bluuebunny/crossref_metadata_2025 huggingface dataset:
Causes of maternal deaths and delays in care: Comparison between routine Maternal Death Surveillance and Response system and an obstetrician expert panel in Tanzania
Authors: Said Ali , Malqvist Mats , Pembe Andrea B. , Massawe Siriel , Hanson Claudia
Published: June 2020

Background To reduce maternal mortality Tanzania introduced Maternal Death Surveillance and Response (MDSR) system in 2015 as recommended by World Health Organization (WHO). All health facilities are to notify and review all maternal deaths inorder to recommend quality improvement actions to reduce deaths in future. The system relies on consistent and correct categorization of causes of maternal deaths and three phases of delays. To assess its adequacy we compared the routine MDSR categorization of causes of death and three phases of delays to those assigned by an independent expert panel with additional information from Verbal Autopsy (VA). Methods Our cross-sectional study included 109 reviewed maternal deaths from two regions in Tanzania for the year 2018. We abstracted the underlying medical causes of death and the three phases of delays from MDSR system records. We interviewed bereaved families using the standard WHO VA questionnaire. The obstetrician expert panel assigned underlying causes of death based on information from medical files and VA according to International Classification of Disease to Death in Pregnancy Childbirth and Puerperium (ICD-MM).They assigned causes to nine ICD-MM groups and identified the three phases of delays. We used Cohen`s K statistic to compare causes of deaths and delays categorization.Results Comparison of underlying causes was done for 99 deaths. While 109 and 84 deaths for expert panel and MDSR respectively were analyzed for delays because of missing data in MDSR system. Expert panel and MDSR system assigned the same underlying causes in 64(64.6%) deaths (K statistic 0.60). Agreement increased in 80(80.8%) when causes were assigned by ICD-MM groups (K statistic 0.76). The obstetrician expert panel identified phase one delays in 74(67.9%), phase two in 24(22.0%) and phase three delays in all 101(100%) deaths that were assessed for this delay while MDSR system identified delays in 42(50.0%), 10(11.9%) and 78(92.9%).The expert panel found human errors in management in 94(93.1%) while MDSR system reported in 53(67.9%) deaths.Conclusions MDSR committees performed reasonably well in assigning underlying causes of death. The obstetrician expert panel found more delays than reported in MDSR system indicating difficulties within MDSR teams to critically review deaths.
Cutaneous anthrax associated with handling carcasses of animals that died suddenly of unknown cause: Arua District, Uganda, January 2015–August 2017
Authors: Aceng Freda Loy , Ario Alex Riolexus , Alitubeera Phoebe Hilda , Kadobera Daniel , Sekamatte Musa , Okethwangu Denis , Bulage Lilian , Harris Julie R. , Nguma Willy , Ndumu Deo Birungi , Buule Joshua , Nyakarahuka Luke , Zhu Bao-Ping
Published: June 2020

Background : Anthrax is a zoonotic vaccine-preventable disease that can be transmitted to humans from infected animals. During May–June 2017, three persons with probable cutaneous anthrax were reported in Arua District, Uganda; one died. All had recently handled carcasses of livestock that died suddenly. During July, a bull in the same community died suddenly. A skin lesion from the deceased person and a blood sample from the bull tested positive by PCR for Bacillus anthracis. The aim of this investigation was to establish the scope of the problem, identify exposures associated with illness, and recommend evidence-based control measures. Methods: We defined a probable case as acute onset of a papulo-vesicular skin lesion subsequently forming an eschar in a resident of Arua District during January 2015–August 2017. A confirmed case was a probable case with a skin sample testing positive by polymerase chain reaction (PCR) for B. anthracis . We identified cases by medical record review and active community search. In a case-control study, we compared exposures between case-patients and frequency- and village-matched asymptomatic controls. We interviewed key animal health staff to learn about livestock deaths. Results: We identified 68 case-patients (67 probable, 1 confirmed), and 2 deaths. Cases occurred throughout the three-year period, peaking during dry seasons. All cases occurred following sudden livestock deaths in the villages. Case-patients came from two neighboring sub-counties: Rigbo (attack rate (AR)=20.1/10,000 population) and Rhino Camp (AR=2.1/10,000). Males (AR=17/100,000) were more affected than females (AR=0.52/100,000). Persons aged 30-39 years (AR=26/100,000 population) were most affected. Among all cases and 136 controls, skinning (OR M-H =5.0, 95%CI: 2.3–11), butchering (OR M-H =22, 95%CI: 5.5–89), and carrying the carcass of livestock that died suddenly (OR M-H =6.9, 95%CI: 3.0–16) were associated with illness. Conclusions: Exposure to carcasses of animals that died suddenly was a likely risk factor for cutaneous anthrax in Arua District during 2015-2017. We recommend public education about signs and symptoms of anthrax, prompt treatment of illness following exposure to animals that died suddenly, and safe disposal of the carcasses. In addition, the anthrax burden in livestock should be investigated to inform the cost-effectiveness of livestock vaccination.
AChE-activity in critically ill patients with suspected septic encephalopathy: a prospective, single-centre study
Authors: Zujalovic Benedikt , Mayer Benjamin , Hafner Sebastian , Balling Florian , Barth Eberhard
Published: June 2020

