bluuebunny/crossref_metadata_2025 huggingface dataset:
Uncertainties in the Annual Cycle of Rainfall Characteristics over West Africa in CMIP5 Models
Authors: Sow Magatte , Diakhaté Moussa , Guichard Françoise , Dieng Diarra , Gaye Amadou T.
Published: July 2019

This study analyses uncertainties associated with the annual cycle of West African rainfall characteristics in 15 simulations of the Coupled Model Intercomparison Project phase 5 (CMIP5) over the Sahel and Guinean regions. Indices based on daily rainfall such as the frequency and the ntensity of wet days, the consecutive dry days (CDD) and wet days (CWD), the 95th percentile of daily rainfall (R95) and its contribution to the umulative monsoon rainfall (R95PTOT) have been assessed. Over both regions, TRMM, GPCP and CHIRPS observational datasets provide very consistent results on the annual cycle of precipitation but less so on the frequency of wet days. Conversely, higher uncertainties are noted on the intensity of wet days over both study areas, particularly over the Guinean region. Overall, CMIP5 simulations present much higher uncertainties in the representation of the mean precipitation climatology, often provide too early (late) onset dates over the Sahel (the Guinean region) and overestimate rainfall during the early and late monsoon phases. These errors do not compensate at the annual scale nor when considering West Africa as a hole. Results also reveal that over the Guinean region, the difficulty of models to represent the annual structure of the mean precipitation strongly involves biases in the representation of the annual cycle of the frequency of wet days. We found strong uncertainties in the simulation of the CWD and he CDD over both areas. Conversely for R95 and R95PTOT, the ncertainties in CMIP5 models appear somewhat weaker, but the magnitude of R95 is largely underestimated in most models.
The Value Functions Approach and Hopf-Lax Formula for Multiobjective Costs via Set Optimization
Authors: Hamel Andreas Heinrich , Visetti Daniela
Published: July 2019

The complete-lattice approach to optimization problems with a vector- or even set-valued objective already produced a variety of new concepts and results and was successfully applied in finance, statistics and game theory. For example, the duality issue for multi-criteria and vector optimization problems could be solved using the complete-lattice approach, compare [11]. So far, it has been applied to set-valued dynamic risk measures (in the stochastic case), as discussed in Feinstein, Rudloff etc. (see [11], for example), but it has not been applied to deterministic calculus of variations and optimal control problems. In this paper, the following problem of set-valued optimization is considered: minimize the functional $$ \overline J_t[y]=\int_0^t \overline L(s,y(s),\dot y(s))\ ds + U_0(y(0)) $$ over all admissible arcs $y$, where $\overline L$ is the associated multifunction to a vector-valued Lagrangian $L$, the integral is in the Aumann sense and $U_0$ is the initial cost. A new concept of \emph{value function}, for which a Bellman's optimality principle holds, is introduced. Also the classical result of the Hopf-Lax formula holds for the generalized value function. Finally, a derivative with respect to the time $t$ and a directional derivative with respect to $x$ of the value function are defined, based on ideas close to the concepts in [12]. The value function is proved to be solution of a suitable Hamilton-Jacobi equation.
Problems Associated with Marketing Food and Drink Specifically at Women
Authors: Spence Charles
Published: July 2019

In recent years, several brands have received much negative press coverage when trying to market their food and drink products specifically at women. This is, in part, because the taste preferences/sensitivities of men and women are actually quite similar. In fact, perhaps the one and only area where consumers are willing to accept (or should that be swallow) ingested products explicitly targeted at women or men is in the case of nutritional foods/supplements. Such products are not really sold on the basis of their taste/flavour anyway. Many consumers are also sensitive to the so-called pink tax, when near-identical products cost more when sold to women rather than to men (e.g., as in the case of female razors). As the four recent examples discussed in this review make clear, it can be difficult to roll-out a new food or beverage product, or else extend a pre-existing product line, that is especially for women without coming across as sexist/condescending. As such, marketers need to tread carefully, otherwise they may end-up generating unwanted negative publicity. Ultimately, therefore, adopting an implicit approach to gender-based marketing, should that be the direction that a brand wants to take, will likely have more chance of avoiding negative publicity than the explicit targeting of food/beverage-related products in what is undoubtedly a highly-politicized area.
Mapping and Navigation for Indoor Robots under ROS: An Experimental Analysis
Authors: Silva Bruno M. F. da , Xavier Rodrigo S. , Gonçalves Luiz M. G.
Published: July 2019

Since it was proposed, the Robot Operating System (ROS) has fostered solutions for various problems in robotics in the form of ROS packages. One of these problems is Simultaneous Localization and Mapping (SLAM), a problem solved by computing the robot pose and a map of its environment of operation at the same time. The increasingly availability of robot kits ready to be programmed and also of RGB-D sensors often pose the question of which SLAM package should be used given the application requirements. When the SLAM subsystem must deliver estimates for robot navigation, as is the case of applications involving autonomous navigation, this question is even more relevant. This work introduces an experimental analysis of GMapping and RTAB-Map, two ROS compatible SLAM packages, regarding their SLAM accuracy, quality of produced maps and use of produced maps in navigation tasks. Our analysis aims ground robots equipped with RGB-D sensors for indoor environments and is supported by experiments conducted on datasets from simulation, benchmarks and from our own robot.
Adipogenesis, Role of Adenosine Monophosphate-Activated Protein Kinase (AMPK) and Use of Plants Products in Combating Obesity
Authors: Ahmad Bilal , Serpell Christopher J , Lim Isabel Fong , Wong Eng Hwa
Published: July 2019

