bluuebunny/crossref_metadata_2025 huggingface dataset:
Prioritising gender, equity, and human rights in a GRADE-based framework to inform future research on self care for sexual and reproductive health and rights
Authors: Siegfried Nandi , Narasimhan Manjulaa , Logie Carmen H , Thomas Rebekah , Ferguson Laura , Moody Kevin , Remme Michelle
Published: March 2020

Introduction

In January 2019, the WHO reviewed evidence to develop global recommendations on self-care interventions for sexual and reproductive health and rights (SRHR). Identification of research gaps is part of the WHO guidelines development process, but reliable methods to do so are currently lacking with gender, equity and human rights (GER) infrequently prioritised.

Methods

We expanded a prior framework based on Grading of Evidence, Assessment, Development and Evaluation (GRADE) to include GER. The revised framework is applied systematically during the formulation of research questions and comprises: (1) assessment of the GRADE strength and quality rating of recommendations; (2) mandatory inclusion of research questions identified from a global stakeholder survey; and (3) selection of the GER standards and principles most relevant to the question through discussion and consensus. For each question, we articulated: (1) the most appropriate and robust study design; (2) an alternative pragmatic design if the ideal design was not feasible; and (3) the methodological challenges facing researchers through identifying potential biases.

Results

We identified 39 research questions, 7 overarching research approaches and 13 discrete feasible study designs. Availability and accessibility were most frequently identified as the GER standards and principles to consider when planning studies, followed by privacy and confidentiality. Selection and detection bias were the primary methodological challenges across mixed methods, quantitative and qualitative studies. A lack of generalisability potentially limits the use of study results with non-participation in research potentially highest in more vulnerable populations.

Conclusion

A framework based on GRADE that includes stakeholders’ values and identification of core GER standards and principles provides a practical, systematic approach to identifying research questions from a WHO guideline. Clear guidance for future studies will contribute to an anticipated ‘living guidelines’ approach within WHO. Foregrounding GER as a separate component of the framework is innovative but further elaboration to operationalise appropriate indicators for SRHR self-care interventions is required.
Impact of electronic palliative care coordination systems (EPaCCS) on care at the end of life across multiple care sectors, in one clinical commissioning group area, in England: a realist evaluation protocol
Authors: Pocock Lucy , French Lydia , Farr Michelle , Morris Richard , Purdy Sarah
Published: March 2020

Introduction

Electronic palliative care coordination systems (EPaCCS) aim to support people approaching the end of life (EOL) to receive consistent care, according to their wishes, that is coordinated effectively across multiple care sectors. They are in use across the UK although empirical evidence into their effectiveness is poor. This paper presents a protocol of a mixed-methods study, to understand how, and by whom, EPaCCS are being used and whether EPaCCS are enabling Healthcare Professionals (HCPs) to coordinate patients’ EOL care.

Methods and analysis

This is a mixed-methods study, carried out within a realist paradigm, to evaluate the impact of an EPaCCS on EOL care as provided by a Clinical Commissioning Group (CCG) in England. This study has two aims: (1) Describe the socio-demographic characteristics of patients who die with an EPaCCS record, their underlying cause of death and place of death and compare these with patients who die without an EPaCCS record. (2) Explore the impact of an EPaCCS on the experience of receiving EOL care for patients and their carers, and understand HCPs’ views and experiences of utilising an EPaCCS to coordinate care for their patients. The study will be conducted in five phases: (1) development of the initial programme theory; (2) focus group with CCG stakeholder board; (3) individual interviews with HCPs, patients, current and bereaved carers; (4) retrospective cohort study of routinely collected data on EPaCCS usage and (5) data analysis and synthesis of study findings.

Ethics and dissemination

The study has been approved by National Health Service South West–Frenchay Research Ethics Committee (REC reference number: 18/SW/0198). Findings will be published in a wide range of outputs targeted at key audiences.
Liver function tests and fibrosis scores in a rural population in Africa: a cross-sectional study to estimate the burden of disease and associated risk factors
Authors: O'Hara Geraldine , Mokaya Jolynne , Hau Jeffrey P , Downs Louise O , McNaughton Anna L , Karabarinde Alex , Asiki Gershim , Seeley Janet , Matthews Philippa C , Newton Robert
Published: March 2020

Objectives

Liver disease is a major cause of morbidity and mortality in sub-Saharan Africa, but its prevalence, distribution and aetiology have not been well characterised. We therefore set out to examine liver function tests (LFTs) and liver fibrosis scores in a rural African population.

Design

We undertook a cross-sectional survey of LFTs. We classified abnormal LFTs based on reference ranges set in America and in Africa. We derived fibrosis scores (aspartate aminotransferase (AST) to Platelet Ratio Index (APRI), fibrosis-4, gamma-glutamyl transferase (GGT) to platelet ratio (GPR), red cell distribution width to platelet ratio and S-index). We collected information about alcohol intake, and infection with HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV).

Setting

We studied a population cohort in South-Western Uganda.

Participants

Data were available for 8099 adults (median age 30 years; 56% female).

