bluuebunny/crossref_metadata_2025 huggingface dataset:
Concepts to Improve the Quality of Production Plans using Machine Learning
Authors: Lingitz Lukas , Sihn Wilfried
Published: June 2020

There are always deviations between production planning and subsequent execution. Furthermore, it was found that the reliability of the production plans and thus the planning quality (PQ) can drop down to 25% in the first three days after plan creation. These deviations are caused by uncertainties, e.g. inaccurate or insufficient planning data such as data quality and availability, inappropriate planning and control systems or unforeseeable events. Production planners therefore use buffers in the form of inventories or extended transitional periods to create possibilities for implementing corrective measures in production control. Buffers, however, lead to increased coordination and control effort and to negative effects, e.g. on inventory, throughput time and capacity utilization. Potentials for more accurate planning remains largely unexploited. The objective of this paper is to investigate the possibilities to increase planning quality. Within a case study the authors demonstrate how machine learning can be used to predict cycle times. Furthermore, the increased accuracy compared to the current method is shown. Based on this, two approaches are presented, focusing on the reduction of gaps between master data and predicted data used during the production planning process. Moreover, further research needs are identified.
The Mortality Effects of Reduced Medicaid Coverage Among International Migrants in Hawaii: 2012–2018
Authors: Molina Teresa , Sentell Tetine , Akee Randall Q. , Onaka Alvin , Halliday Timothy J. , Horiuchi Brian
Published: June 2020

Objectives. To study the impact on mortality in Hawaii from the revoked state Medicaid program coverage in March 2015 for most Compact of Free Association (COFA) migrants who were nonblind, nondisabled, and nonpregnant.

Methods. We computed quarterly crude mortality rates for COFA migrants, Whites, and Japanese Americans from March 2012 to November 2018. We employed a difference-in-difference research design to estimate the impact of the Medicaid expiration on log mortality rates.

Results. We saw larger increases in COFA migrant mortality rates than White mortality rates after March 2015. By 2018, the increase was 43% larger for COFA migrants (P = .003). Mortality trends over this period were similar for Whites and Japanese Americans, who were not affected by the policy.

Conclusions. Mortality rates of COFA migrants increased after Medicaid benefits expired despite the availability of state-funded premium coverage for private insurance and significant outreach efforts to reduce the impact of this coverage change.
Self-Reported Conversion Efforts and Suicidality Among US LGBTQ Youths and Young Adults, 2018
Authors: Green Amy E. , Price-Feeney Myeshia , Dorison Samuel H. , Pick Casey J.
Published: June 2020

Objectives. To explore associations between undergoing sexual orientation or gender identity conversion efforts (SOGICE) and suicidality among young LGBTQ (lesbian, gay, bisexual, transgender, and queer or questioning) individuals.

Methods. Data were derived from a 2018 online cross-sectional study of young LGBTQ individuals (13–24 years of age) residing in the United States. Multivariate logistic regression was used to determine the relative odds of suicidality among young LGBTQ individuals who experienced SOGICE (in comparison with those who did not) after adjustment for age, race/ethnicity, geography, parents’ use of religion to say negative things about being LGBTQ, sexual orientation, gender identity, discrimination because of sexual orientation or gender identity, and physical threats or harm because of sexual orientation or gender identity.

Results. Relative to young people who had not experienced SOGICE, those who reported undergoing SOGICE were more than twice as likely to report having attempted suicide and having multiple suicide attempts.

Conclusions. The elevated odds of suicidality observed among young LGBTQ individuals exposed to SOGICE underscore the detrimental effects of this unethical practice in a population that already experiences significantly greater risks for suicidality.
Management of Subtrochanteric Femoral Fracture Nonunions
Authors: DeRogatis Michael J. , Kanakamedala Ajay C. , Egol Kenneth A.
Published: June 2020

» Compared with other proximal femoral fractures, subtrochanteric fractures are at a higher risk for nonunion because of the high deforming forces in this region, the associated increased risk of malreduction, and the risk of poor bone healing secondary to bisphosphonate use frequently associated with these fractures.

» Further understanding of nonunion of subtrochanteric fractures is of increasing importance given the rise in incidence of subtrochanteric hip fractures.

» Surgeons should be aware of risk factors for nonunion and techniques for prevention as well as surgical management and complications associated with surgical implantation devices.

» Surgeons should also consider using adjuncts including bone-grafting and biologic agents.
Integrated Analysis of Tracer and Pressure-Interference Tests To Identify Well Interference
Authors: Kumar Ashish , Seth Puneet , Shrivastava Kaustubh , Manchanda Ripudaman , Sharma Mukul M.
Published: June 2020

In ultralow-permeability reservoirs, communication between wells through connected fractures can be observed through tracer and pressure-interference tests. Understanding the connectivity between fractured horizontal wells in a multiwell pad is important for infill well drilling and parent-child well interactions. Interwell tracer and pressure-interference tests involve two or more fractured horizontal wells and provide information about hydraulic-fracture connectivity between the wells. In this work, we present an integrated approach based on the analysis of tracer and pressure interference data to obtain the degree of interference between fractured horizontal wells in a multiwell pad.

