bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Effectiveness of Long-Term Acute Care Hospital versus Skilled Nursing Facility Transfer
Authors: Makam Anil , Nguyen Oanh Kieu , Miller Michael E. , Shah Sachin J , Kapinos Kandice A. , Halm Ethan A.
Published: September 2020

BACKGROUND: Long-term acute care hospital (LTACH) use varies considerably across the U.S., which may reflect uncertainty about the effectiveness of LTACHs vs. skilled nursing facilities (SNF), the principal post-acute care alternative. Given that LTACHs receive over triple the reimbursement of SNFs for comparable diagnoses, we sought to compare outcomes and spending between LTACH versus SNF transfer. METHODS: Using Medicare claims linked to electronic health record (EHR) data from six Texas Hospitals between 2009-2010, we conducted a retrospective cohort study of patients hospitalized on a medicine service in a high-LTACH use region and discharged to either an LTACH or SNF and followed for one year. The primary outcomes included mortality, 60-day recovery without inpatient care, days at home, and healthcare spending.RESULTS: Of 3,503 patients, 18% were transferred to an LTACH. Patients transferred to LTACHs were younger (median 71 vs. 82 years), less likely to be female (50.5 vs 66.6%) and white (69.0 vs. 84.1%), but were sicker (24.3 vs. 14.2% for prolonged intensive care unit stay; median diagnosis resource intensity weight of 2.03 vs. 1.38). In unadjusted analyses, patients transferred to an LTACH vs. SNF were less likely to survive (59.1 vs. 65.0%) or recover (62.5 vs 66.0%), and spent fewer days at home (186 vs. 200). Adjusting for demographic and clinical confounders available in Medicare claims and EHR data, LTACH transfer was not significantly associated with differences in mortality (HR, 1.12, 95% CI, 0.94-1.33), recovery (SHR, 1.07, 0.93-1.23), and days spent at home (IRR, 0.96, 0.83-1.10), but was associated with greater Medicare spending ($16,689 for one year, 95% CI, $12,216-$21,162).CONCLUSION: LTACH transfer for Medicare beneficiaries is associated with similar clinical outcomes but with higher healthcare spending compared to SNF transfer. LTACH use should be reserved for patients who require complex inpatient care and cannot be cared for in SNFs.
Stress, Spirituality and Altruism of Brazilian Medical Students during the Covid-19 Pandemic: A Cross-sectional Analysis
Authors: de Lima David Nunes , de Aguiar Ridson Guilherme Parente , Kubrusly Bruna Sobreira , Macedo Danielle S. , Kubrusly Marcos , Lima Danilo Lopes Ferreira , Sanders Lia Lira Olivier
Published: September 2020

When psychosocial stress overcomes people’s coping capacity, spirituality and altruism may become necessary to minimize psychological damage. This study analyzed self-reported measures of stress, spirituality and altruism of 1105 Brazilian Medical students during the Covid-19 pandemic. We found moderate levels of perceived stress, moderate to high levels spirituality, as well as high levels of altruistic attitudes. Reported stress was higher among participants with a previous diagnosis of mental disorder and women. Spirituality correlated positively with altruistic thoughts and emotions, but only altruism was inversely related to stress. Future research should explore the role of spirituality and altruism in stress management.
Giant infiltrating intermuscular angiolipoma of the posterior axioappendicular region: gross and microscopic features
Authors: Adewale Adesanya Olamide , Okeniran Olatayo Segun , Ssempijja Fred , Afodun Adam Moyosore , Olakunle Ojewale Abdulfatai , Ayuba John Tabakwot , Pius Theophilus , Ochieng Juma J. , Ssengendo Ibrahim , Anaya Amnia Diaz
Published: September 2020

Infiltrating intermuscular angiolipomas are rare. We report a cadaveric case of infiltrating angiolipoma in the muscles of the posterior axioappendicular region with literature in the context of live individuals. The macroscopic assessment showed a non-capsulated homogenous yellow mass was located between the trapezius muscle above and rhomboid major muscle below and invaded the dorsal scapular blood vessels from the rhomboid major muscle. It weighed 47.03 g, 8.5 cm x 6.6 cm x 1.7 cm (length, width, and thickness). Microscopic analysis shows mature fat cells, prominent blood vascular components, and no myxoid areas. Infiltrating intermuscular angiolipomas of the chest wall are very rare and to our knowledge, there is the scantiness of similar cases, hence we are providing an extra case of a giant infiltrating intermuscular angiolipoma of the posterior axioappendicular region, with particular emphasis on gross and microscopic features. In such cases, angiolipomas would require complete surgical excision to prevent continued growth, invasion, and recurrence.
Artificial intelligence algorithm for predicting cardiac arrest using electrocardiography
Authors: Kwon Joon-myoung , Kim Kyung-Hee , Jeon Ki-Hyun , Lee Soo Youn , Park Jinsik , Oh Byung-Hee
Published: September 2020

