bluuebunny/crossref_metadata_2025 huggingface dataset:
Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?
Authors: Dalglish Sarah L , Straubinger Sarah , Kavle Justine A , Gibson Lacey , Mbombeshayi Evariste , Anzolo Jimmy , Scott Kerry , Pacqué Michel
Published: July 2019

Recent years have seen increasing momentum towards task shifting of basic health services, including using community health workers (CHW) to diagnose and treat common childhood illnesses. Yet few studies have examined the role of traditional healers in meeting families’ and communities’ health needs and liaising with the formal health system. We examine these issues in Tshopo Province in the Democratic Republic of the Congo, a country with high rates of child mortality (104 deaths per 1000 live births). We conducted 127 in-depth interviews and eight focus group discussions with a range of community members (mothers, fathers and grandmothers of children under 5 years of age) and health providers (CHWs, traditional healers, doctors and nurses) on topics related to care seeking and case management for childhood illness and malnutrition, and analysed them iteratively using thematic content analysis. We find significant divergence between biomedical descriptions of child illness and concepts held by community members, who distinguished between local illnesses and so-called ‘white man’s diseases.’ Traditional healers were far less costly and more geographically accessible to families than were biomedical health providers, and usually served as families’ first recourse after home care. Services provided by traditional healers were also more comprehensive than services provided by CHWs, as the traditional medicine sphere recognised and encompassed care for ‘modern’ diseases (but not vice versa). Meanwhile, CHWs did not receive adequate training, supervision or supplies to provide child health services. Considering their accessibility, acceptability, affordability and ability to recognise all domains of illness (biomedical and spiritual), traditional healers can be seen as the de facto CHWs in Tshopo Province. National and international health policymakers should account for and involve this cadre of health workers when planning child health services and seeking to implement policies and programmes that genuinely engage with community health systems.
Vascular function and stiffness: population epidemiology and concordance in Australian children aged 11–12 years and their parents
Authors: Kahn Freya K , Wake Melissa , Lycett Kate , Clifford Susan , Burgner David P , Goldsmith Greta , Grobler Anneke C , Lange Katherine , Cheung Michael
Published: July 2019

Objectives

To describe the epidemiology and parent–child concordance of vascular function in a population-based sample of Australian parent–child dyads at child age 11–12 years.

Design

Cross-sectional study (Child Health CheckPoint), nested within a prospective cohort study, the Longitudinal Study of Australian Children (LSAC).

Setting

Assessment centres in seven major Australian cities and eight regional towns or home visits, February 2015–March 2016.

Participants

Of all participating CheckPoint families (n=1874), 1840 children (49% girls) and 1802 parents (88% mothers) provided vascular function data. Survey weights and methods were applied to account for LSAC’s complex sample design and clustering within postcodes and strata.

Outcome measures

The SphygmoCor XCEL assessed vascular function, generating estimates of brachial and central systolic blood pressure and diastolic blood pressure, central pulse pressure, augmentation index and carotid–femoral pulse wave velocity. Pearson’s correlation coefficients and multivariable linear regression models estimated parent–child concordance.

Results

Hypertension was present in 3.9% of children and 9.0% of parents. Mean child and parent values for augmentation index were 4.5% (SD 11.6) and 21.3% (SD 12.3), respectively, and those for carotid–femoral pulse wave velocity were 4.48 m/s (SD 0.59) and 6.85 m/s (SD 1.14), respectively. Parent–child correlation for brachial systolic blood pressure was 0.20 (95% CI 0.15 to 0.24), brachial diastolic blood pressure 0.21 (95% CI 0.16 to 0.26), central systolic blood pressure 0.21 (95% CI 0.16 to 0.25), central diastolic blood pressure 0.21 (95% CI0.17 to 0.26), central pulse pressure 0.19 (95% CI 0.14 to 0.24), augmentation index 0.28 (95% CI 0.23 to 0.32) and pulse wave velocity 0.22 (95% CI 0.18 to 0.27).

Conclusions

We report Australian values for traditional and more novel vascular function markers, providing a reference for future population studies. Cross-generational concordance in multiple vascular function markers is already established by age 11–12 years, with mechanisms of heritability remaining to be explored.
Food choices: concordance in Australian children aged 11–12 years and their parents
Authors: Vivarini Prudence , Kerr Jessica A , Clifford Susan A , Grobler Anneke C , Jansen Pauline W , Mensah Fiona K , Baur Louise A , Gibbons Kay , Wake Melissa
Published: July 2019

Objectives

Snack foods—typically high in salt, sugar, fat and/or energy—are likely important to the obesity epidemic. In the context of a population-based health assessment involving parent–child dyads at child age 11–12 years, we report cross-generational concordance in intake at a controlled snack food observation.

Design

Cross-sectional study (Child Health CheckPoint), nested within the Longitudinal Study of Australian Children.

Setting

Assessment centres in seven Australian cities, February 2015–March 2016.

Participants

Of all participating CheckPoint families (n=1874), 1299 children (50.3% girls) and 1274 parents (85.9% mothers) with snack data were included. Survey weights and methods were applied to account for the clustered multistage sample design.

Outcome measures

Partway through the 3.5-hour assessment, parents and children attendedFood Stopseparately for a timed 15 min ‘snack break’. One of four standardised box size/content combinations was randomly provided to all participants on any given day. Total food mass, energy, nutrients and sodium consumed was measured to the nearest 1 g. Pearson’s correlation coefficients and adjusted multivariable linear regression models assessed parent–child concordance in each variable.