We analyze well interference using tracer (chemical tracer and radioactive proppant tracer) and pressure data in an 11-well pad in the Permian Basin. Changes in pressure and tracer concentration in the monitor wells were used to identify and evaluate interference between the source and monitor wells. Extremely low tracer recovery and weak pressure response signify the absence of connected fractures and suggest that interference through matrix alone is insignificant. Combined tracer and pressure-interference data suggest connected fracture pathways between the communicating wells. The degree of interference can be estimated in terms of pressure response times and tracer recovery. An effective reservoir model was used to simulate pressure interference between wells during production. Simulation results indicate that well interference observed during production is primarily because of hydraulically connected fractures.

Combined tracer and pressure-interference analysis provides a unique tool for understanding the time-dependent connectivity between communicating wells, which can be useful for optimizing infill well drilling, well spacing, and fracture sizing in future treatment designs.
Transcriptome analysis reveals a molecular understanding of nicotinamide and butyrate sodium on meat quality of broilers under high stocking density
Authors: Wu Yuqin , Wang Youli , Yin Dafei , Mahmood Tahir , Yuan Jianmin
Published: June 2020

Background: In recent years, increased attention has been focused on breast muscle yield and meat quality in poultry production. Supplementation with nicotinamide and butyrate sodium can improve the meat quality of broilers. However, the potential molecular mechanism is not clear yet. This study was designed to investigate the effects of supplementation with a combination of nicotinamide and butyrate sodium on breast muscle transcriptome of broilers under high stocking density. A total of 300 21-d-old Cobb broilers were randomly allocated into 3 groups based on stocking density: low stocking density control group (L; 14 birds/m2), high stocking density control group (H; 18 birds/m2), and high stocking density group provided with a combination of 50 mg/kg nicotinamide and 500 mg/kg butyrate sodium (COMB; 18 birds/m2), raised to 42 days of age. Results: The H group significantly increased cooking losses, pH decline and activity of lactate dehydrogenase in breast muscle when compared with the L group. COMB showed a significant decrease in these indices by comparison with the H group (P < 0.05). The transcriptome results showed that key genes involved in glycolysis, proteolysis and immune stress were up-regulated whereas those relating to muscle development, cell adhesion, cell matrix and collagen were down-regulated in the H group as compared to the L group. In contrast, genes related to muscle development, hyaluronic acid, mitochondrial function, and redox pathways were up-regulated while those associated with inflammatory response, acid metabolism, lipid metabolism, and glycolysis pathway were down-regulated in the COMB group when compared with the H group. Conclusions: The combination of nicotinamide and butyrate sodium may improve muscle quality by enhancing mitochondrial function and antioxidant capacity, inhibiting inflammatory response and glycolysis, and promoting muscle development and hyaluronic acid synthesis.
Mitochondrial DNA copy number in cervical exfoliated cells and risk of cervical cancer among HPV-positive women
Authors: Sun Wei , Qin Xueyun , Zhou Jing , Xu Mingjing , Lyu Zhangyan , Li Xin , Zhang Kai , Dai Min , Li Ni , Hang Dong
Published: June 2020

Background Although human papillomavirus (HPV) infection has been recognized as the cause of cervical cancer in over 99% of cases, only a minority of HPV-infected women develop this malignancy. Emerging evidence suggests that alterations of mitochondrial DNA copy number (mtCN) may contribute to carcinogenesis. However, the relationship between mtCN and cervical cancer remains unknown.Methods In this case-control study, we included 591 cervical cancer cases and 373 cancer-free controls, all of whom were infected with high-risk HPV. Relative mtCN in cervical cancer exfoliated cells was measured by qRT-PCR assays, and logistic regression analysis was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Interaction between mtCN and HPV types was assessed by using the Wald test in logistic regression models.Results HPV16, 18, 52, and 58 were the most common types in both case and control groups. Median mtCN in cases was significantly higher than that in controls (1.63 vs. 1.23, P = 0.03). After adjustment for age and HPV types, the highest quartile of mtCN was associated with increased odds of having cervical cancer (OR = 1.77, 95% CI = 1.19, 2.62; P < 0.01), as compared to the lowest quartile. A dose-response effect of mtCN on cervical cancer was also observed (Ptrend < 0.001). The interaction between mtCN and HPV types was statistically nonsignificant.Conclusions In women who test HPV positive, the increase of mtCN in cervical exfoliated cells is associated with cervical cancer. This suggests a potential role of mtCN in cervical carcinogenesis.
Schizothorax richardsonii dsRNA dependent protein kinase has three double-stranded RNA binding motifs with a promoter lacking conserved kinase sequence
Authors: Saxena Ankur , Belwal Kiran , Chaturvedi Preeti , Pande Amit
Published: June 2020

The authors have withdrawn this preprint due to author disagreement.
Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study
Authors: Jin Yinzi , Xu Jin , Zhu Weiming , Zhang Yaoguang , Xu Ling , Meng Qingyue
Published: June 2020