Background Up to 70% of septic patients develop a diffuse brain dysfunction accompanying with an increase in mortality, which is referred to as “septic associated encephalopathy”. Neuroinflammation as well as a disturbance of cholinergic transmission are assumed to be the causes of both delirium and septic associated encephalopathy. A possible change in cholinergic activity can be objectified by measuring the erythrocytic acetylcholinesterase activity. It has been shown, however, that the acetylcholinesterase activity, if only single measurements are carried out, is controversial in its significance. Therefore, we wanted to test the hypothesis whether a longitudinal analysis of acetylcholinesterase activity in critically ill patients can help to diagnose a suspected septic-associated encephalopathy and whether acetylcholinesterase activity differs in comparison to non-septic patients.Methods In this prospective, observational, single-center study, 175 patients, admitted to the surgical Intensive Care Unit of the University hospital Ulm, Germany, were included. 45 patients were septic, 130 patients were non septic. All patients were examined daily for the presence of delirium using the CAM-ICU. Daily measurement of the acetylcholinesterase activity was performed in all patients. The acetylcholinesterase activity was analyzed over time using a linear regression model taking into account repeated measurements. By using a time adjusted model, the effect of further possible predictors of acetylcholinesterase activity was analyzed too. For nonparametric distributions quantitative data were compared using Wilcoxon matched-pairs test. For the analysis of the independent samples the Mann-Whitney test was performed. Results In approximately 90% of the septic patients with suspected septic associated encephalopathy a statistically significant, time-dependent in- or decrease in acetylcholinesterase activity could be demonstrated over a period of at least 5 consecutive days.Conclusion The longitudinal measurement of acetylcholinesterase activity over several consecutive days revealed a shift compared to baseline values exclusively in septic patients with supposed septic associated encephalopathy. Therefore, longitudinal measurement of acetylcholinesterase activity may help to diagnose septic associated encephalopathy in patients with sepsis and accompanying delirium symptoms.Trial registration Retrospectively registered at German Clincial Trials Register, registration number DRKS 00020542, date of registration: January 27, 2020
Energy efficiency in an integrated agro-ecosystem at the acid soil area in Mekong delta, Vietnam
Authors: Thao Nguyen Thi Thu , Tung Tra Van , Thao Nguyen Thi Phuong , Thanh Son Le , Braunegg Sibylle , Braunegg Gerhart , Schnitzer Hans , Le Hai Thanh
Published: June 2020

Background: Both exergy and energy analysis methods are used for analysing energy efficiency in all kind of processes, and can be used also in agriculture. The study focuses on the connection of the three main process components (husbandry-crop-fishpond) in a typical farming household in an acid soil region in rural Vietnam. The concept of exergy analysis is used to underline the potential for energy efficiency in alternative processes in the agricultural system. To develop an integrated ecological system towards zero-emission, the analytical methods of material cycles and energy flows use a set of indicators of resource efficiency in a sustainable agriculture.Results: The design of the ideal integrated farming system “Agro-Industrial Zero Emissions Systems” (AIZES) can increase the system efficiency by making use of indigenous natural materials and waste reuse, recycling. Recycling waste for energy, fish feed and fertilizing can result a decrease in half of environmental load. Using exergy analysis to calculate an indicator non-renewable yield ratio (NRYR), the systems imply sustainability of agriculture production.Conclusions: The farming household will be able to replace fuel and electricity resulting in energy self-sufficiency to distribute surplus biogas to surrounding households. Biochar created by mixing the biomass residues with local plants can improve soil quality. Pig sludge can become nutritious fertilizer when mixed with biomass residues. Also, utilizing biogas can reduce purchased electricity.
Higher Plasma Cystatin C is associated with Mortality after Acute Respiratory Distress Syndrome: Findings from a Fluid and Catheter Treatment Trial (FACTT) Substudy
Authors: Hendrickson Carolyn M. , Kwong Yuenting Diana , Belzer Annika G , Shlipak Michael G , Matthay Michael A , Liu Kathleen Dori
Published: June 2020