The increasingly widespread emergence of obesity has become a matter of critical concern around the world due to its association with common morbidities including cancer, cardiovascular diseases and diabetes. Over-nutrition and the sedentary lifestyle are considered as the most significant causes of obesity: appropriate lifestyle and behavior interventions are the corner stones of successful weight loss, but to maintain such a lifestyle is highly challenging. There is therefore an urgent need to develop innovative non- or minimally-toxic means to combat obesity. Accordingly, ample natural products from plants (either as crude extracts or purified phytochemicals) have been scrutinized for their anti-obesogenic properties because they are believed to be non-toxic and cost-effective, and frequently well-accepted by patients because of their traditional use. In this review, we will discuss adipose tissue and adipogenesis, signaling pathways involved in the regulation of adipogenesis, role of energy sensor protein of the body AMPK, and recently reported plant products in the management of obesity. We will provide a common platform for understanding obesity, and a possible mechanism of action for anti-obesogenic plant products through activated AMPK, which will be helpful in the scientific development of traditional herbal medicine.
Effects of Time, Temperature, and Solvent Ratio on the Extraction of Non-Extractable Polyphenols with Anticancer Activity of Barhi Date Palm Kernels Extracts Using Response Surface Methodology
Authors: Mahmud Israa , E. S. Mirghani Mohamed , Yusof Faridah , Al-khatib Ma'an
Published: July 2019

Dietary polyphenols exist in two forms; extractable polyphenols (EPP) or compounds solubilised by aqueous/organic solvents, and non-extractable polyphenols (NEPP) or compounds remain in the corresponding residues after the extraction. At present, most researchers focus on EEP fractions, while NEPP is neglected. Thus, this study aimed to release NEPP from the remaining powder residue of Barhi date palm kernels (BDPK) with acid hydrolysis. The related extraction conditions were determined and optimised using response surface methodology (RSM) for maximisation of NEPP with highest cytotoxic and antioxidant activities. The face-centred central composite design (FCCCD) was used to establish treatments based on three independent variables, namely; extraction temperature, time, and solvent/sample ratio. Under the optimal conditions, the experimental values for DPPH radical-scavenging capacity of NEPP (IC50=57.52µg/mL), and cytotoxicity of NEPP against A549 and HT29 cells were IC50=17.4 µg/mL and 31.4µg/mL, respectively. The experimental values were in agreement with those predicted by RSM models, confirming the suitability of the model employed and the success of RSM for optimisation of the extraction conditions for NEPP from BDPK. These results indicate that NEPP from industrial date fruit waste could be a promising candidate as natural antioxidants with significant antiproliferation effect against A549 and HT29 cancer cells in-vitro.
KOLB’S EXPERIENTIAL LEARNING AS AN EFFECTIVE LEARNING MODEL IN CREATIVE PRODUCT AND ENTREPRENEURSHIP SUBJECTS
Authors: Pamungkas Stephanus Fajar , Widiastuti Indah , Suharno Suharno
Published: July 2019

Student learning outcomes are influenced by the ability of students to understand and the ability of teachers to deliver subject matter. In the delivery of subject matter, appropriate and effective learning models are needed to improve student understanding. This article presents an effective learning model for Creative Products and Entrepreneurship subjects in Vocational School.  The aim of this subject is to form students to have the character, skills, and understanding as an entrepreneur, and to be able to bring up quality young entrepreneurs. To achieve the learning goal, learning activities must involve students directly. The experiential learning model emphasizes the role of active student experience and involvement. Through practice-based learning experiences, students feel more confident in handling jobs in real work. Learning through this model is able to facilitate students in learning so that it could improve student learning outcomes. Therefore, experiential learning is one alternative solution in the Creative Products and Entrepreneurship learning process. The research method used is a review literature by analyzing various relevant sources related to the importance of experiential learning and the challenges of its implementation. Creative Products and Entrepreneurship learning in Vocational Schools is implemented in various forms of production and business-based learning which is a real practice. Through experiential learning, it is expected that entrepreneurial learning objectives could be achieved and young entrepreneurs from Vocational Schools could increase significantly. This is in accordance with the concept of work, continuing study, and entrepreneurship for vocational high school graduates. In addition, it also supports the Entrepreneurial School program as an effort of the government to achieve the vocational high school revitalization target, while at the same time reducing the unemployment rate of vocational high school graduates.
APPLICATION OF PEER TUTORING LEARNING METHODS IN VOCATIONAL SCHOOL STUDENTS
Authors: Irmawan Sandri
Published: July 2019

The learning process is a part that plays an important role in the success of learning. The selection of the right method is one way for the learning process to work as expected. Peer tutoring method is one of the interactive learning methods involving students who are competent in the material taught so they can provide learning guidance to other students. This study aims to improve student learning outcomes in the realm of knowledge and skills through the application of peer tutoring methods. This research is a Classroom Action Research (CAR) conducted in 2 cycles with 4 stages, namely planning, implementation, observation and reflection. The subjects in this study were 34 vocational high school students. Data collection methods used include observation, tests, performance and interviews. Test the validity of the data using data triangulation. The research data was analyzed using a comparative descriptive percentage analysis technique. From the data obtained shows that the application of peer tutoring methods can improve student learning outcomes by 88.23% in the realm of knowledge and 91.17% in skills. From the results of the study it can be concluded that the application of peer tutoring methods can improve the learning outcomes of Vocational High School students.
Electronic Patient-Reported Outcome Collection Systems in Orthopaedic Clinical Practice
Authors: Lizzio Vincent A. , Dekhne Mihir S. , Makhni Eric C.
Published: July 2019

» The recent emphasis on the electronic collection of patient health information has catalyzed the development of numerous platforms for capturing electronic patient-reported outcome measures (EPROMs).