Results

The prevalence of HBV, HCV and HIV infection was 3%, 0.2% and 8%, respectively. The prevalence of abnormal LFTs was higher based on the American reference range compared with the African reference range (eg, for AST 13% vs 3%, respectively). Elevated AST/ALT ratio was significantly associated with self-reported alcohol consumption (p<0.001), and the overall prevalence of AST/ALT ratio >2 was 11% (suggesting alcoholic hepatitis). The highest prevalence of fibrosis was predicted by the GPR score, with 24% of the population falling above the threshold for fibrosis. There was an association between the presence of HIV or HBV and raised GPR (p=0.005) and S-index (p<0.001). By multivariate analysis, elevated LFTs and fibrosis scores were most consistently associated with older age, male sex, being under-weight, HIV or HBV infection and alcohol consumption.

Conclusions

Further work is required to determine normal reference ranges for LFTs in this setting, to evaluate the specificity and sensitivity of fibrosis scores and to determine the aetiology of liver disease.
Investigating the effectiveness of care delivery at an acute geriatric community hospital for older adults in the Netherlands: a protocol for a prospective controlled observational study
Authors: Ribbink Marthe E , Macneil-Vroomen Janet L , van Seben Rosanne , Oudejans Irène , Buurman Bianca M
Published: March 2020

Introduction

Hospital admission in older adults with multiple chronic conditions is associated with unwanted outcomes like readmission, institutionalisation, functional decline and mortality. Providing acute care in the community and integrating effective components of care models might lead to a reduction in negative outcomes. Recently, the first geriatrician-led Acute Geriatric Community Hospital (AGCH) was introduced in the Netherlands. Care at the AGCH is focused on the treatment of acute diseases, comprehensive geriatric assessment, setting patient-led goals, early rehabilitation and streamlined transitions of care.

Methods and analysis

This prospective cohort study will investigate the effectiveness of care delivery at the AGCH on patient outcomes by comparing AGCH patients to two historic cohorts of hospitalised patients. Propensity score matching will correct for potential population differences. The primary outcome is the 3-month unplanned readmission rate. Secondary outcomes include functional decline, institutionalisation, healthcare utilisation, occurrence of delirium or falls, health-related quality of life, mortality and patient satisfaction. Measurements will be conducted at admission, discharge and 1, 3 and 6 months after discharge. Furthermore, an economic evaluation and qualitative process evaluation to assess facilitators and barriers to implementation are planned.

Ethics and dissemination

The study will be conducted according to the Declaration of Helsinki. The Medical Ethics Research Committee confirmed that the Medical Research Involving Human Subjects Act did not apply to this research project and official approval was not required. The findings of this study will be disseminated through public lectures, scientific conferences and journal publications. Furthermore, the findings of this study will aid in the implementation and financing of this concept (inter)nationally.

Trial registration number

NL7896; Pre-results.
Maternal multivitamin intake and orofacial clefts in offspring: Japan Environment and Children's Study (JECS) cohort study
Authors: Yoshida Satomi , Takeuchi Masato , Kawakami Chihiro , Kawakami Koji , Ito Shuichi
Published: March 2020

Objectives

Orofacial clefts are common birth defects with a lack of strong evidence regarding their association with maternal nutrition. We aimed to determine whether a relationship exists between maternal nutrient or multivitamin intake and orofacial clefts.

Design

This is a prospective, population-based nationwide cohort study.

Setting

The study was conducted in 15 regional centres, consisting of local administrative units and study areas.

Participants

A total of 98 787 eligible mother–child pairs of the Japan Environment and Children’s Study were included.

Intervention

Exposures were maternal nutrition and the use of supplemental multivitamins in mothers.

Primary and secondary outcome measures

Outcomes were the occurrence of any orofacial cleft at birth. Multinomial logistic regression analyses were used to evaluate the association between maternal multivitamin intake and the incidence of orofacial clefts.

Results

Of the 98 787 children, 69 (0.07%) were diagnosed with cleft lip alone, 113 (0.11%) were diagnosed with cleft lip and palate, and 52 (0.05%) were diagnosed with cleft palate within 1 month after birth. Regarding the total orofacial cleft outcome, statistically significant point estimates of relative risk ratios (RR) were determined for multivitamin intake before pregnancy (RR=1.71; 95% CI 1.06 to 2.77) and during the first trimester (RR=2.00; 95% CI 1.18 to 3.37), but the association was not significant for multivitamin intake after the first trimester (RR=1.34; 95% CI 0.59 to 3.01). Maternal micronutrient intake via food was not associated with the incidence of orofacial clefts in offspring.

Conclusions

Intake of multivitamin supplements shortly before conception or during the first trimester of pregnancy was found to be associated with an increased incidence of orofacial clefts at birth. Pregnant women and those intending to become pregnant should be advised of the potential risks of multivitamin supplementation.
Evaluating a group-based Yoga of Stress Resilience programme: a pragmatic before–after interventional study protocol
Authors: Alvarez Elizabeth , Sutton Arielle , Barton Bria , Vaidya Shailla
Published: March 2020

Introduction

Rates of mental health illnesses and burnout are increasing internationally. Therapeutic yoga is increasingly used to improve and maintain physical, mental and emotional well-being and general health. This protocol describes a study to evaluate the effectiveness of an existing primary care group-based therapeutic yoga programme, the Yoga of Stress Resilience programme, which combines yoga and psychotherapeutic techniques, in improving mental health and decreasing burnout. Implementation factors will also be evaluated for potential scale-up.

