bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring how triads of people living with dementia, carers and health care professionals function in dementia health care: A systematic qualitative review and thematic synthesis
Authors: Tuijt Remco , Rees Jessica , Frost Rachael , Wilcock Jane , Manthorpe Jill , Rait Greta , Walters Kate
Published: March 2020

Background

Many qualitative studies report the post-diagnostic care experiences of carers and people living with dementia; however, this is not often accompanied by opportunities to hear the corresponding views of their health care professionals and how this triadic relationship functions. The aim of this review was to identify and thematically synthesize the experiences of health care services reported by people living with dementia, their carers and health care professionals.

Methods

Medline, PsycINFO, Embase and CINAHL were searched from inception to 31 July 2019 for qualitative research including people living with dementia, carers and health care professionals. Data were coded and thematically synthesised using NVivo.

Results

Of 10,045 search results, 29 papers relating to 27 studies were included in the final synthesis, including 261 people living with dementia, 444 carers and 530 health care professionals. Six themes emerged related to the functioning of a dementia care triad: (1) involving the person living with dementia, (2) establishing expectations of care and the roles of the members of the triad, (3) building trust, (4) effective communication, (5) continuity of care and (6) understanding the unique relationship dynamics within each triad.

Discussion

The interactions and complexity of triadic dementia care relationships further our understanding of how to improve dementia care. Awareness of possible diverging attitudes highlights areas of necessary improvement and further research into facilitating engagement, such as when multiple professionals are involved or where there are mismatched expectations of the roles of triad members. In order to operate efficiently as a triad member, professionals should be aware of how pre-existing relations can influence the composition of a triad, encourage the involvement of the person living with dementia, clarify the expectations of all parties, establish trusting relationships and enable communication within the direct triad and beyond.
The use of bounce in professional wheelchair tennis
Authors: Sánchez-Pay Alejandro , Torres-Luque Gema , Sanz-Rivas David , Courel-Ibáñez Javier
Published: March 2020

The purpose of this study was to determine the influence of the use of bounce on performance in wheelchair tennis. Data pertaining to all the hits on the ball ( n = 4021) were recorded from 16 men’s singles professional matches. Performance parameters regarding to players’ skill level (high- and low-ranked) the game situation (players and the serve-return situation), technical-tactical aspects (hitting side), and outcome (stroke and point outcome) were included in multivariate regression and decision tree models. The results determined that the skill level ([Formula: see text] = 7.164, p >  0.01) and stroke outcome ([Formula: see text] = 14.099, p >  0.01) were the main predictors of the number of bounces, with high-ranked players using more bounces than the low-ranked. Stroke outcome was the main distinguishing factor of the use of bounce ([Formula: see text] = 51.424, p <  0.01, V =  0.08), with a greater use of zero bounces in winners and errors, one bounce in rallies, and two bounces in winners. These findings should be taken into consideration by coaches to design specific training systems according to the requirements from wheelchair tennis.
A quality improvement project for delirium prevention and management over the Greater Manchester Critical Care Network
Authors: Davis Jessica , Berry Karen , McIntyre Rebecca , Conway Daniel , Thomas Anthony , Hanison James
Published: March 2020

Background

Delirium is a common complication of critical illness with a significant impact on patient morbidity and mortality. The Greater Manchester Critical Care Network established the Delirium Reduction Working Group in 2015. This article describes a region-wide delirium improvement project launched by that group.

Methods

Multiple Plan-Do-Study-Act cycles were undertaken. Cycle 1: April 2015 demonstrated only 48% of patients had a formal delirium screen. Following this a network-wide event took place and the Delirium Standards for the Greater Manchester Critical Care Network were produced. Cycle 2: May 2016 quarterly audits across the network monitored compliance against the agreed standards. Group events involved implementation of a delirium care bundle, sharing best practice, educating staff and providing guidance on the management of delirium. Cycle 3: November 2016 quarterly audit continued and a regional delirium study day was rolled out across the region.

Results

We have 14 different units across our network, all of which have participated in the audit. The first audit showed a delirium point prevalence of 28%, subsequent point prevalence audits demonstrated rates as low as 13%. There has also been an improvement in the use of delirium screening tools. In the first audit 37% of patients had two delirium screens in 24 h, this has increased to 60% in the latest audit. Improvements were also made in availability of sensory aids and pain assessments.

Conclusion

The project has demonstrated the feasibility of delivering a coordinated delirium improvement project across multiple critical care units.
Developing occupation kits in a Hand Therapy Student Experiential Learning Clinic
Authors: Berlet Logan , Kaskutas Vicki
Published: March 2020

Introduction

Combining occupation-based and biomechanical approaches is effective to increase function after hand injury. This project developed and evaluated occupation kits as a means to increase occupation-based practice.

Methods

Descriptive study that utilized existing Disabilities of the Arm, Shoulder and Hand data from 642 patients treated by hand surgeon and patients in our Hand Therapy Student Experiential Learning Clinic (HTSELC) to identify difficult activities. These data informed the selection of occupational areas to address with the kits. Biomechanical demands of each kit developed were quantified by 10 student therapists using the Abilities Questionnaire. Fourteen occupational therapists reviewed and rated the usefulness of each kit by survey. Kits were piloted in the HTSELC, and student therapists documented the percentage of time delivering each intervention type: activity/occupation, preparatory methods and tasks, education, advocacy, and group. The degree of occupation-based practice was compared using intervention type percentages before and after introduction of the kits.