» There are several important considerations for selecting the most appropriate PROM for each orthopaedic practice.

» In this article, we evaluate various aspects of PROMs, examine the challenges and obstacles that are associated with routine collection, and review 6 commonly used electronic collection systems for orthopaedic clinical practice.
O impacto económico da prevenção de úlceras de pressão num hospital universitário
Authors: Venâncio Bruno , Alves Eduardo , Ruano Catarina , Matos Daniela , Valente Sara , Abreu Nuno , Mota Renato
Published: July 2019

Objetivo: As úlceras de pressão constituem uma condição evitável que se traduz numa diminuição da qualidade de vida do doente. Simultaneamente representam um acréscimo nos custos para os serviços de saúde, associados ao aumento do tempo de internamento. A investigação é fundamental para justificar a prevenção enquanto medida de sustentabilidade e melhoria dos cuidados de saúde. O estudo visa estimar o efeito individual das diferentes categorias das úlceras de pressão no incremento do tempo de internamento hospitalar e os ganhos em saúde que derivam da intervenções autónomas e independentes dos enfermeiros do domínio da prevenção das UP. Métodos: A determinação do impacto incremental das diferentes categorias das UP no tempo de internamento é obtida por uso de um modelo econométrico concebido para esse fim. Os ganhos em saúde são determinados com o uso da equação preconizada pela ordem profissional dos enfermeiros (OE). Resultados: O impacto incremental das diferentes categorias de UP no internamento hospitalar é por ordem crescente de severidade clínica da UP de 1,05 dias; 1,64 dias; 3,53 dias e 10,29 dias. Estima-se que tenha sido prevenido o incremento de 2977,61 dias de internamento hospitalar, em resultado da prevenção das úlceras de pressão. Conclusão: É possível incrementar os ganhos em saúde e contribuir na redução do impacto das UP no internamento hospitalar ao clinicamente indispensável através da maximização na efetividade diagnóstica.
Behavioral and Steroidogenic Pharmacology of Phenyl Ring Substituted Etomidate Analogs in Rats
Authors: McGrath Megan , Hofmann Aissa , Raines Douglas
Published: July 2019

Background: Cushing’s syndrome is an endocrine disorder characterized by the overproduction of adrenocortical steroids and associated with significant morbidity. Steroidogenesis enzyme inhibitors are the mainstays of pharmacological treatment. Unfortunately, they produce side effects that limit dosing, efficacy, and patient tolerability. Among the most potent inhibitors is the general anesthetic etomidate whose GABAA receptor-mediated sedative-hypnotic actions restrict use. In this study, we defined the sedative-hypnotic and steroidogenesis inhibiting actions of etomidate and four phenyl-ring substituted etomidate analogs (dimethoxy-etomidate, isopropoxy-etomidate, naphthalene-etomidate, and naphthalene(2)-etomidate) that possess negligible GABAA receptor modulatory activities.
Methods: In the first set of experiments, male Sprague-Dawley rats were assessed for loss of righting reflexes (LoRR) after receiving intravenous boluses of either etomidate (1 mg/kg) or an etomidate analog (40 mg/kg). In the second set of experiments, rats were assessed for LoRR and their abilities to produce adrenocortical and androgenic steroids after receiving 2-hr infusions (0.5 mg kg-1min-1) of either etomidate or an etomidate analog.
Results: All rats that received etomidate boluses or infusions had LoRR that persisted for minutes or hours, respectively. In contrast, no rat that received an etomidate analog had LoRR. Compared to rats in the vehicle control group, rats that received etomidate analog infusions had plasma corticosterone and aldosterone concentrations that were reduced by 80 – 84% and 68 – 94%, respectively. Rats that received etomidate infusions had plasma corticosterone and aldosterone concentrations that were also significantly reduced (by 92% and 96%, respectively). Rats that received etomidate or isopropoxy-etomidate had significant reductions (90% and 57%, respectively) in plasma testosterone concentrations whereas those that received naphthalene-etomidate had significant increases (1,400%) in plasma dehydroepiandrosterone concentrations. Neither etomidate nor any etomidate analog significantly affected plasma androstenedione and dihydrotestosterone concentrations.
Conclusions: Our studies demonstrate that the four phenyl-ring substituted etomidate analogs form a novel class of compounds that are devoid of sedative-hypnotic activities and suppress plasma concentrations of adrenocortical steroids but vary in their effects on plasma concentrations of androgenic steroids. They provide a proof-of-concept for the development of non-sedating etomidate analogs to treat Cushing’s syndrome and other pathologies whose clinical courses may be improved by altering steroid biosynthesis.
A qualitative study exploring patient, family carer and healthcare professional perceptions of providing palliative care for advanced head and neck cancer
Authors: Mayland Catriona Rachel , Doughty Hannah , Rogers Simon , Gola Anna , Mason Stephen , Hubbert Cathy , Macareavy Dominic , Jack Barbara
Published: July 2019

Purpose: To explore patient, family carer and healthcare professionals’ perspectives about providing palliative care for advanced head and neck cancer patients and potential components which could inform a future model of care.