Methods and analysis

A pragmatic before–after interventional trial design will be used to study changes in occupational participation and mental health outcomes, including anxiety, depression, burnout, functional impairment, insomnia, perceived stress, loneliness, self-compassion and readiness for change in adults experiencing anxiety and burnout. Repeated measures analysis of variance will be used to determine changes in outcome measures over time. Regression and multivariate analyses will be conducted to examine relationships between participant characteristics and outcomes and among various outcomes. The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework will be used to guide the analyses.

Ethics and dissemination

Approval from the Hamilton Integrated Research Ethics Board has been waived: project number 7082 (full review waived). Informed consent will be obtained prior to enrolling any participant into the study. All data will be kept confidential. Peer-reviewed publications and presentations will target researchers and health professionals.

Trial registration number

The ClinicalTrials.gov registry (NCT03973216).
Associations of symptoms and quality of life with outcomes in patients with atrial fibrillation
Authors: Krisai Philipp , Blum Steffen , Aeschbacher Stefanie , Beer Jürg H , Moschovitis Giorgio , Witassek Fabienne , Kobza Richard , Rodondi Nicolas , Moutzouri Elisavet , Mahmood Aamina , Healey Jeff S , Zuern Christine S , Kühne Michael , Osswald Stefan , Conen David
Published: March 2020

Objective

We aimed to investigate changes in atrial fibrillation (AF)-related symptoms and quality of life (QoL) over time, and their impact on prognosis.

Methods

We prospectively followed 3836 patients with known AF for a mean of 3.7 years. Information on AF-related symptoms and QoL was obtained yearly. The primary end point was a composite of stroke or systemic embolism. Main secondary end points included stroke subtypes, all-cause mortality, cardiovascular death, hospitalisation for congestive heart failure (CHF), myocardial infarction and major bleeding. We assessed associations using multivariable, time-updated Cox proportional hazards models.

Results

Mean age was 72 years, 72% were male. Patients with AF-related symptoms (66%) were younger (70 vs 74 years, p<0.0001), more often had paroxysmal AF (56% vs 37%, p<0.0001) and had lower QoL (71 vs 72 points, p=0.009). The incidence of the primary end point was 1.05 and 1.02 per 100 person-years in patients with and without symptoms, respectively. The multivariable adjusted HR (aHR) (95% CIs) for the primary end point was 1.11 (0.77 to 1.59; p=0.56) for AF-related symptoms. AF-related symptoms were not associated with any of the secondary end points. QoL was not significantly related to the primary end point (aHR per 5-point increase 0.98 (0.94 to 1.03; p=0.37)), but was significantly related to CHF hospitalisations (0.92 (0.90 to 0.94; p<0.0001)), cardiovascular death (0.90 (0.86 to 0.95; p<0.0001)) and all-cause mortality (0.88 (0.86 to 0.90; p<0.0001)).

Conclusions

AF-related symptoms were not associated with adverse outcomes and should therefore not be the basis for prognostic treatment decisions. QoL was strongly associated with CHF, cardiovascular death and all-cause mortality.
Conditional immune toxicity rate in patients with metastatic renal and urothelial cancer treated with immune checkpoint inhibitors
Authors: Nuzzo Pier Vitale , Pond Gregory R , Abou Alaiwi Sarah , Nassar Amin H , Flippot Ronan , Curran Catherine , Kilbridge Kerry L , Wei Xiao X , McGregor Bradley A , Choueiri Toni , Harshman Lauren C , Sonpavde Guru
Published: March 2020

Background

Immune checkpoint inhibitors (ICIs) are associated with immune-related adverse events (irAEs). Although the incidence and prevalence of irAEs have been well characterized in the literature, less is known about the cumulative incidence rate of irAEs. We studied the cumulative incidence of irAEs, defined as the probability of irAE occurrence over time and the risk factors for irAE development in metastatic urothelial carcinoma (mUC) and renal cell carcinoma (mRCC) patients treated with ICIs.

Methods

We identified a cohort of patients who received ICIs for mUC and mRCC. irAEs were classified using Common Terminology Criteria for Adverse Event (CTCAE) V.5.0 guidelines. The monthly incidence of irAEs over time was reported after landmark duration of therapy. Cumulative incidence of irAEs was calculated to evaluate the time to the first occurrence of an irAE accounting for the competing risk of death. Prognostic factors for irAE were assessed using the Fine and Gray method.

Results

A total of 470 patients were treated with ICIs between July 2013 and October 2018 (mUC: 199 (42.3%); mRCC: 271 (57.7%)). 341 (72.6%) patients received monotherapy, 86 (18.3%) received ICIs in combination with targeted therapies, and 43 (9.2%) received dual ICI therapy. Overall, 186 patients (39.5%) experienced an irAE at any time point. Common irAEs included hypothyroidism (n=42, 22.6%), rush and pruritus (n=36, 19.4%), diarrhea/colitis (n=35, 18.8%), transaminitis (n=32, 17.2%), and pneumonitis (n=14, 7.5%). Monthly incidence rates decreased over time; however, 17 of 109 (15.6%, 95% CI: 9.4% to 23.8%) experienced their first irAE at least 1 year after treatment initiation. No differences in cumulative incidence were observed based on cancer type, agent, or irAE grade. On multivariable analysis, combined ICI therapy with another ICI or with targeted therapy (p<0.001), first-line ICI therapy (p=0.011), and PD-1 inhibitor therapy (p=0.007) were all significantly associated with irAE development.

