bluuebunny/crossref_metadata_2025 huggingface dataset:
Measuring Clinical Uncertainty and Equipoise by Applying the Agreement Study Methodology to Patient Management Decisions
Authors: FAHED Robert , DARSAUT Tim E. , FARZIN Behzad , CHAGNON Miguel , Raymond Jean
Published: June 2020

Background: Clinical uncertainty and equipoise are vague notions that play important roles in contemporary problems of medical care and research, including the design and conduct of pragmatic clinical trials. Our goal was to show how the reliability study methods normally used to assess diagnostic tests can be applied to particular management decisions to measure the degree of clinical uncertainty and equipoise regarding the use of rival management options prior to the conduct of randomized trials.Methods: We first illustrate how we have used the reliability study methodology to measure uncertainty in clinical decision-making regarding mechanical thrombectomy in acute stroke. We then follow the layout provided by standard guidelines to review how the various design elements of diagnostic reliability studies can be adapted to assess the repeatability of management decisions and measure clinical uncertainty.Results: The example shows how this methodology can be used to show disagreement in decisions for thrombectomy, and justify that sufficient clinical uncertainty exists to warrant the conduct of additional randomized trials. The general method we propose is that a sufficient number of diverse individual cases sharing a similar clinical problem and covering a wide spectrum of clinical presentations be assembled into a portfolio that is submitted to a variety of clinicians who routinely manage patients with the clinical problem. Clinicians are asked to independently choose one of the predefined management options, which are selected from those that would be compared within a randomized trial that would address the clinical dilemma. Intra-rater agreement can be assessed at a later time with a second evaluation. Various professional judgments concerning individual patients can then be compared and analyzed using kappa statistics or similar methods. Interpretation of results can be facilitated by providing examples or by translating the results into clinically meaningful summary sentences. Conclusions: Measuring the uncertainty regarding management options for clinical problems may reveal substantial disagreements, provide an empirical foundation for the notions of clinical uncertainty and equipoise, and inform or facilitate the design/conduct of clinical trials to address the clinical dilemma.
A method to audit and score implementation of knowledge translation (KT) interventions in large health regions – an observational pilot study using rectal cancer surgery in Ontario
Authors: Simunovic Marko , Fahim Christine , Coates Angela , Urbach David , Earle Craig , Grubac Vanja , Brouwers Melissa , O'Brien Mary Ann , Baxter Nancy
Published: June 2020

Background: Across Ontario, since the year 2006 various knowledge translation (KT) interventions designed to improve the quality of rectal cancer surgery have been implemented by the provincial cancer agency or by individual researchers. Ontario is divided administratively into 14 health regions. We piloted a method to audit and score for each region of the province the KT interventions implemented to improve the quality of rectal cancer surgery. Methods: We interviewed stakeholders to audit KT interventions used in respective regions over years 2006 to 2014. Results were summarized into narrative and visual forms. Using a modified Delphi approach, KT experts reviewed these data and then, for each region, scored implementation of KT interventions using a 20-item KT Signature Assessment Tool. Scores could range from 20-100 with higher scores commensurate with greater KT intervention implementation. Results: There were thirty interviews. KT experts produced scores for each region that were bimodally distributed, with an average score for 2 regions of 78 (range 73-83) and for 12 regions of 30.5 (range 22-38). Conclusion: Our methods efficiently identified two groups with similar KT Signature scores. Two regions had relatively high scores reflecting numerous KT interventions and the use of sustained iterative approaches in addition to those encouraged by the provincial cancer agency, while 12 regions had relatively low scores reflecting minimal activities outside of those encouraged by the provincial cancer agency. These groupings will be used for future comparative quantitative analyses to help determine if higher KT signature scores correlate with improved measures for quality of rectal cancer surgery.
Disparities in utilization of sexual and reproductive health services among high school adolescents from youth friendly service implemented and non-implemented areas of South Ari district, South Omo zone, Southern Ethiopia: a comparative cross-sectional study.
Authors: Haile Bayu , Shegaze Mulugeta , Feleke Tesfaye , Glagn Mustefa , Andarge Eshetu
Published: June 2020

Background: In recent years, much effort was made to improve access to sexual and reproductive health services (SRH) to adolescents and youths in Ethiopia particularly through establishment of youth friendly service (YFS) corners as part of the existing health care facilities. The existing evidences focused on the utilization of SRH services at YFS alone. There is a dearth of evidence which compares the SRH service use between the YFS implemented and non-implemented areas so that evidences can be drawn to suggest on the successes of the expansion of youth friendly corners. Methods: A school-based comparative cross-sectional study with multistage cluster sampling method was employed. Self-administered questionnaire was used to collect data and the collected data were entered in to Epi data version 4.4.1 software and then exported to SPSS version 20 for analysis. χ2 test was used to see significant difference in magnitude of SRH service utilization between YFS implemented and non-implanted areas. The association between the SRH services utilization and the independent variables was examined using binary logistic regression. Finally, variables having p-value less than or equal to 0.05 in the multivariable logistic regression model were considered as statistically significant.Results: There was a significant difference in the rate of SRH service utilization between YFS implemented (33.8%) and YFS non- implemented (9.9%) areas (χ2=37.49, p<0.001). Higher educational status of mothers (AOR=2.588, 95 % CI: 1.220, 5.491), having open discussion with family (AOR=3.175, 95%CI: 1.624, 6.206), good knowledge (AOR= 4.511, 95% CI: 2.458, 8.278) and having positive attitude (AOR= 5.084, 95% CI: 2.764, 9.352) were positively associated with SRH services utilization.Conclusion: Compared with high schools from YFS implemented areas, the magnitude of utilization of SRH services was significantly lower among students from high schools where health facilities had not yet implemented YFS. There is a need for more efforts to scale up SRH services in YFS non implemented areas among stakeholders at different hierarchies. Such interventions should target on improving open discussion at family level, knowledge and attitude on SRH issues and women education at large.
Prevalence, antimicrobial susceptibility pattern, and associated factors of Salmonella and Shigella among food handlers in Adigrat University student’s cafeteria, Northern Ethiopia, 2018
Authors: Legese Haftom , Kahsay Tsega , Gebrewahd Aderajew , Berhe Brhane , Fseha Berhane , Tadesse Senait , Gebremariam Guesh , Negash Hadush , Mardu Fitsum , Tesfay Kebede , Adhanom Gebre
Published: June 2020