Background: Cystatin C is a well validated marker of glomerular filtration rate in chronic kidney disease. Higher plasma concentrations of cystatin C are associated with worse clinical outcomes in heterogenous critically-ill populations and may be superior to creatinine in identifying kidney injury in critically-ill patients. We hypothesized that elevated levels of plasma cystatin C in patients with Acute Respiratory Distress Syndrome (ARDS) would be associated with mortality. Methods: In a retrospective study, cystatin C was measured by nephelometry on plasma obtained at enrollment from 919 patients in the Fluid and Catheter Treatment Trial. Multivariable logistic regression was performed testing the association between quartiles of cystatin C and 60-day mortality. Analyses were stratified by Acute kidney injury (AKI) status identified in the first 7 days after enrollment by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results : Cystatin C was significantly higher among those patients who died compared to those who survived to 60 days [1.2 (0.9 – 1.9) mg/L vs. 0.8 (0.6 – 1.2) mg/L, p <0.001]. Compared to the lower three quartiles, subjects in the highest quartile of cystatin C had a significantly higher odds of death at 60 days [OR 1.8 (1.2-2.6), p =0.003 in adjusted analyses]; the odds of death incrementally rose in higher cystatin C quartiles compared to the lowest quartile (OR 1.1, 1.8, and 2.5). In adjusted analyses stratified by AKI status, compared to subjects in the lower three quartiles, subjects in the highest quartile of cystatin C with AKI had a significantly higher odds of death at 60 days both in participants with AKI [OR 1.6 (1.0-2.4), p =0.048] and those without AKI [OR 2.4 (1.2-5.0), p =0.017]. In adjusted analyses, there was no significant association between sex-stratified baseline creatinine quartiles and mortality. Conclusions : Higher plasma levels of cystatin C on enrollment were strongly associated with mortality at 60-days in patients with ARDS with and without AKI identified by creatinine-based definitions . Compared to creatinine, cystatin C may be a better biomarker of kidney function in patients with ARDS and therefore identify patients with multiple organ failure at higher risk of death.
Relationship between level of empathy during residency training and perception of professionalism climate
Authors: Aziz Aliya B , Ali Syeda Kauser
Published: June 2020

Background Empathy is one of the vital personality attributes for all physicians. It is essential for establishing general interpersonal relationships among doctors and patients.Unfortunately, there is evidence for the decline of physician’s empathy during the clinical training phase and is a major concern for medical educators worldwide. One of the major factors reported for the decline of this trait is an unprofessional learning environment.Objective This study examines the relationship between empathy level and perception of climate of professionalism among the residents.Method The study participants included 70 residents of Obstetrics & Gynecology and Pediatrics departments of a private sector tertiary care hospital in Karachi, Pakistan. Two self-administered internet based surveys - Jefferson scale of Physician empathy (JSPE) and “professionalism climate instrument”(PCI) - were administered to assess the level of empathy among the participants and their perception of professionalism in the learning environment. The relationship between the level of empathy and professionalism was analyzed using Spearman rank correlation.Results The overall response rate was 81.4% with mean empathy level of 103±13. The internal consistency of each scale measured by Cronbach’s coefficient α was 0.76 for JSPE and 0.65 for PCI. No significant difference was observed in the mean empathy scores between senior and junior residents of both specialties. Statistically significant difference in empathy scores existed between female and male residents (p = 0.012; 95% CI, 2.27 to 17.59). The mean PCI score was 106+8.88 with no significant difference among residents of two specialties. Professionalism score was not found to vary with either the year of residency or gender. Empathy score and professionalism climate were not found to be correlated (rs= 0.56, p = 0.64).Conclusion The findings suggested that empathy is a relatively stable trait that remains unchanged during residency training programs. Female residents had higher empathic concern than the male trainees, however, the empathy level of the participants was not found to be influenced by the climate of professionalism.
Exercise training improves adipocyte accumulation and muscle fibrosis by TGF-β1 and α-SMA reduction after botulinum toxin type A administration in mice
Authors: Na Jungtae , Lee Esther , Im Song I , Kim Yu-jin , Kim Su Young , Kim Beom Joon
Published: June 2020

Background: We aimed to investigate the effect of treadmill exercise on functional recovery of the murine gastrocnemius muscle and nerve after botulinum toxin type A (BoNT-A) administration. Methods: After the injection of 0.5 units of BoNT-A into the gastrocnemius muscle of ICR mice, treadmill exercise was conducted for a 6-week period, after which the muscle volume, weight, and sciatic functional index (SFI) was determined and a nerve conduction study (NCS) and histological evaluation were performed. Results: After exercise, there was no change in the gastrocnemius weight and volume, but NCS and SFI increased. Exercise prevented induced adipocyte accumulation and muscle fibrosis. Moreover, transforming growth factor-β1 and α-smooth muscle actin expressions decreased and CD34, brain-derived neurotrophic factor, and synaptosomal nerve-associated protein 25 expressions increased when treadmill exercise was performed after BoNT-A administration. Conclusions: Exercise can effectively recover the nerve function and would aid in muscle function recovery by preventing fat cell accumulation and muscle fibrosis after BoNT-A administration.
Exosomes derived from mesenchymal stem cells improved core symptoms of genetically modified mice model of autism Shank3B
Authors: Perets Nisim , Oron Oded , Herman Shay , Elliott Evan , Offen Daniel
Published: June 2020

