bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex-specific Plasticity and the Nutritional Geometry of Insulin-Signaling Gene Expression in Drosophila Melanogaster
Authors: McDonald Jeanne M.C. , Nabili Pegah , Thorsen Lily , Jeon Sohee , Shingleton Alexander
Published: November 2020

Background: Sexual-size dimorphism (SSD) is replete among animals, but while the selective pressures that drive the evolution of SSD have been well studied, the developmental mechanisms upon which these pressures act are poorly understood. Ours and others’ research has shown that SSD in Drosophila reflects elevated levels of nutritional plasticity in females versus males, such that SSD increases with dietary intake and body size, a phenomenon called sex-specific plasticity (SSP). Additional data indicate that while body size in both sexes responds to variation in protein level, only female body size is sensitive to variation in carbohydrate level. Here we explore whether these difference in sensitivity at the morphological level are reflected by differences in how the insulin/IGF-signaling (IIS) and TOR-signaling pathways respond to changes in carbohydrates and proteins in females versus males, using a nutritional geometry approach. Results: The IIS-regulated transcripts of 4E-BP and InR most strongly correlated with body size in females and males respectively, but neither responded to carbohydrate level and so could not explain the sex-specific response to body size to dietary carbohydrate. Transcripts regulated by TOR-signaling did, however, respond to dietary carbohydrate in a sex-specific manner. In females, expression of dILP5 positively correlated with body size, while expression of dILP2,3 and 8, was elevated on diets with a low concentration of both carbohydrate and protein. In contrast, we detected lower levels of dILP2 and 5 protein in the brains of females fed on low concentration diets. We could not detect any effect of diet on dILP expression in males.Conclusion: Although females and males show sex-specific transcriptional responses to changes in protein and carbohydrate, the patterns of expression do not support a simple model of the regulation of body-size SSP by either insulin- or TOR-signaling. The data also indicate a complex relationship between carbohydrate and protein level, dILP expression and dILP peptide levels in the brain. In general, diet quality and sex both affect the transcriptional response to changes in diet quantity, and so should be considered in future studies that explore the effect of nutrition on body size.
Mitochondrial Transplantation Improves Stroke-induced Brain Injury: Possible Involvement of Selective Component Recombination
Authors: Xie Qiang , Zeng Jun , Xu Feng , Zheng Yongtao , Li Tianwen , Ren Junwei , Chen Kezhu , Zhang Quan , Xie Rong , Zhu Jianhong
Published: November 2020

Background: Ischemic stroke results in high morbidity and mortality, and mitochondrial dysfunctions play a crucial role in the associated pathological process. Although exogenous mitochondria were used to treat ischemic stroke-induced brain injury, its effects and related mechanisms remain poorly understood, as is the fate of exogenous mitochondria during/after internalization by targeted cells.Methods: The mitochondrial morphology, membrane potential, DNA copy number, mitochondrial stress, metabolic characteristics and tumorigenicity of mNSCs and Neuro-2a cells were evaluated. Hypoxia/reoxygenation-induced cell injury was performed, and after mitochondrial supplementation, the viability, ROS levels, apoptosis and transcriptomic changes were assessed by CCK-8, DCHF-DA probes, flow cytometry, WB and next-generation sequencing analyses. The fate of exogenous mitochondria was further explored using fluorescent dyes and fusion protein analyses during/after internalization by targeted cells. Rat tMCAO models were generated using a suture-occluded method, and at 24 h after mitochondrial transplantation, behavioral changes and brain infarction areas were estimated by multiple score scales and TTC staining, respectively.Results: In this research, we found that mitochondria of Neuro-2a cells had some notable differences compared to that of mNSCs on mitochondrial membrane potential, DNA copy number, stress response and metabolic characteristics, but their shapes were similar and were both no tumorigenicity. Exogenous mitochondrial treatment could increase the cellular viability in an oxygen-dependent pattern, decrease the cellular ROS generation and apoptosis, and alter the transcriptomic characteristics after subjected to hypoxia/reoxygenation in vitro. Selective component recombination might occur during/after internalization of exogenous mitochondria by host cells and was observed with mitochondrial fluorescent dyes and engineered fusion protein. Moreover, mitochondrial transplantation could significantly improve tMCAO-induced rat neurobehavioral deficiency and brain infarction.Conclusions: The results of our present study offer a promising therapeutic strategy for ischemia/reperfusion-induced brain injury and provide preliminary insights regarding the effects and fate of exogenous mitochondria during/after being internalized into host cells.
Populational Level Driving Force of COVID-19 Epidemic and Fatality: A Global Analysis
Authors: Wang Zaisheng , Xie Yewei , Wu Dan , Zheng Lingling , Liao Huipeng , Marley Gifty , Zhang Lei , Tang Weiming
Published: November 2020

