bluuebunny/crossref_metadata_2025 huggingface dataset:
Educational Pest Repellent Games Using Catapults
Authors: Rizka Hadiwiyanti  , Achmad Afandi
Published: August 2020

Slingshots are also a type of traditional weapon used by ancient people to protect themselves from danger and to hunt small birds. Not only that, slingshot is also a toy of Indonesian children in ancient times. But in this modern era, catapults are rarely played by children and are used by farmers to drive out rice field pests. To be able to preserve the slingshot's traditional weapons, a media update is needed. Even though we don't use and play the slingshot, we can find out how to use it through a medium. Today through digital forms of media such as smartphones can help us so that slingshots can be reused, namely through the form of games on smartphones. This study uses the Research and Development method with addie models (Analysis Design Development Implementation Evaluations) that are appropriate and efficient with the stages in making games. The results obtained are games that are made to be applied to various age groups, especially children. The community responded positively because the games made were positive and could re-introduce traditional games that were developed into more modern games and as a medium of entertainment for the community. So that people will get to know traditional slingshot weapons.
Virtual Reality in Pain Therapy: A Requirements Analysis for Older Adults with Chronic Back Pain
Authors: Stamm Oskar , Dahms Rebecca , Müller-Werdan Ursula
Published: August 2020

Background Today immersive environments such as Virtual Reality (VR) offer new opportunities for serious gaming in exercise therapy and psychoeducation. Chronic back pain (CBP) patients could benefit from exergames in VR. The requirements in older CBP patient for a VR pain therapy have not yet been determined in studies. The aim of the study was to perform a requirements analysis for the user group of geriatric patients with CBP for a VR exergame. The objective was to find out the expectations, desires, preferences and barriers in order to collect them as requirements for this vulnerable group and to determine frameworks of therapy by physiotherapists and psychotherapists.Methods We conducted a requirements analysis through semi-structured interviews with 10 elderly participants with CBP. Furthermore, two focus groups were conducted with three physiotherapists and two psychotherapists to determine frameworks of therapy programs for the target group. The qualitative data were transcribed and examined through a structuring content analysis. Subsequently, the results of the analysis were prioritized by all participants of the studyResults The results of the requirements analysis indicate mandatory requirements for the overall system, hardware, software and gamification elements. The key requirements were target-group-specific applications of the VR exergame through e.g. individual briefing, user-friendly handling, inclusion of movement limitations, presentation of everyday scenarios in combination with biofeedback, age-appropriate feedback through praise and awards and a maximum exercise duration of 30 min and 15 min of relaxation.Conclusion It should be possible to use the determined requirements productively to create user-friendly VR exergames that motivate elderly chronic back pain patients to perform exercises regularly.The study is registered in the German Clinical Trials Register (DRKS-ID: DRKS00015294 12.10.2018)
The clinical features and long-term prognosis of asymmetry childhood Guillain-Barré syndrome: a 5-year follow-up.
Authors: Sun Rui-Di , Jiang jun
Published: August 2020

Backgroud: The aim was to investigate clinical features and long-term prognosis of asymmetric childhood Guillain-Barré syndrome (GBS). Methods: In a retrospective cohort study, standardized data from all children with GBS seen at the Wuhan Children’s Hospital were collected regarding clinical presentation, auxiliary examinations and long-term outcome. We compared asymmetry GBS with symmetry GBS. Asymmetry GBS was defined by Medical Research Council (MRC) grade and motor nerves conduction in bilateral limbs. Recovery was defined as a return to normal life with a DSS of 0. Results: GBS was diagnosed in 72 children. 12（16.67%）were asymmetry GBS compared to 60 symmetry GBS . In asymmetry GBS, six children were transient asymmetry weakness and six children were persistent asymmetry weakness. Compared to symmetry weakness GBS, asymmetry weakness GBS had more preschool children (75% vs 25%, P=0.005), longer days on hospital(26.5(15-37) days vs 11(9-15) days, p =0.000), more mechanical ventilation(MV) (50% vs 8.33%, p=0.000), higher Disease severity score(DSS)at nadir of disease(4(3-5) vs 3(1-4), p=0.010), more axonal subtypes(50% vs 15%, p=0.013) and more complications(58.33% vs 8.33%, p=0.000). Eight children had sequelae and sixty-four children had recovery. Compared to recovery group, sequelae group had more axonal subtypes(62.5% vs 15.63%, p=0.002) and more persistent asymmetry weakness(62.5% vs 4.69%, p=0.000). In six persistent asymmetry GBS, 5(83.33%) had abnormal EEG (electroencephalogram) results, 3(50%) children had mild to marked pleocytosis in CSF and 5(83.33%) had sequelae. Conclusions: In conclusion, asymmetry GBS had two types, namely transient and persistent asymmetry weakness. Asymmetry GBS indicated a more complex condition during disease. Most of persistent asymmetry GBS had clinical or subclinical infectious disease and poor prognosis. Inflammatory in anterior horn cells or nerve root by infectious disease may be the possible function in persistent asymmetry GBS.
iTRAQ-based comparative proteomic analysis of differences in the protein profiles of stems and leaves from two alfalfa genotypes
Authors: Sun Hao , Yu Jie , Zhang Fan , Kang Junmei , Li Mingna , Wang Zhen , Liu Wenwen , Zhang Jiaju , Yang Qingchuan , Long Ruicai
Published: August 2020