Background: Partial or an entire deletion of SHANK3 are considered as major drivers in the Phelan McDermid syndrome, in which 75% of patients are diagnosed with autism spectrum disorder (ASD). During the recent years, there was an increasing interest in stem cell therapy in ASD, and specifically, mesenchymal stem cells (MSC). Moreover, it has been suggested that the therapeutic effect of the MSC is mediated mainly via the secretion of small extracellular-vesicle that contain important molecular information of the cell and are used for cell-to cell communication. Within the fraction of the extracellular-vesicles, exosomes were highlighted as the most effective ones to convey the therapeutic effect.Methods: Exosomes derived from MSC (MSC-exo) were purified, characterized and given via intranasal administration to Shank3B KO mice (in concentration of 107 particals/ml). Three weeks post treatment the mice were tested for behavioral scoring and their results were compared to control saline treated and to their wild type littermates. Results: Intranasal treatment with MSC-exo improves the social behavior deficit in multiple paradigms, increases vocalization and reduces repetitive behaviors. We also observed an increase of GABARB1 in the prefrontal cortex.Conclusions: Herein, we hypothesized that MSC-exo would have a direct beneficial effect on the behavioral autistic-like phenotype of the genetically modified Shank3B KO mice model of autism. Taken together, our data indicate that intranasal treatment with MSC-exo improves the core ASD-like deficits of this mouse model autism and therefore has the potential to treat ASD patients carrying the Shank3 mutation.Limitations: Although the behavioral scoring of the MSC-exo treated group was significantly improved compared to their saline treated littermates, there is much more to learn regarding the mechanism of action of the MSC-exo.
Barriers and facilitators for colorectal cancer screening in a low-income urban community in Mexico City
Authors: Unger-Saldaña Karla , Saldaña-Tellez Minerva , Potter Michael B. , Loon Katherine Van , Allen-Leigh Betania , Lajous Martin
Published: June 2020

Background. Colorectal cancer (CRC) incidence and mortality are increasing in many low- and middle-income countries (LMICs), possibly due to a combination of changing lifestyles and improved healthcare infrastructure to facilitate diagnosis. Unfortunately, a large proportion of CRC cases in these countries remain undiagnosed or are diagnosed at advanced stages, resulting in poor outcomes. Decreasing mortality trends in HICs are likely due to evidence-based screening and treatment approaches that are not widely available in LMICs. Formative research to identify emerging opportunities to implement appropriate screening and treatment programs in LMICs is, therefore, of growing importance. We sought to identify potential barriers and facilitators for future implementation of fecal immunochemical test (FIT)-based CRC screening in a public healthcare system in a middle-income country with increasing CRC incidence and mortality. Methods. We performed a qualitative study with semi-structured individual and focus group interviews with different CRC screening stakeholders, including: 30 lay people at average risk for CRC; 13 health care personnel from a local public clinic; and 7 endoscopy personnel from a cancer referral hospital. All interviews were transcribed verbatim for analysis. Data were analyzed using the constant comparison method, under the theoretical perspectives of the Social Ecological Model (SEM), the PRECEDE-PROCEED Model, and the Health Belief Model. Results. We identified barriers and facilitators for implementation of a FIT-based CRC screening program at several levels of the SEM. The main barriers in each of the SEM levels, were: 1) at the social context level: poverty, health literacy and lay beliefs related to gender, cancer, allopathic medicine, and religion; 2) at the health services organization level: a lack of CRC knowledge among health care personnel and the community perception of poor quality of health care; 3) at the individual level: a lack of CRC awareness and therefore lack of risk perception, together with fear of participating in screening activities and finding out about a serious disease. The main facilitators perceived by the participants were CRC screening information and the free provision of screening tests.Conclusions. This study’s findings suggest that multi-level CRC screening programs in middle income countries such as Mexico should incorporate complementary strategies to address barriers and facilitators, such as: 1) provision of free screening tests, 2) education of primary healthcare personnel, and 3) promotion of non fear-based CRC screening messages to the target population, tailored to address common lay beliefs.
“The right time is just after birth”: Acceptability of point-of-care birth testing in Eswatini: qualitative results from infant caregivers, health care workers, and policymakers
Authors: Sacks Emma , Khumalo Philisiwe , Tsabedze Bhekisisa , Montgomery William , Mthethwa Nobuhle , Nhlabatsi Bonisile , Masuku Thembie , Cohn Jennifer , Chouraya Caspian
Published: June 2020

Background: Testing for HIV at birth has the potential to identify infants infected in utero, and allows for the possibility of beginning treatment immediately after birth; point of care (POC) testing allows rapid return of results and faster initiation on treatment for positive infants. Eswatini piloted birth testing in three public maternities for over two years. Methods: In order to assess the acceptability of POC birth testing in the pilot sites in Eswatini, interviews were held with caregivers of HIV-exposed infants who were offered birth testing (N=28), health care workers (N=14), and policymakers (N=10). Participants were purposively sampled. Interviews were held in English or SiSwati, and transcribed in English. Transcripts were coded by line, and content analysis and constant comparison were used to identify key themes for each respondent type. Results: Responses were categorized into: knowledge, experience, opinions, barriers and challenges, facilitators, and suggestions to improve POC birth testing. Preliminary findings reveal that point of care birth testing has been very well received but challenges were raised. Most caregivers appreciated testing the newborns at birth and getting results quickly, since it reduced anxiety of waiting for several weeks. However, having a favorable experience with testing was linked to having supportive and informed family members and receiving a negative result. Caregivers did not fully understand the need for blood draws as opposed to tests with saliva, and expressed the fears of seeing their newborns in pain. They were specifically grateful for supportive nursing staff who respected their confidentiality. Health care workers expressed strong support for the program but commented on the high demand for testing, increased workload, difficulty with errors in the testing machine itself, and struggles to implement the program without sufficient staffing, especially on evenings and weekends when phlebotomists were not available. Policymakers noted that there have been challenges within the program of losing mothers to follow up after they leave hospital, and recommended stronger linkages to community groups. Conclusions: There is strong support for scale-up of POC birth testing, but countries should consider ways to optimize staffing and manage demand.
Differences in trochlear groove based on morphometric measurements of three-dimensional reconstruction models between native knees and five different femoral component designs in Chinese subjects
Authors: chen shi chang , Xu Hua , Gong Shaohua
Published: June 2020