Background: In-hospital cardiac arrest is a major burden in health care. Although several track-and-trigger systems are used to predict cardiac arrest, they often have unsatisfactory performances. We hypothesized that a deep-learning-based artificial intelligence algorithm (DLA) could effectively predict cardiac arrest using electrocardiography (ECG). We developed and validated a DLA for predicting cardiac arrest using ECG. Methods: We conducted a retrospective study that included 47,505 ECGs of 25,672 adult patients admitted to two hospitals, who underwent at least one ECG from October 2016 to September 2019. The endpoint was occurrence of cardiac arrest within 24 hours from ECG. Using subgroup analyses in patients who were initially classified as non-event, we confirmed the delayed occurrence of cardiac arrest and unexpected intensive care unit transfer over 14 days.Results: We used 32,294 ECGs of 10,461 patients and 4,483 ECGs of 4,483 patients from a hospital were used as development and internal validation data, respectively. Additionally, 10,728 ECGs of 10,728 patients from another hospital were used as external validation data, which confirmed the robustness of the developed DLA. During internal and external validation, the areas under the receiver operating characteristic curves of the DLA in predicting cardiac arrest within 24 hours were 0.913 and 0.948, respectively. The high risk group of the DLA showed a significantly higher hazard for delayed cardiac arrest (5.74% vs. 0.33%, P < 0.001) and unexpected intensive care unit transfer (4.23% vs. 0.82%, P < 0.001). A sensitivity map of the DLA displayed the ECG regions used to predict cardiac arrest, with the DLA focused most on the QRS complex. Conclusions: Our DLA successfully predicted cardiac arrest using diverse formats of ECG. The results indicate that cardiac arrest could be screened and predicted not only with a conventional 12-lead ECG, but also with a single-lead ECG using a wearable device that employs our DLA.
Long-Term Exposure to Air Pollution and The Risk of Developing Sudden Sensorineural Hearing Loss
Authors: Tsai Stella Chin-Shaw , Hsu Yi-Chao , Lai Jung-Nien , Chou Ruey-Hwang , Fan Hueng-Chuen , Lin Frank Cheau-Feng , Zhang Ruihong , Lin Cheng-Li , Chang Kuang-Hsi
Published: September 2020

Background The association between exposure to air pollution and sudden sensorineural hearing loss (SSNHL) has not been extensively discussed in the literature. Therefore, we conducted this nationwide study to evaluate the risk of SSNHL in Taiwanese residents with exposure to air pollution.Methods We enrolled subjects aged older than 20 years with no history of SSNHL from 1998 to 2010, and followed up until developing SSNHL, withdrawn from the National Health Insurance program, and the end of the database (2011/12/31). The air quality data are managed by Taiwan Environmental Protection Administration. The annual concentrations of PM2.5, SO2, CO, NO, and NO2 from 1998 to 2010 were classified into the three levels according to tertiles. We calculated the annual average of pollutants from baseline until the end of the study, and classified into tertiles. The adjusted hazard ratio (aHR) was estimated by using the multivariate Cox proportional hazard model.Results When considered continuous air pollutants concentration, subjects who exposed with higher concentration of CO (aHR=2.19, 95%CI=1.52-3.15), NO (aHR=1.02, 95%CI=1.01-1.03), and NO2 (aHR=1.02, 95%CI=1.01-1.04) developing significant higher risk of SSNHL.When classified air pollutants concentration into low, moderate and high level by tertiles, and selected low level as reference, patients exposed with moderate (aHR=1.58, 95%CI=1.21-2.06) or high level (aHR=1.32, 95%CI=1.00-1.74) of PM2.5 showed significant higher risk of developing SSNHL.Conclusion This study indicated an increased risk of SSNHL in residents with long-term exposure to air pollution. Nevertheless, further experimental and clinical studies are needed to validate the study findings.Disclosure statementAll authors declare that there is no conflicts of interest. This study was approved in part by Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW105-TDU-B-212-133019). The committee agree to waive the requirement for consent.
Techno-Economic Analysis for the Role of Single End Energy User in Mitigating GHG Emission
Authors: Ahmed Waqas , Sheikh Jamil Ahmed , Nouman Muhammad , Ullah Mian Farhan , Mahmud M A Parvez
Published: September 2020

Background
End energy user relies on fossil fuel-based national grid to meet their energy demand; hence, indirectly contributing towards greenhouse gases (GHG) emission and causing climate change. This study aims to investigate the minute role of a single, end energy user in GHG mitigation by shifting to the green renewable energy source, photovoltaics (PV) through its techno-economic analysis.
Method
For the study impact, NASA Meteorological Data is used to select an ideal single energy user equipped with 10 kW PV system based on annual- average daily solar radiations and temperature through MATLAB/Simulink, among eleven populous cities of Pakistan. Helioscope software is used to select tilt and azimuthal angle to expose PV surface for most of the solar radiations. Afterwards, RETScreen software is used for cost, financial and GHG analysis.
Results and Conclusion
The proposed system at single end energy user mitigates 6.9 tonnes of CO2 per annum while producing 16,832 kWh per annum and recovering its 7337$ capital cost in less than five years in the project’s 25-year life span. A single energy user invisible to national grid can play a pivotal role in GHG mitigations while earning from its investment and achieving energy independency from the main grid at the same time.
Development and Psychometric Investigation of Career Problems Inventory for Bipolar Disorder Patients
Authors: Rostami Zeinab , Abedi Mohammad Reza , Nilforooshan Parisa
Published: September 2020

The authors have requested that this preprint be removed from Research Square.
A Novel Community Detection Based Genetic Algorithm for Feature Selection
Authors: Rostami Mehrdad , Berahmand Kamal , Forouzandeh Saman
Published: September 2020