Results

Children consumed less grams (151 g [SD 80] vs 165 g [SD 79]) but more energy (1393 kJ [SD 537] vs 1290 kJ [SD 658]) than parents. Parent–child concordance coefficients were small, ranging from 0.07 for sodium intake to 0.17 for carbohydrate intake. Compared with children with parents’ energy intake on the 10th centile, children whose parents were on the 90th centile ate on average 227 kJ more. If extrapolated to one similar unsupervised snack on a daily basis, this equates to an additional 83 050 kJ per year, which could have a cumulative impact on additional body fat.

Conclusions

Although modest at an individual level, this measured parent-child concordance in unsupervised daily snack situations could account for substantial annual population differences in energy, fat and sodium intake for children aged 11–12 years.

Trial registration number

ISRCTN12538380.
Retinal microvasculature: population epidemiology and concordance in Australian children aged 11–12 years and their parents
Authors: Dascalu Julian , Liu Mengjiao , Lycett Kate , Grobler Anneke C , He Mingguang , Burgner David P , Wong Tien Yin , Wake Melissa
Published: July 2019

Objectives

To describe distributions and concordance of retinal microvasculature measurements in a population-based sample of Australian parent–child dyads at child age 11–12 years.

Design

Cross-sectional Child Health CheckPoint study, between waves 6 and 7 of the national population-based Longitudinal Study of Australian Children (LSAC).

Setting

Assessment centres in seven Australian cities, February 2015–March 2016.

Participants

Of the 1874 participating families, 1288 children (51% girls) and 1264 parents (87% mothers, mean age 43.7) were analysed. Diabetic participants and non-biological pairs were excluded from concordance analyses.

Outcome measures

Retinal photographs were taken by non-mydriatic fundus camera. Trained graders scored vascular calibre using semi-automated software, yielding estimates of central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) and arteriolar–venular ratio (AVR). Pearson’s correlation coefficients and multivariable linear regression models assessed parent–child concordance. Survey weights and methods accounted for LSAC’s complex sampling, stratification and clustering within postcodes.

Results

Mean (SD) of CRAE and CRVE were larger in children (159.5 (11.8) and 231.1 (16.5) μm, respectively) than parents (151.5 (14.0) and 220.6 (19.0) μm), yielding similar AVR (children 0.69 (0.05), parents 0.69 (0.06)). Correlation coefficients for parent–child pairs were 0.22 (95% CI 0.16 to 0.27) for CRAE, 0.23 (95% CI 0.17 to 0.28) for CRVE and 0.18 (95% CI 0.13 to 0.24) for AVR. Mother–child and father–child values were similar (0.20 and 0.32 for CRAE, 0.22 and 0.29 for CRVE, respectively). Relationships attenuated slightly on adjustment for age, sex, blood pressure, diabetes and body mass index. Percentiles and concordance are presented for the whole sample and by sex.

Conclusions

Arteriolar and venular calibre were similar to previously documented measures in midlife adult and late childhood populations. Population parent–child concordance values align with moderate polygenic heritability reported in smaller studies.
Hearing, speech reception, vocabulary and language: population epidemiology and concordance in Australian children aged 11 to 12 years and their parents
Authors: Smith Julia , Wang Jing , Grobler Anneke C , Lange Katherine , Clifford Susan A , Wake Melissa
Published: July 2019

Objectives

To describe the epidemiology and parent-child concordance of hearing, speech reception, vocabulary and language in Australian parent-child dyads at child age 11 to 12 years.

Design

Population-based cross-sectional study (Child Health CheckPoint) nested within the Longitudinal Study of Australian Children.

Setting

Assessment centres in seven Australian cities and eight regional towns or home visits around Australia, February 2015 to March 2016.

Participants

Of all participating CheckPoint families (n=1874), 1516 children (50% female) and 1520 parents (87% mothers, mean age 43.8 years) undertook at least one of four measurements of hearing and language.

Outcome measures

Hearing threshold (better ear mean of 1, 2 and 4 kHz) from pure-tone audiometry, speech reception threshold, receptive vocabulary, expressive and receptive languages using a sentence repetition task. Parent-child concordance was examined using Pearson’s correlation coefficients and adjusted linear regression models. Survey weights and methods accounted for Longitudinal Study of Australian Children’s complex sampling and stratification.

Results

Children had a similar speech reception threshold to parents (children mean −14.3, SD 2.4; parents −14.9, SD 3.2 dB) but better hearing acuity (children 8.3, SD 6.3; parents 13.4, SD 7.0 decibels hearing level). Standardised sentence repetition scores were similar (children 9.8, SD 2.9; parents 9.1, SD 3.3) but, as expected, parents had superior receptive vocabularies. Parent-child correlations were higher for the cognitively-based language measures (vocabulary 0.31, 95% CI 0.26 to 0.36; sentence repetition 0.29, 95% CI 0.24 to 0.34) than the auditory measures (hearing 0.18, 95% CI 0.13 to 0.23; speech reception threshold 0.18, 95% CI 0.13 to 0.22). Mother-child and father-child concordances were similar for all measures.