Results

Ten kits were created to address most occupation categories within occupational therapy’s scope of practice. Kits include procedures, safety precautions, and a standardized scale to objectively measure performance. Clinicians noted that kits reflected each occupation well (3.7/5) and 45% reported they were likely to use the kits. After the kits became available in the HTSELC, the percentage of interventions at the occupation/activity level increased from 19% to 26% and biomechanical interventions, including preparatory methods and tasks, decreased from 61% to 49%.

Conclusion

This research suggests that occupation kits can be a first step to help therapists deliver occupation-based interventions in hand therapy settings.
Quantifying the impact of delayed delivery of cardiac rehabilitation on patients’ health
Authors: Hinde Sebastian , Harrison Alexander , Bojke Laura , Doherty Patrick
Published: March 2020

Background

Despite its role as an effective intervention to improve the long-term health of patients with cardiovascular disease and existence of national guidelines on timeliness, many health services still fail to offer cardiac rehabilitation in a timely manner after referral. The impact of this failure on patient health and the additional burden on healthcare providers in an English setting is quantified in this article.

Methods

Two logistic regressions are conducted, using the British Heart Foundation National Audit of Cardiac Rehabilitation dataset, to estimate the impact of delayed cardiac rehabilitation initiation on the level of uptake and completion. The results of these regressions are applied to a decision model to estimate the long-term implications of these factors on patient health and National Health Service expenditure.

Results

We demonstrate that the failure of 43.6% of patients in England to start cardiac rehabilitation within the recommended timeframe results in a 15.3% reduction in uptake, and 7.4% in completion. These combine to cause an average lifetime loss of 0.08 years of life expectancy per person. Scaled up to an annual cohort this implies 10,753 patients not taking up cardiac rehabilitation due to the delay, equating to a loss of 3936 years of life expectancy. We estimate that an additional £12.3 million of National Health Service funding could be invested to alleviate the current delay.

Conclusions

The current delay in many patients starting cardiac rehabilitation is causing quantifiable and avoidable harm to their long-term health; policy and research must now look at both supply and demand solutions in tackling this issue.
The acromion–greater tuberosity impingement index: A new radiographic measurement and its association with rotator cuff pathology
Authors: Liu Hai-Xiao , Xu Xin Xian , Xu Dao Liang , Hu Yue Zheng , Pan Xiao-Yun , Yu Zhang , Xu You-Jia
Published: March 2020

Purpose:

Several radiographic parameters describe humeral head coverage by the acromion. We describe a new radiographic measurement, the acromion–greater tuberosity impingement index (ATI), and its ability to predict rotator cuff pathology.

Methods:

The ATI was measured with magnetic resonance imaging (MRI) and X-ray analysis in 83 patients with rotator cuff pathology and 76 patients with acute rotator cuff tears. The lateral acromial angle (LAA), acromion type, the acromion index (AI) and the critical shoulder angle (CSA) were measured to assess their correlations with the ATI. Receiver operating characteristic (ROC) curves were used to predict degenerative rotator cuff pathology. The change in the ATI after acromion surgery was evaluated in both groups.

Results:

According to the ROC curves, the ATI is a good predictor of degenerative rotator cuff pathology on both X-ray (cut-off, 0.865) and MRI (cut-off, 0.965). Patients with degenerative rotator cuff pathology had a significantly higher average ATI compared to the trauma group ( p = 0.001 for X-ray and MRI). The degenerative group had a significantly lower LAA ( p = 0.001) and a higher ratio of type III acromion ( p = 0.035) than the trauma group. The ATI on X-ray was negatively related to the LAA and positively related to the AI, the CSA and acromion type (each p < 0.05). The ATI on MRI was negatively related to the LAA and positively related to the AI and acromion type (each p <0.05). More patients in the degenerative group than the trauma group needed acromioplasty or acromion decompression ( p < 0.05). The ATI on MRI was significantly lower after acromion surgery compared to before surgery in both groups ( p < 0.05).

Conclusion:

The ATI is a good predictor of degenerative supraspinatus tendon tears or subacromial impingement syndrome. The ATI on MRI is more accurate and can precisely guide acromion surgery.
Injury-Related Fears During the Return-to-Sport Phase of ACL Reconstruction Rehabilitation
Authors: Meierbachtol Adam , Obermeier Michael , Yungtum William , Bottoms John , Paur Eric , Nelson Bradley J. , Tompkins Marc , Russell Hayley C. , Chmielewski Terese L.
Published: March 2020

Background:

Fear of reinjury is common after anterior cruciate ligament reconstruction (ACLR) and often deters a return to preinjury sport participation. A better understanding of injury-related fear is needed to inform rehabilitation strategies.

Purpose/Hypothesis:

The purpose of this study was to (1) identify individual fear-evoking tasks or situations, (2) compare the intensity and amount of change relative to other injury-related fears (reinjury, knee giving way, and knee pain) after completion of a return-to-sport training program, and (3) determine whether standardized questionnaires can identify the intensity of fear for the individual fear-evoking task or situation and for fear of reinjury. The hypothesis was that the task or situation that evokes fear would vary across patients and the intensity of that fear would be higher and show less change after return-to-sport training compared with other injury-related fears.