The selection of features is an essential data preprocessing stage in data mining. The core principle of feature selection seems to be to pick a subset of possible features by excluding features with almost no predictive information as well as highly associated redundant features. In the past several years, a variety of meta-heuristic methods were introduced to eliminate redundant and irrelevant features as much as possible from high-dimensional datasets. Among the main disadvantages of present meta-heuristic based approaches is that they are often neglecting the correlation between a set of selected features. In this article, for the purpose of feature selection, the authors propose a genetic algorithm based on community detection, which functions in three steps. The feature similarities are calculated in the first step. The features are classified by community detection algorithms into clusters throughout the second step. In the third step, features are picked by a genetic algorithm with a new community-based repair operation. Nine benchmark classification problems were analyzed in terms of the performance of the presented approach. Also, the authors have compared the efficiency of the proposed approach with the findings from four available algorithms for feature selection. The findings indicate that the new approach continuously yields improved classification accuracy.
Correlation Study of Chest CT Features of Severe/Critical type COVID-19 with Early Renal Damage and Clinical Prognosis
Authors: Li Guan , Ge Yongchun , Sun Zhiyuan , Luo Song , Wang Wen , Zhou Changsheng , zhou Fan , Zhang Xin , Dong Jie , Cao Zhiqiang , Zhang Longjiang , Lu Guangming
Published: September 2020

Background: Among patients with confirmed severe/critical type COVID-19, we found that although the seurm creatinine (Cr) value is in normal range, patients might have occured early renal damage. For severe/critical type COVID-19 patients, whether some chest CT features can be used to predict the early renal damage or clinical prognosis.Methods: 162 patients with severe/critical type COVID-19 were reviewed retrospectively in 13 medical centers from China. According to the level of eGFR, 162 patients were divided into three groups, group A (eGFR < 60 ml/min/1.73m2), group B (60 ml/min/1.73m2 ≤ eGFR < 90 ml/min/1.73m2 group) and group C (eGFR ≥ 90 ml/min/1.73m2). All patients’ baseline clinical characteristics, laboratory data, CT features and clinical outcomes were collected and compared. The eGFR and CT features was assessed using univariate and multivariate Cox regression.Results: Baseline clinical characteristics showed that there were significant differences in age, hypertension, cough and fatigue among groups A, B and C. Laboratory data analysis revealed significant differences between the three groups of leukocyte count, platelet count, C-reactive protein, aspartate aminotransferase, creatine kinase. Chest CT features analysis indicated that crazy-paving pattern has significant statistical difference in groups A and B compared with group C. The eGFR of patients with crazy-paving pattern was significant lower than those without crazy-paving pattern (76.73 ± 30.50 vs. 101.69 ± 18.24 ml/min/1.73m2, p < 0.001), and eGFR (OR = 0.962, 95% CI = 0.940-0.985) was the independent risk factor of crazy-paving pattern. The eGFR (HR = 0.549, 95% CI = 0.331-0.909, p = 0.020) and crazy-paving pattern (HR = 2.996, 95% CI = 1.010-8.714, p = 0.048) were independent risk factors of mortality.Conclusions: In patients with severe/critical type COVID-19, the presence of crazy-paving pattern on chest CT are more likely occured the decline of eGFR and poor clinical prognosis. The crazy-paving pattern appeared could be used as an early warning indicator of renal damage and to guide clinicians to use drugs reasonably.
Visceral Adipose Tissue Promotes Pressure-Induced Heart Failure Associated with Circulating Fatty Acids
Authors: Shi Wenjiao , Peng Yuanzhi , Du Jianer , Weng Xiaojian
Published: September 2020

Background: Visceral adipose tissue (VAT) is the main source of circulating fatty acids (FAs) that provides the energy substrate for the heart. Till now, studies have not shown a clear association between individual circulating FAs and heart failure (HF). In this study, we aimed to investigate the changes in circulating FAs in HF mice and their association with VAT by removing epididymal white adipose tissue (eWAT).Methods: Male C57BL/6J mice were divided into normal control and eWAT excision groups. Each group was then divided into sham group and HF group. The transverse aortic constriction (TAC) was used to induce pressure-mediated cardiac failure. HE staining and Masson’ staining were used to observe cardiac morphology. Echocardiography was used to determine diastolic left ventricular posterior wall (LVPWd), diastolic left ventricular internal diameter (LVIDd) and fractional shortening (FS%). RT-PCR was used to determine mRNA expression of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), MYH7, CTGF, collagen 1 (COL1), COL3A1 in heart tissue of mice. HPLC measurement was used to determine serum level of FAs.Results: Cardiac enlargement and fibrosis were observed after TAC surgery evidenced by increased LVPWd, LVIDd, and increased mRNA expression of ANP, BNP, MYH7, CTGF, COL1, COL3A1 in heart tissue (P<0.05). Among various FAs species, serum arachidic acid (P<0.001), behenic acid (P<0.001), lignoceric acid (P<0.01), and docosapentaenoic acid (P<0.05) levels in HF mice were significantly decreased versus sham group. However, above mentioned four serum fatty acids were significantly decreased in both sham and HF group with eWAT excision compared with eWAT reserved. In addition, the changes accompanied by LVPWd significantly decreased and FS% significantly increased.Conclusion: Serum arachidic acid, behenic acid, lignoceric acid, and docosapentaenoic acid levels were significantly decreased in pressure-induced HF mice, most importantly, VAT excision alleviated TAC-induced cardiac failure by decreasing these four kinds of fatty acids levels.
Cordycepin Reverses Cisplatin Resistance in Non-Small Cell Lung Cancer by Activating AMPK and Inhibiting the AKT Signaling Pathway
Authors: Liao Xiao-Zhong , Gao Ying , Zhao Hong-Wei , Zhou Mi , Chen Dan-Lei , Tao Lan-Ting , Guo Wei , Sun Ling-Ling , Gu Chu-Ying , Chen Han-Rui , Xiao Zhi-Wei , Zhang Jia-Xing , He Mei-Fang , lin lizhu
Published: September 2020