Background: People bypass primary healthcare (PHC) institutions to seek expensive healthcare at high-level hospitals, leading to escalating medical costs and inefficient use of resources. In 2009, China launched nationwide synergic policies on primary care strengthening, to tackle access to healthcare and financial protection. This study aimed to assess the impact of the two policy areas, health insurance and health workforce, on healthcare seeking behavior.Methods: Drawing on national survey data before (2008) and after (2013) the policies, we linked individual-level data on healthcare-seeking behavior with county-level data on health workforce and health insurance. We constructed a multilevel zero-inflated negative binomial regression to examine the impacts of average reimbursement rate (ARR) of health insurance and the density of registered physicians on outpatient/inpatient visits, and multilevel multinomial logistic regression for the impacts on choice of outpatient/inpatient care providers. Results: Although the increase in health insurance ARR and physician density have positive impacts on individuals’ healthcare use, their impacts might be weakened during 2008 and 2013, and the negative impacts of investment of those in PHC institutions on likelihood of visiting hospitals was larger. The negative impacts of ARR at PHC institutions on likelihood of visiting county-, municipal- and higher-level hospitals in 2013 was 28 percentage points, 66 percentage points and 33 percentage points larger than these in 2008.Conclusions: Primary care strengthening requires synergic policies. Effective mechanisms for coordination across multisectoral actions are necessities for deepening those policies to ensure efficient delivery of healthcare without experiencing financial risks.
A cross-sectional study of Swiss ambulatory care services use by multimorbid patients in primary care in the light of the Andersen model
Authors: Messi Mia , Mueller Yolanda , Haller Dagmar M. , Zeller Andreas , Neuner-Jehle Stefan , Streit Sven , Burnand Bernard , Herzig Lilli
Published: June 2020

Background: Multimorbidity is frequently encountered in primary care and is associated with increasing use of healthcare services. The Andersen Behavioral Model of Health Services Use is a multilevel framework classifying societal, contextual, and individual characteristics about the use of healthcare services into three categories: 1. predisposing factors, 2. enabling factors, and 3. need factors. The present study aimed to explore multimorbid patients' use of ambulatory healthcare in terms of homecare and other allied health services, visits to GPs, and number of specialists involved. A secondary aim was to apply Andersen's model to explore factors associated with this use. Method: In a cross-sectional study, 100 Swiss GPs enrolled up to 10 multimorbid patients each. After descriptive analyses, we tested the associations of each determinant and outcome variable of healthcare use, according to the Andersen model: predisposing factors (patient's demographics), enabling factors (health literacy (HLS-EU-Q6), deprivation (DipCare)), and need factors (patient's quality of life (EQ-5D-3L), treatment burden (TBQ), severity index (CIRS), number of chronic conditions, and of medications). Logistic regressions (dichotomous variables) and negative binomial regressions (count variables) were calculated to identify predictors of multimorbid patients' healthcare use.Results: Analyses included 843 multimorbid patients; mean age 73.0 (SD 12.0), 28–98 years old; 48.3% men; 15.1% (127/843) used homecare. Social deprivation (OR 0.75, 95%CI 0.62–0.89) and absence of an informal caregiver (OR 0.50, 95%CI 0.28–0.88) were related to less homecare services use. The use of other allied health services (34.9% (294/843)) was associated with experiencing pain (OR 2.49, 95%CI 1.59–3.90). The number of contacts with a GP (median 11 (IQR 7-16)) was, among other factors, related to the absence of an informal caregiver (IRR 0.90, 95%CI 0.83–0.98). The number of specialists involved (mean 1.9 (SD 1.4)) was linked to the treatment burden (IRR 1.06, 95%CI 1.02–1.10).Conclusion: Multimorbid patients in primary care reported high use of ambulatory healthcare services variably associated with the Andersen model's factors: healthcare use was associated with objective medical needs but also with contextual or individual predisposing or enabling factors. These findings emphasize the importance of adapting care coordination to individual patient profiles.
Engagement Complications of Adolescents with Borderline Personality Disorder: Navigating Through a Zone of Turbulence
Authors: Desrosiers Lyne , St-Jean Micheline , Laporte Lise , Lord Marie-Michèle
Published: June 2020

Objective: Premature treatment discontinuation is a widespread phenomenon in child and adolescent mental health services that impacts treatment benefits and costs of care. Adolescents with borderline personality disorder (BPD) are heavy users of health care services and notoriously difficult to engage in treatment. However, there is hardly any data regarding this phenomenon with these youths. Considering that BPD treatment is associated with intense and chaotic therapeutic processes, exploring barriers emerging in the course of treatment could be relevant. Thus, conceptualizing treatment dropout as a process evolving from engagement to progressive disengagement, and ultimately to dropout, could highlight the mechanisms involved. The aim of this study was to describe the process of treatment disengagement and identify warning signs that foreshadow dropouts of adolescents with BPD. Method: A constructivist grounded theory method was used. This method has been favoured based on the assumption that the behaviours and decisions leading to disengagement may be better informed by the subjective experience of treatment. Thirty-three interviews were conducted to document 11 treatment trajectories with 3 groups of informants (9 adolescents with BPD 13-17 of age, 11 parents, and 13 clinicians). Results: Well before dropout occurs, different phenomena identified as “engagement complications” characterize the disengagement process. These unfold according to a three-step sequence starting with negative emotions associated with the appropriateness of treatment, the therapeutic relationship or the vicissitudes of treatment. These emotions will then generate treatment interfering attitudes that eventually evolve into openly disengaged behaviours. These complications, which may sometimes go unnoticed, punctuate the progression from treatment engagement to disengagement leading the way towards the development of a “zone of turbulence” which creates a vulnerable and unstable therapeutic process presenting risk for late dropout. Conclusion: Engagement of adolescents with BPD is neither static nor certain, but on the contrary, subject to their fluctuating perceptions. Therefore, it can never be taken for granted. Clinicians must constantly pay attention to emergent signs of engagement complications. Maintaining the engagement of adolescents with BPD should be a therapeutic objective akin to reducing symptomatology or improving psychosocial functioning, and should therefore be given the same attention.
Doubly robust estimator of risk in the presence of censoring dependent on time-varying covariates: application to a primary prevention trial for coronary events with pravastatin
Authors: Kawahara Takuya , Shinozaki Tomohiro , Matsuyama Yutaka
Published: June 2020