Background: The p rosthetic trochlear design is important in postoperative patellofemoral kinematics and knee function. However, little research has been conducted on the differences in trochlear groove between native and prosthetic knees. We aimed to investigate the differences between Chinese native knees and prosthetic knees of five different femoral component designs using three-dimensional computerized quantification Of the entire trochlear length. Methods: Virtual total knee arthroplasty was performed using three-dimensional models of 42 healthy Chinese knees matched to the femoral components of five different prosthe tic systems by mechanical alignment . T he deepest points of the trochlear groove were marked in multiple cross sections for both the native and prosthetic knees . Taking the lower extremity mechanical axis as reference line, the differences in the mediolateral location of the trochlear groove were analyzed between the native and prosthetic knees. Results: From the proximal to the distal end, the native trochlear groove started from 0° cross section and extended laterally and then medially , with its turning point located at 69° cross section . T he prosthetic trochlear groove showed a similar medial orientation and extended more proximally, but varied in mediolateral location and the length extending to the intercondylar notch . Compared with the proximal portion of the native trochlear groove , the prosthetic knee s extended along a paradoxical orientation and started from a more proximal and lateral position to 3.2 mm in the 0° cross section , with maximal discrepancy. Distally, the prosthetic trochlear groove s were located significantly medial to 2.4 mm in the 69° cross section , with maximal discrepancy. Conclusion: The prosthetic trochlear design varie d among the different types and did not conform to the native knee in terms of shape, orientation, and location, which may cause soft tissue tension imbalance and abnormal patellofemoral biomechanics during knee flexion. This study may provide useful information for creating prosthetic trochlear design s that conform with the native knee anatomy to optimize patellofemoral biomechanics and reduce the risk of patellofemoral complications.
Identification and co-expression analysis of long noncoding RNAs and mRNAs involved in the deposition of intramuscular fat in Aohan fine-wool sheep
Authors: Han Fuhui , Li Jing , Liu Nan , Zhao Ranran , Liu Lirong , Li Lanlan , Li Qian , He Jianning
Published: June 2020

Background: Intramuscular fat (IMF) content has become one of the most important indicators for measuring meat quality, and levels of IMF are affected by various genes. Long non-coding RNAs (lncRNAs) are widely expressed non-coding RNAs that play an important regulatory role in a variety of biological processes; however, research on the lncRNAs involved in sheep IMF deposition is still in its infancy. Aohan fine-wool sheep (AFWS), one of China's most important meat-hair, dual-purpose sheep breed, provides a great model for studying the role of lncRNAs in the regulation of IMF deposition. We identified lncRNAs by RNA sequencing in longissimus dorsi muscle (LDM) samples of sheep at two ages: 2 months (Mth-2) and 12 months (Mth-12). Results: We identified a total of 26,247 genes and 6,935 novel lncRNAs in LDM samples of sheep. Among these, 606 mRNAs and 408 lncRNAs were differentially expressed. We then compared the structural characteristics of lncRNAs and mRNAs. We obtained target genes of differentially expressed lncRNAs (DELs) and performed enrichment analyses using Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG). We found that target mRNAs were primarily enriched in lipid metabolism, lipid transport, regulation of primary metabolic processes and developmental pathways. Based on the results of important KEGG pathways, we obtained six candidate lncRNAs that potentially regulate lipid deposition and constructed an lncRNA-mRNA co-expression network that included MSTRG.792.1- SCD , MSTRG.8227.1- ACAA2 , MSTRG.10679.1- FADS2 , MSTRG.21942.1- PLA2G4E , MSTRG.21380.1- FZD4 and MSTRG.9270.1- ULK1 . We speculated that these candidate lncRNAs might play a role by regulating the expression of target genes. We randomly selected five mRNAs and five lncRNAs to verify the accuracy of the sequencing data by qRT-PCR. Conclusions: Our study provided a list of the lncRNAs and mRNAs related to intramuscular lipid deposition in sheep and laid a foundation for future research on regulatory mechanisms.
Barriers and Facilitators of Kangaroo Mother Care Adoption in Five Chinese Hospitals: a Qualitative Study
Authors: Yue Jieya , Liu Jun , Williams Sarah , Zhang Bo , Zhao Yingxi , Zhang Qiannan , Zhang Lin , Liu Xin , Wall Stephen , Wetzel Greta , Zhao Gengli , Bouey Jennifer
Published: June 2020

Background
Kangaroo mother care (KMC) has been proved to be a safe and cost-effective standard of care for preterm babies. China hasn’t adopted the KMC practice widely until recently. We aim to assess barriers and facilitators of KMC adoption in neonatal intensive care units (NICUs) and postnatal wards in China.