BackgroundThe COVID-19 has become a pandemic worldwide. 216 countries and regions reported their occurrence of COVID-19 cases by 19th Sep 2020. Meanwhile, the COVID-19 had infected more than 30 million people and caused almost one million deaths until 19th Sep 2020.MethodWe scoped data related to reported epidemic durations, incidences, fatalities, and epidemic risk factors of the studied countries. Disease Development Speed (DDS), Population-Level Incidence (PLI), and Case-Fatality Rate (CFR) were calculated to assess the COVID-19 pandemic globally. The Spearman rank correlation was applied to further explore the relationship among DDS, PLI, CFR, and their influencing factors.Result216 countries and regions had reported their COVID-19 cases by 19th Sep 2020. Globally, the medians of epidemic duration, DDS, PLI, and CFR were 167 days (IQR: 158-175 days; Range: 110-221 days),4.6 (IQR: 3.1-6.0; Range: 1.8-10.1), 17.0 (IQR: 5.3-56.0; Range: 0.36-1758.3), and 2.2% (IQR: 1.3%-3.5%) respectively. DDS, PLI, and CFR were found enjoying positive correlations with the urban population proportion, UHC (Universal Health Coverage) service coverage, the population with basic handwashing facilities at home, the number of reported deaths, and the number of doctors and nurses.ConclusionNationwide development of the COVID-19, its incidence and fatality suggested regional similarity in the world. National population structure, human resources of medical staff, structure of national health expenditure, and the sanitation facility were revealed as vital risk factors for the COVID-19 in epidemiology.
The Psychological Impact of the COVID-19 Pandemic on Adults With Autism: A Survey Study Across Three Countries
Authors: Oomen Danna , Nijhof Annabel Dineke , Wiersema Jan Roelf
Published: November 2020

BackgroundPrevious studies have reported a negative psychological and mental health impact of the COVID-19 pandemic. This impact is likely to be stronger for people with autism as they are at heightened risk of mental health problems and because the pandemic directly affects social functioning and everyday routines. We therefore examined COVID-19-related changes in mental health, the impact of the pandemic on their social life and routines, satisfaction with pandemic-related information and tips, and participants’ wishes for guidance. MethodsWe used a mixed-method approach, collecting quantitative and qualitative survey data from adults with and without autism across three European countries: Belgium, the Netherlands, and the United Kingdom (N = 1044). ResultsWe found an increase in depression and anxiety symptoms in response to the pandemic for both the non-autism and the autism group, which was greater for adults with autism. Furthermore, adults with autism showed a greater increase in worries about their pets, work, getting medication and food, and their own safety/security. They felt more relieved from social stress, yet experienced the loss of social contact as difficult. Adults with autism also felt more stressed about the loss of routines. Pleasant changes noted by adults with autism were the increase in solidarity and reduced sensory and social overload. Adults with autism frequently reported problems with cancellation of guidance due to the pandemic and expressed their wish for (more) autism-specific information and advice. LimitationsOur sample is likely to reflect some degree of selection bias, and longitudinal studies are needed to determine long-term effects. ConclusionsResults highlight the psychological burden of the pandemic on adults with autism and shed light on how to support them during this COVID-19 pandemic, which is especially important now that the pandemic is likely to have a prolonged course. There is a need for accessible, affordable (continued) support from health services. Guidance may focus on the maintenance of a social network, and adjusting routines to the rapid ongoing changes. Finally, we may learn from the COVID-19-related changes experienced as pleasant by adults with autism to build a more autism-friendly society post-pandemic.
Continuous Noninvasive Blood Gas Estimation in Critically Ill Pediatric Patients With Respiratory Failure
Authors: Dong Junzi , Xu-Wilson Minnan , Conroy Bryan R. , Khemani Robinder G. , Newth Christopher J.L.
Published: November 2020

BackgroundPatients supported by mechanical ventilation require frequent invasive blood gas samples to monitor and adjust the level of support. We developed a transparent and novel blood gas estimation model to provide continuous monitoring of blood pH and arterial CO2 in between gaps of blood draws, using only readily available noninvasive data sources in ventilated patients. MethodsThe model was trained on a derivation dataset (1,883 patients, 12,344 samples) from a tertiary pediatric intensive care center, and tested on a validation dataset (286 patients, 4,030 samples) from the same center obtained at a later time. The model uses pairwise non-linear interactions between predictors and provides point-estimates of blood gas pH and arterial CO2 along with a range of prediction uncertainty.ResultsThe model predicted within Clinical Laboratory Improvement Amendments of 1988 (CLIA) acceptable blood gas machine equivalent in 74% of pH samples and 80% of PCO2 samples. Prediction uncertainty from the model improved estimation accuracy by identifying and abstaining on a minority of high-uncertainty samples.ConclusionsThe proposed model estimates blood gas pH and CO2 accurately in a large percentage of samples. The model’s abstention recommendation coupled with ranked display of top predictors for each estimation lends itself to real-time monitoring of between gaps of blood draws, and the model may be used to help users determine when a new blood draw is required and delay blood draws when not needed.
Blunt Aortic Traumatic Injury Management: An Observational Study in 10 French Trauma Centers.
Authors: Boutin Louis , Caballero Marie-Josée , Guarrigue Delphine , Hammad Emanuelle , Rennuit Isabelle , Delhaye Nathalie , Neuschwander Arthur , Meyer Alain , Bitot Valérie , Mathais Quentin , Boutonnet Mathieu , Julia Pierre , Olaf Mercier , Duranteau Jacques , Hamada Sophie Rym
Published: November 2020