Background: In the presence of dependent censoring even after stratification of baseline covariates, the Kaplan–Meier estimator provides an inconsistent estimate of risk. To account for dependent censoring, time-varying covariates can be used along with two statistical methods: the inverse probability of censoring weighted (IPCW) Kaplan–Meier estimator and the parametric g-formula estimator. The consistency of the IPCW Kaplan–Meier estimator depends on the correctness of the model specification of censoring hazard, whereas that of the parametric g-formula estimator depends on the correctness of the models for event hazard and time-varying covariates. Methods: We combined the IPCW Kaplan–Meier estimator and the parametric g-formula estimator into a doubly robust estimator that can adjust for dependent censoring. The estimator is theoretically more robust to model misspecification than the IPCW Kaplan–Meier estimator and the parametric g-formula estimator. We conducted simulation studies with a time-varying covariate that affected both time-to-event and censoring under correct and incorrect models for censoring, event, and time-varying covariates. We applied our proposed estimator to a large clinical trial data with censoring before the end of follow-up.Results: Simulation studies demonstrated that our proposed estimator is doubly robust, namely it is consistent if either the model for the IPCW Kaplan–Meier estimator or the models for the parametric g-formula estimator, but not necessarily both, is correctly specified. Simulation studies and data application demonstrated that our estimator can be more efficient than the IPCW Kaplan–Meier estimator.Conclusions: The proposed estimator is useful for estimation of risk if censoring is affected by time-varying risk factors.
Distributed causality in resting-state network connectivity in the acute and remitting phases of RRMS
Authors: Wu Lin , Huang Muhua , Zhou Fuqing , Zeng Xianjun , Gong Honghan
Published: June 2020

Background: Although previous studies have shown that intranetwork abnormalities in brain functional networks are correlated with clinical/cognitive impairment in multiple sclerosis (MS), there is little information regarding the pattern of causal interactions among cognition-related resting-state networks (RSNs) in different disease stages of relapsing-remitting MS (RRMS) patients. We hypothesized that abnormalities of causal interactions among RSNs occurred in RRMS patients in the acute and remitting phases.Patients and methods: Seventeen patients in the acute phases of RRMS, 24 patients in the remitting phases of RRMS, and 23 appropriately matched healthy controls participated in this study. First, we used group independent component analysis to extract the time courses of the spatially independent components from all the subjects. Then, the Granger causality test was used to investigate the causal relationships among RSNs in the spectral domain and to identify correlations with clinical indices . Results: Compared with the patients in the acute phase of RRMS, patients in the remitting phase of RRMS showed a significantly lower expanded disability status scale, modified fatigue impact scale scores, and significantly higher paced auditory serial addition test (PASAT) scores. Compared with healthy subjects, during the acute phase, RRMS patients had significantly increased driving connectivity from the right executive control network (rECN) to the anterior salience network (aSN), and the causal coefficient was negatively correlated with the PASAT score. During the remitting phase, RRMS patients had significantly increased driving connectivity from the rECN to the aSN and from the rECN to the visuospatial network. Conclusion: Together with the disease duration (mean disease duration < 5 years) and relatively better clinical scores than those in the acute phase, abnormal connections, such as the information flow from the rECN to the aSN and the rECN to the visuospatial network, might provide adaptive compensation in the remitting phase of RRMS.
Uptake and predictors of direct-acting antiviral treatment for hepatitis C among people receiving opioid agonist therapy in Sweden and Norway: a drug utilization study from 2014 to 2017
Authors: Aas Christer F. , Vold Jørn Henrik , Skurtveit Svetlana , Odsbu Ingvild , Chalabianloo Fatemeh , Lim Aaron G. , Johansson Kjell Arne , Fadnes Lars Thore
Published: June 2020