Study Design:

Case series; Level of evidence, 4.

Methods:

Participants included 33 patients (15 males; mean age, 18 years) with ACLR who enrolled in a group-format return-to-sport training program. Questionnaires completed before and after return-to-sport training included items to specify fear-evoking tasks or situations, items to rate the intensity of various injury-related fears, the Anterior Cruciate Ligament Return to Sport after Injury scale (ACL-RSI), and the Tampa Scale for Kinesiophobia (TSK-11).

Results:

The most common fear-evoking task or situation was cutting, followed by contact, jumping, and other. Intensity of fear-evoking task or situation was higher than other injury-related fears, but all fears decreased in intensity after training. The ACL-RSI score better identified the intensity of fear for the individual fear-evoking task or situation and for fear of reinjury than did the TSK-11 score.

Conclusion:

Activities that evoke fear vary across patients, but fear of cutting is common. The intensity of common fears after ACLR decreased after advanced group training, and large effect sizes were seen for nearly all examined fears. Fear of reinjury and intensity of individually feared tasks may be better reflected in the ACL-RSI score than the TSK-11 score.
Export Sophistication and Trade Elasticities
Authors: Thorbecke Willem , Salike Nimesh
Published: March 2020

Does a country’s export structure impact the way that exchange rates affect trade? Do more sophisticated products exhibit lower demand elasticities? Using panel data for major exporters over the 1992–2016 period and dynamic ordinary least squares techniques, we find that price elasticities are higher for low-technology goods such as textiles and footwear than for high-technology goods such as pharmaceuticals and medical equipment. We also find that elasticities are larger for less advanced countries such as China than for more advanced countries such as Switzerland. We draw policy implications from these findings for countries exposed to safe haven capital flows, for countries facing long-term appreciation pressures and for countries that specialise in low-technology exports.

JEL Classification: F14, F10
Targeting CD300f to enhance hematopoietic stem cell transplantation in acute myeloid leukemia
Authors: Abadir Edward , Silveira Pablo A. , Gasiorowski Robin E. , Ramesh Murari , Romano Adelina , Mekkawy Ahmed H. , Lo Tsun-Ho , Kabani Karieshma , Sutherland Sarah , Pietersz Geoffrey A. , Ho P. Joy , Bryant Christian E. , Larsen Stephen R. , Clark Georgina J.
Published: March 2020

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) significantly reduces the rate of relapse in acute myeloid leukemia (AML) but comes at the cost of significant treatment-related mortality. Despite the reduction in relapse overall, it remains common, especially in high-risk groups. The outcomes for patients who relapse after transplant remains very poor. A large proportion of the morbidity that prevents most patients from accessing allo-HSCT is due to toxic nonspecific conditioning agents that are required to remove recipient hematopoietic stem and progenitor cells (HSPCs), allowing for successful donor engraftment. CD300f is expressed evenly across HSPC subtypes. CD300f has transcription and protein expression equivalent to CD33 on AML. We have developed an anti-CD300f antibody that efficiently internalizes into target cells. We have generated a highly potent anti-CD300f antibody-drug conjugate (ADC) with a pyrrolobenzodiazepine warhead that selectively depletes AML cell lines and colony forming units in vitro. The ADC synergizes with fludarabine, making it a natural combination to use in a minimal toxicity conditioning regimen. Our ADC prolongs the survival of mice engrafted with human cell lines and depletes primary human AML engrafted with a single injection. In a humanized mouse model, a single injection of the ADC depletes CD34+ HSPCs and CD34+CD38−CD90+ hematopoietic stem cells. This work establishes an anti-CD300f ADC as an attractive potential therapeutic that, if validated in transplant models using a larger cohort of primary AML samples, will reduce relapse rate and toxicity for patients with AML undergoing allo-HSCT.
Overexpression of PpSnRK1α in tomato enhanced salt tolerance by regulating ABA signaling pathway and reactive oxygen metabolism
Authors: Wang Wen-Ru , Liang Jia-Hui , Wang Gui-Fang , Sun Mao-Xiang , Peng Fu-Tian , Xiao Yuan-Song
Published: March 2020

Background

SNF-related Kinase 1 (SnRK1) is a key component of the cell signaling network. SnRK1 is known to respond to a wide variety of stresses, but its exact role in salt stress response and tolerance is still largely unknown.

Results

In this study, we reported that overexpression of the gene encoding the α subunit ofPrunus persica SnRK1(PpSnRK1α) in tomato could improve salt stress tolerance. The increase in salt stress tolerance inPpSnRK1α-overexpressing plants was found to correlate with increasedPpSnRK1αexpression level and SnRK1 kinase activity. AndPpSnRK1αoverexpression lines exhibited a lower level of leaf damage as well as increased proline content and reduced malondialdehyde (MDA) compared with wild-type (WT) lines under salt stress. Furthermore,PpSnRK1αenhanced reactive oxygen species (ROS) metabolism by increasing the expression level of antioxidase genes and antioxidant enzyme activities. We further sequenced the transcriptomes of the WT and threePpSnRK1αoverexpression lines using RNA-seq and identified about 1000PpSnRK1α-regulated genes, including many antioxidant enzymes, and these genes were clearly enriched in the MAPK signaling pathway (plant), plant-pathogen interactions and plant hormone signaling transduction and can respond to stimuli, metabolic processes, and biological regulation. Furthermore, we identified the transcriptional levels of several salt stress-responsive genes,SlPP2C37,SlPYL4,SlPYL8,SlNAC022,SlNAC042,andSlSnRK2family were altered significantly byPpSnRK1α, signifying thatSnRK1αmay be involved in the ABA signaling pathway to improve tomato salt tolerance. Overall, these findings provided new evidence for the underlying mechanism ofSnRK1αconferment in plant salt tolerance phenotypes.