Conclusions

We provide population reference values for multiple measures spanning auditory and verbal communication systems in children and mid-life adults. Concordance values aligned with previous twin studies and offspring studies in adults, in keeping with polygenic heritability that is modest for audition but around 60% for language by late childhood.
Long-term observational approach in women with histological diagnosis of cervical low-grade squamous intraepithelial lesion: an Italian multicentric retrospective cohort study
Authors: Ciavattini Andrea , Serri Matteo , Di Giuseppe Jacopo , Liverani Carlo Antonio , Gardella Barbara , Papiccio Maria , Delli Carpini Giovanni , Morini Stefano , Clemente Nicolò , Sopracordevole Francesco
Published: July 2019

Objective

To evaluate the risk of progression to high-grade squamous intraepithelial lesion (HSIL) (CIN2-3) or invasive cancer in women with histopathological diagnosis of low-grade squamous intraepithelial lesion (LSIL) (CIN1), managed in a long-term observational approach up to 5 years.

Design

Retrospective cohort study.

Setting

Four tertiary referral hospital.

Participants

434 women with adequate colposcopy and complete colposcopic charts were included in the present analysis. Women with glandular lesions on the referral cytology or previous diagnosis of cervical dysplasia or invasive cervical cancer or with synchronous vaginal, or with HIV infection or immunodepression were excluded.

Primary and secondary outcome measures

The main study outcome was the rate of progression to histopathological HSIL (CIN2-3) or invasive cancer at any time during 5 years of follow-up. The possible risk factors were also evaluated. As secondary outcome, we analysed the possible risk factors at the 24-month evaluation for histopathological HSIL (CIN2-3) or invasive cancer progression between 2 and 5 years from initial diagnosis.

Results

A progression to histopathological HSIL (CIN2-3) was found in a total of 32 (7.4%) cases during 5 years of follow-up. A histopathological diagnosis of HSIL (CIN3) was found in four patients (0.9%) and no case of invasive cancer was detected. High-grade cytology at inclusion and the presence of a positive high-risk human papillomavirus (HR-HPV) DNA test at 2 years from inclusion maintained a significant correlation with the risk of histopathological progression to HSIL (CIN2-3).

Conclusions

The results of our study showed a low rate (7.4%) of histopathological progression to HSIL (CIN2-3) in women with LSIL (CIN1) diagnosis during long-term follow-up up to 5 years. In case of positive HR-HPV DNA test at the 2 years evaluation an excisional treatment could be the preferred choice to prevent progression to HSIL (CIN2-3) in the following years, preferring a continuation of follow-up in case of HR-HPV DNA negative result.
Building patient capacity to participate in care during hospitalisation: a scoping review
Authors: Goodridge Donna , McDonald Meghan , New Lucia , Scharf Murray , Harrison Elizabeth , Rotter Thomas , Watson Erin , Henry Chrysanthus , Penz Erika D
Published: July 2019

Objectives

To map the existing literature and describe interventions aimed at building the capacity of patients to participate in care during hospitalisation by: (1) describing and categorising the aspects of care targeted by these interventions and (2) identifying the behaviour change techniques (BCTs) used in these interventions. A patient representative participated in all aspects of this project.

Design

Scoping review.

Data sources

MEDLINE, Embase and CINAHL (Inception −2017).

Study selection

Studies reporting primary research studies on building the capacity of hospitalised adult patients to participate in care which described or included one or more structured or systematic interventions and described the outcomes for at least the key stakeholder group were included.

Data extraction

Title and abstract screening and full text screening were conducted by pairs of trained reviewers. One reviewer extracted data, which were verified by a second reviewer. Interventions were classified according to seven aspects of care relevant to hospital settings. BCTs identified in the articles were assigned through consensus of three reviewers.

Results

Database searches yielded a total 9899 articles, resulting in 87 articles that met the inclusion criteria. Interventions directed at building patient capacity to participate in care while hospitalised were categorised as those related to improving: patient safety (20.9%); care coordination (5.7%); effective treatment (5.7%) and/or patient-centred care using: bedside nursing handovers (5.7%); communication (29.1%); care planning (14%) or the care environment (19.8%). The majority of studies reported one or more positive outcomes from the defined intervention. Adding new elements (objects) to the environment and restructuring the social and/or physical environment were the most frequently identified BCTs.

Conclusions

The majority of studies to build capacity for participation in care report one or more positive outcomes, although a more comprehensive analysis is warranted.
Exploratory qualitative study to understand the underlying motivations and strategies of the private for-profit healthcare sector in urban Bangladesh
Authors: Adams Alayne Mary , Ahmed Rushdia , Shuvo Tanzir Ahmed , Yusuf Sifat Shahana , Akhter Sadika , Anwar Iqbal
Published: July 2019

Objectives

This paper explores the underlying motivations and strategies of formal small and medium-sized formal private for-profit sector hospitals and clinics in urban Bangladesh and their implications for quality and access.

Methods

This exploratory qualitative study was conducted in Dhaka, Sylhet and Khulna City Corporations. Data collection methods included key informant interviews (20) with government and private sector leaders, in-depth interviews (30) with clinic owners, managers and providers and exit interviews (30) with healthcare clients.

Results

Profit generation is a driving force behind entry into the private healthcare business and the provision of services. However, non-financial motivations are also emphasised such as aspirations to serve the disadvantaged, personal ambition, desire for greater social status, obligations to continue family business and adverse family events.

The discussion of private sector motivations and strategies is framed using the Business Policy Model. This model is comprised of three components:products and services, and efforts to make these attractive including patient-friendly discounts and service-packages, and building ‘good’ doctor-patient relationships;the market environment, cultivated using medical brokers and referral fees to bring in fresh clientele, and receipt of pharmaceutical incentives; and finally,organisational capabilities, in this case overcoming human resource shortages by relying on medical staff from the public sector, consultant specialists, on-call and less experienced doctors in training, unqualified nursing staff and referring complicated cases to public facilities.