Methods
We conducted clinical observations and semi-structured interviews with nurses, physicians, and parents who performed KMC in seven NICUs and postnatal wards housed in five hospitals in different provinces of China between August and September 2018. The interviews provided first-hand stakeholder perspectives on barriers and facilitators of KMC implementation and sustainability. We further explored health system’s readiness and families’ willingness to sustain KMC practice following its pilot introduction. We coded data for emerging themes related to financial barriers, parent- and hospital-level perceived barriers, and facilitators of KMC adoption, specifically those unique in the Chinese context.

Results
Five hospitals with KMC pilot programs were selected for clinical observations and 38 semi-structured interviews were conducted. Common cultural barriers included concerns with the conflict with traditional postpartum confinement (Zuo-yue-zi) practice and grandparents’ resistance, while a strong family support is a facilitator for KMC adoption. Some parents reported anxiety and guilt associated with having a preterm baby, which can be a parental-level barrier to KMC. Hospital-level factors such as fear of nosocomial infection and shortage of staff and spaces impeded the KMC implementation, and supportive community and peer group organized by the hospital contributed to KMC uptake. Financial barriers included lodging costs for caregivers and supply costs for hospitals.

Conclusions
We provided a comprehensive in-depth report on the multi-level KMC barriers and facilitators in China. We recommend policy interventions specifically addressing these barriers and facilitators and increase family and peer support to improve KMC adoption in China. We also recommend that well-designed local cultural and economic feasibility and acceptability studies should be conducted before the KMC uptake.
Resistance to Antihypertensive Drugs Targeting Renin Angiotensin Aldosterone System in Cancer patients: A Case Series
Authors: GOEL Mishita , Varandani Rajiv , Okwuosa Tochukwu
Published: June 2020

Hypertension impacts overall prognosis in cancer patients. There are no specific recommendations for its management in these patients. We report a case series of 5 cancer patients with suboptimal BP lowering and even worsening BP with ACEi or ARBs that improved to normal upon discontinuation of these drugs.
Tissue alkaline phosphatase activity and expression in an experimental infant swine model of cardiopulmonary bypass with deep hypothermic circulatory arrest
Authors: Khailova Ludmila , Robison Justin , Jaggers James , Ing Richard , Lawson Scott , Treece Amy , Soranno Danielle , Lujan Suzanne Osorio , Davidson Jesse
Published: June 2020

Background: Infant cardiac surgery with cardiopulmonary bypass results in decreased circulating alkaline phosphatase that is associated with poor postoperative outcomes. Bovine intestinal alkaline phosphatase infusion represents a novel therapy for post-cardiac surgery organ injury. However, the effects of cardiopulmonary bypass and bovine-intestinal alkaline phosphatase infusion on tissue-level alkaline phosphatase activity/expression are unknown.Methods: Infant pigs (n=20) underwent cardiopulmonary bypass with deep hypothermic circulatory arrest followed by four hours of intensive care. Seven control animals underwent mechanical ventilation only. Cardiopulmonary bypass/deep hypothermic circulatory arrest animals were given escalating doses of bovine intestinal alkaline phosphatase infusion (0-25U/kg/hr; n=5/dose). Kidney, liver, ileum, jejunum, colon, heart and lung were collected for measurement of tissue alkaline phosphatase activity and mRNA.Results: Tissue alkaline phosphatase activity varied significantly across organs with the highest levels found in the kidney and small intestine. Cardiopulmonary bypass with deep hypothermic circulatory arrest resulted in decreased kidney alkaline phosphatase activity and increased lung alkaline phosphatase activity, with no significant changes in the other organs. Alkaline phosphatase mRNA expression was increased in both the lung and the ileum. The highest dose of bovine intestinal alkaline phosphatase resulted in increased kidney and liver tissue alkaline phosphatase activity.Conclusions: Changes in alkaline phosphatase activity after cardiopulmonary bypass with deep hypothermic circulatory arrest and bovine intestinal alkaline phosphatase delivery are tissue specific. Kidneys, lung, and ileal alkaline phosphatase appear most affected by cardiopulmonary bypass with deep hypothermic circulatory arrest and further research is warranted to determine the mechanism and biologic importance of these changes.
Moderate rate of transmitted resistance mutations to antiretrovirals and genetic diversity in newly HIV-1 patients diagnosed in Benin.
Authors: TCHIAKPE EDMOND , Keke Rene K , Vidal Nicole , Ahoussinou Clément , Sekpe Olga , Dagba Hermione G , Gbaguidi Eric , Tonoukouen Conrad , Afangnihoun Aldric , Bachabi Moussa , Gangbo Flore A , Ndiaye Halimatou Diop , Kane Coumba Toure
Published: June 2020