Conclusions

This study quantitates the incidence of developing irAEs due to ICI conditioned on time elapsed without irAE development. Although the monthly incidence of irAEs decreased over time on therapy, patients can still develop delayed irAEs beyond ICI discontinuation, and thus, continuous vigilant monitoring is warranted.
Comparison of the use of Alvarado and AIR scores as an adjunct to the clinical diagnosis of acute appendicitis in the pediatric population
Authors: Musbahi Aya , Rudd Darren , Dordea Matei , Gopinath Bussa , Kurup Vijay
Published: March 2020

Background

Acute appendicitis is one of the most common causes of acute abdominal pain with an incidence of 1.17 per 1000 and lifetime risk of approximately 7%. It remains the most common indication for emergency abdominal surgery in childhood. Diagnosis of acute appendicitis is particularly difficult in young women and the pediatric population. In the USA, CT imaging is used to avert diagnostic dilemma, however the procedure is associated with radiation risk in this vulnerable population. Additionally, the procedure has high cost and variable availability.

Methods

A retrospective study involving all suspected pediatric cases of appendicitis between the ages of 5 and 17 who were operated on between 2012 and 2015 was carried out. Data were collated from clinical notes on age, sex, ultrasound findings; postoperative complications, white cell count, neutrophils, C-reactive protein, histology result, and number of days to theater. All patients in the time period were retrospectively scored on the Alvarado and Appendicitis Inflammatory Response (AIR) scores.

Results

A total of 239 patients between 11 and 17 (mean 13.6±SE) years of age were included in the study. Of these, 79 had preoperative ultrasound, of which 52 were negative, and only one patient had CT scan. 213 of the patients had an appendicectomy and 26 had diagnostic laparoscopy with no appendicectomy. Of the 213 appendixes removed, 71 were histopathologically normal, giving a negative appendectomy rate of 33.3%. 28 appendixes were perforated. The average number of days from admission to theater was 1.0 SE in males and 1.424 in females (p=0.0498). The average number of days from admission to theater in those who had ultrasound was 2.03 days compared with 0.75 in those who did not have ultrasound (p<0.0001). AIR scoring that was high and medium risk showed slightly lower negative appendicectomy rates but not significantly different.

Conclusions

Our study has found no significant difference between the AIR scores and Alvarado. There is a role for scoring systems to be used to aid in the decision to undergo imaging and as an adjunct to clinical diagnosis.
Exploring the flavour structure of the high-scale MSSM
Authors: Isidori Gino , Trifinopoulos Sokratis
Published: March 2020

We analyse the sensitivity of quark flavour-changing observables to the MSSM, in a regime of heavy superpartners. We analyse four distinct and motivated frameworks characterising the structure of the soft-breaking terms by means of approximate flavour symmetries. We show that a set of six low-energy observables with realistic chances of improvement in the near future, namely $$\Delta M_{s,d}$$ΔMs,d, $$\epsilon _K$$ϵK, $$\epsilon _K'/\epsilon _K$$ϵK′/ϵK, $$\mathcal {B} (K\rightarrow \pi \nu {{\bar{\nu }}})$$B(K→πνν¯), and the phase of D–$${\bar{D}}$$D¯ mixing, could play a very important role in characterising these frameworks for superpartner masses up to $$\mathcal {O}(100)$$O(100) TeV. We show that these observables remain very interesting even in a long-term perspective, i.e. even taking into account the direct mass reach of the most ambitious future high-energy colliders.
Automatic Analysis of Complex Interactions in Microservice Systems
Authors: Dai Fei , Chen Hao , Qiang Zhenping , Liang Zhihong , Huang Bi , Wang Leiguang
Published: March 2020

Interactions in microservice systems are complex due to three dimensions: numerous asynchronous interactions, the diversity of asynchronous communication, and unbounded buffers. Analyzing such complex interactions is challenging. In this paper, we propose an approach for interaction analysis using model checking techniques, which is supported by the Process Analysis Toolkit (PAT) tool. First, we use Labeled Transition Systems (LTSs) to model interaction behaviors in microservice systems as sequences of send actions under synchronous and asynchronous communications. Second, we introduce a notion of correctness called “interaction soundness” which is considered as a minimal requirement for microservice systems. Third, we propose an encoding of LTSs into the CSP# process algebra for automatic verification of the property interaction soundness. The experimental results show that our approach can automatically and effectively identify interaction faults in microservice systems.
Sini‐San Regulates the NO‐cGMP‐PKG Pathway in the Spinal Dorsal Horn in a Modified Rat Model of Functional Dyspepsia
Authors: Wu Zhenyu , Lu Xiaofang , Zhang Shengsheng , Zhu Chunyang
Published: March 2020