Conclusions

Our findings demonstrated that plant salt stress resistance can be affected by the regulation of theSnRK1α. Further molecular and genetic approaches will accelerate our knowledge ofPpSnRK1αfunctions, and inform the genetic improvement of salt tolerance in tomato through genetic engineering and other related strategies.
Detection and recognition thresholds for five basic tastes in patients with mild cognitive impairment and Alzheimer’s disease dementia
Authors: Kouzuki Minoru , Ichikawa Junya , Shirasagi Daiki , Katsube Fumiya , Kobashi Yuuki , Matsumoto Hideki , Chao Huichia , Yoshida Shintaro , Urakami Katsuya
Published: March 2020

Background

Patients with Alzheimer’s disease dementia (ADD) are thought to exhibit taste disorders; however, this has not been extensively studied. We investigated gustatory functions and factors affecting taste in patients with ADD or mild cognitive impairment (MCI) and in non-demented controls (NDCs) and evaluated associations between cognitive impairment and gustatory functions.

Methods

We recruited 29 patients with ADD, 43 with MCI, and 14 with NDCs. We obtained medical and medication history, measured salivary secretion volumes, and performed cognitive function tests, blood tests, whole-mouth gustatory tests, and dietary and gustatory questionnaires.

Results

Patients with ADD showed significantly higher recognition threshold values than NDCs (p < 0.05). Many individuals did not recognize umami at the maximum concentration, and this happened more frequently in patients with ADD or MCI than in NDCs. Evaluation items other than cognitive function tests did not show significant differences among the groups, but many individuals had decreased salivation, low serum zinc levels, and were on multiple medications. We found a significant correlation between recognition threshold and age (r = 0.229, p < 0.05) and cognitive function test score (r = 0.268, p < 0.05).

Conclusions

Patients with ADD showed impairment of gustatory function. Gustatory impairment in patients with MCI could not be confirmed. However, many individuals with MCI did not recognize umami, either. Our results suggest that taste disorders in elderly people with cognitive decline occur independently of factors affecting taste such as salivation, zinc levels, or prescription drugs.

Trial registration

The study was registered in the UMIN Clinical Trials Registry on February 10, 2017, with reference number UMIN000026087.
Biologically active pigment and ShlA cytolysin of Serratia marcescens induce autophagy in a human ocular surface cell line
Authors: Brothers Kimberly M. , Stella Nicholas A. , Shanks Robert M. Q.
Published: March 2020

Background

The cellular process of autophagy is essential for maintaining the health of ocular tissue. Dysregulation of autophagy is associated with several ocular diseases including keratoconus and macular degeneration. It is known that autophagy can be used to respond to microbial infections and that certain microbes can exploit the autophagic process to their benefit. In this study, a genetic approach was used to identify surface-associated and secreted products generated by the opportunistic pathogenSerratia marcescensinvolved in activation of autophagy.

Methods

A recombinant human corneal limbal epithelial cell line expressing a LC3-GFP fusion protein was challenged with normalized secretomes from wild-type and mutantS. marcescensderivatives. LC3-GFP fluorescence patterns were used to assess the ability of wild-type and mutant bacteria to influence autophagy. Purified prodigiosin was obtained from stationary phase bacteria and used to challenge ocular cells.

Results

Mutations in the global regulatorseepRandgumBgenes highly reduced the ability of the bacteria to activate autophagy in corneal cells. This effect was further narrowed down to the secreted cytolysin ShlA and the biologically active pigment prodigiosin. Purified prodigiosin and ShlA fromEscherichia colifurther supported the role of these factors in activating autophagy in human corneal cells. Additional genetic data indicate a role for flagellin and type I pili, but not the nuclease, S-layer protein, or serratamolide biosurfactant in activation of autophagy.

Conclusions

This work identifies specific bacterial components that activate autophagy and give insight into potential host-pathogen interactions or compounds that can be used to therapeutically manipulate autophagy.
Rare cause of repeated pulmonary embolism: a case of primary pleural squamous cell carcinoma and literature review
Authors: Chen Zhongzhong , Feng Tingting , Wang Meng , Xu Xingxiang , Wang Yuxiu , Li Yiran , Min Lingfeng
Published: March 2020

Background

Malignant tumors are risk factors for a pulmonary embolism (PE), and a PE caused by a tumor is not uncommon. Primary pleural squamous cell carcinoma (PPSCC) is a rare malignancy; thus, a related PE is extremely rare.