Background: Blunt aortic trauma injury (BTAI) in severe trauma patients is rare but lethal and is the second leading cause of death after brain damage. Development in automotive technology have reduced mortality at the scene of the accident and increased hospital admissions for patients with aortic injury. The aim of this work was to proceed with an epidemiologic analysis of BTAI on a French cohort.Methods: This is a multicentric retrospective study including patients admitted between 2013 and 2018 in 10 French trauma centers and participating in the Traumabase® registry. Demographic, diagnostic and therapeutic data were collected. Severity of aortic injuries was classified according to the Vancouver grades. Results: 209 patients were included, mean age was 43 years (19) and 168 (80%) were men. They had a Red Flag of 2[1-3], an injury severity score of 39 (18.3) and several associated lesions: 4[3-5]. The calculated prevalence of BTAI was 1%.Mechanisms associated with BTAI were high kinetic accidents, with severe thoracic injury. Patients presented with high clinical suspicion for severe hemorrhage. The time to diagnosis increased with the severity of aortic injury (grade 1: 94[74-143] minutes, grade 2: 129[106-143] minutes, grade 3: 117[100-170] minutes, grade 4: 154[112-202] minutes, p=0.02). Overall mortality was 20% and increased with the severity of aortic injury (grades 1: 6%, grades 2: 12%, grades 3: 22% et grades 4: 65%, p<0.001). The delay before death was 1,5[1-4.7] days (grade 1: 2[1.5-3] days, grade 2: 12[1-42.7] days, grade 3: 2[1-6.2] days, grade 4: 1[1-1.5] days, p=0.003).Among deceased patients, 16 (38%) had hemorrhagic shock, 13 (31%) had post-hemorrhagic multiple organ failure, 5 (12%) had cerebral cause, and 8 (19%) had septic shock. Conclusions: Patients with BTAI presented severe trauma with multiple associated injuries, were victims of a high kinetic accident and had an overall 20% mortality with a 65% mortality rate for grade 4 patients. They died of hemorrhagic shock in more than 2/3 of the cases and received endovascular treatment in 2/3 of the case.Trial registration: Advisory Committee for Information Processing in Health Research (CCTIRS, 11.305 bis). National Commission on Informatics and Liberties Data protection agency (CNIL, 911461 and 2211878). National institutional review board requirements (Comité de Protection des Personnes Paris VI, Paris, France).
Imaging Features of Primary Non-Hodgkin’s Lymphoma of Long Bones
Authors: Yu Bao-Hai , Han Zeng-Wu , Wu Yuan , Han Shu-Man , Wen Jin-Xu , Cao Lei , Wu Wen-Juan , Gao Bu-Lang
Published: November 2020

The authors have requested that this preprint be removed from Research Square.
Is Follow-up Needed for Infants with Graf Type I Hip at Screening?
Authors: Matsubayashi Shohei , Matsuzaki Hiroki , Tsujimoto Ritsu , Osaki Makoto
Published: November 2020

Background: The purpose was to determine if follow-up of infants with Graf Type I hip at screening is required. Methods: Overall, 526 hips in 263 infants (61 males and 202 females) born between April 2015 and March 2018 who underwent primary screening for hip dislocation and presented to our department for secondary hip dislocation examination were included. Among these, 250 (59 males and 191 females) infants had bilateral Graf Type I hips for a total of 500 hips. Ultrasound results and physical examination at the initial visit and after 3 months were compared. X-rays were taken at the age of 1 year, and the proportion of infants with an acetabular index of 30° or greater was evaluated. Results: There were 0 hips that deteriorated from Graf Type I to II or higher among the infants. There were also 25 infants with abduction limitations in flexion at the initial visit, which was still present in 3 out of 23 infants 3 months later. There were 49 infants with asymmetry of the femoral or inguinal skin creases at the initial visit, which was still present in 9 out of 48 infants 3 months later. At the age of 1 year, an acetabular index of 30° or greater was observed in 35 out of 402 hips (8.7%).Conclusion: Ultrasounds at 3 months later were not required in any of the infants with Graf Type I hip at initial diagnosis. Some infants were diagnosed with acetabular dysplasia at the age of 1 year.
Impact of a Novel Boar Pheromone on Weaned Sow Behavior and Reproduction
Authors: Bello Antonio Vela , Río Laura Lafoz del , Reyero David , Merdy Olivier
Published: November 2020