Background: Treatment with direct-acting antiviral agents (DAAs) offers an opportunity to eliminate hepatitis C virus (HCV) endemic among people who inject drugs (PWID) and people enrolled in opioid agonist therapy (OAT) programs. The objective of this study was to estimate and to compare HCV treatment uptake after the introduction of DAAs among patients receiving OAT in Sweden and Norway. We also aimed to evaluate predictors of DAAs treatment among OAT patients in both countries.Methods: This observational study was conducted with data from The Swedish Prescribed Drug Register and The Norwegian Prescription Database. We studied dispensed medications to calculate HCV treatment among OAT patients from 2014 to 2017 in Sweden and Norway. HCV prevalence was estimated from primary and secondary sources. Dispensations of medicines from different therapeutic areas, which served as proxy for co-morbidities in 2017, were conditionally adjusted for age, gender, and OAT medications. Logistic regression was used to evaluate these parameters. Results: In total 3,529 individuals were identified with dispensed OAT in the Swedish cohort and 7,739 individuals in the Norwegian cohort. HCV treatment was utilized by 407 persons in Sweden and 920 in Norway during the study period. Annual HCV and DAA treatment uptake increased in both countries. The estimated cumulative HCV treatment uptake at the end of 2017 was 31% in Norway and 28% in Sweden. DAA treatment was associated with increased age (aOR 1.8; 95% CI 1.0-3.2) and the dispensation of drugs used for diabetes (aOR 3.2; 95% CI 1.8-5.7) in Sweden. In Norway, lipid modifying agents and antibacterials were associated with decreased odds (aOR 0.4; 95%CI 0.2-0.9, aOR 0.8; 95%CI 0.6-1.0).Conclusions: An increase in DAA treatment and HCV treatment uptake was observed among Swedish and Norwegian OAT patients whilst introducing new direct-acting antiviral treatment regimens. However, more than two thirds of the OAT population in Norway and Sweden were untreated at the beginning of 2018. A further scale-up is crucial in order to control and eliminate the HCV endemic among OAT patients.
Switch to autophagy the key mechanism for trabecular meshwork death in severe glaucoma.
Authors: Rao Aparna , Sahay Prity , Chakraborthy Munmun , Prusty Birendra , Sriniva Sandhya , Mishra Pragyan , Modak Rahul , Suar Mrutyunjay
Published: June 2020

Background
The key differences in cell deathmechanisms in the trabecular meshwork (TM) in adult moderate and severe primary glaucoma remain still unanswered. This studyexplored key differences in cell deathmechanisms in the trabecular meshwork (TM) in adult moderate and severe primary glaucoma.
Methods
Select cell death related proteins differentially expressed on mass spectrometric analysis in ex-vivo dissected TM specimens patients with severe adult primary open angle (POAG) or angle closure glaucoma (PACG) compared to controls (cadaver donor cornea), were validated for temporal changes in cell death related gene expression on in-vitro primary human TM cell culture after 48 hours (moderate) or 72 hours (severe) oxidative stress with H2O2 (400-1000uM concentration). These were compared with histone modifications after oxidative stress in HTM culture and peripheral blood of patients with moderate and severe glaucoma.
Results
Autophagy related proteins seemed to be the predominant cell death mechanism over apoptosis in ex-vivo dissected TM specimens in severe glaucoma. Analyzing HTM cell gene expression at 48 hrs and 72 hours of oxidative stress, autophagy genes were up-regulated at 48 hours of exposure > 72 hours which was in contrast to apoptosis related genes showing down-regulation at 72 hours. There was corresponding preferential abrupt upregulation of autophagy genes in the peripheral blood of the patients with severe glaucoma with associated increased expression of H3K14ac in HTM after 72 hrs of oxidative stress and in peripheral blood of severe POAG and PACG patients. Necrosis seemed to play a minimal role in cell death in moderate or severe stress in cell lines or peripheral blood.
Conclusion
A preference of autophagy over apoptosis may be underlie the mechanism of stage transition from moderate to severe glaucoma in the trabecular meshwork or peripheral blood which may be tightly regulated by epigenetic modulators. Associated epigenetic control mediating the unidirectional upregulation of autophagy in severe glaucoma requires to be explored.
Reactional Ultrasonic Systems And Microwave Irradiation For Pretreatment Of Agro-Industrial Waste To Increase Enzymatic Activity
Authors: Czapela Fabiane Fernanda , Kubeneck Simone , Preczeski Karina Paula , Dalastra Caroline , Scapini Thamarys , Bonatto Charline , Stefanski Fábio Spitza , Camargo Aline Frumi , Zanivan Jessica , Mossi Altemir José , Fongaro Gislaine , Treichel Helen
Published: June 2020

Pretreatment of keratinous residues using an ultrasonic reaction system provides greater enzymatic production in less time. This is a promising technology for measuring enzyme activity and microwave processes. In the present work, an ultrasonic probe reaction system was used to evaluate the potential of swine hair pretreatment. The pretreated material was submerged with non-pretreated residues for 9 days to obtain the enzyme. Enzyme activity was measured in the extracts obtained using the ultrasonic probe, ultrasonic bath, and microwave. We also used the enzymatic concentration technique with NaCl and acetone. Homemade enzymatic extracts were evaluated for their ability to degrade swine hair and chicken feathers by comparing them with the activities commercial enzymes. Macrobeads gave greater energy dissipation in less time, providing greater enzyme activity (50.8 U/mL over 3 days). In terms of waste degradation, non-pretreated swine hair was more promising. The ultrasonic probe reaction system had the potential to evaluate increased enzyme activity (38.4% relative activity) and the enzyme concentration increased activity by 53.5%. The homemade enzymatic extract showed promise for degradation of keratinous residues.
Person-centred care in practice: Perspectives from a short-course regimen for multi-drug resistant tuberculosis in Karakalpakstan, Uzbekistan
Authors: Horter Shona , Stringer Beverley , Gray Nell , Parpieva Nargiza , Safaev Khasan , Tigay Zinaida , Singh Jatinder , Achar Jay
Published: June 2020