Case presentation

A previously healthy 49-year-old female patient was admitted to Northern Jiangsu People’s Hospital owing to chest tightness, cough, and breathing difficulty that persisted for 3 days. Following admission, a computed tomography (CT) pulmonary angiography revealed an embolism in the main pulmonary artery, upper and lower pulmonary artery branch. The patient was treated with alteplase, warfarin, and antibiotics. Over the following year, she experienced recurrent chest pain and tightness and breathing difficulty, with multiple CT pulmonary angiography revealing thrombosis in the right and left main pulmonary artery. No abnormalities were observed in surrogate markers of autoimmune diseases, tumor antigen testing, or ultrasonography; thus, the cause of recurrent PE was not identified. Subsequently, a positron emission tomography-computed tomography (PET-CT) examination revealed diffuse heterogeneous thickening of the right pleura and substantially increased glucose metabolism. A CT-guided pleural biopsy was performed, and histopathological examination of the pleura eventually revealed a diagnosis of PPSCC.

Conclusions

PPSCC is a rare tumor that lacks specific clinical manifestations and is difficult to detect with imaging techniques. The occurrence of PE as the primary manifesting symptom in a patient with PPSCC is extremely rare. Thus, malignant tumors should be considered in patients with no risk factors for PE and/or in those with recurrent PE. An immediate diagnosis and adequate intervention can be achieved with increased awareness of this diagnosis and subsequent related examinations.
The effect of smear layer on bacterial penetration through roots obturated using zinc oxide eugenol-based sealer
Authors: Buurma Hilbrand A. , Buurma Brian J.
Published: March 2020

Background

Smear layer removal has been shown to reduce bacterial penetration through root canal obturations when resin-based endodontic sealer is used. The purpose of this in vitro study was to test this effect when a non-resin-based sealer is used.

Material and methods

Thirty root segments were assigned to the following groups: Smear layer removed (n = 8); smear layer retained (n = 8); negative controls (n = 10; 5 with smear layer, 5 without); and positive controls (n = 4; 2 with smear layer, 2 without). After rotary instrumentation, smear layers were removed in the treatment group and half of controls using 17% ethylenediamenetetraacetic acid (EDTA) prior to obturation. Each obturated root was affixed into a dual-chamber leakage model employingStreptococcus mutans. Roots were incubated at 37 °C for 120 d. Days until lower chamber turbidity occurred was recorded for each sample, and data were analyzed usingKaplan-Meiersurvival curve analysis (p = 0.05).

Results

No negative controls leaked, while all positive controls were turbid within 1 day. Mean days to leakage for roots with smear layer intact was 82.75 (+/− 33.29, 95% CI), although three never leaked. Mean days to leakage through roots with smear layer removed was 46.25 (+/− 26.67, 95% CI), and all leaked. Treatment survival curves were significantly different (p = 0.048).

Conclusions

Under the conditions and limitations of this study, retaining the smear layer reduced the rate of bacterial penetration through canals which had been obturated using zinc oxide eugenol (ZOE) -based sealer.
Violence against healthcare workers and other serious responses to medical disputes in China: surveys of patients at 12 public hospitals
Authors: Du Yuxian , Wang Wenxin , Washburn David J. , Lee Shinduk , Towne Samuel D. , Zhang Hao , Maddock Jay E.
Published: March 2020

Background

Workplace violence against healthcare workers is a global issue that is on the rise, with Chinese healthcare workers facing growing challenges with hospital violence. Attacks on medical staff have increased in recent years with no clear resolution. Prior research focused on policies to improve the doctor-patient relationship and better protect clinicians, but few studies addressed the patient perspective. This paper examines patients’ choices when facing a medical dispute and identifies groups who are more likely to respond to conflict with violence or other serious actions.

Methods

Patient survey responses were collected in 12 leading public hospitals in five Chinese provinces with 5556 participants. The survey asked sociodemographic information, patients’ attitudes (e.g., general optimism, trust in their physicians, perceived healthcare quality), and their primary response to a medical dispute. From least to most severe, the options range from “complaining within the family” to “violence.” We used t-tests and Chi-square tests to explore the relationships between reactions and patient characteristics. We also performed multivariable logistic regressions to determine the impact of sociodemographics and provider trust on the seriousness of responses.

Results

The primary response of a third of respondents was complaining to hospital or health department officials (32.5%). Seeking legal help (26.3%) and direct negotiation with doctors (19.6%) were other frequent responses. More serious responses included 83 stating violence (1.5%), 9.7% expressing a desire to expose the issue to the news media, and 7.4% resorting to seeking third-party assistance. Patients who were more likely to report “violence” were male (OR = 1.81, p < .05), high-income earners (OR = 3.71, p < .05), or reported lower life satisfaction (OR = 1.40, p < .05). Higher trust scores were associated with a lower likelihood of a serious response, including violence (OR = 0.80, p < .01).

Conclusion

Most respondents reported mild reactions when facing a medical dispute. Among those who reported the intent of serious reactions, some sociodemographic characteristics and the trust of physicians could be predictive. To prevent future hospital violence, this work helps identify the characteristics of patients who are more likely to seek severe approaches to medical dispute resolution, including resorting to violence. From these results, hospitals will be better able to target specific groups for interventions that build patient-provider trust and improve general patient satisfaction.
Emergency department-based medication review on outpatient health services utilization: interrupted time series
Authors: Kitchen Sophie A. , McGrail Kimberlyn , Wickham Maeve E. , Law Michael R. , Hohl Corinne M.
Published: March 2020

Background

One in nine emergency department (ED) visits in Canada are caused by adverse drug events, the unintended and harmful effects of medication use. Medication reviews by clinical pharmacists are interventions designed to optimize medications and address adverse drug events to impact patient outcomes. However, the effect of medication reviews on long-term outpatient health services utilization is not well understood. This research studied the effect of medication review performed by clinical pharmacists on long-term outpatient health services utilization.