Conclusions

In the context of low public sector capacity and growing healthcare demands in urban Bangladesh, private for-profit engagement is critical to achieving universal health coverage (UHC). Given the informality of the sector, the nascent state of healthcare financing, and a weak regulatory framework, the process of engagement must be gradual. Further research is needed to explore how engagement in UHC can be enabled while maintaining profitability. Incentives that support private sector efforts to improve quality, affordability and accountability are a first step in building this relationship.
How do surgeons’ trade-off between patient outcomes and risk of complications in total knee arthroplasty? a discrete choice experiment in Australia
Authors: Szawlowski Sandie , Choong Peter F M , Li Jinhu , Nelson Elizabeth , Nikpour Mandana , Scott Anthony , Sundararajan Vijaya , Dowsey Michelle M
Published: July 2019

Objective

To measure the trade-off between risk of complications versus patient improvement in pain and function in orthopaedic surgeons’ decisions about whether to undertake total knee arthroplasty (TKA).

Methods

A discrete choice experiment asking surgeons to make choices between experimentally-designed scenarios describing different levels of operative risk and dimensions of pain and physical function. Variation in preferences and trade-offs according to surgeon-specific characteristics were also examined.

Results

The experiment was completed by a representative sample of 333 orthopaedic surgeons (n=333): median age 52 years, 94% male, 91% fully qualified. Orthopaedic surgeons were willing to accept substantial increases in absolute risk associated with TKA surgery for greater improvements in a patient’s pain and function. The maximum risk surgeons were willing to accept was 40% for reoperation and 102% for the need to seek further treatment from a general practitioner or specialist in return for a change from postoperative severe night-time pain at baseline to no night-time pain at 12 months. With a few exceptions, surgeon-specific characteristics were not associated with how much risk a surgeon is willing to accept in a patient undergoing TKA.

Conclusion

This is the first study to quantify risk-benefit trade-offs among orthopaedic surgeons performing TKA, using a discrete choice experiment. This study provides insight into the risk tolerance of surgeons.
Screening a nation for hepatitis C virus elimination: a cross-sectional study on prevalence of hepatitis C and associated risk factors in the Rwandan general population
Authors: Umutesi Justine , Liu Carol Yingkai , Penkunas Michael J , Makuza Jean Damascene , Ntihabose Corneille K , Umuraza Sabine , Niyikora Julienne , Serumondo Janvier , Gupta Neil , Nsanzimana Sabin
Published: July 2019

Objectives

We analysed data collected during programmatic screening activities conducted in 2017 to describe hepatitis C virus (HCV) seroprevalence in the general population and identify associated factors.

Design

We analysed data collected between June and September 2017. For both seroprevalence and viraemia, variations across demographic and geographic factors were assessed and multivariate regression models were fit to identify factors independently associated with each marker. Geospatial data were examined for visualisation.

Setting

HCV screening was organised within each of the 30 districts in Rwanda. One designated location in each district was selected as the screening site and screening took place for 1 week at each site.

Participants

This study included 124 223 male and female volunteers. Anti-HCV-positive individuals were followed up with HCV RNA viral load (VL) testing for infection confirmation.

Main outcome measures

Two markers were examined: the presence of HCV antibodies and HCV RNA VL.

Results

Among 124 223 individuals screened, 11 003 (8.86%, 95% CIs: 8.70% to 9.02%) were positive for anti-HCV. Anti-HCV prevalence varied by age with the oldest age group (>55 year olds) having a prevalence of 16.46% (95% CIs: 16.14% to 16.80%) and the youngest age group (<25 year olds) having a prevalence of 2.20% (95% CIs: 1.93% to 2.50%) (crude OR=8.78). After adjustment for covariates, an association remained between anti-HCV prevalence and age (p<0.001), province (p<0.001) and socioeconomic status (p<0.001). Of the 3771 anti-HCV-positive individuals who had an available HCV RNA VL result, 2099 (55.66%, 95% CI: 54.06% to 57.25%) had a detectable HCV RNA VL. Age was also associated with HCV viraemia (p<0.001).

Conclusion

Results suggest that over 55% of individuals who screened positive for HCV-antibodies were chronically infected. Targeted screening for HCV among older individuals is recommended, given the association between age and infection. Further geographical hotspots of HCV infection can also inform targeted screening as Rwanda moves towards HCV elimination.
Assessing the safety and pharmacokinetics of the monoclonal antibodies, VRC07-523LS and PGT121 in HIV negative women in South Africa: study protocol for the CAPRISA 012A randomised controlled phase I trial
Authors: Mahomed Sharana , Garrett Nigel , Capparelli Edmund , Baxter Cheryl , Zuma Nonhlanhla Yende , Gengiah Tanuja , Archary Derseree , Moore Penny , Samsunder Natasha , Barouch Dan H , Mascola John , Ledgerwood Julie , Morris Lynn , Abdool Karim Salim
Published: July 2019

Introduction

Despite extensive prevention campaigns and scale-up of antiretroviral therapy, HIV incidence among young women in southern Africa remains high. While the development of an efficacious vaccine remains a challenge, the discovery of broadly neutralising monoclonal antibodies (mAbs) has created the opportunity to explore passive immunisation as a long-acting injectable HIV prevention strategy. The purpose of this trial is to provide safety, pharmacokinetic (PK) and functional activity data of VRC07-523LS and PGT121 when administered subcutaneously (SC) to young South African women. Going forward, the aim is to select the ideal dose and/or monoclonal antibody for co-formulation and testing with CAP256-VRC26.25LS, a potent monoclonal antibody against subtype C virus, in an efficacy trial.