Methods: Using a naturalistic, interpretative approach, within Northwest England, a purposive sample of adult head and neck cancer patients was selected. Their family carers were also invited to participate. Healthcare professionals (representing head and neck surgery and specialist nursing; oncology; specialist palliative care; general practice and community nursing) were recruited. All participants underwent face-to-face or telephone interviews. A thematic approach, using a modified version of Colazzi’s framework, was used to analyse the data.

Results: In total, 17 interviews were conducted (nine patients, four joint with family carers and eight healthcare professionals). Three main themes relating to challenges in providing palliative care were identified: the ‘need for support at critical moments’ in the patients’ disease trajectory; ‘communication challenges’ and ‘complexity of decision-making’. Additionally, three themes related to key components to inform a future model of care: ‘partnership model’; ‘timely and responsive engagement of Specialist Palliative Care’; and ‘good linkage and connections’.

Conclusions: Conceptually, the identified ‘critical moments’ in the patients’ disease trajectory should be a focus for future interventions to help improve and support care. These interventions should direct improvements in the provision of information and psychological support. Models of palliative care for this population need to be developed in partnership with existing services to ensure care is delivered in a coordinated and timely manner.
Sarcopenic obesity and associations with mortality in old women and men – a prospective observational study
Authors: von Berens Åsa , Obling Sine R , Nydahl Margaretha , Koochek Afsaneh , Lissner Lauren , Skoog Ingmar , Frändin Kerstin , Skoglund Elisabeth , Rothenberg Elisabet , Cederholm Tommy
Published: July 2019

Background

The combined effect of sarcopenia and obesity, i.e., sarcopenic obesity, has been associated with disability and worse outcomes in older adults, but results are conflicting. The objectives of this study were to describe the prevalence of sarcopenic obesity (SO) in older adults, and to examine how the risk of mortality is associated with different body composition phenotypes.

Methods

Data were obtained from two Swedish population studies, the Gothenburg H70 Birth Cohort Studies of 521 women and men at the age of 75, and the Uppsala Longitudinal Study of Adult Men (ULSAM), which included 288 men aged 88 years. Sarcopenia was defined using the EWGSOP2 definition. Obesity was defined by any of three established definitions: body mass index ≥30 kg/m2, fat mass >30%/ >42% or waist circumference ≥88 cm/≥102 cm for women and men, respectively. The Kaplan-Meier survival curve and the Cox proportional hazard model were used for 10-year and 4-year survival analyses in the H70 and ULSAM cohorts, respectively.

Results

SO was observed in 4% of the women and 11% of the men in the H70 cohort, and in 10% of the ULSAM male cohort. The 75-year-old women with SO had a higher risk (HR 3.25, 95% confidence interval (1.2-8.9)) of dying within ten years compared to those with a “normal” phenotype. A potential similar association with mortality among the 75-year-old men was not statistically significant. In the older men aged 88 years, obesity was associated with increased survival.

Conclusions

SO was observed in 4-11% of community-dwelling older adults. In 75-year-old women SO appeared to associate with an increased risk of dying within ten years. In 88-year-old men, the results indicated that obesity was related to a survival benefit over a four year period.
Oncologic outcomes after immediate breast reconstruction following mastectomy: Comparison of implant and flap using propensity score matching
Authors: Ha Jeong Hyun , Hong Ki Yong , Lee Han-Byoel , Moon Hyeong-Gon , Han Wonshik , Noh Dong-Young , Lim Joonho , Yoon Sehoon , Chang Hak , Jin Ung Sik
Published: July 2019

Background

Although immediate breast reconstruction has been reported to be oncologically safe, no affirmative study comparing the two reconstruction methods exists. We investigated breast cancer recurrence rates in two breast reconstruction types; implant reconstruction and autologous flap reconstruction.

Methods

A retrospective cohort study was performed on propensity score-matched (for age, stage, estrogen receptor status) patients who underwent IBR after mastectomy at Seoul National University Hospital between 2010 - 2014. The main outcomes determined were locoregional recurrence-free interval (LRRFI) and disease-free interval (DFI).

Results

We analyzed 496 patients among 731 patients following propensity score matching (Median age 43, 247 implant reconstruction and 249 flap reconstruction). During median follow-up of 58.2 months, DFI was not different between the two groups at each tumor stage. However, flap reconstruction showed inferior DFI compared to implant reconstruction in patients with high histologic grade (p=0.012), and with high Ki-67 (p=0.028). Flap reconstruction was related to short DFI in multivariate analysis in aggressive tumor subsets. Short DFI after flap reconstruction in aggressive tumor cell phenotype was most evident in hormone positive/Her-2 negative cancer (p=0.008). LRRFI, on the other hand, did not show difference according to reconstruction method regardless of tumor cell aggressiveness.