Methods

Data included information from 10,783 patients who were part of a prospective, multi-centre quality improvement evaluation from 2011 to 2013. Outpatient health services utilization was defined as total ED visits and physician contacts, aggregated to four physician specialty groups: general and family practitioners (GP); medical specialists; surgical specialists; and imaging and laboratory specialists. During triage, patients deemed high-risk based on their medical history, were systematically allocated to receive either a medication review (n = 6403) or the standard of care (n = 4380). Medication review involved a critical examination of a patient’s medications to identify and resolve medication-related problems and communicate these results to community care providers. Interrupted time series analysis compared the effect of the intervention on health services utilization relative to the standard of care controlling for pre-intervention differences in utilization.

Results

ED-based pharmacist-led medication review did not result in a significant level or trend change in the primary outcome of total outpatient health services utilization. There were also no differences in the secondary outcomes of primary care physician visits or ED visits relative to the standard of care in the 12 months following the intervention. Our findings were consistent when stratified by age, hospital site, and whether patients were discharged on their index visit.

Conclusion

This was the first study to measure long-term trends of physician visits following an ED-based medication review. The lack of differences in level and trend of GP and ED visits suggest that pharmacist recommendations may not have been adequately communicated to community-based providers, and/or recommendations may not have affected health care delivery. Future studies should evaluate physician acceptance of pharmacist recommendations and should encourage patient follow-up to community providers.
TDP-43 promotes the formation of neuromuscular synapses through the regulation of Disc-large expression in Drosophila skeletal muscles
Authors: Strah Nina , Romano Giulia , Introna Clelia , Klima Raffaella , Marzullo Marta , Ciapponi Laura , Megighian Aram , Nizzardo Monica , Feiguin Fabian
Published: March 2020

Background

The ribonuclear protein TDP-43 has been implicated in the pathophysiology of amyotrophic lateral sclerosis (ALS), with genetic mutations being linked to the neurological symptoms of the disease. Though alterations in the intracellular distribution of TDP-43 have been observed in skeletal muscles of patients suffering from ALS, it is not clear whether such modifications play an active role in the disease or merely represent an expression of muscle homeostatic mechanisms. Also, the molecular and metabolic pathways regulated by TDP-43 in the skeletal muscle remain largely unknown. Here, we analyze the function of TBPH, the Drosophila melanogaster ortholog of TDP-43, in skeletal muscles.

Results

We modulated the activity of TDP-43 in Drosophila muscles by means of RNA interference and observed that it is required to promote the formation and growth of neuromuscular synapses. TDP-43 regulated the expression levels of Disc-large (Dlg), and restoring Dlg expression either in skeletal muscles or in motoneurons was sufficient to suppress the locomotive and synaptic defects of TDP-43-null flies. These results were validated by the observation of a decrease in Dlg levels in human neuroblastoma cells and iPSC-differentiated motoneurons derived from ALS patients, suggesting similar mechanisms may potentially be involved in the pathophysiology of the disease.

Conclusions

Our results help to unveil the physiological role of TDP-43 in skeletal muscles as well as the mechanisms responsible for the autonomous and non-autonomous behavior of this protein concerning the organization of neuromuscular synapses.
Non-confirming replication of “Performance of InSilicoVA for assigning causes of death to verbal autopsies: multisite validation study using clinical diagnostic gold standards,” by Flaxman et al.
Authors: Li Zehang Richard , McCormick Tyler H. , Clark Samuel J.
Published: March 2020

Background

A verbal autopsy (VA) is an interview conducted with the caregivers of someone who has recently died to describe the circumstances of the death. In recent years, several algorithmic methods have been developed to classify cause of death using VA data. The performance of one method—InSilicoVA—was evaluated in a study by Flaxman et al., published in BMC Medicine in 2018. The results of that study are different from those previously published by our group.

Methods

Based on the description of methods in the Flaxman et al. study, we attempt to replicate the analysis to understand why the published results differ from those of our previous work.

Results

We failed to reproduce the results published in Flaxman et al. Most of the discrepancies we find likely result from undocumented differences in data pre-processing, and/or values assigned to key parameters governing the behavior of the algorithm.

Conclusion

This finding highlights the importance of making replication code available along with published results. All code necessary to replicate the work described here is freely available on GitHub.
Sex disparities in dietary intake across the lifespan: the case of Lebanon
Authors: Nasreddine Lara , Chamieh Marie Claire , Ayoub Jennifer , Hwalla Nahla , Sibai Abla-Mehio , Naja Farah
Published: March 2020

Background

Little is known about sex-based dietary differences in middle-income countries, particularly those undergoing the nutrition transition. This study aims at examining sex disparities in energy and macronutrients’ intakes, food consumption patterns, and micronutrients’ adequacy in Lebanon, while adopting a life course approach.