Objective Seventeen years after the start of the IBAARV (Beninese initiative for access to antiretrovirals), transmitted drug resistance mutations in ARV naïve patients and HIV-1 genetic diversity were investigated in Benin. Results Drug resistance mutations were detected in (27/248; 10.9%) according to the WHO SDRM 2009 list, with a predominance of mutations directed to NNRTIs drugs (24/248; 10%). Phylogenetic and recombination analyses showed a predominance of CRF02_AG strains (165/248; 66.5%) and a high genetic diversity with five other variants and 39 URFs (15.7%) which contained portions of strains that co-circulate in Benin. Eight recent transmission chains revealed active ongoing transmission of HIV-1 strains among ARV naïve patients. Our study showed a moderate primary drug resistance mutations rate and also provided recent data on the HIV-1 variants that circulate in Benin. Regular monitoring of primary drug resistance is required to adapt HIV-1 treatment strategies and adoption of new WHO recommendations in Benin.
Clinical characteristics and risk factors of patients with severe COVID-19 in Jiangsu province, China: a retrospective multicentre cohort study
Authors: Liu Songqiao , Luo Huanyuan , Wang Yuancheng , Cuevas Luis E. , Wang Duolao , Ju Shenghong , Yang Yi
Published: June 2020

Background: Coronavirus Disease-2019 (COVID-19) has become a major health event that endangers people health throughout China and the world. Understanding the factors associated with COVID-19 disease severity could support the early identification of patients with high risk for disease progression, inform prevention and control activities, and potentially reduce mortality. This study aims to describe the characteristics of patients with COVID-19 and factors associated with severe or critically ill presentation.Methods: Multicentre retrospective cohort study of all individuals with confirmed Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infections diagnosed at 24 COVID-19-designated hospitals in Jiangsu province between the 10th January and 15th March 2020. Demographic, clinical, laboratory, and radiological data were collected at hospital admission and data on disease severity were collected at from admission. Patients were categorised as asymptomatic/mild/moderate, and severe/critically ill according to the worst level of COVID-19 recorded during hospitalisation.Results: A total of 625 patients, 64 (10.2%) were severe/critically ill and 561 (89.8%) were asymptomatic/mild/moderate. All patients were discharged and no patients died. Patients with severe/critically ill COVID-19 were more likely to be older, to be single onset (i.e. not to a cluster of cases in family/community), to have a medical history of hypertension and diabetes; had higher temperature, faster respiratory rates, lower peripheral capillary oxygen saturation (SpO2), and higher CT image quadrant scores and pulmonary opacity percentage; had increased C-reactive protein, fibrinogen, and D-dimer on admission; and had lower white blood cells, lymphocyte, and platelet counts and albumin on admission than asymptomatic/mild/moderate cases. Multivariable regression showed that odds of being a severe/critically ill case were associated with age (year) (OR 1.06, 95%CI 1.03-1.09), lymphocyte count (109/L) (OR 0.25, 95%CI 0.08-0.74), and pulmonary opacity in CT (per 5%) on admission (OR 1.31, 95%CI 1.15-1.51).Conclusions: Severe or critically ill patients with COVID-19 is about one-tenths of patients in Jiangsu. Age, lymphocyte count, and pulmonary opacity in CT on admission were associated with risk of severe or critically ill COVID-19.
Objective Validation of YouTubeTM Educational Videos for the Instruction of Regional Anesthesia Nerve Blocks: A Novel Approach
Authors: Tewfik George , Work Adam , Shulman Steven , Discepola Patrick
Published: June 2020

Background: YouTubeTM (“YouTube”) is often used as an educational tool to instruct anesthesia providers on regional anesthesia nerve blocks. However, there is no current objective standard to assess the educational quality of these user-uploaded videos. A new approach was used to objectively validate these videos by comparing them to high quality educational sources for the seven most commonly used nerve blocks.Objective: We sought to evaluate the educational quality of user-uploaded videos when compared to the highest quality anesthesia society websites (NYSORA, ACEP, USRA)Methods: After reviewing the instructional material available for the seven most frequently conducted nerve blocks on high-quality reference websites, we documented the educational characteristics present including such things as indications, volume, anatomy, etc. Next we reviewed the five most popular videos on YouTube for each block (by views) and documented the presence or absence of these educational characteristics. Results: Eighteen educational characteristics were documented in the “high-quality” anesthesia society reference material. Correlation was sought between this material and YouTube videos. Although there were varying degrees of correlation between the high quality sources and the videos, rarely did YouTube videos contain as high a percentage of these educational characteristics as the well-established sources. Some videos contained very few of these important educational characteristics. Conclusion: Although YouTube has been used an educational tool, we recommend that only high quality sources be used to teach or illustrate regional anesthesia nerve blocks.
Neurodevelopmental outcome and respiratory management of congenital central hypoventilation syndrome: a retrospective study
Authors: Ogata Tomomi , Muramatsu Kazuhiro , Miyana Kaori , Ozawa Hiroshi , Iwasaki Motoki , Arakawa Hirokazu
Published: June 2020