Conclusion

Although there is no difference in cancer recurrence according to reconstruction method in general, flap-based reconstruction showed higher systemic recurrence associated with histologically aggressive tumors.
Identification of Circulating miR-210 as a Promising Biomarker for Lung Adenocarcinoma
Authors: Xue Jinru , Xin Hua , Jia Erna , Ren Na
Published: July 2019

Background: Lung adenocarcinoma (LUAD), with an increasing morbidity and mortality globally, is the most common histological subtype of lung cancer (LC). Early diagnosis of LUAD can significantly prolong survival time. Multiple researches have revealed that circulating miRNAs might be used as promising biomarkers for early detection of LUAD
Material and Methods: A meta-analysis was conducted to find circulating miRNAs for early diagnosis of LUAD and summarized their diagnostic values based on GEO database. Further, by bioinformatics analysis we predicted the target genes of circulating miRNAs owning statistically significant, and explored the molecular regulation mechanisms and biological processes of the target genes in the pathogenetic of LUAD.
Results: overall, six datasets were eligible, information on original expression levels of circulating miR-21, miR-155, miR-210, miR-126, miR-486, miR-182, and miR-17 extracted independently by two reviewers. Finally, we found circulating miR-210 had good diagnostic efficacy for LUAD detection, the combined AUC value was 0.83. We then predicted 480 overlapped genes of miR-210 at least 5 of 11 databases. Bioinformatics analysis showed statistically significant GO analysis 38 items and KEGG pathways 21 items. Response to hypoxia may be the mainly involved biological process of miR-210 in LUAD. Nine hub genes (FBXO, FBXL, MGRN1, ATG7, CUL3, RAB, ADAMTS, SEMA, THBS2) were obtained by construct PPI network.
Conclusions: our study implied that circulating miR-210 may be a promising noninvasive biomarker for early detection of LUAD, but further researches are needed to validate the promising results and to identify specific biological processes and target genes.
Radiological characteristics study on epithelioid glioblastoma, a rare subtype of GBM
Authors: Deng Xiaojuan , Luo Qingya , Tang Xiaolin , Chen Youqiang , Mao Chengyi , Fang Jingqin
Published: July 2019

Purpose

Epithelioid glioblastoma (eGBM) is rare and a newly recognized subtype of GBM. Given the short of studies focusing on radiological characteristics of these tumors, we aimed to report the radiological features of eGBM deriving from six patients.

Methods

Six patients with pathologically diagnosed as eGBM were enrolled in this retrospective study. CT and pre-operative MR examinations with conventional and advanced sequences, such as diffusion weighted imaging and so on were analyzed. Immunohistological staining and mutation analysis of BRAF V600E was also explored.

Results

Only case 6 showed a co-locating tumor which was verified to be a diffuse astrocytoma (WHO II), other cases demonstrated single intracerebral tumor. Majority of the tumors originated in cerebral cortex, two cases involved corpus callosum. Tumors demonstrated iso-, hypo- or mixed intensity on T1WI, hyper- or mixed intensity on T2WI and FLAIR, heterogeneous enhancement on post-contrasted imaging. Involvement of leptomeninge, which appeared as leptomenigeal thickening and abnormal enhancing was discovered in 4 cases. Peritumoral edema (4/6) and hemorrhage (3/6) was common, calcium was only seen in case 5. Notable restrictive diffusion and consequently decreased rADC was found in solid component in 5 cases. Most cases demonstrated increased Cho and Lac/Lip value on 1H-MRS, and promoted rCBV value on PWI. The cases with CT examination showed an ill-defined mass with mixed density.

Conclusions

Although there are some overlaps between typical GBM and eGBM, some radiological characteristics, such as location (often in cerebral cortex), involvement of leptomeninge and intratumoral calcium, may support the diagnosis of eGBM.
Testing a pyriproxyfen auto-dissemination station attractive to gravid Anopheles gambiae sensu stricto for the development of novel attract-and-kill strategies for malaria vector control
Authors: Mbare Oscar , Lindsay Steven W. , Fillinger Ulrike
Published: July 2019

Background

Larval source management is an effective supplementary tool for malaria vector control although it is not used widely in sub-Saharan Africa. This study explored whether an attract-and-kill strategy could contaminate gravid Anopheles gambiae sensu stricto with the insect growth regulator, pyriproxyfen, at a bait-station, for dissemination to larval habitats.

Methods

A bait-station comprising an artificial pond, containing water was treated with 20 ppm cedrol, an oviposition attractant, was covered with pyriproxfen-treated netting. Three identical semi-field cages were used to assess the potential of gravid Anopheles gambiae sensu stricto to transfer pyriproxyfen from the bait-station to three open ponds. Gravid females were released in the test and one of the control cages that had no pyriproxyfen on its bait-station. No mosquitoes were released in the third cage with a pyriproxyfen-treated station. Transfer of pyriproxyfen to open ponds was assessed by monitoring emergence of late instar insectary-reared An. gambiae sensu stricto larvae introduced into the open ponds. Liquid chromatography-mass spectrometry was used to quantify the amount of pyriproxyfen carried by a mosquito and the amount transferred to water.