Background: Cisplatin (DDP) is the firs-line chemotherapeutic agent for the treatment of NSCLC. However, DDP resistance limits their usage to maximize the antineoplastic effect. The aims of this study were to investigate whether cordycepin (Cor) could reverse multidrug resistance (MDR) in NSCLC and to explore the underlying mechanisms.Methods: Cell proliferation and apoptosis were analyzed in NSCLC cell lines in vitro and in vivo, parental and DDP-resistant A549 cells, treated with DDP alone or combination with Cor. Proteins of different signaling pathways were investigated between DDP-sensistive and -insensitive A549 cell lines by GO terms and KEGG analysis, and perturbations of the MAPK and PI3K-AKT signaling pathways were evaluated by western blot. Results: Our data showed that Cor enhanced DDP inhibition of cell proliferation and promotion of apoptosis markedly compared to DDP alone group in both A549 and A549DDP. The synergic actions were associated with activation of AMPK and inhibition of AKT, mTOR and downstream P709S6K, S6 phosphorylation in the AKT pathway.Conclusion: Cor/DDP combination has synergistic effect on inhibiting proliferation and promoting apoptosis of NSCLC cells in the presence or absence of DDP resistance.
Radiomics for Prediction of Radiation-induced Lung Injury After Robotic Stereotactic Body Radiotherapy of Lung Cancer: Results From Two Independent Institutions
Authors: Bousabarah Khaled , Blanck Oliver , Temming Susanne , Wilhelm Maria-Lisa , Hoevels Mauritius , Baus Wolfgang W. , Ruess Daniel , Visser-Vandewalle Veerle , Ruge Maximilian I. , Treuer Harald , Kocher Martin
Published: September 2020

Objectives: To generate and validate a state-of-the-art radiomics model for prediction of radiation-induced lung injury and oncologic outcome in non-small cell lung cancer (NSCLC) patients treated with robotic stereotactic body radiation therapy (SBRT).Methods: A radiomics model was generated from the planning CT images of 110 patients with primary, inoperable stage I/IIa NSCLC who were treated with robotic SBRT using a risk-adapted fractionation scheme at the University Hospital Cologne (training cohort). In total, 851 radiomic features fulfilling the standards of the Image Biomarker Standardization Initiative (IBSI) were extracted from the outlined gross tumor volume (GTV) and used to build a model for prediction of local control (LC), disease-free survival (DFS), overall survival (OS) and development of local lung fibrosis (LF) by means of a gradient-boosted ensemble of regression trees. In addition, predictive clinical and dosimetric parameters were identified from a standard univariate Cox regression analysis. The radiomics model was validated in a comparable cohort of 71 patients treated by robotic SBRT at the Radiosurgery Center in Northern Germany (test cohort).Results: Oncologic outcome did not differ between the two cohorts (OS at 36 months 56% vs. 43%, p=0.065; median DFS 25 months vs. 23 months, p=0.43; LC at 36 months 90% vs. 93%, p=0.197). Local lung fibrosis developed in 33% vs. 35% of the patients (p=0.75), all events were observed within 36 months. In the training cohort, the radiomics model was able to distinguish low-risk from high risk patients for OS, DFS, LC and LF with a high accuracy (p < 0.001). In the test cohort, the model for development of lung fibrosis retained its predictive power and could differentiate patients with a high risk for developing LF from those with a low risk (p=0.016). In contrast, the radiomics model failed to predict OS, DFS and LC in the test cohort. Also, none of the clinical and dosimetric parameters predictive for development of LF in the training cohort (GTV-Dmean, GTV-Dmax, PTV-D95%, Lung-D1ml, age) had a significant impact on the occurrence of LF in the test cohort.Conclusion: Despite the obvious difficulties in generalizing predictive models for oncologic outcome and toxicity, this analysis shows that a carefully designed radiomics model for prediction of local lung fibrosis after SBRT of early stage lung cancer performs well across different institutions.
Discovery of Vespasiano Bignami Paintings at The National Theater of Costa Rica Trough Technical Photography and UV-Vis Spectroscopy
Authors: Barboza Geraldine Conejo , Hernandez Eduardo Libby , Cruz Carmen Marin , Herrera-Sancho Oscar-Andrey
Published: September 2020