The present study investigated the effect of Chinese medicine Sini‐San (SNS) on visceral hypersensitivity in a rat model of functional dyspepsia (FD), and it explored related underlying mechanisms. The rat model of FD was developed by combining neonatal iodoacetamide (IA) treatment and adult tail‐clamping. After SNS treatment, the behavior and electromyographic testing were performed to evaluate the visceromotor responses of rats to gastric distention. Immunofluorescence was used to detect the distribution of iNOS‐positive cells in the spinal dorsal horn, while the real‐time quantitative PCR and western blot were used for detection of the gene expression of c‐fos, iNOS, and GABAb and protein levels of iNOS and GABAb in the spinal dorsal horn, respectively. The protein concentration of cGMP and PKG proteins in the spinal dorsal horn were quantified by enzyme‐linked immunosorbent assay. In this study, SNS treatment significantly reduced the behavioral score and electromyographic response to graded intragastric distension pressure. The middle‐dose of SNS treatment significantly reduced the distribution of iNOS‐positive cells in the spinal dorsal horn of FD model rats. The gene expression of c‐fos, iNOS, and GABAb and the protein contents of iNOS, GABAb, cGMP, and PKG in the spinal dorsal horn of FD model rats were restored to a normal level by middle‐dose of SNS treatment. Our results suggest that Sini‐San may alleviate the visceral hypersensitivity in FD model rats via regulation of the NO/cGMP/PKG pathway in the spinal dorsal horn.
Construction of Nonsinusoidal Oscillation Waveform Function and Technological Parameters for Continuous Casting Mold
Authors: Zhou Chao , Zhang Xingzhong , Wang Fang , Ren Subo
Published: March 2020

Nonsinusoidal oscillation techniques can shorten the negative strip time and improve the slab surface quality in the process of steel continuous casting. But the acceleration of nonsinusoidal oscillation is higher than that of the sinusoidal oscillation. So it is easy to result in the impact for the mold movement. To solve this problem, a nonsinusoidal oscillation waveform function of mold was constructed, which had good dynamic characteristics. And the smaller acceleration can reduce the impact of the oscillator. By analyzing the parameters of oscillation technology, the calculation method of each oscillation technological parameter for seven section functions was presented and the multitechnological parameter curves were given. Based on the technological parameters of sinusoidal oscillation, a synchronous control model of nonsinusoidal oscillation was determined. The results show that the parameters can satisfy the limit value in theory, which can enhance the casting speed, surface quality of slab, and provide reference for further practice in industry.
Involvement of Cathepsins in Innate and Adaptive Immune Responses in Periodontitis
Authors: Yan Xu , Wu Zhou , Wang Biyao , Yu Tianhao , Hu Yue , Wang Sijian , Deng Chunfu , Zhao Baohong , Nakanishi Hiroshi , Zhang Xinwen
Published: March 2020

Periodontitis is an infectious disease whereby the chronic inflammatory process of the periodontium stimulated by bacterial products induces specific host cell responses. The activation of the host cell immune system upregulates the production of inflammatory mediators, comprising cytokines and proteolytic enzymes, which contribute to inflammation and bone destruction. It has been well known that periodontitis is related to systemic inflammation which links to numerous systemic diseases, including diabetes and arteriosclerosis. Furthermore, periodontitis has been reported in association with neurodegenerative diseases such as Alzheimer’s disease (AD) in the brain. Regarding immune responses and inflammation, cathepsin B (CatB) plays pivotal role for the induction of IL‐1β, cathepsin K‐ (CatK‐) dependent active toll‐like receptor 9 (TLR9) signaling, and cathepsin S (CatS) which involves in regulating both TLR signaling and maturation of the MHC class II complex. Notably, both the production and proteolytic activities of cathepsins are upregulated in chronic inflammatory diseases, including periodontitis. In the present review, we focus on the roles of cathepsins in the innate and adaptive immune responses within periodontitis. We believe that understanding the roles of cathepsins in the immune responses in periodontitis would help to elucidate the therapeutic strategies of periodontitis, thus benefit for reduction of systemic diseases as well as neurodegenerative diseases in the global aging society.
Applying Fast Scanning Method Coupled with Digital Image Processing Technology as Standard Acquisition Mode for Scanning Electron Microscopy
Authors: Oho Eisaku , Suzuki Kazuhiko , Yamazaki Sadao
Published: March 2020

This study proposes an efficient and fast method of scanning (e.g., television (TV) scan) coupled with digital image processing technology to replace the conventional slow-scan mode as a standard model of acquisition for general-purpose scanning electron microscopy (SEM). SEM images obtained using the proposed method had the same quality in terms of sharpness and noise as slow-scan images, and it was able to suppress the adverse effects of charging in a full-vacuum condition, which is a challenging problem in this area. Two problems needed to be solved in designing the proposed method. One was suitable compensation in image quality using the inverse filter based on characteristics of the frequency of a TV-scan image, and the other to devise an accurate technique of image integration (noise suppression), the position alignment of which is robust against noise. This involved using the image montage technique and estimating the number of images needed for the integration. The final result of our TV-scan mode was compared with the slow-scan image as well as the conventional TV-scan image.
Intelligent Injection Molding on Sensing, Optimization, and Control
Authors: Zhao Peng , Zhang Jianfeng , Dong Zhengyang , Huang Junye , Zhou Hongwei , Fu Jianzhong , Turng Lih-Sheng
Published: March 2020