Background: To explore the molecular regulatory mechanisms of early stem and leaf development, proteomic analysis was performed on leaves and stems of F genotype alfalfa, with thin stems and small leaves, and M genotype alfalfa, with thick stems and large leaves. Results: Based on fold-change thresholds of >1.20 or <0.83 ( p <0.05), a large number of proteins were identified as being differentially enriched between the M and F genotypes: 249 downregulated and 139 upregulated in stems and 164 downregulated and 134 upregulated in leaves. The differentially expressed proteins in stems were mainly involved in amino acid biosynthesis, phenylpropanoid biosynthesis, carbon fixation, and phenylalanine metabolism. The differentially expressed proteins in leaves were mainly involved in porphyrin and chlorophyll metabolism, phenylpropanoid biosynthesis, starch and sucrose metabolism, and carbon fixation in photosynthetic organisms. Six differentially enriched proteins were mapped onto the porphyrin and chlorophyll metabolism pathway in leaves of the M genotype, including five upregulated proteins involved in chlorophyll biosynthesis and one downregulated protein involved in chlorophyll degradation. Eleven differentially enriched proteins were mapped onto the phenylpropanoid pathway in stems of the M genotype, including two upregulated proteins and nine downregulated proteins. Conclusion: Enhanced chlorophyll synthesis and decreased lignin synthesis provided a reasonable explanation for the larger leaves and lower levels of stem lignification in M genotype alfalfa. This proteomic study aimed to classify the functions of differentially enriched proteins and to provide information on the molecular regulatory networks involved in stem and leaf development.
LncRNAH19 improves insulin resistance in skeletal muscle by regulating heterogeneous nuclear ribonucleoprotein A1
Authors: Gui Weiwei , Zhu WeiFen , Zhu Yiyi , Tang Shengjie , Zheng Fenping , Yin Xueyao , Lin Xihua , Li Hong
Published: August 2020

Background：Skeletal muscle is essential for glucose and lipid metabolism. Growing evidence reveals the importance of long non-coding RNAs (LncRNAs) in metabolism. This study aimed to investigate the function of LncRNA H19 (H19) in lipid metabolism of skeletal muscle and its potential mechanisms.Methods: Glucose tolerance, serum insulin and lipid content in serum and skeletal muscle were determined in control and H19-overexpressed db/db mice. Lipid metabolism was evaluated in H19-overexpressed or H19-silencing muscle cells by detecting lipid contents and mitochondria related functions. The underlying mechanisms were explored by RNA pull-down, mass spectrometry and RNA immunoprecipitation (RIP). Results: H19 was downregulated in skeletal muscle of db/db mice. H19 overexpression in db/db mice inhibited lipid ectopic deposition in skeletal muscle, meanwhile improved glucose intolerance and insulin resistance as compared with control db/db mice treated with ad-GFP. Furthermore, overexpression of H19 reversed FFA-induced lipid accumulation and increased cellular respiration in muscle cells, while H19 knockdown exhibited opposite effects in muscle cells. Mechanistically, H19 interacted with heterogeneous nuclear ribonucleoprotein (hnRNPA1) which was validated by RNA pulldown and RIP analysis, which increased translation of fatty acid oxidation closely related genes PGC1a and CPT1b. Conclusion: Our data suggest that overexpression of H19 ameliorates insulin resistance by reducing ectopic lipid accumulation in skeletal muscle. The possible underlying mechanisms are that overexpression of lncRNAH19 promotes fatty acids oxidation via targeting of hnRNPA1.
Reference Values and Related Factors for Peak Expiratory Flow in Middle-aged and Elderly Chinese
Authors: Ji Chao , Dai Huixu , Zhao Zhiying , Liu Tiancong , Tong Shuhui , Zhang Xiaohang , Xia Yang
Published: August 2020

Background: Peak expiratory flow (PEF), as an essential index used for screening and monitoring asthma, chronic obstructive pulmonary disease, and respiratory mortality especially in elderly, is recommended especially for low resource settings in low- and middle-income countries. However, few reports have focused on the reference of PEF in China, especially in the middle-aged and elderly. Thus, the aim of this study was to determine age- and sex-specific reference values of PEF in the middle-aged and older Chinese population.Methods: There were 11,717 participants included for reference value analysis and 11,340 participants were included for risk factor analysis. The PEF was measured using a peak flow meter in L/min. The distribution of PEF terciles stratified by sex and age were reported. Multiple linear regression analysis was used to determine the associations between risk factors and PEF.Results: The PEF was higher in men than women across all age subgroups. The value of PEF decreased with age in both men and women. Height, weight, handgrip strength, and household air pollution were positively associated with PEF, and age, waist circumference smoking status were negatively associated with PEF significantly in both men and women (all P <0.05). The mean values were 9.38 L/min and 64.12 L/min for men and women. Meanwhile, the prevalence of low PEF was 1.62% and 2.16% for men and women, respectively.Conclusions: Age- and sex-specific centiles of PEF for the middle-aged and older Chinese population were estimated. The reference values for low PEF were provided for epidemiological studies and clinical practice in the future. Interventions on lung function or respiratory disease should be pay more attention on factors associated with PEF.
In-depth analysis of the genomic landscape of 86 metastatic neuroendocrine neoplasms reveals subtype-heterogeneity and potential therapeutic targets
Authors: Mostert Bianca , Riet Job van , de Werken Harmen van , Cuppen Edwin , Eskens Ferry , Tesselaar Margot , Veenendaal Linde , Klümpen Heinz-Josef , Dercksen Marcus , Valk Gerlof , Lolkema Martijn , Sleijfer Stefan
Published: August 2020