Methods and analysis

CAPRISA 012A is a randomised, double blinded, placebo-controlled phase I trial to assess the safety and PK profile of two mAbs, VRC07-523LS and PGT121 administered SC to 35 young HIV negative women at low risk for HIV infection. Women will be randomised into seven groups of five participants each. In each group, women will be randomised (4:1) to the active intervention, VRC07-523LS and/or PGT121, or placebo. Participants will be followed up for 24 weeks after the administration of the last dose of study product with a total study duration of 72 weeks. Safety in the study will be assessed by the number and percentage of reactogenicity and adverse events experienced by participants and the relatedness to study product. The PK study design was based on preliminary PK data for VRC07-523LS and PGT121.

Ethics and dissemination

Ethical approval has been granted by the South African Health Products Regulatory Authority and by the University of KwaZulu-Natal Biomedical Research Ethics Committee. Results will be presented at international conferences and published in academic peer-reviewed journals. Trial results will be uploaded on the clinical trial registry.

Trial registration number

PACTR201808919297244; Pre-results.
‘Big issues’ in neurodevelopment for children and adults with congenital heart disease
Authors: Verrall Charlotte E , Blue Gillian M , Loughran-Fowlds Alison , Kasparian Nadine , Gecz Jozef , Walker Karen , Dunwoodie Sally L , Cordina Rachael , Sholler Gary , Badawi Nadia , Winlaw David
Published: July 2019

It is established that neurodevelopmental disability (NDD) is common in neonates undergoing complex surgery for congenital heart disease (CHD); however, the trajectory of disability over the lifetime of individuals with CHD is unknown. Several ‘big issues’ remain undetermined and further research is needed in order to optimise patient care and service delivery, to assess the efficacy of intervention strategies and to promote best outcomes in individuals of all ages with CHD. This review article discusses ‘gaps’ in our knowledge of NDD in CHD and proposes future directions.
Bioactive adrenomedullin, proenkephalin A and clinical outcomes in an acute heart failure setting
Authors: Molvin John , Jujic Amra , Navarin Silvia , Melander Olle , Zoccoli Giada , Hartmann Oliver , Bergmann Andreas , Struck Joachim , Bachus Erasmus , Di Somma Salvatore , Magnusson Martin
Published: July 2019

Objectives

In an acute heart failure (AHF) setting, proenkephalin A 119–159 (penKid) has emerged as a promising prognostic marker for predicting worsening renal function (WRF), while bioactive adrenomedullin (bio-ADM) has been proposed as a potential marker for congestion. We examined the diagnostic value of bio-ADM in congestion and penKid in WRF and investigated the prognostic value of bio-ADM and penKid regarding mortality, rehospitalisation and length of hospital stay in two separate European AHF cohorts.

Methods

Bio-ADM and penKid were measured in 530 subjects hospitalised for AHF in two cohorts: Swedish HeArt and bRain failure inVESTigation trial (HARVEST-Malmö) (n=322, 30.1% female; mean age 75.1+11.1 years; 12 months follow-up) and Italian GREAT Network Rome study (n=208, 54.8% female; mean age 78.5+9.9 years; no follow-up available).

Results

PenKid was associated with WRF (area under the curve (AUC) 0.65, p<0.001). In multivariable logistic regression analysis of the pooled cohort, penKid showed an independent association with WRF (adjusted OR (aOR) 1.74, p=0.004). Bio-ADM was associated with peripheral oedema (AUC 0.71, p<0.001), which proved to be independent after adjustment (aOR 2.30, p<0.001). PenKid was predictive of in-hospital mortality (OR 2.24, p<0.001). In HARVEST-Malmö, both penKid and bio-ADM were predictive of 1-year mortality (aOR 1.34, p=0.038 and aOR 1.39, p=0.030). Furthermore, bio-ADM was associated with rehospitalisation (aOR 1.25, p=0.007) and length of hospital stay (β=0.702, p=0.005).

Conclusion

In two different European AHF cohorts, bio-ADM and penKid perform as suitable biomarkers for early detection of congestion severity and WRF occurrence, respectively, and are associated with pertinent clinical outcomes.
Building toolkits for COPD exacerbations: lessons from the past and present
Authors: Sapey Elizabeth , Bafadhel Mona , Bolton Charlotte E , Wilkinson Thomas , Hurst John R , Quint Jennifer K
Published: July 2019

In the nineteenth century, it was recognised that acute attacks of chronic bronchitis were harmful. 140 years later, it is clearer than ever that exacerbations of chronic obstructive pulmonary disease (ECOPD) are important events. They are associated with significant mortality, morbidity, a reduced quality of life and an increasing reliance on social care. ECOPD are common and are increasing in prevalence. Exacerbations beget exacerbations, with up to a quarter of in-patient episodes ending with readmission to hospital within 30 days. The healthcare costs are immense. Yet despite this, the tools available to diagnose and treat ECOPD are essentially unchanged, with the last new intervention (non-invasive ventilation) introduced over 25 years ago.