Injection molding is one of the most significant material processing methods for mass production of plastic products. It is widely used in various industry sectors, and its products are ubiquitous in our daily life. The settings and optimization of the injection molding process dictate the geometric precision and mechanical properties of the final products. Therefore, sensing, optimization, and control of the injection molding process have a crucial influence on product quality and have become an active research field with abundant literature. This paper defines the concept of intelligent injection molding as the integral application of these three procedures—sensing, optimization, and control. This paper reviews recent studies on methods for the detection of relevant physical variables, optimization of process parameters, and control strategies of machine variables in the molding process. Finally, conclusions are drawn to discuss future research directions and technologies, as well as algorithms worthy of being explored and developed.
Masked Hypotension due to Elevated Venous Pressure in a Patient with Complex Adult Congenital Heart Disease
Authors: Rigger Wytch , Javaheri Sean P. , Sharma Gyanendra K. , Nahman Norris Stanley , Sheynshteyn Mark , Weintraub Neal L.
Published: March 2020

An adult with surgically corrected Tetralogy of Fallot presented with profoundly elevated central venous pressure (CVP) and acute renal dysfunction thought secondary to acute on chronic right heart failure. Treatment with dopamine promoted diuresis and a stabilization of renal function. Repeated attempts to wean the patient from dopamine were associated with hypotension and worsening renal failure. Invasive hemodynamic assessment unexpectedly demonstrated high cardiac output with low systemic vascular resistance (SVR). In retrospect, the markedly elevated CVP had concealed the impact of reduced SVR on blood pressure. After reversible causes of low SVR state were excluded, the patient was successfully managed with oral alpha-adrenergic agents. While typically negligible under physiologic conditions, elevated CVP can artificially increase mean arterial pressure. We have coined the term “masked hypotension” to describe this unique pathophysiological phenomenon.
Study for Predicting Land Surface Temperature (LST) Using Landsat Data: A Comparison of Four Algorithms
Authors: Mustafa Elhadi K. , Co Yungang , Liu Guoxiang , Kaloop Mosbeh R. , Beshr Ashraf A. , Zarzoura Fawzi , Sadek Mohammed
Published: March 2020

The soft computing models used for predicting land surface temperature (LST) changes are very useful to evaluate and forecast the rapidly changing climate of the world. In this study, four soft computing techniques, namely, multivariate adaptive regression splines (MARS), wavelet neural network (WNN), adaptive neurofuzzy inference system (ANFIS), and dynamic evolving neurofuzzy inference system (DENFIS), are applied and compared to find the best model that can be used to predict the LST changes of Beijing area. The topographic change is considered in this study to accurately predict LST; furthermore, Landsat 4/5 TM and Landsat 8OLI_TIRS images for four years (1995, 2004, 2010, and 2015) are used to study the LST changes of the research area. The four models are assessed using statistical analysis, coefficient of determination (R2), root mean square error (RMSE), and mean absolute error (MAE) in the training and testing stages, and MARS is used to estimate the important variables that should be considered in the design models. The results show that the LST for the studied area increases by 0.28°C/year due to the urban changes in the study area. In addition, the topographic changes and previously recorded temperature changes have a significant influence on the LST prediction of the study area. Moreover, the results of the models show that the MARS, ANFIS, and DENFIS models can be used to predict the LST of the study area. The ANFIS model showed the highest performances in the training (R2 = 0.99, RMSE = 0.78°C, MAE = 0.55°C) and testing (R2 = 0.99, RMSE = 0.36°C, MAE = 0.16°C) stages; therefore, the ANFIS model can be used to predict the LST changes in the Beijing area. The predicted LST shows that the change in climate and urban area will affect the LST changes of the Beijing area in the future.
The Association of Health Literacy with High-Quality Home Blood Pressure Monitoring for Hypertensive Patients in Outpatient Settings
Authors: Fu Sau Nga , Dao Man Chi , Wong Carlos King Ho , Cheung Bernard Man Yung
Published: March 2020

Worldwide hypertension (HT) guidelines recommend use of home blood pressure monitoring (HBPM) in patients with persistent suboptimal blood pressure (BP) readings. It is not clear how patients with limited health literacy could perform HBPM to assist BP control. This study aimed at finding the association between HBPM and patients from lower socioeconomic classes, particularly on the effect of health literacy or educational level. Three electronic databases (MEDLINE, EMBASE, and PubMed) were searched for primary studies with keywords including educational level, health literacy, numeracy, home blood pressure monitoring, accuracy, and quality. The PRISMA guideline was followed. The quality of the literature was assessed by the Cochrane tool and modified Newcastle-Ottawa Scale. Nineteen interventional studies and 29 cross-sectional studies were included. Different populations used different cutoffs to report patients’ educational level, whereas health literacy was rarely measured. Three studies used psychometric validated tools to assess health literacy. The quality of HBPM could be assessed by the completion of the procedures’ checklist or the number of HBPM readings recorded. The association between subjects’ health literacy or educational level and the quality of HBPM was variable. The interventional studies showed that increasing professional-patient contact time could improve patients’ knowledge, efficacy, and quality of HBPM. Conclusion. Patients’ educational level and literacy were not the limiting factors to acquire high-quality HBPM. High-quality HBPM could be achieved by the structured educational intervention. The quality and amount of evidence on this topic are limited. Therefore, further studies are warranted.
Quantum-Based Feature Selection for Multiclassification Problem in Complex Systems with Edge Computing
Authors: Liu Wenjie , Chen Junxiu , Wang Yuxiang , Gao Peipei , Lei Zhibin , Ma Xu
Published: March 2020