Metastatic neuroendocrine neoplasms (mNEN) form clinically and genetically heterogeneous malignancies, characterized by distinct prognoses based upon primary tumor localization, functionality, grade, proliferation index and diverse outcomes to treatment. Here, we report the mutational landscape of 86 whole-genome sequenced mNEN. This landscape revealed distinct genomic subpopulations of mNEN based on primary localization and differentiation grade; we observed relatively high tumor mutational burdens (TMB) in neuroendocrine carcinoma (5.45 somatic mutations per megabase) with TP53, KRAS, RB1, MYC and APC as major drivers versus an overall low TMB in neuroendocrine tumors (1.08). Furthermore, we observed distinct drivers which were enriched with somatic aberrations in pancreatic (MEN1, ATRX, DAXX, PCNT and SETD2) and midgut-derived neuroendocrine tumors (CDKN1B). Finally, 49% of mNEN patients revealed extensions of their treatment-repertoire based upon actionable (and responsive) somatic aberrations; potentially directing improvements in mNEN treatment strategies.
Recognition and Management of Agitation in Acute Mental Health Services: A Qualitative Evaluation of Staff Perceptions
Authors: Tucker Joshua , Whitehead Lisa , Palamara Peter , Rosman Josephine Xenia , Seaman Karla
Published: August 2020

Background: Agitation among patients is a common and distressing behaviour across a variety of health care settings, particularly inpatient mental health. Unless recognised early and effectively managed it can lead to aggression and personal injury. The aim of this paper is to explore the experiences of mental health nurses in recognising and managing agitation in an inpatient mental health setting and the alignment of these experiences with best practice and person-centred care. Methods: This study used a qualitative cross-sectional descriptive methodology. Semi-structured focus group interviews were conducted with twenty-one nurses working in a mental health unit in 2018. Nursing staff described their experiences of assessing and managing agitation. Descriptive and Thematic Analysis were undertaken of the transcribed focus group dialogue. Results: Nurses combined their clinical knowledge, assessment protocols and training with information from patients to make an individualised assessment of agitation. Nurses also adopted an individualised approach to management by engaging patients in decisions about their care. In keeping with best practice recommendations, de-escalation strategies were the first choice option for management, though nurses also described using both coercive restraint and medication under certain circumstances. From the perspective of patient-centred care, the care provided aligned with elements of person-centred care nursing care.Conclusion: The findings suggest that clinical mental health nurses assess and manage agitation, with certain exceptions, in line with best practice and a person-centred care nursing framework.
A Novel Handheld Bimanual Surgical Robot for Single-Port Laparoscopic Surgery
Authors: Feng Zhe , Dong Dinghui , Ma Tao , Wang Yue , Chen Huan , Wu Rongqian , Lv Yi , Zhu HaoYang
Published: August 2020

Background: single-port laparoscopic surgery is a hotspot of minimally invasive surgery, but its promotion is limited because of operational triangulation and instrument conflict. Robot technologies can cleverly solve this dilemma. But most of the surgery robots need high cost and long time to setup and mainly for complex surgery currently. There is no portable single-port laparoscopic robotic surgical instruments suitable for simple abdominal surgery. Method: This paper presents a handheld single-port laparoscopic surgical robot. It consists of two manipulate arms, both of the arms have 2 degrees of freedom, and two more degrees of freedom can be applied by handheld. The left arm has the function of pulling tissue, while the right arm is equipped with a laser fiber, which can be used for tissue cutting and hemostasis with a 980nm diode laser. Kinematics analysis, dynamic simulation, modal analysis and vitro simulation experiments were conducted to verify the feasibility for the handheld single-port laparoscopic robot. Result: The bimanual surgical robot can provide enough workspace, the gripper and laser head have stable working ability, and can successfully complete the fenestration and drainage of hepatic cyst. Conclusion: This bimanual surgical robot has the potential to become a surgical instrument for simple intraperitoneal surgery. It can provide a small, portable and inexpensive surgical robot system.
Long-segment versus short-segment fixation through a posterior approach for tuberculous spondylodiscitis of the mid-thoracic spine in adults: a study of mid- to long-term efficacy
Authors: Xu Zhenchao , Wang Xiyang , Chen Gang , Liu Zheng
Published: August 2020

Background

This retrospective study aimed to perform comparatively evaluate the mid- to long-term efficacy of long-segment and short-segment fixations via the posterior approach as treatment for tuberculous spondylodiscitis in the mid-thoracic spine.
Methods

A total of 95 patients with tuberculous spondylodiscitis in the mid-thoracic spine underwent surgery via the posterior approach including single-stage posterior debridement, interbody fusion, and pedicle screw fixation. Long-segment fixations were performed for 46 patients (group A), while short-segment fixations were performed for the other 49 patients (group B). Clinical and radiological outcomes were assessed during mid- to long-term follow-up.
Results