An ECOPD is ‘an acute worsening of respiratory symptoms that results in additional therapy’. This symptom and healthcare utility-based definition does not describe pathology and is unable to differentiate from other causes of an acute deterioration in breathlessness with or without a cough and sputum. There is limited understanding of the host immune response during an acute event and no reliable and readily available means to identify aetiology or direct treatment at the point of care (POC). Corticosteroids, short acting bronchodilators with or without antibiotics have been the mainstay of treatment for over 30 years. This is in stark contrast to many other acute presentations of chronic illness, where specific biomarkers and mechanistic understanding has revolutionised care pathways. So why has progress been so slow in ECOPD? This review examines the history of diagnosing and treating ECOPD. It suggests that to move forward, there needs to be an acceptance that not all exacerbations are alike (just as not all COPD is alike) and that clinical presentation alone cannot identify aetiology or stratify treatment.
Energy dissipation in a deep tailwater stilling basin with partial flaring gate piers
Authors: Zhou Zhao , Wang Junxing , Zhu David Z.
Published: July 2019

Flaring gate piers (FGPs) have been used to increase energy dissipation in stilling basins downstream of spillways. For projects with a low water head and large unit discharge together with a deep tailwater level, energy dissipation inside a conventional stilling basin is usually insufficient. This paper proposes a new partial flaring gate pier (partial FGP) scheme to intensify the energy dissipation inside the stilling basin. The results for the no FGP scheme, the conventional FGP scheme, and the partial FGP scheme were compared using a physical model study and numerical simulations. It was found that the partial FGP scheme (the alternation of flaring and no flaring gate piers in chambers) can contain the submerged hydraulic jump and high-speed water jet in the upstream region of the stilling basin. Thus, the water jet from the FGP chamber was forced to laterally diffuse, thereby intensifying the shear friction and turbulent kinetic energy and forming a vertical vortex from the bottom to the surface. Compared with the other two schemes, the flow pattern in the partial FGP scheme was improved significantly with much deeper air entrainment depth inside the stilling basin and much lower turbulent kinetic energy in the outgoing flow. The mean velocity of the outgoing flow also decreased by more than 20%. The common problems of secondary hydraulic jump outside the stilling basin were eliminated.
Evaluating traffic operations performance of directional interchange with semi-direct ramp connections with loops
Authors: Hamad Khaled , Ismail Abdulkarim
Published: July 2019

The purpose of this research is to evaluate the performance of the directional interchange with semi-direct ramp connections with loops (DI-SDRL) in terms of traffic operations under a wide range of traffic demand conditions. Towards this end, the performance of this interchange has been compared with that of a conventional one, i.e., directional with loops interchange (DLI). Thirty different traffic scenarios were developed to test their performance using a state-of-the-art traffic microsimulation tool PTV-VISSIM. The results showed that the DI-SDRL interchange design outperforms the conventional DLI interchange in terms of vehicle hours traveled and mean speed. Nevertheless, the DI-SDRL underperforms the DLI in terms of vehicle kilometres traveled. There was no significant difference in terms of mean delay. At the individual-segment level, the analysis showed that the DI-SDRL interchange outperforms the DLI at diverging segments; in contrast, the DLI interchange outperforms the DI-SDRL at merging segments.
Scattering theory for mathematical models of the weak interaction
Authors: Alvarez Benjamin Louis , Faupin Jérémy
Published: July 2019

We consider mathematical models of the weak decay of the vector bosons [Formula: see text] into leptons. The free quantum field Hamiltonian is perturbed by an interaction term from the standard model of particle physics. After the introduction of high energy and spatial cut-offs, the total quantum Hamiltonian defines a self-adjoint operator on a tensor product of Fock spaces. We study the scattering theory for such models. First, the masses of the neutrinos are supposed to be positive: for all values of the coupling constant, we prove asymptotic completeness of the wave operators. In a second model, neutrinos are treated as massless particles and we consider a simpler interaction Hamiltonian: for small enough values of the coupling constant, we prove again asymptotic completeness, using singular Mourre’s theory, suitable propagation estimates and the conservation of the difference of some number operators.
Interpretation of the changes in 2018 National Essential Medicine List (NEML) from the specialists
Authors: Li Chuyu , Pan Xinyao , Leung Wingting , Huang Zengshu , Zhou Jing , Wang Ling
Published: July 2019

On 25 October 2018, National Essential Medicine List (NEML) of China was formally published by National Health Commission and it has been executed since 1 November. The new NEML, which includes 685 drugs with more than 1110 kinds of dosage forms and more than 1810 kinds of specifications, further standardizes dosage forms and specifications of drugs. The new catalog not only increases the number of categories, but also optimizes the structure of the drug list. It highlights the need for basic drugs in aspects of common diseases, chronic diseases, serious diseases and public health. Besides, the normalization of dosage forms and specifications, and the persistence of emphasizing the combination of Western and Chinese medicine are both the characteristics of it. This news report is composed of several parts including brief introduction of NEML, the difference between NEML and National Directory of Health Insurance (NDHI) which is likely to be confused with NEML, the dissection of the change of medicine varieties, relevant policies and potential issues of NEML. We intend to give a comprehensive interpretation of NEML from different perspectives.
Mid-Eocene giant slope failure (sedimentary mélanges) in the Ligurian accretionary wedge (NW Italy) and relationships with tectonics, global climate change and the dissociation of gas hydrates
Authors: Festa Andrea , Cavagna Simona , Barbero Edoardo , Catanzariti Rita , Pini Gian Andrea
Published: July 2019