Results

86% (95% CI 81-89%) of larvae introduced into the open ponds in the two control cages developed into adults. Transfer of pyriproxyfen to the test cage depended on the distance of the pond from the bait-station. While only 25% (95% CI 22-29%) adult emergence was observed in larvae introduced into ponds 4.4 m from the bait-station, the emergence rates increased to 92% (95% CI 89-94%) in larvae introduced in ponds 10.3 m away. Each mosquito was contaminated with 112 µg (95% CI 93-123 µg) pyriproxyfen, whilst 230 ng/L (95% CI 180-290 ng/L) was transferred by a single female to 100 ml of water.

Conclusions

Pyriproxyfen was auto-disseminated by gravid females from attractive bait-stations, but mainly to aquatic habitats near the bait station. To make this approach feasible for malaria vector control, stronger attractants and better pyriproxyfen delivery systems are needed.
HIV-1 CRF01_AE subtype and HIV-1 DNA level among patients with chronic HIV-1 infection: a correlation study
Authors: Lyu Tingxia , Yue Yongsong , Evelyn Hsieh , Han Yang , Zhu Ting , Song Xiaojing , Cao Wei , Lyu Wei , Wang Jianhua , Li Taisheng
Published: July 2019

Background

The impact of HIV-1 subtype (CRF01_AE and non-CRF01_AE) on HIV-1 DNA levels in HIV-1 chronically infected patients with suppressive antiretroviral therapy (ART) remains poorly understood. To evaluate the correlation of HIV-1 subtype with DNA level, and identify baseline predictors of HIV-1 DNA decay.

Methods

ART-naïve HIV-1-infected patients from two large multi-center studies in China were classified into CRF01_AE and non-CRF01_AE subtype groups. Peripheral blood samples were collected at baseline and week 12, 24, 48 and 96 after ART initiation and total HIV-1 DNA levels were quantified by real-time PCR. HIV-1 DNA levels at week 96 were categorized into high, moderate, and low levels, reflecting HIV-1 DNA ≥ 3, 2–3, ≤ 2 log10 copies/106 PBMCs, respectively, and the corresponding proportion of CRF01_AE and non-CRF01_AE subtype were compared. The baseline predictors of low HIV-1 total DNA levels (≤ 2 log10 copies/106 PBMCs) at week 96 were evaluated using a logistic regression model.

Results

Compared to the non-CRF01_AE subtypes (n=185), patients with CRF01_AE subtype (n=188) harboured a higher level of HIV-1 DNA (median: 3.19 vs. 2.95 log10 copies/106 PBMCs, P < 0.001) prior to treatment. After 96 weeks of ART, HIV-1 DNA levels remained higher in the CRF01_AE subtype group (median: 2.63 vs. 2.39 log10 copies/106 PBMCs, P = 0.002). There was no significant difference in the proportion of patients achieving high (22.3% vs. 14.6%, P = 0.054), moderate (59.6% vs. 60.5%, P = 0.849) and low levels (18.1% vs 24.9%, P = 0.111) between CRF01_AE and non-CRF01_AE groups. In the multivariable analysis, baseline HIV-1 DNA level and CD4+ T cell count but not the subtype were independent risk factors for achieving HIV-1 DNA level ≤ 2 log10 copies/106 PBMCs.

Conclusion

HIV-1 CRF01_AE subtype is neither correlated with HIV-1 DNA reservoir decline nor a prognostic factor for achieving lower HIV-1 DNA levels (≤ 2 log10 copies/106 PBMCs) after ART. However, higher HIV-1 DNA level in HIV-1 CRF01_AE patients should be aroused much attention and strengthen surveillance during ART.
The Comparison of the adverse events of Pentavalent and DPT vaccines in 2-6 months infants in Iran: A national study
Authors: Moradi Ghobad , Khazaei Zaher , Zahraei Seyed Mohsen , Yaghini Fateme , Amjadian Mohiadin , Roshani Daem
Published: July 2019

Background

Vaccination is the most remarkable intervention in public health and is an effective strategy in order to control infectious diseases among infants. This study attempted to compare the adverse events of Pentavalent and DPT vaccines together.

Methods

This is a cross sectional (analytical-descriptive) study in which the 2-6 months healthy infants, having received DPT in 2013 and Pentavalent in 2015, were studied for their experienced adverse events related to these vaccines. Percentage, mean, standard deviation and chi-square tests were used to describe and analyze the data.

Results

The results showed that 10464 and 17561 adverse events, which are associated with DPT and Pentavalent respectively, were recorded in the infants who received these vaccines throughout Iran. Mazandaran, Qazvin and Golestan provinces reported the highest number of adverse events, respectively (15.74%, 11.25%, and 9.12%). Moreover, Pentavalent seemed to have more recorded adverse events compared to DPT, high fever had the highest record rate for DPT (47.4%) and mild localized complications was the highest for Pentavalent (31.68%). There was a significant relationship between the kind of vaccine and the type of reaction, adverse event categorization, the country produced the vaccine and the infants' place of residence (p<0.05).

Conclusion

Severe localized adverse events including high fever, vomiting, diarrhea and restlessness seemed to be less in Pentavalent compared to DPT vaccine. Therefore, substituting Pentavalent for DPT in infants seems to reduce the adverse events among them.
Prevalence, clinical presentation and outcome of tuberculosis in patients with chronic kidney disease at a tertiary care hospital in Nepal
Authors: Pradhan Ravi Ranjan , Sigdel Mahesh Raj
Published: July 2019

Background:
Tuberculosis (TB) is a serious public health threat in low- and middle-income countries like Nepal. Chronic kidney disease (CKD) patients are at higher risk of developing new infection as well as reactivation of TB. We aimed to determine the prevalence, clinical presentations, and outcome of TB in patients with CKD in Nepal.