The average follow-up periods for groups A and B were 75.5 ± 11.8 and 76.8 ± 11.6 months, respectively. The operative time and intraoperative blood loss were lower in group B than in group A (P < 0.05). Both management approaches significantly corrected the kyphotic deformity detected either in the early postoperative period or at the final visit after long-term follow-up (P > 0.05). Bony fusion was generated after average periods of 10.8 ± 2.1 months and 11.0 ± 2.0 months in groups A and B, respectively. Favorable outcomes were observed on assessment of neurological function and patients’ well-being at the final follow-up.
Conclusion

No therapeutic differences were observed between long-segment and short-segment fixation as surgical treatment for mid-thoracic Pott’s disease during mid- to long-term follow-up. Kyphotic deformity and neurological impairment were significantly relieved via both posterior fixation approaches, with patients’ well-being reaching a favorable level. Moreover, short-segment fixation led to less blood loss and required a shorter operative time.
Coping Abilities of Nursing Graduates Under Public Health Emergency (COVID-19): A Cross-Sectional Study
Authors: Xu Bin , Yu Jian , Li Suyuan , Chen Lu , Lin Zheng
Published: August 2020

Background: Public health emergencies are serious social problems, threatening people's lives, causing considerable economic losses, and related to all mankind life and health and safety. Nurses are essential in the fight against the public health emergency, corona virus disease 2019 (COVID-19). Nursing graduates are considered as backup health care providers for licensed nurses, the coping abilities and crisis management of nursing students at present deserve attention all around the world. Methods: 2035 graduating nursing graduates were invited to participate in mobile phone app-based survey from Feb 6 to 20, 2020. The demographic items, psychological and behavioral responses, and the coping abilities were conducted. Multiple linear regression was used to identify the independent factors to nursing graduates’ coping abilities under COVID-19.Results: 1992 submitted were valid. Multiple linear regression analysis showed that Confidence to overcome difficulties, Optimism, Active coping, Help seeking and Practice hospital as designated treatment unit were independently associated with the positive coping of graduates. Fear of COVID-19, Optimism, Avoidance, Help seeking and Severity of epidemic around were independently associated with the negative coping of graduates.
Dialysis Care for U.S. Military Veterans in Puerto Rico during the 2017 Atlantic Hurricane Season, a Retrospective Cohort Study
Authors: Lukowsky Lilia , Dobalian Aram , Kalantar-Zadeh Kamyar , Der-Martirosian Claudia
Published: August 2020

Continuity of care for End Stage Renal Disease (ESRD) patients is critical as they are at heightened risk for increased morbidity and mortality if their typically 3-times a week hemodialysis treatment is interrupted because of disaster-related disruptions in equipment, electricity, water, communication, or transportation.(1-4) For example, a month after Hurricane Katrina (2005), more than 50% of the dialysis facilities in Louisiana were still closed due to major damage caused by the hurricane.(5) These closures contributed to an increase in renal-related hospitalizations in the hurricane-affected areas.(6),(7) Similarly, during Hurricane Sandy (October 29, 2012), 306 dialysis facilities in New York and New Jersey were closed right after the hurricane struck.(2) Major disruptions in dialysis services caused by Sandy led to missed dialysis care during the first week post-Sandy for both U.S. Department of Veterans Affairs (VA) and non-VA patients. Major disruptions in dialysis services might have contributed to an increase in the 30-day mortality rate of 1.83% in Sandy-affected areas compared to 1.6% for the same month in the preceding year.(5, 8)
Exploring the Consequences of Early Marriage among Kurdish Women: A Qualitative Study in Western Iran
Authors: Solhi Mahnaz , Azar Farbod Ebadi Fard , Farahani Farideh Khalajabadi , Lebni Javad Yoosefi
Published: August 2020

Background: Early marriage is one of the most important social issues for young women, which can have many consequences, so this study was conducted to explain the consequences of early marriage among Kurdish women in western Iran.Methods: This qualitative study was conducted with the approach of conventional content analysis among Iranian Kurdish women who were married under the age 18. The data were saturated through semi-structured interviews with 30 women selected by purposeful sampling. Data analysis was performed by Graneheim and Lundman method.Results: 389 codes, 14 subcategories, 4 sub-categories and 2 main categories were extracted from data analysis. Negative consequences of early marriage include 1- Physical and psychological problems (high-risk pregnancy and childbirth, physical illnesses, yearning and remorse, psychological challenges) 2- Family problems (experience of violence, dissatisfaction with married life, experience of multiple roles, lack of independence in Family life) 3. Social problems (social deviance, deprivation of social and health services, social isolation, deprivation of job and educational opportunities) and positive consequences include receiving intra- family support, improving living conditions and opportunities for progress and empowerment.Conclusions: It is possible to reduce the negative consequences of early marriage through teaching young women to have a less dangerous pregnancy and childbirth, training and using psychological counseling on how to deal with personal problems and married life, and providing appropriate social and health services for them.
Assessing the routine-practice gap for home blood pressure monitoring among Chinese adults with hypertension
Authors: Zuo Hui-Juan , Ma Ji-Xiang , Wang Jin-Wen , Chen Xiao-Rong
Published: August 2020