Methods

Data were derived from a national cross-sectional survey conducted in Lebanon in 2008/2009. The study sample consisted of 3636 subjects: 956 children and adolescents aged 6–19.9 years; 2239 adults aged 20–59.9 years and 441 older adults aged above 60 years. At the households, trained nutritionists conducted face-to-face interviews with participants to complete a sociodemographic questionnaire and one 24-h diet recall. Food items were categorized into 25 food groups. The Nutritionist Pro software was used for the analysis of dietary intake data and the estimation of energy, macronutrients’, and micronutrients’ intakes.

Results

In all age groups, males had significantly higher energy intakes, while females had significantly higher fiber intakes. In addition, in adolescents aged 12–19.9 years, females had higher fat intakes as compared to males (37.02 ± 0.6% vs 35.03 ± 0.61%), and in adults aged 20–59.9 years, females had significantly higher total fat (37.73 ± 0.33% vs 36.45 ± 0.38%) and saturated fat intakes (11.24 ± 0.15% vs 10.45 ± 0.18%). These differences in macronutrient intakes were not observed in younger children nor in older adults. Sex-based differences in food groups’ intakes were also observed: men and boys had significantly higher intakes of red and processed meat, bread, fast food, soft drinks, and alcohol, while girls and women had higher intakes of fruits, vegetables, milk, and sweets. In all age groups, females had lower micronutrient intakes compared to males, including calcium, iron, and zinc.

Conclusions

This study identified sex-specific priorities that ought to be tackled by context-specific interventions to promote healthier diets in Lebanon. The fact that sex-based differences in nutrient intakes and food consumption patterns were the most noticeable in the adolescent and adult years, hence women’s reproductive years call for concerted efforts to improve nutrition for women and girls as this would lay the foundation not only for their future education, productivity, and economic empowerment, but also for the health of future generations.
LTBP1 promotes esophageal squamous cell carcinoma progression through epithelial-mesenchymal transition and cancer-associated fibroblasts transformation
Authors: Cai Rui , Wang Ping , Zhao Xin , Lu Xiansheng , Deng Ruxia , Wang Xiaoyu , Su Zhaoji , Hong Chang , Lin Jie
Published: March 2020

Background

Esophageal squamous cell carcinoma (ESCC) is one of the most prevalent cancers worldwide. Due to its high morbidity and mortality rates, it is urgent to find a molecular target that contributes to esophageal carcinogenesis and progression. In this research, we aimed to investigate the functions of Latent transforming growth factor β binding protein 1(LTBP1) in ESCC progression and elucidate the underlying mechanisms.

Methods

The tandem mass tag-based quantitative proteomic approach was applied to screen the differentially expressed proteins (DEPs) between 3 cases of ESCC tumor samples and paired normal tissues. Then the DEPs were validated in human ESCC tissues using western blot assays and GEPIA database respectively. The expression level of LTBP1 was detected in 152 cases of ESCC tissues and paired normal tissues. Loss-of-function assays were performed to detect the function of LTBP1 in vivo and in vitro. Immunofluorescence and Western blot assays were used to detect the expression of apoptosis, epithelial–mesenchymal transition (EMT) and cancer-associated fibroblasts (CAFs) markers.

Results

A total of 39 proteins were screened to be up-regulated (ratio > 2.0) in all three ESCC tissues. The results of immunohistochemistry assays indicated that the expression level of LTBP1 was higher in ESCC tissues than that in paired normal tissues (p < 0.001). Overexpression of LTBP1 was positively associated with lymphatic metastasis in ESCC (p = 0.002). Down-regulation of LTBP1 inhibited the invasion and migration as well as metastatic abilities in vitro and in vivo. It was also observed the down-regulation of LTBP1 not only decreased the mesenchymal phenotypes but also inhibited TGFβ-induced EMT in ESCC cells. We further found that down-regulation of LTBP1 enhanced ESCC cells’ sensitivity to 5-FU treatment. Inhibition of LTBP1 expression could also attenuate induction of CAFs transformation and restrain fibroblast express fibronectin (FN1) in ESCC cells.

Conclusion

Overexpression of LTBP1 was associated with lymph node metastasis in ESCC. Our results indicated that LTBP1 not only increased the malignant behaviors of ESCC cells but also induced EMT and CAFs transformation. Our studies suggested an oncogenic role of LTBP1 in ESCC progression and it may serve as a potential therapeutic target for ESCC patients.
RETRACTED ARTICLE: HNF4A-AS1/hnRNPU/CTCF axis as a therapeutic target for aerobic glycolysis and neuroblastoma progression
Authors: Song Huajie , Li Dan , Wang Xiaojing , Fang Erhu , Yang Feng , Hu Anpei , Wang Jianqun , Guo Yanhua , Liu Yang , Li Hongjun , Chen Yajun , Huang Kai , Zheng Liduan , Tong Qiangsong
Published: March 2020

Background

Aerobic glycolysis is a hallmark of metabolic reprogramming that contributes to tumor progression. However, the mechanisms regulating expression of glycolytic genes in neuroblastoma (NB), the most common extracranial solid tumor in childhood, still remain elusive.