The complex systems with edge computing require a huge amount of multifeature data to extract appropriate insights for their decision making, so it is important to find a feasible feature selection method to improve the computational efficiency and save the resource consumption. In this paper, a quantum-based feature selection algorithm for the multiclassification problem, namely, QReliefF, is proposed, which can effectively reduce the complexity of algorithm and improve its computational efficiency. First, all features of each sample are encoded into a quantum state by performing operations CMP and Ry, and then the amplitude estimation is applied to calculate the similarity between any two quantum states (i.e., two samples). According to the similarities, the Grover–Long method is utilized to find the nearest k neighbor samples, and then the weight vector is updated. After a certain number of iterations through the above process, the desired features can be selected with regards to the final weight vector and the threshold τ. Compared with the classical ReliefF algorithm, our algorithm reduces the complexity of similarity calculation from O(MN) to O(M), the complexity of finding the nearest neighbor from O(M) to OM, and resource consumption from O(MN) to O(MlogN). Meanwhile, compared with the quantum Relief algorithm, our algorithm is superior in finding the nearest neighbor, reducing the complexity from O(M) to OM. Finally, in order to verify the feasibility of our algorithm, a simulation experiment based on Rigetti with a simple example is performed.
Phytochemical Study and Antibacterial and Antibiotic Modulation Activity of Punica granatum (Pomegranate) Leaves
Authors: Trabelsi Amine , El Kaibi Mohamed Amine , Abbassi Aïmen , Horchani Amira , Chekir-Ghedira Leila , Ghedira Kamel
Published: March 2020

This study aimed to determine phytochemical contents, antibacterial properties, and antibiotic modulating potential of Punica granatum leaf extracts: hexane, chloroform, ethyl acetate, ethanol, and aqueous extracts as well as an extract enriched with total oligomer flavonoids (TOFs). The TOF extract contained the highest value of phenols and flavonoids. Rutin, luteolin, gallic acid, and ellagic acid were determined by HPLC analysis of this extract. The antibacterial activity was assayed by the disc diffusion method and microdilution method against Staphylococcus aureus and Escherichia coli standard ATCC strains and clinical isolates resistant strains. The TOF extract was the most active against all tested strains. The checkerboard method was used for the determination of synergy between two antibiotics (amoxicillin and cefotaxime) and P. granatum leaf extracts. The best synergistic interaction was found with TOF extract combined with amoxicillin for penicillin-resistant E. coli and penicillin-resistant S. aureus. These results can be assigned to tannins, flavonoids, and phenolic acids found in P. granatum leaf extracts. Pomegranate leaf extracts or active compounds isolated from these extracts could be used to fight the emergence and spread of resistant bacterial strains.
Cardioprotective Effect of Croton macrostachyus Stem Bark Extract and Solvent Fractions on Cyclophosphamide‐Induced Cardiotoxicity in Rats
Authors: Ayza Muluken Altaye , Balasubramanian Rajkapoor , Berhe Abera Hadgu
Published: March 2020

Context. Croton macrostachyus Hochst. ex Delile (Euphorbiaceae) has been used in traditional medicine to manage heart failure and other heart diseases in Ethiopia. Objective. To evaluate the antioxidant and cardioprotective activities of stem bark extract and solvent fractions of Croton macrostachyus on cyclophosphamide‐induced cardiotoxicity in rats. Materials and Methods. DPPH free radical scavenging assay method was used to determine antioxidant activity whereas Sprague‐Dawley rats were used to evaluate the cardioprotective activity. Except for the normal control, all groups were subjected to cyclophosphamide (200 mg/kg, i.p.) toxicity on the first day. Enalapril at 10 mg/kg was used as a reference. The hydromethanolic crude extract (100, 200, and 400 mg/kg) and aqueous and ethyl acetate fractions (100 and 200 mg/kg, each) were administered for 10 days. The cardioprotective activities were evaluated using cardiac biomarkers such as Troponin I, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), total cholesterol (TC), triglyceride (TG), and histopathological studies of heart tissue. Results. Crude extract and ethyl acetate and aqueous fractions exhibited free radical scavenging activities at IC50 of 594 μg/mL, 419 μg/mL, and 716 μg/mL, respectively. Crude extract at 400 mg/kg decreased the levels of troponin, AST, ALT, and ALP to 0.29 ± 0.06 ng/mL, 103.00 ± 7.63 U/L, 99.80 ± 6.18 U/L, and 108.80 ± 8.81 U/L, respectively. In addition, ethyl acetate fraction at 200 mg/kg decreased the levels of troponin, AST, ALT, and ALP to 0.22 ± 0.02 ng/mL, 137.00 ± 14.30 U/L, 90.33 ± 6.13 U/L, and 166.67 ± 13.50 U/L, respectively, compared with the cyclophosphamide control group. Conclusions. Croton macrostachyus possesses cardioprotective activities and it could be a possible source of treatment for cardiotoxicity induced by cyclophosphamide.
Preprocessing Unevenly Sampled RR Interval Signals to Enhance Estimation of Heart Rate Deceleration and Acceleration Capacities in Discriminating Chronic Heart Failure Patients from Healthy Controls
Authors: Cao Ping , Ye Bailu , Yang Linghui , Lu Fei , Fang Luping , Cai Guolong , Su Qun , Ning Gangmin , Pan Qing
Published: March 2020