Introduction: Person-centred care, an internationally recognised priority, describes the involvement of people in their care and treatment decisions, and the consideration of their needs and priorities within service delivery. Clarity is required regarding how it may be implemented in practice within different contexts. The standard multi-drug resistant tuberculosis (MDR-TB) treatment regimen is lengthy, toxic and insufficiently effective. 2019 World Health Organisation guidelines include a shorter (9-11-month) regimen and recommend that people with MDR-TB be involved in the choice of treatment option. We examine the perspectives and experiences of people with MDR-TB and health-care workers (HCW) regarding person-centred care in an MDR-TB programme in Karakalpakstan, Uzbekistan, run by Médecins Sans Frontières and the Ministry of Health.Methods: A qualitative study comprising 48 interviews with 24 people with MDR-TB and 20 HCW was conducted in June-July 2019. Participants were recruited purposively to include a range of treatment-taking experiences and professional positions. Interview data were analysed thematically using coding to identify emerging patterns, concepts, and categories relating to person-centred care, with Nvivo12.Results: People with MDR-TB were unfamiliar with shared decision-making and felt uncomfortable taking responsibility for their treatment choice. HCW were viewed as having greater knowledge and expertise, and patients trusted HCW to act in their best interests, deferring the choice of appropriate treatment course to them. HCW had concerns about involving people in treatment choices, preferring that doctors made decisions. People with MDR-TB wanted to be involved in discussions about their treatment, and have their preference sought, and were comfortable choosing whether treatment was ambulatory or hospital-based. Participants felt it important that people with MDR-TB had knowledge and understanding about their treatment and disease, to foster their sense of preparedness and ownership for treatment. Involving people in their care was said to motivate sustained treatment-taking, which some felt directly observed treatment (DOT) could undermine. Conclusions: There is a preference for doctors choosing the treatment regimen, linked to shared decision-making unfamiliarity and practitioner-patient knowledge imbalance. Involving people in their care, through discussions, information, and preference-seeking could foster ownership and self-responsibility, supporting sustained engagement with treatment, which DOT may contradict.
Comparative In Vitro Quality Evaluation of Different Brands of Ibuprofen Tablets Marketed in Mekelle, Ethiopia
Authors: Welegebrial Brhane Gebrehiwot , Kahsay Getu , Eticha Tadele , Gebretsadik Hailekiros
Published: June 2020

Objective: Quality of pharmaceutical products is required to guarantee their safety and efficacy. The aim of this study was to evaluate the physicochemical quality attributes of different brands of ibuprofen tablets marketed in Mekelle, Ethiopia. The methods stated in the British Pharmacopeia were adopted for weight uniformity, hardness, friability, disintegration test and assay of drug content. Dissolution test was also carried out as stated in the United States Pharmacopeia. To compare dissolution profile, statistical analysis of drug release at different time points were employed. Results: All the brands were found with acceptable pharmacopeial specifications for weight uniformity, friability, hardness, assay of drug content and dissolution test. Six brands fulfilled the pharmacopeial requirements of disintegration test while one brand failed to disintegrate as per the BP specification. However, there were statistically significant difference in weight, hardness, disintegration, dissolution and amount of drug content among the tested samples. Thus, from this study we can conclude that all the products fulfilled the required quality evaluation parameters as stipulated in pharmacopeias except one brand which failed the disintegration test. However, the in vitro dissolution profile indicated that there may be a potential bio-in equivalence among the pharmaceutical products.
Effectiveness over 10 years (2004-2014) of the e chinococcosis control progamme in China ： Impact on humans and dogs population interventions
Authors: Yu Qing , Xiao Ning , Han Shuai , Tian Tian , Zhou Xiaonong
Published: June 2020

Background A national control program for echinococcosis has been in effect since 2005 in China. This program has applied a comprehensive strategy, and good control results have been achieved. The objective of this study is focusing on the effectiveness of the programme with two indices, including patients treatment and registered dogs deworming, in endemic areas of echincoccosis control over the period of 10 years (2004-2014) in China. Methods 10 provinces and autonomous regions of China were chosen for this study and a database was established that included demography at county and township levels, grouping available patients into those subjected to surgery and those receiving drug treatment after population screening. All statistical analyses were performed using Microsoft Excel software and SPSS software and the results are shown as percentages with the corresponding 95% confidence intervals (95% CIs). Results The study showed that over this period, the coverage rate (the grant total average rate) of surgical patient (after surgical operation) treatment had increased with 32.4% and with 81.3% for medical treatment with albendazole. Meanwhile, it increased by 58.6% for the deworming of registered dog since 2007. The accumulated costs amounted to US$ 27.03 million after discount for patients and registered dog treatment, which is 1/4 (27.03/110.67) of the total accumulated financial inputs (US$ 110.67 million from the Chinese Government. Since the implementation of the national program, it has increased 57 times (1705.9/30.1=57) with respect to the annual financial inputs (costs) and 368 times (11,067.9/30.1=368) with respect to all accumulated financial inputs (costs). Conclusions As found through this study, it is suggested that more attention should be paid to controlling wild canines during the ongoing program period and sustainable follow-up evaluations are crucial for success and continued implementation of the national program, which will be necessary until the disease is under control and has been eliminated in all endemic areas of China.
Myoinositol to total choline ratio in IDH wild-type gliomas as a prognostic factor on preoperative magnetic resonance spectroscopy
Authors: Kumon Masanobu , Nakae Shunsuke , Murayama Kazuhiro , Kato Takema , Ohba Shigeo , Inamasu Joji , Abe Masato , Yamada Seiji , Sasaki Hikaru , Ohno Yoshiharu , Hasegawa Mitsuhiro , Kurahashi Hiroki , Hirose Yuichi
Published: June 2020