BackgroundReproductive performance on commercial farms depends on the ability to identify sexual behavior and breed females during estrus. The presence of a boar is essential in determining sow sexual behaviors and is greatly mediated by the adult boar odor. This study sought to examine the effects of a novel boar salivary pheromone on weaned sow sexual receptivity and subsequent reproductive performance. MethodsOne hundred weaned sows were randomly assigned to either a control treatment where sows were exposed during heat detection to a live mature boar (BG) or to BOARBETTER® (Vétoquinol, Lure, France), given as a single spray while a boar grunting audio file was played (PG). Sexual behaviors were assessed twice daily during a Back-Pressure Test (BPT). Sows expressing behavioral estrus were mated. Ultrasound was used to assess ovarian activity from weaning until the end of ovulation. Reproductive and prolificacy data were collected until farrowing.ResultsTwelve sows were eliminated from the study because of early ovulation, no ovulation, or infectious disease. Breeding rate did not differ between the two treatments (BG: 100% vs PG: 91%). Sows in the BG had a shorter wean-to-estrus interval (97 vs 108 h) and longer estrus duration than PG sows (57 vs 39 h; p < 0.05). Wean-to-ovulation interval did not differ but onset of estrus to ovulation interval was longer in PG compared with BG sows (40 vs 30 h, p < 0.01). Follicle size at the onset of estrus was larger among PG than BG sows (5.76 vs 5.43 mm, p = 0.04). Timing of ovulation relative to insemination did not differ between the two treatment groups. Pregnancy rates were identical or similar for sows in the two treatment groups (93%) as was number of pigs born per litter.ConclusionsExposing weaning sows to the novel pheromone and the boar grunting sound achieved high estrus detection rate. Estrus was delayed and shortened but sows were successfully bred and were farrowed. Despite the absence of teaser boar, the procedure incorporating the novel pheromone and the boar grunting sound was shown to be efficient for sow breeding.
Laparoscopic Gastrectomy Plus D2 Lymphadenectomy is as Effective as Open Surgery in Terms of Long-Term Survival: A Single-Institution Study on Gastric Cancer.
Authors: Wang Yawei , An Tailai , Wang Yan , Wu Wang , Lu Xiaofang , Jiang Jiling
Published: November 2020

Background: Laparoscopic surgery has been widely accepted to treat early-stage gastric cancer. However, it is still controversial to perform laparoscopic gastrectomy plus D2 lymphadenectomy for locally advanced gastric cancer. We performed the present study to compare the long-term outcomes of patients after laparoscopic or open gastrectomy plus D2 lymphadenectomy . Methods: The clinicopathological data of 182 gastric cancer patients receiving gastrectomy plus D2 lymphadenectomy between January 2011 and December 2015 at Shenzhen Traditional Chinese Medicine Hospital were retrospectively retrieved. The overall survival (OS) and disease-free survival (DFS) of these 182 patients were compared.Results: On the whole, OS (P=0.789) and DFS (P=0.672) of patients receiving laparoscopic gastrectomy plus D2 lymphadenectomy were not significantly different from those of patients receiving open surgery. For stage I patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P=0.573) and DFS (P=0.157). Similarly, for stage II patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P=0.567) and DFS (P=0.830). For stage III patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P=0.773) and DFS (P=0.404). Laparoscopic or open gastrectomy plus D2 lymphadenectomy was not proven by Cox regression analysis to be an independent prognostic factor for OS and DFS.Conclusions: For patients with gastric cancer, laparoscopic gastrectomy plus D2 lymphadenectomy was not inferior to open surgery in terms of long-term outcomes.
A Value-based Steering Model for Healthcare
Authors: Pitkänen Laura , Torkki Paulus , Tolkki Helena , Leskelä Riikka-Leena
Published: November 2020

BackgroundWhen the commissioner of healthcare services is responsible for all health services of a certain population, the commissioner is incentivized to steer service producers towards better value (i.e. outcomes relative to costs). Value-based healthcare provides a setting for creating better value, but it is currently limited to some patient segments, not the whole population, and does not serve the purpose of steering multiple service providers with varying service portfolios and different degrees of specialization. This paper presents a tentative value-based steering model that aims to fill this gap in research and in practice.ResultsWe constructed a value-based steering model which consists of three parts: (1) the principles of steering; (2) the steering process; and (3) Value Steering Canvas, a concrete tool for steering. ConclusionsThe commissioning body can start using value-based steering without changes in legislation or the present service system.
Seed Dispersal as a Search Strategy: Dynamic and Fragmented Landscapes Select for Multi-scale Movement Strategies in Plants
Authors: Treep Jelle , de Jager Monique , Bartumeus Frederic , Soons Merel B.
Published: November 2020