Paintings are one of the most striking means that human beings have used to share our history, learning, personal beliefs and thoughts. Paintings reflect the connection between the artist and its time, not only in the thematic and stylistic aspects, but in the availability of art materials such as pigments, vehicles and varnishes. Establishing and understanding these relations are key to provide accurate information about the artist’s palette and developing conservation strategies. The ceiling of the Foyer of the National Theater of Costa Rica is decorated with three large format paintings from the 19 th century made by the Italian painter Vespasiano Bignami. The paintings are known as La Poesía, La Música and La Danza (The Poetry, the Music and The Dance) and have undergone restorations in the past. However, their state of conservation is unknown and thus demand accurate scientific examination in order to document their status and the extent of undocumented previous restoration work. To overcome those issues, we propose the application of a combination of non-invasive and in-situ techniques to obtain information about the red pigment composition and actual state of conservation. We employed technical photography in the Visible (Vis) and Near Infrared (IR) regions, using panoramic stitching techniques in order to obtain high resolution images of the very large artworks. Several conservation problems were observed such as: detachment of pigments, cracks, stains, and sections with undocumented restorations. In the IR and in the False Color Infrared (IRFC) images we observed a very conspicuous behavior of the red pigment used in the three paintings. Particular areas with the red pigment were fluorescent, and through Ultraviolet fluorescence (UVF) imaging we identified the pigment as through its red-coral fluorescence as Madder Lake, by comparison to a historical pigments reference palette (Pigment Checker from Cultural Heritage Science Open Source). Measurements in five different red pigmented zones using UV-Vis spectroscopy in La Musica show bands in the 550-650 nm region. A Lorentz Model nonlinear curve fit to the bands allowed us to correlated the fluorescent pigment in the paintings of Vespasiano Bignami with Madder Lake.
Identification of porcine imprinted genes involved in skeletal muscle development by high-throughput sequencing
Authors: Hou Xinhua , Wang Zishuai , Wang Ligang , Zhao Fuping , Liu Xin , Gao Hongmei , Shi Lijun , Yan Hua , Zhang Longchao , Wang Lixian
Published: September 2020

Background

Imprinted genes—exhibiting parent-specific transcription—play essential roles in the process of mammalian development and growth. To further understand the imprinted genes involved in skeletal muscle development, DNA-seq and RNA-seq were used to explore the characteristics of imprinted genes involved in skeletal muscle development from porcine reciprocal crosses.
Results

A total of 211 paternally and 417 maternally imprinted genes were obtained in this study. Of the candidate imprinted genes, 50 paternally and 112 maternally imprinted genes possessed cytosine and guanine dinucleotide (CpG) islands in their promoters that may have regulated the imprinted gene expression. Imprint-related motifs were predicted and PBX1 motifs may mediate the expression of imprinted genes in the process of skeletal-muscle development. Functional analysis showed that a maternally imprinted gene of EPHB1 was involved in skeletal muscle cell proliferation. Imprinted genes involved in the biological processes of cell proliferation, differentiation and fusion were also analyzed. More maternally imprinted genes, including ADRA1D, E2F1, FBXO40, GHRH and WNT5A, were involved in skeletal muscle development than paternally imprinted genes.
Conclusions

Skeletal muscle development is crucial for meat production. This study identified 628 porcine imprinted genes in skeletal muscle and revealed their functional role in skeletal muscle development. Our findings should further assist with the potential use of imprinted genes in pig breeding.
Circularly-polarized THz wave emission from a micro-thin water flow
Authors: Huang Hsin-Hui , Juodkazis Saulius , Gamaly Eugene , Nagashima Takeshi , Yonezawa Tetsu , Hatanaka Koji
Published: September 2020

Intense THz wave sources are highly expected for further progresses in nonlinear THz science and practical implementation of non-ionizing radiation in sensing and communications. Solid-based sources have inherent limits of material breakdown, while intense laser irradiation of liquids is a promising emerging technique for THz wave and hard X-ray emission. Water-based THz emission shows intensity enhancements up to 103 times when laser-pulse pairs with nanosecond delay are used. Here we show circularly- polarized THz wave emission from thin water flow irradiated by two time-separated and linearly-polarized femtosecond laser pulses. THz time-domain spectroscopy reveals the circularly-polarized THz emission dominates 4.7 ns after the first pulse irradiation. THz wave detection delay in the spectroscopy and time-resolved micrography indicate that the THz wave emission originates from the rarefied volume in front of the flow. Radial relaxation of charges (currents) in the focal volume where ponderomotive charge depletion occurred is the origin for the circular polarization; tight focusing localized THz wave emission to the sub-wavelength region.
Early Mobility After Fragility Hip Fracture: A Mixed Methods Embedded Case Study
Authors: Haslam-Larmer Lynn , Donnelly Catherine , Auais Mohammad , Woo Kevin , DePaul Vincent
Published: September 2020

BackgroundFollowing a hip fracture up to 60% of patients are unable to regain their pre-fracture level of mobility. For hospitalized older adults, the deconditioning effect of bedrest and functional decline has been identified as the most preventable cause of loss of ambulation. Participating in early mobility activities can decrease the overall length of hospital stay and aid in re-establishing a patients’ functional status. Recent studies demonstrate that this older adult population spends greater than 80% of their time in bed during hospitalization, despite being ambulatory prior to their fracture. We do not fully understand why there continues to be such high rates of sedentary times, given that evidence demonstrates functional decline is preventable and early mobility recommendations have been available for over a decade.MethodsA descriptive mixed method embedded case study was selected to understand the phenomenon of early mobility after fragility hip fracture surgery. In this study, the main case was one post-operative unit with a history of recommendation implementation, and the embedded units were patients recovering from hip fracture repair. Data from multiple sources provided an understanding of mobility activity initiation and patient participation.ResultsActivity monitor data from eighteen participants demonstrated a mean sedentary time of 23.18h. Median upright time was 24 min, and median number of steps taken was 30. Qualitative interviews from healthcare providers and patients identified two main categories of themes; factors that are external to the person (system, healthcare provider team, environment) and factors that are unique to the person (psychological and physical factors). Discussion There are multi-level factors that require consideration with implementation of best practice interventions, namely, systemic, healthcare provider related, and patient related. Recommendations are being sustained at the system level, and the unit has embraced a strong interdisciplinary approach. At the micro level, patients identify several factors influencing their participation, which ultimately demonstrates successful uptake of recommendations.ConclusionsThe study reports several variables to be important considerations for facilitating early mobility. Communicating mobility expectations and addressing physical and psychological readiness are essential. Our findings can be used to develop meaningful patient centred interventions to address these barriers.
Clinico-Pathological Findings and Spatial Distributions of Esophageal Cancer in Arsi Zone, Central Ethiopia
Authors: Deybasso Haji Aman , Roba Kedir Teji , Nega Berhanu , Belachew Tefera
Published: September 2020