Background: Home blood pressure monitoring (HBPM) is recommended and specified for diagnosis, treatment adjustment and management of most hypertension cases by hypertension guidelines. This study aimed to evaluate the HBPM behaviour and to explore the routine-practice gap among Chinese adults with hypertension. Methods: Between October 2014 and November 2014, data were collected from 20 communities across three cities and six townships in three provinces located in Beijing, Shandong and Jiangsu Provinces in China. A total of 2,272 patients with hypertension aged ≥35 years were registered with a primary health station in local communities were selected by simple random sampling. Results: Among 2,272 subjects, 45.3% owned a home sphygmomanometer. In addition, 27.5% (625/2,272) engaged in HBPM weekly or more frequently. Healthcare providers’ advice was the strongest factor contributing to home sphygmomanometer ownership and weekly HBPM behaviour, with an odds ratio of 13.50 and 8.97. Patients with uncontrolled hypertension were more likely to conduct HBPM regularly (morning and evening), measure their BP two or three times in each measuring session and report 7 consecutive days of HBPM than patients with controlled hypertension (8.8% vs. 5.8%, P=0.042; 14.3% vs. 8.1%, P=0.002; and 19.9% vs. 12.4%, P=0.005, respectively). Only 16.0% (165/1,030) of patients actively reported their HBPM readings to doctors. Conclusion: The strategies of HBPM specified by ESH/ESC hypertension guidelines (2013) and those from China (2018) are seldom achieved in current practice in China. Only a small proportion of patients actively participate in utilizing home BP measurements to enhance their care. HBPM may be improved by healthcare providers’ specific advice and training.
Challenges and coping strategies in non-communicable disease management during COVID-19 in Addis Ababa, Ethiopia: A qualitative study
Authors: Ketema Bezawit , Kaba Mirgissa , Addissie Adamu , Kantelhardt Eva Johanna
Published: August 2020

Background People with comorbidities are at higher risk of becoming severely ill with COVID-19. Evidence has shown that those with cardiovascular diseases, chronic respiratory diseases, diabetes and cancer had more severe illness and worse prognosis with COVID-19 compared to patients without comorbidities. Insufficient numbers of health workers, high financial barriers and lack of access to quality-assured medicines have been challenges for patients with non-communicable diseases (NCDs) in developing countries, even before COVID-19. Therefore, this study aimed to explore the challenges and coping strategies in NCD management during COVID-19 in Addis Ababa, Ethiopia.Methods This study followed a phenomenological study approach to explore challenges and coping strategies using the experience of healthcare professionals (HCPs) and people with NCDs. Twenty-two individuals (13 HCPs and nine people with NCDs) were recruited purposively and invited for in-depth interview. All interviews were made by telephone and data collected using interview guide. There was pre-interview telephonic conversation to ask participants for a convenient time and date for the actual interview. At the end of every interview, a summary of the interview notes was read to the participants to ensure the correct interpretation of participants’ original views. ATLAS.ti version 7 software was used to assist in the coding and categorisation. Thematic analysis was employed to understand the challenges and coping strategies in NCD management during COVID-19 in Addis Ababa, Ethiopia.Results Challenges posed by COVID-19 to people with NCD included postponement of NCD follow-up due to fear of COVID-19 infection, transportation problems and unwelcoming healthcare facilities; stress related to fear of death and absence of social support; and reduced physical activity in relation to staying at home. For the HCPs, a shortage of personal protective equipment and an absence of standards and guidelines were the common challenges. Telemedicine was the typical coping strategy used by HCPs, while people with NCDs were mostly expecting spiritual protection and safeguarding.Conclusions We concluded that the postponement of NCD follow-up, in addition to stress and reduced physical activity, may worsen the increasing mortality from preventable NCDs in the country. We recommend every COVID-19 response measures to target NCD health service independently.
Analysis of Continuity of Care and Related Factors in Diabetes Patients in Korea
Authors: Shin Ji Yeh , Kim Ha Jin , Cho BeLong , Yang Yun Jun , Yun Jae Moon
Published: August 2020

Background: Diabetes is one of the fastest growing diseases with approximately 463 million patients worldwide. It is established that to manage diabetes, continuity of care in primary care setting is crucial. We aim to statistically define and analyze factors of continuity that are associated with patient, clinic and geographical relationship.Methods: We used 2014~2015 claim data from National Health Insurance Service (NHIS), with 39,096 eligible outpatient attendances across 29,912 office-based clinics. We applied multivariable logistic regression to analyze factors that may affect three kinds of continuity of care index for each patient: most frequent provider continuity index (MFPC), modified-modified continuity index (MMCI), and continuity of care index (COC). Results: Mean value of continuity of care indices were MFPC 0.90, MMCI 0.96, COC 0.85. Among patient factors, old age above 80 (MFPC 0.81 [0.74-0.89], MMCI 0.84 [0.76-0.92], COC 0.81 [0.74-0.89]) and disability were strongly associated with lower continuity of care. Another significant factor was residential area: further the patients lived from their primary care clinic, lower the continuity of diabetes care (MFPC 0.74 [0.70–0.78], MMCI 0.70 [0.66–0.73], COC 0.74 [0.70–0.78]). Patients who lived in metropolitan area had higher continuity of care compared to other areas (metropolitan area, MFPC 1.19 [1.17-1.27], MMCI 1.17 [1.10-1.25], COC 1.19 [1.12-1.27]). There was no statistical significance among clinic factors, such as number of hired physicians or nurses hired per clinic, between the lower and the higher continuity of care groups.Conclusion: Geographical proximity of patient’s residential area and clinic location showed highest correlation as factor of continuity. Political support is necessary to geographically align the imbalance of supply and demand of medical needs.
GSD_1.0 (canFam4): A novel canine reference genome resolves genomic architecture and uncovers transcript complexity
Authors: Wang Chao , Wallerman Ola , Arendt Maja-Louise , Sundström Elisabeth , Karlsson Åsa , Nordin Jessika , Mäkeläinen Suvi , Pielberg Gerli Rosengren , Hanson Jeanette , Ohlsson Åsa , Saellström Sara , Rönnberg Henrik , Ljungvall Ingrid , Häggström Jens , Bergström Tomas , Hedhammar Åke , Meadows Jennifer , Lindblad-Toh Kerstin
Published: August 2020

