI = 5.49–108.82). A notably greater difference of inappropriate antibiotic prescribing was seen in purchased versus direct care.

Conclusions

Significant differences existed between provision of LVC services in direct and purchased care, unlike previous studies showing little difference between publicly and privately insured children. In fiscal year 2015, 1 in 7 children received one of 20 types of LVC. These proportions are higher than prior estimates from privately and publicly insured children, suggesting the particular need to focus on decreasing wasteful care in the MHS. Collectively, these studies demonstrate the high prevalence of LVC in children and the necessity of reducing potentially harmful care in this vulnerable population.
Characterization of Salmonella spp. isolated from chickens in Central China
Authors: Wang Xin , Wang Honglin , Li Tingting , Liu Feifei , Cheng Yiluo , Guo Xiaodong , Wen Guoyuan , Luo Qingping , Shao Huabin , Pan Zishu , Zhang Tengfei
Published: August 2020

Background

Salmonella is an important zoonotic pathogen, and chickens are one of its main hosts. Every year, Salmonella infections pose a serious threat to the poultry industry in developing countries, especially China. In this study, a total of 84 Salmonella isolates recovered from sick and healthy-looking chickens in central China were characterized by serotyping, MLST-based strain typing, presence of potential virulence factors, and antimicrobial resistance profiles.

Result

Data showed that the main serotypes of Salmonella isolates in central China were Salmonella enterica serovar Gallinarum biovar Pullorum, Salmonella enterica serovar Gallinarum biovar Gallinarum, Salmonella enterica serovar Enteritidis and Salmonella enterica serovar Typhimurium, and among them, S. Pullorum was the dominant type in both sick and healthy-looking chickens, accounting for 43.9 and 46.5%, respectively, while S. Enteritidis was only found in healthy-looking chickens. All isolates exhibited higher resistance rates to ampicillin (97.6%), tetracycline (58.3%) and colistin (51.2%), and among these isolates, 49.5% were resistant to more than three drugs in different combinations. S. Enteritidis was the most severe multidrug-resistant serotype, which showed higher resistance rates to colistin, meropenem and ciprofloxacin. Multilocus sequence typing (MLST) revealed that S. Gallinarum and S. Enteritidis isolates were clustered in clade 1, which belonged to two and one STs, respectively. All S. Typhimurium isolates were clustered in clade 3, and belonged to three STs. However, S. Pullorum were distributed in three clades, which belonged to 7 STs. Twenty-seven virulence-associated genes were detected, and expected cdtB, which was absent in all the isolates, the other 26 genes were conserved in the closely related Salmonella serogroup D (S. Enteritidis, S. Pullorum, and S. Gallinarum).

Conclusion

Salmonella serogroup D was the major subgroup, and S. Pullorum was the most common type in sick and healthy-looking chickens in central China. Drug resistance assays showed serious multiple antimicrobial resistances, and S. Enteritidis was the most severe drug-resistant serotype. MLST showed that there was correlation between serotypes and genotypes in most Salmonella isolates, except S. Pullorum, which showed complicated genetic diversity firstly. These results provide important epidemiological information for us to control Salmonella in chickens.
Multivisceral resection for adenocarcinoma of the pancreatic body and tail—a retrospective single-center analysis
Authors: Beetz Oliver , Sarisin Akin , Kaltenborn Alexander , Klempnauer Jürgen , Winkler Michael , Grannas Gerrit
Published: August 2020

Background

Adenocarcinoma of the pancreatic body and tail is associated with a dismal prognosis. As patients frequently present themselves with locally advanced tumors, extended surgery including multivisceral resection is often necessary in order to achieve tumor-free resection margins. The aim of this study was to identify prognostic factors for postoperative morbidity and mortality and to evaluate the influence of multivisceral resections on patient outcome.

Methods

This is a retrospective analysis of 94 patients undergoing resection of adenocarcinoma located in the pancreatic body and/or tail between April 1995 and December 2016 at our institution. Uni- and multivariable Cox regression analysis was conducted to identify independent prognostic factors for postoperative survival.

Results

Multivisceral resections, including partial resections of the liver, the large and small intestines, the stomach, the left kidney and adrenal gland, and major vessels, were carried out in 47 patients (50.0%). The median postoperative follow-up time was 12.90 (0.16–220.92) months.

Median Kaplan-Meier survival after resection was 12.78 months with 1-, 3-, and 5-year survival rates of 53.2%, 15.8%, and 9.0%. Multivariable Cox regression identified coeliac trunk resection (p = 0.027), portal vein resection (p = 0.010), intraoperative blood transfusions (p = 0.005), and lymph node ratio in percentage (p = 0.001) as independent risk factors for survival. Although postoperative complications requiring surgical revision were observed more frequently after multivisceral resections (14.9 versus 2.1%; p = 0.029), postoperative survival was not significantly inferior when compared to patients undergoing standard distal or subtotal pancreatectomy (12.35 versus 13.87 months; p = 0.377).