Background – Plant dispersal is a critical factor driving ecological responses to global changes. Knowledge on the mechanisms of dispersal is rapidly advancing, but selective pressures responsible for the evolution of dispersal strategies remain elusive. Recent advances in animal movement ecology identified general strategies that may optimize efficiency in animal searches for food or habitat. Here we explore the potential for evolution of similar general movement strategies for plants.Methods – We propose that seed dispersal in plants can be viewed as a strategic search for suitable habitat, where the probability of finding such locations has been optimized through evolution of appropriate dispersal kernels. Using model simulations, we demonstrate how dispersal strategies can optimize key dispersal trade-offs between finding habitat, avoiding kin competition, and colonizing new patches. These trade-offs depend strongly on the landscape, resulting in a tight link between optimal dispersal strategy and spatiotemporal habitat distribution.Results – Our findings reveal that multi-scale seed dispersal strategies that combine a broad range of dispersal scales, including Lévy-like dispersal, are optimal across a wide range of dynamic and patchy landscapes. At the extremes, static and patchy landscapes select for dispersal strategies dominated by short distances, while uniform and highly unpredictable landscapes both select for dispersal strategies dominated by long distances.Conclusions – By viewing plant seed dispersal as a strategic search for suitable habitat, we provide a reference framework for the analysis of plant dispersal data. Consideration of the entire dispersal kernel, including distances across the full range of scales, is key. This reference framework helps identify plant species’ dispersal strategies, the evolutionary forces determining these strategies and their ecological consequences, such as a potential mismatch between plant dispersal strategy and altered spatiotemporal habitat dynamics due to land use change. Our perspective opens up directions for future studies, including exploration of composite search behaviour and ‘informed searches’ in plant species with directed dispersal.
Effect of Female Sex Work Targeted Community-based Interventions Along the HIV Treatment Cascade in Sub-Saharan Africa: A Systematic Review and Meta-analysis
Authors: Atuhaire Lydia , Adetokunboh Olatunji , Shumba Constance , Nyasulu Peter S
Published: November 2020

Background: Female Sex Workers are extremely vulnerable and highly susceptibility to being infected with human immunodeficiency virus. As a result, community based targeted interventions have been recommended as one of the models of care to improve access to HIV services and continued engagement in care. However little is known about the specific community intervention packages that have optimal effect on FSWs access and retention in HIV care. This paper synthesized evidence on the effectiveness of community-based interventions that provided HIV services to FSWs across all stages of HIV care cascade.Methods: We defined the 5 steps that make up the HIV care cascade and categorized them as outcomes, namely HIV testing, HIV diagnosis, linkage to care, ART use and viral suppression. We conducted a systematic search of randomized controlled trials, cohort and cross sectional studies done in sub-Saharan African countries and published from 2004 to 2020. We reviewed studies with data on the implementation of community interventions for any of the HIV care cascade stage. The data were analyzed using random effects meta-analysis where possible and for the rest of the studies, data were synthesized using summary statistics. Results: The significant impact of the community interventions was observed on HIV testing, HIV diagnosis and ART use. However, for HIV testing and ART use, the improvement was not sustained for the entire period of implementation. There were minimal interventions that had impact on HIV diagnosis, with only one community service delivery model showing significance. Generally, the interventions that had reasonable impact are those that implemented targeted and comprehensive package of HIV services provided at one location, and with unique strategies specific to each cascade stage.Conclusions: The effect of community-based interventions varies across the different stages of HIV care cascade with impact observed in specific strategies with features unique to each cascade stage. Moreover, positive effects of these strategies were short term and with small-scale implementation. As such, the information on long-term treatment outcomes, and the extent to which FSWs remain engaged in care is sparse. There is need to conduct a further research to deepen the assessment of the effectiveness of community-based interventions on HIV care cascade for FSWs. This will enhance identification of evidence based optimal interventions that will guide effective allocation of scarce resources for strategies that would have a significant impact on HIV service delivery.Systematic review registration: PROSPERO CRD42020157623.
Neonatal Septicaemia in Sub-Saharan Africa: A Protocol for Systematic Review and Meta-analysis.
Authors: Alao Micheal Abel , Tongo Oluwakemi O , Ayede Idowu Adejumoke , Diala Michael Udochukwu , Ibrahim Olayinka Rasheed , Gbadero Daniel A , Nna Emmanuel Okechukwu , Slusher Tina M
Published: November 2020

Background: The morbidity and mortality from neonatal septicaemia (NNS) in low-middle income country remain high at the background of strained health care delivery system.The burden, pooled risks and outcomes of NNS are largely unknown. We aimed to produce a protocol for synthesizing evidence from available data for neonatal septicaemia in sub-Saharan Africa.Methods: We developed a search strategy using MeSH, text words and entry terms. Nine databases will be searched: PubMed, Embase, CINAHL, AJOL, Google Scholar, Web of Science, Cochrane Library, Research gate and Scopus. Only Observational studies retrievable in the English Language will be included. The primary measurable outcome is the proportion of neonatal with septicaemia while secondary outcomes include proportion of bacterial isolates and their antibiogram, risk factors for NNS, in hospital mortality, length of hospital stay, frequency of necrotizing enterocolitis and other sequel . All identified studies will be screened based on the inclusion criteria. Data will be deduplicated in Endnote version 9, before exporting to Rayyan QCRI for screening. Extractable data will include first author’s name and year of publication, the country and regions in sub-Saharan Africa, total neonatal admissions, number with sepsis, the sample size, bacterial isolates, antibiogram, in-hospital mortality, length of hospital stay and frequency of necrotizing enterocolitis.All studies will be assessed for methodological, clinical and statistical heterogeneity. The NIH Quality assessment tool for observational studies and the Cochrane tool of risk of bias will be used to assess for the strength of evidence. Publication bias will be assessed using the funnel plot.Discussion: Results will be presented as the prevalence, standard error and confidence interval of newborns with neonatal septicaemia in sub-Saharan Africa. Subgroup analysis using categorical data such as risk factors, bacterial isolates, antibiogram and outcomes of neonatal septicaemia will also be reported. A cumulative meta-analysis will be done to assess the time trend of the risk factors, pathogens and antibiogram.The CMA version 3 will be used for statistical analysis. Results will be presented in forest plots.Systematic Review Registration: This protocol is registered in PROSPERO, registration number CRD42020219604.
A Near-Peer Surgical Teaching Programme for Junior Doctors
Authors: Hussain Shoaib Fahad , Toi Teri Hsiao Hsui , Laurent Edward Peter , Seraj Shaikh Sanjid , Samer-ul-Haque
Published: November 2020