Background: Arsi Zone is one of the esophageal cancer endemic areas and reported to have high incidence of esophageal cancer in Ethiopia. This study assessed clinico-pathological patterns and spatial distributions of esophageal cancer in Arsi Zone, Oromia, Central Ethiopia.Methods: A cross sectional study design was carried out by abstracting data from 403 patients` records that were treated from January 2015 to January 2019. Data were collected by using structured data collection form and Geographical Positioning System software. The collected data were summarized in the form of tables, figures, means and standard deviations. Statistical data analysis was done using SPSS software version 21.0 while geospatial analysis was conducted using the Arc-GIS 10.1 software.Results: The disease was prominent among individuals aged 50 to 59 years. The mean age of females and males was 52.2(SD+10.41) and 56.94(SD +12.27) years respectively. The vast majority (98.3%) of the cases had squamous cell carcinoma. Dysphagia with weight loss accounted for 87.6 percent of the presenting symptoms. The tumor was located at the lower thorax of 42.9% of the patients. Majority (62%) of the patients were from the eastern and north-eastern parts of the Arsi zone. Overwhelming majorities of the patients were from the Robe, Jaju, Disksis and Sude districts.Conclusion: Dysphagia with weight loss was the major symptom during first visit. Squamous cell carcinoma was the predominant histopathological type. Eastern and the northeastern parts of the Zone are the most affected regions. Future studies should focus on the determinants of EC and precise areas with high incidence by using prospective studies through the population and/or facility-based cancer registry systems
Impact of the COVID-19 Pandemic on Residents’ Clinical Training and Psychosocial Well-Being in Saudi Arabia’s Western Region
Authors: Alshareef Reem , Zahrani Abdullah Al , Alzhrani Meshari , Suwaidi Abdulaziz , Alamry Bander
Published: September 2020

Background: The novel COVID-19 pandemic has imposed a significant burden on healthcare systems. Similarly, it has also affected the performance and well-being of the medical staff working during the pandemic. However, to what extent COVID-19 is affecting medical staff is still unclear, especially among physicians.Objective: This study aims to evaluate the negative effect of the COVID-19 pandemic on the medical training and psychological well-being of resident doctors practicing in the western region in Saudi Arabia.Patients and Methods: This is a quantitative cross-sectional study that included a survey distributed to residents physicians working in the western region in Saudi Arabia. The survey included questions on demographic data and factors influencing the academic training, attitude, and daily habits of the residents during the pandemic. Psychological impact was assessed using the Kessler Psychological Distress Scale. Data analysis was executed using IBM SPSS version 26. Results: A total of 121 residents responded to this survey. Of all respondents, 71.1% were junior residents, 66.9% had a medical specialty; and 33% were family medicine doctors, followed by 17% from general surgery. In regards to work amid the pandemic, 36.1% were in contact with confirmed COVID-19 patients, and 35.5% had to work overtime during the pandemic. Of the respondents, 44% described their training as extremely affected, and 32% strongly agreed and 53% agreed that their psychological well-being was negatively affected. Further, 39.6% were smoking more than they used to. Female and junior residents’ training was significantly more negatively affected than their peers’ (p=0.039 and 0.011, respectively). There was a non-significant difference detected between the residents regarding the factors negatively affecting their psychological well-being. Conclusion: Residents working during the pandemic in the western area of Saudi Arabia were significantly affected by the pandemic from both professional and psychological perspectives. Further research on how the pandemic is affecting doctors in other areas in Saudi Arabia is needed.
High-intensity Exercise and Cognitive Function in Cognitively Normal Older Adults: A Randomised Clinical Trial
Authors: Brown Belinda , Frost Natalie , Rainey-Smith Stephanie R. , Doecke James , Markovic Shaun , Gordon Nicole , Weinborn Michael , Sohrabi Hamid R. , Laws Simon M. , Martins Ralph N , Erickson Kirk I , Peiffer Jeremiah J
Published: September 2020