Background: Isocitrate dehydrogenase (IDH) wild-type gliomas tend to be pathologically defined as glioblastomas. We previously reported that, unlike IDH-mutant gliomas, IDH wild-type gliomas showed significantly lower ratios of myoinositol to total choline (i.e., the Ins/Cho ratio) on magnetic resonance (MR) spectroscopy. Given that IDH-mutant gliomas also have much better prognoses than IDH wild-type gliomas, we hypothesized that this lower Ins/Cho ratio is associated with malignancy in adults with supratentorial gliomas. Therefore, we calculated the Ins/Cho ratios of patients with supratentorial IDH wild-type gliomas and investigated their progression free survival (PFS) and overall survival (OS) to determine its utility as a prognostic marker.Methods: We classified IDH wild-type gliomas (n = 30) into two groups based on the Ins/Cho ratios, and compared patient backgrounds, pathological findings, PFS, OS, and copy number aberrations.Results: Compared with the group with high Ins/Cho ratios, the group with low Ins/Cho ratios had shorter PFS (P = 0.020) and OS (P = 0.037) durations. Multivariate analysis demonstrated that the Ins/Cho ratio correlated significantly with PFS (hazard ratio 0.34, P = 0.027). Conclusion: We conclude that the preoperative Ins/Cho ratio can be used as a novel prognostic factor for IDH wild-type gliomas.
ROCK2 promotes osteosarcoma growth and glycolysis by up-regulating HKII via phospho-PI3K/AKT signalling
Authors: Deng Xue qaing , Deng Jianyong , Yi Xuan , Zou Yeqing , Hao Liang
Published: June 2020

Background: Osteosarcoma (OS) is a malignant bone tumour that exhibits a high mortality. While tumours thrive in a state of malnutrition, the mechanism by which OS cells adapt to metabolic stress through metabolic reprogramming remains unclear. Methods: We analysed the expression of ROCK2 in osteosarcoma tissues by RT-qPCR and Western blot. Cell proliferation were analysed using CCK8, EdU and colony formation assays. The level of Cell glycolysis was detected by glucose-6 phosphate, glucose consumption, lactate production and ATP levels.Results: Herein, our study showed that ROCK2 expression in OS tissues was higher than in adjacent tissues. Functional assays have demonstrated that ROCK2 contributes to the growth of OS cells by inducing aerobic glycolysis. The current study revealed that ROCK2 knockdown decreased the levels of mitochondrial hexokinase II (HKII). And also indicated that ROCK2 served as a key enzyme in glycolysis and that it served an important role in tumour growth. A significant positive correlation was identified between the mRNA and protein expressions of ROCK2 and HKII, further demonstrating that ROCK2-induced glycolysis and proliferation was dependent on HKII expression in OS cells. Mechanistically, ROCK2 promotes HKII expression by activating the phospho-PI3K/AKT signalling pathway. Conclusions: Taken together, the results of the current study linked the two drivers of OS growth and aerobic glycolysis, and identified a new mechanism of ROCK2 control in OS.
Prevalence and associated factors of undernutrition among pregnant women vising ANC clinic in Silte zone, southern Ethiopia
Authors: Muze Mohammed , Yesse Mubarak , Kedir Shemsu , Mustefa Abdulmejid
Published: June 2020

Background: Maternal undernutrition is highly prevalent in underdeveloped country. Hence, this study was intended to determine prevalence and associated factors of undernutrition among pregnant women visiting ANC follow up clinics of health facilities.Method: Facility based cross sectional study was conducted from July to January 2019. Data was collected by using structured interviewer administered questionnaire. Mid upper arm circumference (MUAC) was measured by standard non stretchable MUAC tape. Systematic random sampling technique was used to select 422 study participants from 11 randomly selected health facilities. Sample size was allocated proportionately to each health facilities. Data was entered into a computer using Epi data 3.1 and edited, cleaned and analyzed using SPSS version 20. Both bivariate and multiple logistic regression analyses was employed to identify factors associated with maternal undernutrition.Result: This study found 91 (21.8%) of study subjects were undernourished. Age greater than 31 years of women (AOR=0.15; 95% CI: 0.03, 0.93), Birth intervals > 2 years (AOR= 0.18; 95% CI: 0.04, 0.76), good nutritional knowledge (AOR=0.34; 95% CI: 0.17, 0.67), and having no dietary change as a result of current pregnancy AOR=6.02; 95% CI: 2.99, 12.14) were significantly associated with undernutrition.Conclusion and recommendation: The prevalence of undernutrition among pregnant women was 21.8 % indicates little decrement. Age of women, Birth intervals, and Dietary change as a result of current pregnancy and Nutrition knowledge were important risk factors/ predictors of undernutrition (MUAC < 23 cm). Government, and other concerned bodies should strength nutritional counseling of pregnant women at health setting and in community level with giving special emphasis to adolescent pregnant women (Age ≤20 years old).
Barriers and facilitators to the effective de-escalation of conflict behaviours in forensic high-secure settings: A qualitative study
Authors: Goodman Helena , Brooks Cat Papastavrou , Price Owen , Barley Elizabeth Alexandra
Published: June 2020