Methods:
A hospital-based cross-sectional study was performed at Tribhuvan University Teaching Hospital (TUTH), a tertiary level referral centre in Kathmandu, Nepal. We included patients older than 16 years with the diagnosis of CKD stage 3, 4, 5, and 5D (CKD 5 on maintenance dialysis); renal transplant recipients and patients living with HIV/AIDS were excluded. Tuberculosis was diagnosed based on clinical, radiological and laboratory findings. Prior written informed consent was obtained. Approval was obtained from Institutional review Board of Institute of Medicine. Data entry and statistical analysis were performed using SPSS v21.

Results:
A total of 401 patients with CKD were included in the study (mean age, 50.92 ±17.98 years; 64.8% male). The prevalence of TB in CKD patients was found to be 13.7% (55), out of which 49 were newly diagnosed cases. Most common clinical presentations of TB in CKD were anorexia (85.7%), fever (83.7%), weight loss (51%), and cough (49%). Thirty eight patients (69.1 %) had extrapulmonary TB (EPTB), 12 (21.8%) had pulmonary TB, 3 (5.5%) had disseminated TB and 2 (3.6%) had miliary TB. Only 4.1% cases were sputum smear positive. Pleural effusion (34.2%) was the most common EPTB. At 2 months of starting anti-tubercular therapy, 29 patients out of the 49 newly cases of TB (59.2%) had responded to therapy. Mortality at 2 months was 28.6% (14 died amongst 49 patients). Four out of 49 patients (8.2%) didn’t improve, and 2 (4%) patients were lost to follow up.

Conclusion:
Prevalence and mortality of TB was higher in cohort of CKD. Special attention must be given to these people for timely diagnosis and treatment as the presentation is different and diagnosis can be missed.
The first survey on defensive medicine among Iranian surgeons: prevalence and its related factors
Authors: Zarei Ehsan , Ashtar-Nakhaei Faezeh , Daneshkohan Abbas , Zali Alireza
Published: July 2019

Introduction

Defensive medicine (DM) is defined as the deviation of a physician from normal behavior or what is good practice aimed at decreasing or preventing from the complaints and criticism by the patients or their families. The current study aimed at examining DM behaviors in a sample of Iranian surgeons.

Methods

In this cross-sectional study, 235 surgeons were selected by systematic random sampling method. The data gathering tool was a researcher-made questionnaire which its validity and reliability were confirmed. For data analysis, Fisher's exact test, Kruskal-Wallis test, Chi-square and logistic regression tests were used in SPSS 21 software.

Results

The most common positive DM behaviors including unnecessary biopsy (78.7%), imaging and laboratory tests (72.3% and 70.6%), and refusing to accept high-risk patients (61.7%) was also the most common negative DM behavior among surgeons. The likelihood of DM behaviors was more in young and less experienced surgeons. Other variables such as gender, specialty and complaint history also had a positive effect on some DM behaviors (p <0.05).

Conclusion

Strategies such as reforming the rules and regulations for medical errors and patient complaints, increasing monitoring of service delivery, developing and implementing medical guidelines and evidence-based medicine, and reforming medical liability insurance system are effective to reduce DM behaviors in order to prevent its adverse effects on the health system and patients.
Impact of weight trajectory after bariatric surgery on co-morbidity evolution and burden
Authors: Davis Jason , Saunders Rhodri
Published: July 2019

Background
Bariatric surgery in its various forms has been shown to be an effective intervention for weight management in select patients. Different types of surgery such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy demonstrate different efficacies in weight loss and co-morbidity resolution. Even within a single type of surgery, different patients respond differently and have differing weight-change trajectories post-surgery. The present analysis explores how improving a patient’s post-surgical weight change could impact on co-morbidity prevalence, treatment and associated costs in the Canadian setting.
Methods
Published data were used to derive statistical models to predict weight loss and co-morbidity evolution after RYGB. A 100-patient cohort was compared for an optimal versus a poor weight trajectory over a 10-year time horizon after surgery. Costs (2018 CAD$) were considered from the Canadian public payer perspective for diabetes, hypertension and dyslipidaemia. Robustness of results was assessed using probabilistic sensitivity analyses using the R language.
Results
Models fitted to patient data for total weight loss and co-morbidity evolution (resolution and new onset) demonstrated good fitting. Having a good versus poor weight trajectory resulted in a decreased burden, saving 181, 817, and 530 patient-years of diabetes, hypertension and dyslipidaemia treatment respectively. Cohorts on a good weight trajectory following RYGB had $1.9 million lower costs at 10 years than those on a poor weight trajectory.
Conclusions
Within a cohort of patients receiving the same type of bariatric surgery, achieving a good versus a poor weight loss trajectory can have a significant impact on outcomes by reducing the number of patient years of co-morbidity treatment and corresponding cost. Given the burden associated with a poor weight trajectory, health care systems should consider how best to ensure that more patients achieve a good long-term weight trajectory after bariatric surgery.
Women’s choices for breast cancer surgery in Italy: quality and equity implications
Authors: Ferre Francesca , Seghieri Chiara , Nuti Sabina
Published: July 2019

Background

Equity and quality in healthcare are key goals embraced by universal healthcare systems; however, inequalities in access and unwarranted variations in quality of care are well documented in the Italian healthcare system. To reduce unwarranted variation and improve equal utilization of services at hospital level, national quality standards have been applied for selected clinical procedures including oncological surgery for which there is evidence of a positive relationship between volumes and clinical outcomes. However, high dispersion of surgical interventions across hospitals still exists highlighting the need to understand the determinants behind women’s choice for hospital for breast surgery.