Background: Congenital central hypoventilation syndrome (CCHS) is a rare disease characterized by sleep apnea. Anoxia often occurs soon after birth, and it is important to prevent anoxia-mediated central nervous system complications; however, data on the relationship between respiratory management and the prognosis for intellectual development of patients with CCHS is not well yet investigate. Methods: We performed a retrospective chart review cohort study of patients with CCHS in Japan. We investigated the risk and prognostic factors for developmental outcomes and examined the disease in terms of its symptoms, diagnosis, complications, and treatment. Results: Of the 123 patients with CCHS included in the survey, 88 patients were 6 years old and older. They were divided into two group based on their intelligence quotient. Those treated using positive-pressure ventilation via tracheostomy in the first three months of life had a better developmental prognosis than those managed via tracheostomy after three months of age and those treated by ventilation using mask (OR = 3.80; 95% CI: 1.00–14.37, OR = 4.65; 95% CI: 1.11–19.37). There was no significant difference in physical development (P = 0.64).Conclusions: The best respiratory treatment for patients with CCHS is ventilation via tracheostomy, initiated ideally before the age of three months.
A spatiotemporal simulation study on the transmission of harmful microorganisms through connected healthcare workers in a hospital ward setting
Authors: Niekerk Magnus J. M. van , Stein Alfred A. , Doting Edwina M. H. E. , Lokate Mariëtte M. , Braakman-Jansen Annemarie L. M. A. , Gemert-Pijnen Lisette J. E. W. C. van
Published: June 2020

Background: Transmission of harmful microorganisms may lead to infections and poses a major threat to patients and healthcare workers in healthcare settings. The most effective countermeasure against the transmission and spread of harmful microorganisms is the adherence to spatiotemporal hand hygiene policies, but adherence rates are relatively low and vary over space and time. The spatiotemporal effects on the transmission and spread of harmful microorganisms for varying levels of hand hygiene compliance are unknown. The objectives of this study are to (1) identify a healthcare worker occupancy group of potential super-spreaders and (2) quantify spatiotemporal effects on the transmission and spread of harmful microorganisms for varying levels of hand hygiene compliance caused by this group.Methods: Spatiotemporal data were collected in a ward of an academic hospital using radio frequency identification technology for seven days. A potential super-spreader healthcare worker occupation group was identified using the contact data derived from the frequency identification sensors. The effects of five probability distributions of hand hygiene compliance and three rates of harmful microorganism transmission were simulated using a dynamic agent-based simulation model. The effects of initial simulation assumptions on the simulation results were quantified using five risk factors.Results: Nurses, doctors and patients are together responsible for 78.8% of all contacts. Nurses made up 57% of all contacts, which is more than five times that of doctors (11.1%). This identifies nurses as the potential super-spreader healthcare worker occupation group. For initial simulation conditions of extreme lack of hand hygiene compliance (5%) and high transmission rates (5% per contact moment), a colonized nurse can transfer microbes to three of the 17 healthcare worker or patients encountered during the 87 minutes of visiting 22 rooms while colonized. The harmful microorganism transmission potential for nurses is higher during weeknights (5 pm – 7 am) and weekends as compared to weekdays (7 am – 5 pm). Conclusion: Spatiotemporal behaviour and social mixing patterns of healthcare can change the expected number of transmissions and spread of harmful microorganism by super-spreaders in a closed healthcare setting. These insights can be used to develop better-informed infection prevention and control strategies.
A rare mutation c.1663G>A (p.A555T) in the MMUT gene associated with mild clinical and biochemical phenotypes of methylmalonic acidemia in 30 Chinese patients
Authors: Liang Lili , Shuai Ruixue , Yu Yue , Qiu Wenjuan , Shen Linghua , Wu Shengnan , Wei Haiyan , Chen Yongxing , Yang Chiju , Xu Peng , Chen Xigui , Zou Hui , Feng Jizhen , Niu Tingting , Hu Haili , Ye Jun , Zhang Huiwen , Lu Deyun , Gong Zhuwen , Zhan Xia , Ji Wenjun , Yu Yongguo , Gu Xuefan , Han Lianshu
Published: June 2020

Background: Methylmalonic acidemia is an inherited organic acid metabolic disease. it involves multiple physiological systems and has variable manifestations. The primary causative gene MMUT carries wide range of mutations, and one of them, c.1663G>A (p.A555T), is considered to be of an extremely rare type. So far, little is known about the clinical features of patients carrying this mutation. In the present study, we aimed to define the clinical and biochemical features of the patients with this genotype.Methods: Among 328 mut type methylmalonic acidemia patients from multiple hospitals in China, we collected 30 compound heterozygous patients sharing the mutation c.1663G>A (p.A555T) in the MMUT gene. Their clinical characteristics and biochemical index were described in detail and compared with methylmalonic acidemia patients without this variant. Results: Most of these patients were diagnosed via newborn screening (26/30), treated in a timely manner, and kept healthy (24/30). Disease onset occurred in 7 patients. Developmental delay or intellectual impairment occurred in 4 patients. Vitamin B12 is responsive in 100% of these patients (29/29). The blood propionylcarnitine, blood propionylcarnitine/acetylcarnitine ratio, urinary methylmalonic acid, urinary methylcitric acid before and after treatment in c.1663G>A (p.A555T) carrying patients were much lower than those in non-c.1663G>A (p.A555T) carrying patients.Conclusion: Compared to patients with other mutations in the MMUT gene, patients with the c.1663G>A (p.A555T) mutation showed later onset, milder clinical phenotype, lighter biochemical abnormalities, better vitamin B12 responsiveness, lower morbidity, easier metabolic control, and thereby better prognosis. Newborn screening project plays an important role in early diagnosis, treatment, and prognosis of these patients.