We present GSD_1.0, a novel high-quality domestic dog reference genome with chromosome length scaffolds and gap number reduced 41-fold, from 23,836 to 585. Annotation with novel and existing long and short read RNA-seq, miRNA-seq and ATAC-seq, revealed that 32.1% of closed gaps harboured previously hidden functional elements, including promoters, genes and miRNAs. A catalogue of canine “dark” regions was made to facilitate mapping rescue. Alignment in these regions is difficult, but we demonstrate that they harbour trait-associated variation. Key genomic regions were completed, including the Dog Leukocyte Antigen (DLA), T Cell Receptor (TCR) and 366 COSMIC cancer genes. The sequencing of 27 dogs from 19 breeds with linked read technology uncovered 22.1 million SNPs, indels and larger structural variants. Intersection with protein coding genes showed that 1.4% could directly influence gene products, and so provide a source of normal or aberrant phenotypic modifications.
A Case Report of Infective Endocarditic Aortic Valve Abscess with Perforation in Infant
Authors: Yang Yanfeng , Si Feifei , Jin Mei , Yang Sheng
Published: August 2020

Background: Infective endocarditis (IE) is an uncommon but a potentially life-threatening infectious disease in children. The epidemiology of IE has changed in the past three to four decades and its incidence has been increasing recently. This case with atypical present including culture-negative and no-cardiovascular diseases got cardiovascular structural damage that deteriorate in short time. Case presentation: This case was an infant less than one year old without basic cardiovascular disease,and this case was admitted with Kawasaki disease early. His diagnosis was infective endocarditic aortic valve abscess with perforation. The patient received intravenous injection of cefotaxime for two days and piperacillin sulbactam and cefazolin for six days. On 9 th day, piperacillin sulbactam combining with vancomycin were used. On 10 th day, the patient was sent to cardiac surgery department to receive aortic valve repair. The operation is successful.The abscess cavity of the inferior aortic valve and the vegetations on the aortic valve were completely removed, the left coronary valve was removed, and the left coronary valve was locally widened by autologous pericardial patch. Conclusions: Infective Endocarditis in children may be difficult to diagnosis and manage.and the treatment are becoming a new challenge for conventional antibiotic therapy. Some IE require serial follow-up to determine potential need for subsequent cardiovascular surgery (CVS) intervention despite microbiologic cure with antimicrobial therapy.
Identification and analysis of the signaling pathways, matrix-digestion enzymes, and motility components controlling Vibrio cholerae biofilm dispersal
Authors: Bridges Andrew , Fei Chenyi , Bassler Bonnie
Published: August 2020

Bacteria alternate between being free-swimming and existing as members of sessile multicellular communities called biofilms. The biofilm lifecycle occurs in three stages: cell attachment, biofilm maturation, and biofilm dispersal. Vibrio cholerae biofilms are hyper-infectious and biofilm formation and dispersal are considered central to disease transmission. While biofilm formation is well-studied, almost nothing is known about biofilm dispersal. Here, we conduct an imaging screen for V. cholerae mutants that fail to disperse, revealing three classes of dispersal components: signal transduction proteins, matrix-degradation enzymes, and motility factors. Signaling proteins dominated the screen and among them, we focused on an uncharacterized two-component sensory system that we name DbfS/DbfR for Dispersal of Biofilm Sensor/Regulator. Phospho-DbfR represses biofilm dispersal. DbfS dephosphorylates and thereby inactivates DbfR, which permits dispersal. Matrix degradation requires two enzymes: LapG, which cleaves adhesins, and RbmB, which digests matrix polysaccharide. Reorientations in swimming direction, mediated by CheY3, are necessary for cells to escape from the porous biofilm matrix. We suggest that these components act sequentially: signaling launches dispersal by terminating matrix production and triggering matrix digestion and, subsequently, cell motility permits escape from biofilms. This study lays the groundwork for interventions that modulate V. cholerae biofilm dispersal to ameliorate disease.
Assessing Human Appropriation of Net Primary Production in Various Vegetation Types Based on the Spatio-Temporal Fusion Model in Xiong'an New Area During 2000-2018
Authors: Tang Jia , Zhang Qing , Zeng Jingyu , Zhang Rongrong , Li Xingrong , Tian Yanqin , Wang Qianfeng
Published: August 2020