Methods

Crucial transcriptional regulators and their downstream glycolytic genes were identified by integrative analysis of a publicly available expression profiling dataset. In vitro and in vivo assays were undertaken to explore the biological effects and underlying mechanisms of transcriptional regulators in NB cells. Survival analysis was performed by using Kaplan-Meier method and log-rank test.

Results

Hepatocyte nuclear factor 4 alpha (HNF4A) and its derived long noncoding RNA (HNF4A-AS1) promoted aerobic glycolysis and NB progression. Gain- and loss-of-function studies indicated that HNF4A and HNF4A-AS1 facilitated the glycolysis process, glucose uptake, lactate production, and ATP levels of NB cells. Mechanistically, transcription factor HNF4A increased the expression of hexokinase 2 (HK2) and solute carrier family 2 member 1 (SLC2A1), while HNF4A-AS1 bound to heterogeneous nuclear ribonucleoprotein U (hnRNPU) to facilitate its interaction with CCCTC-binding factor (CTCF), resulting in transactivation of CTCF and transcriptional alteration of HNF4A and other genes associated with tumor progression. Administration of a small peptide blocking HNF4A-AS1-hnRNPU interaction or lentivirus-mediated short hairpin RNA targeting HNF4A-AS1 significantly suppressed aerobic glycolysis, tumorigenesis, and aggressiveness of NB cells. In clinical NB cases, high expression of HNF4A-AS1, hnRNPU, CTCF, or HNF4A was associated with poor survival of patients.

Conclusions

These findings suggest that therapeutic targeting of HNF4A-AS1/hnRNPU/CTCF axis inhibits aerobic glycolysis and NB progression.
Prognostic impact of elevated lactate levels on mortality in critically ill patients with and without preadmission metformin treatment: a Danish registry-based cohort study
Authors: Posma Rene A. , Frøslev Trine , Jespersen Bente , van der Horst Iwan C. C. , Touw Daan J. , Thomsen Reimar W. , Nijsten Maarten W. , Christiansen Christian F.
Published: March 2020

Background

Lactate is a robust prognostic marker for the outcome of critically ill patients. Several small studies reported that metformin users have higher lactate levels at ICU admission without a concomitant increase in mortality. However, this has not been investigated in a larger cohort. We aimed to determine whether the association between lactate levels around ICU admission and mortality is different in metformin users compared to metformin nonusers.

Methods

This cohort study included patients admitted to ICUs in northern Denmark between January 2010 and August 2017 with any circulating lactate measured around ICU admission, which was defined as 12 h before until 6 h after admission. The association between the mean of the lactate levels measured during this period and 30-day mortality was determined for metformin users and nonusers by modelling restricted cubic splines obtained from a Cox regression model.

Results

Of 37,293 included patients, 3183 (9%) used metformin. The median (interquartile range) lactate level was 1.8 (1.2–3.2) in metformin users and 1.6 (1.0–2.7) mmol/L in metformin nonusers. Lactate levels were strongly associated with mortality for both metformin users and nonusers. However, the association of lactate with mortality was different for metformin users, with a lower mortality rate in metformin users than in nonusers when admitted with similar lactate levels. This was observed over the whole range of lactate levels, and consequently, the relation of lactate with mortality was shifted rightwards for metformin users.

Conclusion

In this large observational cohort of critically ill patients, early lactate levels were strongly associated with mortality. Irrespective of the degree of hyperlactataemia, similar lactate levels were associated with a lower mortality rate in metformin users compared with metformin nonusers. Therefore, lactate levels around ICU admission should be interpreted according to metformin use.
Depression, anxiety, stress, and dysmenorrhea: a protocol for a systematic review
Authors: Pakpour Amir H. , Kazemi Farideh , Alimoradi Zainab , Griffiths Mark D.
Published: March 2020

Background

Dysmenorrhea is one of the most common menstrual disorders and is influenced by various factors. Psychological disorders including anxiety, depression, and stress have been suggested as influencing dysmenorrhea, but previous findings are inconsistent. This study will investigate the relationship between depression/anxiety/stress and dysmenorrhea using a systematic review and meta-analysis.

Methods

Online databases including PsycINFO, Scopus, PubMed, Science Direct, ProQuest, ISI Web of Knowledge, and Embase will be searched. Appropriate keywords and MeSH terms will be used to retrieve the journal papers published from 1990 until the end of December 2019. To improve search coverage, the reference lists of all included studies will be reviewed to find eligible papers. Inclusion criteria include the following: descriptive, cohort, case-control, and cross-sectional studies; the relationship between depression/anxiety/stress and dysmenorrhea being an objective of the study; and published in peer-reviewed journals. The paper selection, data extraction, and quality assessment of selected studies will be performed independently by two researchers, and disagreements will be resolved through discussions. The Newcastle-Ottawa Quality Assessment Scale will be used to assess the quality of selected studies. A quantitative synthesis will be performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) via the STATA software, if retrieving enough number of studies with no severe methodological heterogeneities. Otherwise, qualitative synthesis will be used to report the findings.

Discussion

To the best of our knowledge, this will be the first systematic review on this topic. Performing an inclusive search in major databases over a wide timescale is one key strength of the proposed study and will maximize the coverage of the original research studies on this topic. Results of present study are expected to lead to deeper understanding the relationship between common mental health conditions and dysmenorrhea.

Systematic review registration

PROSPERO CRD42018102199