Methods

We apply mixed logit regression to investigate the determinants, both at patient and provider level, associated with women’s choice of hospital for breast surgery. Patient level non-emergency hospital data are used to model breast cancer surgical choices in Tuscany region, Italy. We considered hospitalizations occurring during 2016. We focused on the effects of travel time and hospital performance for breast cancer treatments (elective surgery) in different patient groups. Hospital quality indicators include structural variables (volumes), measurement of process (timeliness) and quality of surgical procedures as recommended by clinical guidelines (proportion of breast-conservative surgery and execution of the sentinel lymph node biopsy).

Results

Results reveal that women prefer hospitals nearby, delivering high volumes of interventions with an appropriate surgical approach. Differences in women choice depend on education and age. Highly educated patients travelled further to seek surgical intervention for breast cancer and were likely to select high performing hospitals. Moreover, older women preferred quicker response compared to younger women when awaiting surgical interventions.

Conclusions

Differences in patient choice highlight equity concerns in access to elective breast cancer surgery. These results could be used to optimize the allocation of resources toward breast cancer units that meet quality and efficacy standards to increase the efficiency and responsiveness of breast cancer care.
A Systematic Review to Assess the Effectiveness of Technology-Based Interventions to Address Obesity in Children
Authors: McMullan Megan , Millar Rachel , Woodside Jayne
Published: July 2019

Background: Childhood obesity is associated with a multitude of co-morbidities, including hypertension, hyperlipidaemia, cardiovascular disease and type 2 diabetes. Childhood obesity can also affect a young person’s social, emotional and mental health if they encounter negative prejudice and social marginalisation. Given the prevalence of overweight and obese children globally, it is imperative that effective interventions are developed. Children are receptive to information conveyed via digital means, therefore, the use of technology may play a crucial role in interventions to reduce childhood obesity. This systematic review aimed to review and critically appraise the literature published to date in relation to the effectiveness of technology-based interventions, employed as secondary prevention, in addressing childhood obesity.
Methods: An electronic search strategy was undertaken in Medline and Embase, covering publications up to and including 12th July 2018. Randomised controlled trials assessing the effectiveness of technology-based interventions on weight-related outcomes in children, aged 8 to 18, published only in the English language, were included.
Results: From an initial search total of 1,012 studies, 11 met the inclusion criteria. They were assessed for methodological quality using the Cochrane Risk of Bias Tool for Randomised Controlled Trials and were analysed using a narrative approach. The findings of this review showed a weak evidence base regarding the role of technology-based interventions, employed as secondary prevention, to address childhood obesity. Of the eleven studies reviewed, three (27%) showed a positive relationship between technology-based interventions and weight-related outcomes in overweight or obese children.
Conclusions: This review suggests that technology-based interventions, primarily active video games, as well as internet or web-based interventions and mobile phone communications, may, with further research, have the potential to impact positively on weight-related outcomes. It is difficult to determine the degree of efficacy of these technology-based interventions, as only two databases were searched, selecting only English language articles. Moreover, the included studies demonstrated a lack of high-quality evidence. The lack and heterogeneity of studies with technology-based interventions is a further limitation.
Effect of Elevated Concentrations of Copper Ions on Growth Characteristics and Synthesis of Steroidal Glycosides in Suspension Plant Cell Culture of Tribulus terrestris L.
Authors: Kochkin D.V. , Galishev В A. , Nosov A.M.
Published: July 2019

In order to optimize the productivity of plant cell cultures for pharmacologically valuable compounds(steroidal glycosides), the effect of the elevated concentrations copper ions on growth and biosynthetic characteristics of the suspension culture of Tribulus terrestris L. has been studied. It was shown that the increase in the content of copper ions in nutrient medium by 5-100 times (up to 10 uM) did not practically affect growth characteristics of the cell culture; however, high concentrations (5 and 10 uM) caused a significant (below 50%) decrease in the cell viability. It was proved by UPLC ESI MS that the T. terrestris biomass contains a furostanol glycoside, terrestrinin B, and its 25(R)-stereoisomer. An increase in the concentration of copper ions in the medium provided a significant (up to 3 times) increase in the content of furostanol glycosides in the first cultivation cycle, and this compound was maintained in the next 5-7 cultivation cycles, although its content was 1.5-2 times lower. On the contrary, changes in the hormonal status of the medium (removal of α-NAA) could result in changes in the composition of furostanol glycosides (disappearance or a drastic decrease in the content of terrestrozin N derivatives, the presence of which in this plant cell culture was shown previously). It may be concluded that heavy metals (copper ions) can intensify the formation of steroidal glycosides in T. terrestris cell culture, whereas growth regulators (for example, auxins) can change their qualitative composition.

copper ions, steroidal glycosides, plant suspension cell culture, Tribulus terrestris

The work was financially supported by the Russian Science Foundation (№ 16-14-00126).