Background: Surgical departments across the UK are having to mitigate increasing service demands, budget constraints and changes to work patterns, with their statutory duty to provide high-quality training and education. In an overstretched NHS, securing consultant-led teaching for junior doctors has become increasingly difficult leading to the rise of near-peer teaching. We evaluate the long-term effectiveness of a near-peer surgical teaching programme for junior doctors. Methods: We developed a rolling 12-week trainee-led, didactic surgical education programme for junior doctors and incorporated a three-tiered leadership and handover mechanism involving lead junior doctors, registrars and a lead consultant to ensure consistency and programme continuity. Junior doctors delivered presentations to their peers with close supervision and input from registrars. Participants provided session and supervision feedback using 5-point scales and free-text responses. Data was collected using Google Forms™ and analysed using student’s t-test on Microsoft Excel®. Results: 42 junior doctors responded to our end-of-programme feedback surveys covering December 2018 to April 2020. The overall programme (8.83±1.08/10), topic relevance (4.62±0.58/5), presentation quality (4.60±0.50/5) and supervisor knowledge (4.81±0.40/5) were rated highly by respondents. 95.2% (n=40) of respondents had attended more than 3 sessions and 71.4 % (n=30) had delivered teaching. Respondents also reported significant improvements in subject knowledge (3.72±0.92/5 to 4.50±0.56/5, P<0.0001), clinical confidence, presentation and teaching skills following each session. Conclusions: This long-term near-peer teaching programme addressed the educational needs of junior doctors and developed their presentation and organisational skills. Supervision and input from registrars facilitated discussion and reinforced key concepts. Our strategy also facilitated workplace-based assessments and familiarisation with local management protocols for new cohorts of doctors rotating in Surgery at Basildon University Hospital. We also recently adapted this into a virtual programme in response to the COVID-19 pandemic, maintaining clinical education and expanding our audience. The success of this programme highlights the role that trainees can play in designing, developing and coordinating an effective surgical teaching programme.
No Difference in Effects of ‘PACE Steps to Success’ Palliative Care Program for Nursing Home Residents With and Without Dementia: A Pre-Planned Subgroup Analysis of the Seven-Country PACE Trial
Authors: Miranda Rose , Smets Tinne , Noortgate Nele Van Den , Steen Jenny T. van der , Deliens Luc , Payne Sheila , Szczerbińska Katarzyna , Pautex Sophie , Humbeeck Liesbeth Van , Gambassi Giovanni , Kylänen Marika , Block Lieve Van den
Published: November 2020

Background ‘PACE Steps to Success’ is a multicomponent training program aiming to integrate generalist and non-disease-specific palliative care in nursing homes. This program did not improve residents’ comfort in the last week of life, but it appeared to improve quality of care and dying in their last month of life. Because this program included only three dementia-specific elements, its effects might differ depending on the presence or stage of dementia. We aimed to investigate whether the program effects differ between residents with advanced, non-advanced, and no dementia.Methods Pre-planned subgroup analysis of the PACE cluster-randomized controlled trial in 78 nursing homes in seven European countries. Participants included residents who died in the previous four months and had advanced (n=104 to 177), non-advanced (n=110 to 167) or no dementia (n=137 to 157). The nursing home staff or general practitioner assessed the presence of dementia; severity was determined using two highly-discriminatory staff-reported instruments. Using after-death questionnaires, staff assessed comfort in the last week of life (Comfort Assessment in Dying–End-of-Life in Dementia-scale; primary outcome) and quality of care and dying in the last month of life (Quality of Dying in Long-Term Care scale; secondary outcome).Results We found no subgroup differences on comfort, comparing advanced versus without dementia (baseline-adjusted mean sub-group difference 2.1; p-value=0.177), non-advanced versus without dementia (2.7; p=0.092), and advanced versus non-advanced dementia (-0.6; p=0.698); or on quality of care and dying, comparing advanced and without dementia (-0.6; p=0.741), non-advanced and without dementia (-1.5; p=0.428), and advanced and non-advanced dementia (0.9; p=0.632).Conclusions The lack of subgroup difference suggests that while the program did not improve comfort in dying residents with or without dementia, it appeared to equally improve quality of care and dying in the last month of life for residents with dementia (regardless of the stage) and those without dementia. A generalist and non-disease-specific palliative care program, such as PACE Steps to Success, is a useful starting point for future palliative care improvement in nursing homes, but to effectively improve residents’ comfort, this program needs further development.Trial registration. ISRCTN, ISRCTN14741671. Registered 8 July 2015 – Retrospectively registered.http://www.isrctn.com/ISRCTN14741671
Facilitating Factors for Implementing Multigenerational Exchanges in Regional Locations: A Cross-sectional Study in Niigata City, Japan
Authors: Morita Kumiko , Kobayashi Minako , Aoki Rieko , Nagamine Hitomi , Yamamoto Harumi , Ohtake Fumi , Hoki Mika , Sumita Hiroko , Maruyama Kayo , Mitsuhashi Kayoko , Sasaki Akiko
Published: November 2020