BACKGROUND: Physical inactivity has been consistently linked to increased risk of cognitive decline; however, studies examining the impact of exercise interventions on cognition have produced inconsistent findings. Some observational studies suggest exercise intensity may be important for inducing cognitive improvements; however, this has yet to be thoroughly examined in older adult cohorts. The objective of the current study was to evaluate the effect of systematically manipulated high-intensity and moderate-intensity exercise interventions on cognition. In addition, we investigated individual variability in exercise response by examining effects of relevant genetic factors and changes in cardiorespiratory fitness on cognitive change.METHODS: This multi-arm randomised clinical trial investigated the effects of 6-months of high-intensity exercise and moderate-intensity exercise, compared with an inactive control, on cognition. Outcome measures were assessed at pre- (baseline), post- (6 months), and 12-months post-intervention. Ninety-nine cognitively normal men and women (aged 60 – 80 years) were enrolled from October 2016 to November 2017. Participants that were allocated to an exercise group (i.e., high-intensity or moderate-intensity) engaged in cycle-based exercise two times per week for 6 months. Cognition was assessed using a comprehensive neuropsychological test battery. Cardiorespiratory fitness was evaluated by a graded exercise test. Apolipoprotein e4 genotype and brain-derived neurotrophic factor Val66Met carriage were identified.RESULTS: There was a dose-dependent effect of exercise intensity on cardiorespiratory fitness; whereby the high-intensity group experienced greater increases in fitness than the moderate-intensity and control groups. However, there was no direct effect of exercise on cognition. We observed an association between changes in global cognition and executive function and changes in cardiorespiratory fitness from pre- to post-intervention: this relationship was strongest in brain-derived neurotrophic factor non-Met carriers.CONCLUSIONS We did not observe a direct effect of exercise on cognition. Nevertheless, our data suggests genetics may moderate the relationship between fitness and cognitive change following exercise, and this should be examined further in larger trials.TRIAL REGISTRATION: This study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617000643370). Registered 3rd May 2017 - retrospectively registered. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372780
Distinctive Epigenomic Alterations in NF1-deficient Cutaneous and Plexiform Neurofibromas Drive Differential MKK/p38 Signaling
Authors: Grit Jamie L. , Johnson Benjamin K. , Dischinger Patrick S. , Essenburg Curt J. , Adams Marie , Campbell Stacy , Pollard Kai , Pratilas Christine A. , Triche Tim J. , Graveel Carrie R. , Steensma Matt
Published: September 2020

Benign peripheral nerve sheath tumors are the clinical hallmark of Neurofibromatosis Type 1. They account for substantial morbidity and mortality in NF1. Cutaneous (CNF) and plexiform neurofibromas (PNF) share nearly identical histology but maintain different growth rates and risk of malignant conversion. The reasons for this disparate clinical behavior are not well explained by recent genome or transcriptome profiling studies. We hypothesized that CNFs and PNFs are epigenetically distinct tumor types that exhibit differential signaling due to genome-wide and site-specific methylation events. We interrogated the methylation profiles of 45 CNFs and 17 PNFs from NF1 subjects with the Illumina EPIC 850K methylation array. Based on these profiles, we confirm that CNFs and PNFs are epigenetically distinct tumors with broad differences in higher order chromatin states and specific methylation events altering genes involved in key biological and cellular processes, such as inflammation, RAS/MAPK signaling, actin cytoskeleton rearrangement, and oxytocin signaling. Based on our identification of two separate DMRs associated with alternative leading exons in MAP2K3, we demonstrate differential RAS/MKK3/p38 signaling between CNFs and PNFs. Epigenetic reinforcement of RAS/MKK/p38 was a defining characteristic of CNFs leading to pro-inflammatory signaling and chromatin conformational changes, whereas PNFs signaled predominantly through RAS/MEK. Tumor size also correlated with specific CpG methylation events. Taken together, these findings confirm that NF1 deficiency influences the epigenetic regulation of RAS signaling fates, accounting for observed differences in CNF and PNF clinical behavior. The extension of these findings is that CNFs may respond differently than PNFs to RAS-targeted therapeutics raising the possibility of targeting p38-mediated inflammation for CNF treatment.
Good Practices and Lessons Learned in Developing Local Language Tools to Support Stakeholder Engagement Activities
Authors: Chemonges Elinor Wanyama , Dicko Bakara , Toe Lea Pare , Coulibaly Mamadou , Barry Nourou , Bayala Korotimi , Diabate Abdoulaye , Drabo Mouhamed , Kayondo Jonathan , Kekele Souleymane , Kodio Souleymane , Ky Anselme Dinyiri , Linga Richard Ronny , Magala Emmanuel , Meda Wilfrid Ihibna , Mukwaya Solome , Namukwaya Annet , Robinso Benjamin , Samoura Hatoumata , Sanogo Kadiatou , thizy delphine , Traore Fatoumata
Published: September 2020

Stakeholder engagement is an essential pillar for the development of innovative public health interventions, including genetic approaches for malaria vector control. Scientific terminologies are largely lacking in local languages yet, when research activities involve international partnership, the question of technical terminology and its translation is crucial for effective and meaningful communication with stakeholders. Target Malaria, a not-for-profit research consortium developing innovative genetic approaches to malaria vector control, carried out a linguistic exercise in Mali, Burkina Faso and Uganda to establish the appropriate translation of its key terminology to local languages of sites where the teams operate. While reviewing the literature, there was no commonly agreed approach to establish such glossary of technical terms in local languages of the field sites where Target Malaria operates. Because of its commitment to the value of co-development, Target Malaria decided to apply this principle for the linguistic work and to take the opportunity of this process to empower communities to take part in the dialogue on innovative vector control. The project worked with linguists from other institutions (whether public research ones or private language center) who developed a first potential glossary in the local language after better understanding the project scientific approach. This initial glossary was then tested during focus groups with community members, which significantly improved the proposed translations by making them more appropriate to the local context and cultural understanding. The stepwise process revealed the complexity and importance of elaborating a common language with communities as well as the imbrication of language with cultural aspects. This exercise demonstrated the strength of a co-development approach with communities and language experts as a way to develop knowledge together and to tailor communication to the audience even in the language used.
Invasive Pulmonary Cryptococcal Infection Masquerading as Lung Cancer With Brain Metastases: A Case Report
Authors: Echieh Chidiebere Peter , Nwagboso Chmaobi I , Ogbudu Stephen O , Eze Nkemakolam John , Ochang Ernest A , Jibrin Paul , Etiuma Anietimfon U , Bassey Okon O
Published: September 2020