Background: Humans have induced great changes in terrestrial ecosystems. The human appropriation of net primary production (HANPP) quantifying the intensity of anthropogenic extraction from ecosystem has been widely used to evaluate ecological sustainable development. However, the coarse-resolution of calculating data for the HANPP leads to biased results in a small scale. Furthermore, the spatio-temporal patterns and dynamics of the HANPP in a human-dominated heterogeneous region are still unclear. Methods: This study investigates the state-level new area Xiong'an New Area and applies the spatial and temporal nonlocal filter-based fusion model (STNLFFM) to generated new datasets, which is combined with our previously improved Carnegie–Ames–Stanford approach (CASA) to estimate HANPP. Spatio-temporal variations of HANPP are mapped and assessed using Mann–Kendall (M–K) trend analysis approach from 2000 to 2018 with a high resolution. The relationship among the HANPP, subcomponents, and natural–social–economic-driven factors is discussed herein. Results: The results show that the STNLFFM-derived fusion images fitted well with the observed images having the superior correlation coefficient (r), structural similarity index, root mean square error, and mean absolute deviation of 0.75, 0.76, 0.035, and 0.026, respectively, and the normalized difference vegetation index (NDVI) differences are mainly concentrated on the range of 0–0.15 for all months. The HANPP derived by the fusion-based images, above 60% of potential NPP, varied across the whole area, especially between various vegetation types. The HANPP exhibited a significant positive correlation (r > 0.46, P < 0.05) with precipitation and held an uptrend because of the increase of the harvested HANPP which related with the socio-economic conditions having the determination coefficients above 0.76.Conclusions: The spatio-temporal fusion contributed to fine spatial patterns and trends of HANPP among various vegetation types. Though the harvested HANPP increased from 2000 to 2018, the agricultural and socio-economic developments did not bring extensive HANPP growth, indicating that the expansion has not violated its sustainable development goal. The results provide a deep insight of the background characteristics in Xiong'an New Area, which has great potential in supporting the future scientific construction of the new area.
Epigenetic Silencing of Tumor Suppressor lncRNA NKILA: Implication on NF-κB Signaling in Non-Hodgkin’s Lymphoma
Authors: Zhang Min Yue , Deng Ming Dan , Wang Lu Qian , Au-Yeung Rex K.H. , Chim Chor Sang
Published: August 2020

Background: NKILA, localized to 20q13.31, is a negative regulator of NF-κB signaling implicated in carcinogenesis. As a CpG island is embedded in the promoter region of NKILA, we hypothesized that NKILA is a tumor suppressor lncRNA reversibly silenced by promoter DNA methylation in non-Hodgkin’s lymphoma (NHL). Results: By pyrosequencing-verified methylation-specific PCR (MSP), NKILA was unmethylated in normal healthy controls, including 10 peripheral blood buffy coats and 11 normal tonsils tissue, but completely methylated in one (10%) NHL cell line SU-DHL-6. Among the lymphoma cell lines, by semi-quantitative RT-PCR, methylation of NKILA was inversely correlated with its expression. In the completely methylated SU-DHL-6 cells, hypomethylation treatment with 5-Aza-2'-deoxycytidine resulted in promoter demethylation and re-expression of NKILA transcript. In NHL primary samples (n=102), NKILA methylation was observed none of mantle cell lymphoma (MCL) cases, but in 29 (51.79%) diffuse large-B cell lymphoma (DLBCL) and 4 (20%) peripheral T-cell lymphoma (PTCL) cases, hence preferentially methylated in DLBCL than MCL (P < 0.0001) and PTCL (P = 0.007). Mechanistically, knockdown of NKILA resulted in promoting IkBα phosphorylation, which was associated with nucleus translocation of total p65 and phosphorylated p65 in SU-DHL-1 cells, hence constitutive NF-κB activation. Functionally, knock-down of NKILA in SU-DHL-1 cells led to decreased cell death and increased cellular proliferation, indicating a tumor suppressor role of NKILA in NHL cells. Conclusions: NKILA was a tumour suppressor lncRNA frequently hypermethylated in DLBCL. Promoter DNA methylation-mediated NKILA silencing led to increase of cellular proliferation and decrease of cell death via repression of NF-κB signaling in NHL cells.
Adolescent Sexual and Reproductive Health Care Service Availability and delivery in Public Health Facilities of Plateau State Nigeria
Authors: Envuladu Esther Awazzi , Massar Karlijn , Wit John de
Published: August 2020

To assessed the availability, accessibility, appropriateness and quality of ASRH services in Primary health care facilities in Plateau State, Nigeria, a cross sectional study was conducted in 230 PHCs across the three senatorial zones of Plateau state. Primary data was obtained through face to face interview with heads of facilities from December 2018 to May 2019 using an adapted questionnaire from WHO with five domains ascertaining the extent that ASHR services were available and provided. The questionnaires were administered to the head of the facilities. Very few PHCs in the state had space (1.3%) and equipment (12.2%) for ASRH services. The proportion of PHCs offering counselling on sexuality was 11.3%, counselling on safe sex was 17%, counselling on contraception was 11.3%, and management of gender based violence was 3%. Most facilities were not operating at convenient time for adolescents. Only 2.6% PHCs had posters targeted at ASRH and just 7% of the PHCs had staff trained on ASRH. It was concluded that majority of the PHCs surveyed in Plateau State Nigeria lacked dedicated space, basic equipment and essential sexual and reproductive health care services for ASRH
Study of Kenyan Optometrists View on Future of Optometry and Prospective Impact on Public Health
Authors: Muma Shadrack , Obonyo Stephen
Published: August 2020