Background: In the process of community building, it is important to create a place for multigenerational exchanges. To consider the promotion of multigenerational exchanges in regional locations, it is important to clarify whether operational systems, regional characteristics, and social capital are related to the implementation of multigenerational exchanges and how these exchanges contribute to community building.Methods: The participants were representatives from 455 Chiiki no Cha-no-Ma (hereafter “Cha-no-Ma”), and the study was implemented in Niigata City, Japan. There were 405 responses (a response rate of 89.0%), with the analytical target being the 401 locations that agreed to participate in the study. A cross-sectional study based on a self-assessment questionnaire method was implemented, and questionnaires were returned directly to the researchers after completion. The survey details included basic information (e.g., date of establishment, frequency of meetings, number of managers and users, qualification of the representative, etc.); characteristic of regional activities; a Social Capital Scale; the effects of the Cha-no-Ma being implemented by the representative (12 items); challenges for management (16 items); and the implementation of multigenerational exchanges.Results: The items that had a significant connection to the implementation of multigenerational exchanges were “Frequency of meetings” (p < 0.001) and “Characteristic regional activities” (p = 0.026). With the relevant factors, a binomial logistic regression analysis was conducted, and the odds ratio for those with a high frequency of meetings was 3.839.There was a significantly higher ratio of the implementation of multigenerational exchanges when the effects were a “connection with the region” (p = 0.006) and “conversations with different generations” (p = 0.004). There was a significantly higher ratio of the implementation of multigenerational exchanges when the challenge was “no support from residents” (p = 0.002).Conclusions: To promote multigenerational exchanges in regional locations, meetings should be held at least once a week, with qualified personnel and the use of regional activities such as making local foods and festivals. It is clear from this community-based study that the implementation of multigenerational exchanges is an important activity for community building because it is related to connection within the community.
Occupational risk factors for shoulder chronic tendinous pathology in the Spanish automotive manufacturing sector: a case-control study.
Authors: DIEZ-CABALLERO BEATRIZ RODRIGUEZ , Alfonso-Beltran Joaquin , Bautista Iker J. , Barrios Carlos
Published: November 2020

Background: Musculoskeletal Diseases (MSDs) are among the most prevalent health problems encountered in the workforce in Europe. Multiple risk factors contribute to their onset. In the present study, different individual risk factors for chronic tendinous pathology affecting the shoulder were analysed in a sample of workers from the automotive manufacturing sector.Methods: An observational retrospective study was conducted with 73 cases of officially recognised and compensated occupational diseases and 94 aleatory cases of healthy workers from the same car assembly company. The experimental group comprised individuals with tendinous chronic pathology of the rotator cuff. Multiple variables that identified the risks present in the job were assessed along with participants clinical evaluation. Furthermore, two standardised guidelines for risk factors assessment were also used: the Spanish National Institute of Social Security (INSS) and the American Occupational Information Network (O*Net). Both descriptive statistical analysis and Odds ratios calculations considering the occupational disease as a dependent variable were performed.Results: The use of hand tools, exposure to mechanical pressure in the upper limbs and awkward postures were the most prevalent risk factors. Pressure on the palm of the hand and the hand tool impacting the hand were also important risk factors. Some psychosocial factors such as lack of autonomy and mental workload were also associated shoulder tendinous diseases. The association of age, load handling, and awkward postures were the core risk factors responsible for most of the tendinous chronic injuries of the shoulder in this sample of car assembly workers.Conclusions: Both ergonomic and psychosocial factors were present and increased the risk of developing occupational chronic tendinopathies at the shoulder in this sample of workers. Aging, load handling, and awkward postures showed the strongest predictive values. Greater knowledge of how risk factors interact would facilitate the design of better preventive workplace strategies.
Knowledge and perception of COVID-19 pandemic. Before-and-after online community survey.
Authors: Nazar Wojciech , Leszkowicz Julia , Pieńkowska Agata , Brzeziński Michał , Szlagatys-Sidorkiewicz Agnieszka , Plata-Nazar Katarzyna Gabriela
Published: November 2020