Conclusions

Our data indicates that multivisceral resection in cases of locally advanced pancreatic carcinoma of the body and/or tail is justified, as it is not associated with increased mortality and can even facilitate long-term survival, albeit with an increase in postoperative morbidity. Simultaneous resections of major vessels, however, should be considered carefully, as they are associated with inferior survival.
Biased technical change in hospital care and the demand for physicians
Authors: Blank Jos L. T. , Niaounakis Thomas K. , Valdmanis Vivian G.
Published: August 2020

Background

The development of labour productivity is relevant for accurately planning future staffing requirements, especially in sectors where technological developments may drive labour substitution. The present study investigates how labour productivity has developed across Dutch medical specialists (2007–2017) and discusses its implications for workforce planning, also in relation to the existing literature.

Methods

A regression model is developed in which the number of full-time equivalents is related to production (admissions), hospital characteristics and a trend parameter. The trend parameter captures the average annual change in the number of full-time equivalents per production output and is a measure for labour productivity. The model is applied to a micro-data set of Dutch hospitals in the period 2007–2017 across 24 different specialties using regression methods.

Results

The results indicate an increase in the number of full-time equivalents per admission has increased for most specialisms and that labour productivity has thus decreased. However, there is considerable heterogeneity and uncertainty across different specialisms.

Conclusions

The results amplify the issue of medical personnel shortages driven by the growing demand for health care. The research outcomes are linked to the existing literature regarding physicians’ productivity. Changes in accountability such as using relative value units, incentive payments, use of staff and mid-level providers, and technology have been discussed, and some consensus has been reached.
Simvastatin induces adverse effects on proliferation and mineralization of human primary osteoblasts
Authors: Sabandal Martin Mariano Isabelo , Schäfer Edgar , Aed Jonathan , Jung Susanne , Kleinheinz Johannes , Sielker Sonja
Published: August 2020

Background

Frequently statins were administered to reduce the LDL-concentration in circulating blood. Especially simvastatin (SV) is an often prescribed statin. Pleiotropic effects of these drugs were reported. Thus, the aim of this study was to evaluate effects of SV on osteoblastic mineralization.

Methods

After informed consent primary osteoblasts were collected from tissue surplus after treatment of 14 individuals in the Department of Cranio-Maxillofacial Surgery, University Hospital Münster. The cells were passaged according to established protocols. Viability, mineralization capability and osteoblastic marker (alkaline phosphatase) were determined at day 9, 13 and 16 after adding various SV concentrations (0.05 μM, 0.1 μM, 0.5 μM, 1.0 μM). Statistical analysis was performed using the Kruskal-Wallis-test.

Results

The cell cultures showed a time and dose-dependent significantly decreased viability (p < 0.01) and a significantly increased mineralization (p < 0.01) in a late mineralization stage after adding SV. The typical alteration of the alkaline phosphatase (ALP) levels during osteogenic differentiation was not recognizable.

Conclusions

The pleiotropic effects found for different SV concentrations were possibly originated from other mineralization pathways beside the ALP induced one. Additionally, possible alterations of protein expression levels during mineralization and investigation of possible deviating application of SV in other treatment fields can be considered after gaining a deeper insight in the affected mechanisms.
Systematic human rights violations, traumatic events, daily stressors and mental health of Rohingya refugees in Bangladesh
Authors: Riley Andrew , Akther Yasmin , Noor Mohammed , Ali Rahmat , Welton-Mitchell Courtney
Published: August 2020

Background

Almost 900,000 Rohingya refugees currently reside in refugee camps in Southeastern Bangladesh. Prior to fleeing Myanmar, Rohingya experienced years of systematic human rights violations, in addition to other historical and more recent traumatic events such as the burning of their villages and murder of family members, friends and neighbors. Currently, many Rohingya struggle to meet basic needs in refugee camps in Bangladesh and face mental health-related concerns that appear linked to such challenges. The purpose of this study is to describe systematic human rights violations, traumatic events, daily stressors, and mental health symptoms and to examine relationships between these factors.

Methods

Cross-sectional data was collected from a representative sample of 495 Rohingya refugee adults residing in camps in Bangladesh in July and August of 2018.

Results

Respondents reported high levels of systematic human rights violations in Myanmar, including restrictions related to expressing thoughts, meeting in groups, travel, religious practices, education, marriage, childbirth, healthcare, and more. Events experienced in Myanmar included exposure to gunfire (99%), destruction of their homes (93%), witnessing dead bodies (92%), torture (56%), forced labor (49%), sexual assault (33%), and other events. More than half (61%) of participants endorsed mental health symptom levels typically indicative of PTSD, and more than two thirds (84%) endorsed levels indicative of emotional distress (symptoms of anxiety and depression). Historic systematic human rights violations, traumatic events, and daily stressors were associated with symptoms of posttraumatic stress, as well as depression and anxiety. Respondents reported numerous stressors associated with current life in the camps in Bangladesh as well as previous stressors, such as harassment, encountered in Myanmar.

Conclusions

Findings underscore the impact of systematic human rights violations, targeted violence, and daily stressors on the mental health of Rohingya in Bangladesh. Those working with Rohingya should consider the role of such factors in contributing to poor mental health. This research has the potential to inform interventions targeting such elements. Future research should examine the relationships between mental health and human rights violations over time.