Background: Violent and aggressive incidents are common within mental health settings and are often managed using high-risk physical interventions such as restraint and seclusion. De-escalation is a first-line technique to manage conflict behaviours and prevent violence and aggression. There is limited research into the use of de-escalation in high-secure settings. This study investigated staff, patient and carer perspectives on the barriers and facilitators to using de-escalation for conflict behaviours.Methods: Semi-structured individual interviews (n=12) and focus groups (n=3) were conducted with eight patients, four carers and twenty-five staff members in a high-secure hospital in England. Interviews and focus groups were informed by the theoretical domains framework and were digitally recorded, transcribed verbatim and analysed using framework analysis and the COM-B behaviour change model. Results: Four themes and 15 sub-themes (barriers and facilitators) were identified. Themes related to capabilities (building relationships: knowing the patient and knowing yourself), opportunities (filling the void: challenges within the high-security environment; dynamic relationships) and motivation (keeping everyone safe). Strong staff-patient therapeutic relationships underpinned by trust, fairness, consistency and an awareness of the trauma-aggression link were considered key to successful de-escalation. Specific psychological and interpersonal skills including empathy, respect, reassurance, sincerity, genuine concern and validation of the patient perspective are needed to achieve this. Barriers related to the physical environment; organisational resources, practices and systems; staff traumatisation; hierarchical and punitive attitudes towards patient care, and an insufficient understanding of psychiatric diagnoses, especially personality disorder. It was apparent across themes that fear, which was experienced by both staff and patients, was a driver for many behaviours. Conclusions: This work has identified organizational and behaviour change targets for interventions seeking to reduce violence and restrictive practices through the use of de-escalation in high-secure hospitals. The potential for, and occurrence of, violence in such settings is high and leads to fear in patients and staff. The factors which promote fear in each group should be addressed in de-escalation training.
Comparing outpatient and inpatient utilization rate in physicians, informed healthcare service consumers, and non-physicians, uninformed healthcare service consumers
Authors: Mohebi Farnam , Ahmadnezhad Elham , Mansournia Mohammad Ali , Majdzadeh Reza , Harirchi Iraj , Ahmadi Naser , Ghanbari Ali
Published: June 2020

Background

Supplier-induced demand(SID)cause a considerable but preventable economic burden on health systems.SID exists when the supplier changes a patient’s demand for his greater interest because of their asymmetric medical information.The informed patient is expected to resist demand induction;thus,his amount of utilization would be free of induction.In this study,we aimed to examine the impact of the opportunity of SID,information asymmetry,on healthcare utilization.As the nature of the association of interest could be considered to be the same in variety of contexts,we believe our results are generalizable to other countries as well.
Methods

We compared the individual outpatient and inpatient utilization rates in randomly chosen physicians(medically-informed)and non-physicians(medically-uninformed)with university degree and same living area in the Tehran province,the capital of Iran.Subjects were chosen by simple random selection with replacement from the relevant phone number list.Phone number lists were extracted from the Tehran province phone number list categorized by occupation.We excluded non-physicians with at least one physician in their close family and medical interns and subjects who did not answer the phone call and were unwilling to cooperate.Negative-binomial was used for comparing incidence rates of utilization(Hurdle in inpatient utilization),adjusted for demographic characteristics,insurance coverage,access to healthcare,and health status as healthcare-utilization-altering factors.The data collection tool consisted of 22 questions and was designed based on the list of the services that are prone to be induced by a supplier.The questionnaire was face-validated and content-validated in face to face interviews.
Results

In 349 physicians and 295 non-physicians,the adjusted outpatient and inpatient-utilization incidence was higher in non-physicians(incidence-rate-ratio: 1.38 and 3.19,respectively),p-value < 0.05.The only variable that correlated significantly with utilization rates was the presence of chronic diseases as the incidence rate of inpatient utilization was in patients with chronic conditions was 2.01 times of the individuals without.
Conclusions

The higher incidence rate of utilization in non-physicians comparing to physicians suggest SID existence and might be caused by information asymmetry and non-physicians’ vulnerability for SID,especially that utilization-altering factors were considered in the study design and analysis.The findings validate policies to regulate service provision,plan an appropriate payment system,which is mainly fee for service payment in Iran,and increase general population-health information via trusted routes.