Upper Lutetian–Bartonian sedimentary mélanges, corresponding to ancient mud-rich submarine mass transport deposits, are widely distributed over an area
c.
300 km long and tens of kilometres wide along the exhumed outer part of the External Ligurian accretionary wedge in the Northern Apennines. The occurrence of methane-derived carbonate concretions (septarians) in a specific tectonostratigraphic position below these sedimentary mélanges allows us to document the relationships among a significant period of regional-scale slope failure, climate change (the Early and Mid-Eocene Optimum stages), the dissociation of gas hydrates and accretionary tectonics during the Ligurian Tectonic Phase (early–mid-Lutetian). The distribution of septarians at the core of thrust-related anticlines suggests that the dissociation of gas hydrates was triggered by accretionary tectonics rather than climate change. The different ages of slope failure emplacement and the formation of the septarians support the view that the dissociation of gas hydrates was not the most important trigger for slope failure. The latter occurred during a tectonic quiescence stage associated with a regressive depositional trend, and probably minor residual tectonic pulses, which followed the Ligurian Tectonic Phase, favouring the dynamic re-equilibrium of the External Ligurian accretionary wedge. Our findings provide useful information for a better understanding of the factors controlling giant slope failure events in modern accretionary settings, where they may cause tsunamis.
Antiallodynic Effects of Cannabinoid Receptor 2 (CB2R) Agonists on Retrovirus Infection-Induced Neuropathic Pain
Authors: Sheng Wen S. , Chauhan Priyanka , Hu Shuxian , Prasad Sujata , Lokensgard James R.
Published: July 2019

The most common neurological complication in patients receiving successful combination antiretroviral therapy (cART) is peripheral neuropathic pain. Data show that distal symmetric polyneuropathy (DSP) also develops along with murine acquired immunodeficiency syndrome (MAIDS) after infection with the LP-BM5 murine retrovirus mixture. Links between cannabinoid receptor 2 (CB2R) and peripheral neuropathy have been established in animal models using nerve transection, chemotherapy-induced pain, and various other stimuli. Diverse types of neuropathic pain respond differently to standard drug intervention, and little is currently known regarding the effects of modulation through CB2Rs. In this study, we evaluated whether treatment with the exogenous synthetic CB2R agonists JWH015, JWH133, Gp1a, and HU308 controls neuropathic pain and neuroinflammation in animals with chronic retroviral infection. Hind-paw mechanical hypersensitivity in CB2R agonist-treated versus untreated animals was assessed using the MouseMet electronic von Frey system. Multicolor flow cytometry was used to determine the effects of CB2R agonists on macrophage activation and T-lymphocyte infiltration into dorsal root ganglia (DRG) and lumbar spinal cord (LSC). Results demonstrated that, following weekly intraperitoneal injections starting at 5 wk p.i., JWH015, JWH133, and Gp1a, but not HU308 (5 mg/kg), significantly ameliorated allodynia when assessed 2 h after ligand injection. However, these same agonists (2x/wk) did not display antiallodynic effects when mechanical sensitivity was assessed 24 h after ligand injection. Infection-induced macrophage activation and T-cell infiltration into the DRG and LSC were observed at 12 wk p.i., but this neuroinflammation was not affected by treatment with any CB2R agonist. Activation of JAK/STAT3 has been shown to contribute to development of neuropathic pain in the LSC and pretreatment of primary murine microglia (2 h) with JWH015-, JWH133-, or Gp1a-blocked IFN-gamma-induced phosphorylation of STAT1 and STAT3. Taken together, these data show that CB2R agonists demonstrate acute, but not long-term, antiallodynic effects on retrovirus infection-induced neuropathic pain.
miR-451 Silencing Inhibited Doxorubicin Exposure-Induced Cardiotoxicity in Mice
Authors: Li Jun , Wan Weiguo , Chen Tao , Tong Suiyang , Jiang Xuejun , Liu Wanli
Published: July 2019

Oxidative stress and cardiomyocytes apoptosis were closely involved in the pathological process of doxorubicin- (Dox-) induced cardiac injury. MicroRNA-451 (miR-451) was mainly expressed in cardiomyocytes. However, the role of miR-451 in Dox-induced cardiac injury remained unclear. Our study aimed to investigate the effect of miR-451 on Dox-induced cardiotoxicity in mice. We established a Dox-induced cardiotoxicity model in the mice and manipulated miR-451 expression in the heart using a miR-451 inhibitor, which was injected every other day beginning at one day before Dox injection. Oxidative stress and apoptosis in the hearts were evaluated. miR-451 levels were significantly increased in Dox-treated mice or cardiomyocytes. miR-451 inhibition attenuated Dox-induced whole-body wasting and heart atrophy, reduced cardiac injury, restored cardiac function, and improved cardiomyocyte contractile function. Moreover, miR-451 inhibition reduced oxidative stress and cardiomyocytes apoptosis in vivo and in vitro. miR-451 inhibition increased the expression of calcium binding protein 39 (Cab39) and activated adenosine monophosphate activated protein kinase (AMPK) signaling pathway. A specific inhibitor of AMPK abolished the protection provided by miR-451 inhibition against cell injury in vitro. In conclusion, miR-451 inhibition protected against Dox-induced cardiotoxicity via activation of AMPK signaling pathway.
Sustainable Supply Chain Network Design with Carbon Footprint Consideration: A Case Study in China
Authors: Jiang Yue , Zhao Yang , Dong Mengyuan , Han Shuihua
Published: July 2019