Background: Cryptococcosis is a global disease problem. Although seen more frequently in the severely immuno-suppressed, it can also be seen in patients without apparent immuno-suppression. Patients with pulmonary Cryptococcosis typically present with cryptococcal pneumonia while brain cryptococcosis present with meningitis. Case presentation: Here we present our experience in the management of a 33-year-old immunocompetent man, diagnosed of invasive pulmonary Cryptococcal disease with spread to the brain. This case is unique because the patient was previously treated for tuberculosis and presented with typical bronchopulmonary (difficulty in breathing and cough), thoracic (diminished breath sounds and dull percussion notes), extra-thoracic (intra-cranial space occupying lesion) as well as Computed Tommography (CT) Scan features attributable to lung cancer. Diagnosis of Cryptococcosis was made by identification of oval thick-walled yeast on histology of lung biopsy specimen.Conclusions: We conclude that invasive Cryptococcosis affecting the lung and brain may present with a clinical picture similar to metastatic lung cancer. We recommend routine fungal stains and fungal culture in suspected cases.
Predicting the Quality of Life in Patients With Painful Diabetic Neuropathy (PDN) Based on Pain Severity, Pain Catastrophizing, Pain Acceptance, Depression, Anxiety, and Sleep Disturbance: Assessing the Prevalence of Psychiatric Symptoms in Iranian Patients With PDN.
Authors: Rezaei Parnian , Rajaeiramsheh Fereshteh , Davoudi Mohammadreza , Taheri Amir Abbas
Published: September 2020

Background: This study aimed to predict the quality of life in patients with Painful Diabetic Neuropathy (PDN) based on pain severity, pain catastrophizing, pain acceptance, depression, anxiety, and sleep disturbance. Also, assessing the prevalence of psychiatric symptoms in Iranian patients with PDN.Method: In this descriptive correlational study, 1500 MTBI patients admitted to the diabetes centers in Tehran, Iran, from November 2019, to August 2020 were selected using the convenient sampling method. One thousand one hundred twenty patients (mean age, 53.6± 12.6 years) participated in the research. Data were collected using the Quality of life (NeuroQol) questionnaire (as a dependent variable); Beck Depression Inventory, Beck Anxiety Inventory, 10-cm visual analog scale (pain severity), Pain Catastrophizing Scale (PCS), Chronic Pain Acceptance Questionnaire (CPAQ) and Pittsburgh Sleep Quality Index (PSQI). Finally, the data were analyzed in SPSS‑26 by multiple regression analysis.Results: The study results showed that the regression model was significant (P < 0.5), in which variables predicted 42% of total changes in the quality of life in patients. Predicting factors from the most significant to the lowest include depression, pain catastrophizing, pain acceptance, pain severity, sleep disturbance, and finally, anxiety. Also, in patients with PDN, the prevalence rates of sleep disturbances, depression, and anxiety are 85.5%, 68.2%, and 62.1%, respectively. Also, comorbid depression and anxiety were found in 47% of patients.Conclusion: The findings of this study show a considerable relationship between these factors and quality of life. Thus, it is suggested to design more specific psychological‑based rehabilitation programs concerning these variables to improve these patients' quality of life, focusing on stronger variables (depression and pain catastrophizing) for reaching better treatment outcomes. Furthermore, according to the findings of this research, which shows a high level of anxiety, depression, and sleep disturbance in Iranian patients with PDN, all experts and clinicians must focus on these psychiatric symptoms to reduce disease problems.
Single-Port Robot-Assisted Perineal Radical Prostatectomy: Our Initial Experience
Authors: Huang Bin , Wu Yukun , Li Wenji , Wang Zongren , Chen Junxing , Chen Lingwu
Published: September 2020

Purpose: To evaluate the clinical value of robot-assisted perineal radical prostatectomy (RPRP) in the treatment of early localized prostate cancer.Methods: We retrospectively analyzed 3 consecutive patients diagnosed with prostate cancer from January 2020 to May 2020 who received RPRP in our center. The main outcomes assessed were operating time, perioperative complications and need for conversion to open surgery. Results: 3 patients successfully underwent RPRP with no conversion to open surgery. No intra-operative complications were seen. Average operative time was 201.67±61.53 min, console time was131.67±32.53 min, with an estimated blood loss of 183.33±28.87mL. 2 patients were discharged within 10 days postoperatively with perineal drainages removed. The Foley catheter was removed 2 weeks after surgery. One patient had a positive surgical margin (33.3%). 2 patients were continent immediately after removal of the Foley catheter, 1 patient was continent 1 month postoperatively. The sexual function of 2 patients recovered within 1 month and 1 patient recovered within 3 months. The PSA reexamination was 0-0.1µg/L one month after operation.Conclusion: For patients with early localized prostate cancer, robot-assisted perineal radical prostatectomy is a safe and effective method, and has outstanding advantages in radical tumor resection and postoperative urine control.