Objective. The deceleration capacity (DC) and acceleration capacity (AC) of heart rate, which are recently proposed variants to the heart rate variability, are calculated from unevenly sampled RR interval signals using phase-rectified signal averaging. Although uneven sampling of these signals compromises heart rate variability analyses, its effect on DC and AC analyses remains to be addressed. Approach. We assess preprocessing (i.e., interpolation and resampling) of RR interval signals on the diagnostic effect of DC and AC from simulation and clinical data. The simulation analysis synthesizes unevenly sampled RR interval signals with known frequency components to evaluate the preprocessing performance for frequency extraction. The clinical analysis compares the conventional DC and AC calculation with the calculation using preprocessed RR interval signals on 24-hour data acquired from normal subjects and chronic heart failure patients. Main Results. The assessment of frequency components in the RR intervals using wavelet analysis becomes more robust with preprocessing. Moreover, preprocessing improves the diagnostic ability based on DC and AC for chronic heart failure patients, with area under the receiver operating characteristic curve increasing from 0.920 to 0.942 for DC and from 0.818 to 0.923 for AC. Significance. Both the simulation and clinical analyses demonstrate that interpolation and resampling of unevenly sampled RR interval signals improve the performance of DC and AC, enabling the discrimination of CHF patients from healthy controls.
Uso de la evaluación en 360 grados para medir competencias en residentes de programas de postítulo de especialidades médicas.
Authors: Correa Fernandez Diego Patricio , Gonzalez Gallardo Claudia
Published: March 2020

Introducción: La formación en educación médica debe reflexionar continuamente sobre cómo está preparando a los médicos en el logro de nuevas competencias que puedan dar respuesta a los constantes cambios que está viviendo la sociedad. Es así como, en distintos países, han surgido modelos que definen el marco de competencias necesarias para todo médico especialista. Para estos modelos es fundamental que cada rol y competencia sea evaluado correctamente para garantizar su óptima adquisición. Uno de los instrumentos propuestos en la literatura internacional para realizar esto es la evaluación en 360º, que además entrega una retroalimentación oportuna al residente. Método: Se realizó una revisión de la literatura utilizando PubMed y Google Scholar. Fueron incluidos estudios en inglés y español que ocuparan la evaluación en 360º para evaluar competencias médicas en residentes. Resultados: La evaluación en 360º es una de las nuevas herramientas que permite dar una evaluación global de las competencias médicas. Consiste en una pauta de observación estructurada que entrega al residente una retroalimentación desde distintos puntos de vista de su práctica cotidiana, al incluir la información obtenida de diferentes grupos de interés para el residente. Conclusiones: La evaluación en 360º parece ser un método útil para implementar una evaluación del desempeño de los residentes desde distintos puntos de vista.
Sobre las causas de la extrema violencia en Chile: una replica
Authors: Cabello Felipe
Published: March 2020

Una carta. Entiendo que no necesita resumen
MAFB Promotes Cancer Stemness and Tumorigenesis in Osteosarcoma through a Sox9-Mediated Positive Feedback Loop
Authors: Chen Yanyan , Wang Tao , Huang Mengxi , Liu Qin , Hu Chao , Wang Bin , Han Dong , Chen Cheng , Zhang Junliang , Li Zhiping , Liu Chao , Lei Wenbin , Chang Yue , Wu Meijuan , Xiang Dan , Chen Yitian , Wang Rui , Huang Weiqian , Lei Zengjie , Chu Xiaoyuan
Published: March 2020

Despite the fact that osteosarcoma is one of the most common primary bone malignancies with poor prognosis, the mechanism behind the pathogenesis of osteosarcoma is only partially known. Here we characterized differentially expressed genes by extensive analysis of several publicly available gene expression profile datasets and identified musculoaponeurotic fibrosarcoma oncogene homolog B (MAFB) as a key transcriptional regulator in osteosarcoma progression. MAFB was highly expressed in tumor tissues and required for proliferation and tumorigenicity of osteosarcoma cells. MAFB expression was elevated in osteosarcoma stem cells to maintain their self-renewal potential in vitro and in vivo through upregulation of stem cell regulator Sox9 at the transcriptional level. Sox9 in turn activated MAFB expression via direct recognition of its sequence binding enrichment motif on the MAFB locus, thereby forming a positive feedback regulatory loop. Sox9-mediated feedback activation of MAFB was pivotal to tumorsphere-forming and tumor-initiating capacities of osteosarcoma stem cells. Moreover, expression of MAFB and Sox9 was highly correlated in osteosarcoma and associated with disease progression. Combined detection of both MAFB and Sox9 represented a promising prognostic biomarker that stratified a subset of patients with osteosarcoma with shortest overall survival. Taken together, these findings reveal a MAFB–Sox9 reciprocal regulatory axis driving cancer stemness and malignancy in osteosarcoma and identify novel molecular targets that might be therapeutically applicable in clinical settings.

Significance:

Transcription factors MAFB and Sox9 form a positive feedback loop to maintain cell stemness and tumor growth in vitro and in vivo, revealing a potential target pathway for therapeutic intervention in osteosarcoma.