With the environment concern increasing, corporations are facing new challenges on carbon management in supply chain network. In this paper, environmental consideration is introduced to traditional supply chain management, and the sustainable supply chain (SSC) is designed considering carbon footprint. We develop a mixed integer linear programming (MILP) model to get the optimal decisions on partner selection, technology selection, and transportation mode selection, as well as material procurement, product supply, and recovery mode. For validating the model, a beverage company in China is used. We also analyze the impact of supply chain uncertainties such as carbon emission price and recovery rate of returned products on the decision of SSC design.
The Anti-Inflammatory Effects of CXCR5 in the Mice Retina following Ischemia-Reperfusion Injury
Authors: Cao Xing , Li Wen , Liu Ying , Huang Hu , Ye Chang-Hua
Published: July 2019

Object. Retinal ischemia-reperfusion (I/R) injury is a common pathological process in many ophthalmic diseases; there are no effective therapeutic approaches available currently. Increasing evidence indicates that microglia mediated neuroinflammation plays an important role in the retinal I/R injury. In this study, we aimed to investigate the roles of chemokine receptor CXCR5 in the pathological process of retinal I/R injury model. Method. Retinal I/R injury model was established in CXCR5 knockout and wild mice by the acute elevation of intraocular pressure (AOH) for 60 minutes, and the eyes were harvested for further analyses. The cellular location of CXCR5 was detected by immunofluorescence staining; the expressions of CXCR5 and CXCL13 after I/R injury were analyzed by quantitative RT-PCR. The retinal microglia were detected as stained for Iba1 (+). Leakage of inflammatory cells was observed on the H&E stained cryosections. The protein expression and quantification of zonula occludens (ZO-1) were determined by Western blotting and densitometry. Capillary degeneration was identified on the intact retinal vasculatures prepared by trypsin digestion. Results. The number of activated microglia marked by Iba1 antibody in the retina was increased after retinal I/R injury in both KO and WT mice, more significant in KO mice. The leakage of inflammatory cells was observed largely at 2 days after injury, but there was no or little leakage at 7 days. The number of inflammatory cells (mainly neutrophils) was greater in CXCR5 KO mice than in WT mice, mainly located under internal limiting membrane. CXCR5 deficiency led to more ZO-1 degradation in CXCR5 KO mice compared to C57BL6 WT mice 2 days after reperfusion. The cellular capillaries were also significantly increased in the KO mice compared to the WT mice. Conclusion. Our findings suggest that the chemokine receptor CXCR5 may protect retina from ischemia-reperfusion injury by its anti-inflammatory effects. Thus, CXCR5 may be a promising therapeutic target for the treatment of retinal I/R injury.
A Case of Fetal Tachycardia after Electroconvulsive Therapy: A Possible Effect of Maternal Hypoxia and Uterine Contractions
Authors: Watanabe Anri , Ayani Nobutaka , Waratani Miyoko , Hasegawa Tatsuji , Ishii Maki , Matsuoka Teruyuki , Narumoto Jin
Published: July 2019

Electroconvulsive therapy (ECT) is considered to be an effective and safe treatment for depression in pregnant women in that it avoids the risk of psychotropic pharmacotherapy. However, clinicians should be cautious about the adverse effects in the fetus, such as fetal cardiac arrhythmia. Most of the previous studies have demonstrated a reduction in fetal heart rate associated with ECT. However, we encountered a case of fetal tachycardia after maternal ECT-induced convulsions. The patient was a woman who was 30 weeks’ pregnant and had severe depression; fetal tachycardia (180–200 bpm) occurred immediately after the electrical stimulation and lasted for more than 30 minutes. The fetal tachycardia might have been caused by maternal hypoxia and uterine contractions. To our knowledge, this is the first report of fetal tachycardia as an adverse effect of ECT. Prolonged fetal tachycardia may cause fetal heart failure. Therefore, oxygenation during convulsions and careful fetal cardiac monitoring are essential when administering ECT in pregnancy.
Combined Administration of Streptozotocin and Sucrose Accelerates the Appearance of Type 2 Diabetes Symptoms in Rats
Authors: Barragán-Bonilla Martha Isela , Mendoza-Bello Juan Miguel , Aguilera Penélope , Parra-Rojas Isela , Illades-Aguiar Berenice , Ramírez Mónica , Espinoza-Rojo Mónica
Published: July 2019

Type 2 diabetes is a disease with a high global prevalence, characterized by chronic hyperglycemia, insulin resistance, polyphagia, polydipsia, polyuria, and changes in body weight. Animal models have been very useful for the study of this disease and to search for new therapeutic targets that delay, attenuate, or avoid diabetic complications. The purpose of this work was to establish a model of type 2 diabetes and exhibit the majority of the characteristics of the disease. Two-day-old male and female Wistar rats were treated once with streptozotocin (70 or 90 mg/kg body weight). After weaning, they were given a sucrose-sweetened beverage (SSB; sucrose at 10 or 30%) during 7 or 11 weeks; their body weight and food intake were measured daily. With the rats at 14 weeks of age, we determined the following: (a) fasting blood glucose, (b) oral glucose tolerance, and (c) insulin tolerance. We found that the supplementation of sucrose at 10% for 7 weeks in male rats which had previously been given streptozotocin (70 mg/kg) at neonatal stage leads to the appearance of the signs and symptoms of the characteristic of type 2 diabetes in adulthood.