Background COVID-19 pandemic impacts many communities worldwide. In this study the Poles' knowledge about COVID-19 as well as people’s behaviours, attitudes and fears during the pandemic were assessed. Changes in these between the outset of the pandemic and the imposition of the strictest lockdown measures in Poland were investigated.Methods Physicians, nurses, students of medicine-oriented faculties, non-medical professionals, students of non-medicine-oriented faculties and secondary school students were surveyed by an anonymous online questionnaire two times: at the onset of the pandemic and in the second week of the strictest lockdown. Statistical analyses were performed using non-parametric tests – Pearson Chi Square, Kruskal-Wallis tests.Results In total 2618 responses were collected. At the beginning people knew that the respiratory system was attacked (97.9%); correctly identified the major symptoms of COVID-19 (95.0%) and ways to prevent infection: hand washing (99.8%), covering mouth (85.9%) and the need to call sanitary-epidemiological services if one experienced COVID-19-like symptoms (92.1%).The biggest changes between the first and second phase of the study concerned behaviours: more people wearing facial masks (+37.5%) and staying at home (+66.1%). Respondents in the second wave of the survey were also more scared of the pandemic (+19.6%), economic crisis (+64.1%), and worried about their families (+26.5%). However, they were less afraid of the quarantine (lockdown) (-18.2%). Nurses and physicians were the most worried groups.Conclusions The study showed that even at the outset of the pandemic Polish population had a good initial knowledge about symptoms, transmission, and preventive behaviours regarding COVID-19. People revealed more short-term concerns, such as the worries about coping with quarantine and isolation. After a month, the knowledge and the concerns among the respondents changed. A shift towards long-term pandemic management issues was observed. Respondents reported to experience more fears concerning the pandemic in general, as well as economic and healthcare crises. Medical professionals reported higher level of fear of the pandemic than other groups included in this study. This study uses before-and-after approach which highlights the changes in people’s knowledge and perception of the COVID-19 pandemic during the pandemic’s progression.
The Evaluation of stomatology English Education in China Based on ‘Guanghua Cup’ International Clinical Skill Exhibition Activity
Authors: Wang Xi , Liu Yangjingwen , Yang Le , Zhou Kai , Cao Yang , Hong Yun , Huang Shuheng , Lin Zhengmei
Published: November 2020

Background: English education in professional areas has become more and more important with the increasing internationalization of health profession education in countries around the world. In this study, we aimed to evaluate current Chinese stomatology English education based on Chinese participants’ ability to apply stomatology English during an international stomatology skill competition called the ‘Guanghua Cup activity’.Methods: The registration rate of English and Chinese volunteers and the answer rate and accuracy of Chinese and international contestants on the English knowledge quiz were statistically described. A five-point Likert scale questionnaire was delivered to all participants. The data were analyzed using the Spearman test, Kruskal-Wallis rank sum test and Mann-Whitney U test.Results: Among the 194 students, the English and Chinese volunteer registration rate was 7.73% and 30.93%, respectively. The answer rate of Chinese contestants and international contestants in the English quiz was 25% and 75%, with an accuracy rate of 50% and 66.70%, respectively. The questionnaire was graded by Likert five-level classification. There was a positive correlation between the use of English textbooks in classes and the communication with international teachers and students in the competition (Rs=0.348, p=0.016). English volunteers had more preparation in English before the competition, more opportunities to communicate with international peers, and greater improvement in English ability than the contestants and Chinese volunteers(p<0.001). After the competition, all participants paid more attention to stomatology English (p<0.001).Conclusions: Chinese stomatology students have difficulty in stomatology English application. The ‘Guanghua Cup’ helps to improve English proficiency of English volunteers and arouses the interest of stomatology English for all participants. Chinese stomatology school needs to strengthen and reach a consensus in stomatology English education.
Comparison of different detection methods for Mycoplasma pneumoniae infection in children with community-acquired pneumonia
Authors: Tang Mingyu , Wang Dong , Tong Xing , Zhang Jing , Zhang Lei , Wu Yufen , Cao Qing , Yin Yong
Published: November 2020

Background: Due to the lack of a sensitive, specific and rapid detection method, etiological diagnosis of pneumonia caused by Mycoplasma pneumoniae (M. pneumoniae, MP) is a constantly challenging issue. This retrospective study aimed to compare the diagnostic methods for mycoplasma pneumoniae in children and evaluate their values.Methods: From November 2018 to June 2019, 830 children with community-acquired pneumonia were selected from the Department of Respiratory Medicine, Shanghai Children's Medical Center. On the first day of hospitalization, sputum, throat swabs, venous blood samples were collected for MP-IgM (particle agglutination, PA), MP-IgM (immune colloidal gold technique, GICT), MP-DNA, MP-RNA (simultaneous amplification and testing, SAT), and MP-DNA (real-time polymerase chain reaction, RT-PCR)Results: Among these 830 children, RT-PCR showed that the positive rate was 36.6% (304/830), in which the positive rate of macrolide-resistant (A2063G mutation) accounted for 86.2% (262/304). Using RT-PCR as the standard, MP-RNA (SAT) had the highest specificity (97.5%), and MP-IgM (PA) had the highest sensitivity (74.0%) and Youden index (53.7%). If MP-RNA (SAT) was combined with MP-IgM (PA), its Kappa value (0.602), sensitivity (84.2%), specificity (78.7%), Youden index (62.9%), were higher than those of single Mycoplasma pneumoniae detection.Conclusions: Our research indicated that a combination of MP-RNA (SAT) plus MP-IgM (PA) as an early diagnostic method for children with clinical manifestations of Mycoplasma pneumoniae pneumonia might lead to reliable results.