Background: VISION 2020: The Right to Sight, was to ensure that by the year 2020, a great reduction in the incidences of avoidable blindness be recorded. This was achivable by training optometrists. Kenya has a population of 47 million, with 56 registered optometrists who are not regulated by the government. However there is no data on optometrists view on the future of optometry in Kenya and the public health implication. Methods: A semi-structured questionnaire was emailed to 56 registered optometrists. The questionnaire contained broad areas such as demographics of participants, their view on status of optometry in kenya, challenges faced by the optometrists, availability of lecturers, their concerns on the way forward and how these issues impacts on public health. A chi-square was used to look at associations and odds ratio was computed.Results: A vast majority (90%) of the respondents suggested that regulating optometry will be the only solution to their problems. Most respondents 91.7% agreed that the situation has impacted negatively on the public health. General public awareness on what is optometry should be enhanced 79%. The qualitative analysis produced four broad themes: (1) regulation; (2) unity; (3) public health implication and (4) creating public awareness. Conclusion: The key recommendations was to lobby for regulation of optometry practise and there is need for public awareness on what is optometry and their role in the eye care. Adequate lecturers should be recruited to ensure quality among graduates in delivery to the public.
Knowledge, Socio-cognitive Perceptions and the Practice of Hand Hygiene and Social Distancing During the COVID-19 Pandemic: A Cross-sectional Study of UK University Students
Authors: Barrett Christine , Cheung Kei Long
Published: August 2020

BackgroundDuring the first wave of the COVID-19 pandemic, social distancing and hand hygiene have been the primary means of reducing transmission in the absence of effective treatments or vaccines, but understanding of their determinants is limited. This study aimed to investigate knowledge and socio-cognitive perceptions, and their associations with such protective behaviours, in UK university students. MethodsA cross-sectional online survey of 293 students was undertaken on 13 May 2020. Survey questions addressed demographics, knowledge of the disease and effectiveness of the protective measures, risk perception, socio-cognitive perceptions (e.g. attitude, social support, and self-efficacy), habit, time factors and trust, as well as the hand hygiene and social distancing behaviours. Multiple linear regression was used to identify the strongest associations of potential determinants with behaviour.ResultsParticipants reported high levels of social distancing with 88.9 % answering “Mostly” or “Always” for every activity, but only 42.0% reporting the same for all hand hygiene activities. Knowledge of the effectiveness of each activity in preventing transmission was high, with 90.7% and 93.5% respectively identifying at least 7 of 8 hand hygiene or 9 of 10 social distancing activities correctly. Habit (β = 0.39, p <0.001) and time factors (β = 0.28, p <0.001) were the greatest contributors to unique variance in hand hygiene behaviour, followed by ethnicity (β = -0.13, p =0.014) and risk perception (β = 0.13, p = 0.016). For social distancing behaviour, the determinants were self-efficacy (β = 0.25, p <0.001), perceived advantages (β = 0.15, p = 0.022), trust in policy (β = 0.14, p = 0.026) and gender (β = -0.14, p = 0.016). Regression models explained 40% hand hygiene and 25% social distancing variance.ConclusionsThis study indicated that communications about effectiveness of hand hygiene and social distancing behaviours had been effective in terms of knowledge acquisition. However, in the light of likely second waves of COVID-19, attention to maintaining social distancing behaviour and improving hand hygiene behaviour may need to address more difficult areas of changing habits, overcoming time factors and building trust, as well as interventions to increase self-efficacy and address risk perception concerns.
Bi-level Planning Model for Urban Energy Steady State Optimal Configuration
Authors: Wang Yongli , Zhou Minhan , Dong Huanran , Cai Chengcong , Liu Chen , Yang Jiale , Li Fang
Published: August 2020

BackgroundWith the rapid development of social economy, energy consumption has continued to grow, and the contradiction between energy supply and demand has become increasingly tense. Cities account for two-thirds of global primary energy demand that makes urban energy systems become a center of sustainable transitions.MethodsThis paper builds a bi-level planning model for steady state optimal configuration to realize the reasonable planning of the urban energy structure. The first level mainly analyzes the relationship between coal, petroleum, natural gas, and renewable energy when the energy system is in a stable state. Based on the steady-state relationship of multiple energy sources, the second level is mainly aiming at energy allocation of the city, to achieve the minimization of construction and operating costs of the urban energy system, as well as the pollutant emissions. And nonlinear system dynamics and the non-dominated sorting genetic algorithm II (NSGA-II) algorithm are implemented to solve the model.ResultsThe model studies the interaction between four energy sources to find out the demand of each energy source when the urban energy system is in a stable state. To illustrate the advantage of the method, the application of the planning model proposed in this paper is discussed in the energy system of city J of China. Under the premise of ensuring the stability of the urban energy system, the city J has two energy planning schemes: mainly coal or mainly high-quality energy.ConclusionThe coal-based energy structure can save economic costs. However, from the perspective of actual demand or ecological environment, the urbanization level of city J is relatively high, and the coal-based energy structure is unreasonable and may cause greater environmental pollution. Under the type of high-quality energy development model, city J should continue to strengthen the adjustment of the industrial structure and optimize and upgrade the urban development path. The focus is on strengthening the use of clean energy and improving energy efficiency, thereby further reducing the demand for traditional fossil energy in the process of economic development.