Background

Food handlers play a significant role in the transmission of foodborne infection. Salmonella and Shigella are the most common foodborne pathogens and their infections are a major public health problem globally. Thus, this study was aimed to determine the prevalence, antimicrobial susceptibility patterns, and associated factors of Salmonella and Shigella among food handlers.

Methodology

A cross-sectional study was conducted from March to August 2018 at Adigrat University student cafeteria, Northern Ethiopia. Data on socio-demographic and associated factors were collected using a structured questionnaire. Fresh stool samples were collected from 301 food handlers and transported to Adigrat University Microbiology Laboratory. Bacterial isolation and antimicrobial susceptibility test were performed using standard bacteriological methods. Data analysis was performed using SPSS version 22 and P < 0.05 with a corresponding 95% confidence interval was considered statistically significant.

Results

A total of 301 food handlers were included in this study. The majority of study participants were females 265 (88.0%). About 22 (7.3%) and 11 (3.7%) of food handlers were found to be positive for Salmonella and Shigella respectively. Hand washing after using a bathroom with water only, hand washing after using the bathroom, hand washing after touching dirty materials, hand washing before food handling and fingernails status were significant associated factors identified. None of the Salmonella and Shigella isolates was sensitive to ampicillin. On the other hand, low resistance was found for chloramphenicol, ceftriaxone, and ciprofloxacin.

Conclusion

The present study revealed that the prevalence of Salmonella and Shigella among food handlers was 22 (7.3%) and 11 (3.7%) respectively. Such colonized food handlers can contaminate food, drinks and could serve as a source of infection to consumers via the food chain. This indicates that there is a need for strengthened infection control measures to prevent Salmonella and Shigella transmission in the students’ cafeteria.
Applying an intersectionality lens to the Theoretical Domains Framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour
Authors: Etherington Nicole , Rodrigues Isabel Braganca , Giangregorio Lora , Graham Ian D. , Hoens Alison M , Kasperavicius Danielle , Kelly Christine , Moore Julia E. , Ponzano Matteo , Presseau Justin , Sibley Kathryn M. , Straus Sharon
Published: June 2020

Background: A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors (e.g. age, gender) and structures of power (e.g. ageism, sexism), offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods: An interdisciplinary Framework Committee (n=17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the and its domains TDF. An iterative approach aimed at building consensus was used to finalize recommendations.Results: Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality-enhanced TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Considerations and prompts were designed to assist users to reflect on how individual identities and structures of power may play a role in barriers and facilitators to behaviour change and subsequent intervention implementation. Conclusions: Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. Considering the role of intersecting social factors when identifying barriers and facilitators to implementing research evidence may result in more targeted and effective interventions that better reflect the realities of those involved.
Locoregional recurrence patterns in women with breast cancer who have not undergone post-mastectomy radiotherapy
Authors: Zhao Xuran , Tang Yu , Wang Shulian , Yang Yong , Fang Hui , Wang Jianyang , Jing Hao , Zhang Jianghu , Sun Guangyi , Chen Siye , Jin Jing , Song Yongwen , Liu Yueping , Chen Bo , Qi Shunan , Li Ning , Tang Yuan , Lu Ningning , Ren Hua , Li Ye-Xiong
Published: June 2020

Background : To analyze the patterns of locoregional recurrence in breast cancer patients after mastectomy. Methods : The retrospective study included 7073 women with breast cancer without post-mastectomy radiotherapy: 4604 (65.1%) had pT1-2N0 disease (low risk); 2042 (28.9%), pT1-2N1 (intermediate risk); and 427 (6.0%), pT3-4 and/or pN2-3, or pT1-2N1 after neoadjuvant chemotherapy (high risk). The distribution of cumulative locoregional recurrence was analyzed. The local recurrence and regional recurrence rates were estimated by the Kaplan-Meier method, and differences were compared with the log-rank test. Multivariate analysis was performed using Cox logistic regression analysis. Results: In the median follow-up of 63.0 months, 469 patients had locoregional recurrence: chest wall recurrence in 238 cases (50.7%), supraclavicular/infraclavicular nodes in 236 (50.3%) cases, axilla in 92 (19.6%), and internal mammary nodes in 50 (10.7%) cases. The 5-year local recurrence and regional recurrence rates were 2.5% and 4.4%, respectively. Subgroup analysis of the three risk groups and five molecular subtypes (luminal A, luminal B-Her2 negative, luminal B-Her2 positive, Her2-enriched, and triple negative) also showed that the chest wall and supraclavicular/infraclavicular nodes were the most common recurrence sites. Age, tumor location, T stage, N stage, and hormone receptor status were independent prognostic factors for both local recurrence and regional recurrence (p < 0.05). Conclusions: The chest wall and supraclavicular/infraclavicular nodes are common sites of locoregional recurrence in breast cancer, irrespective of disease stage or molecular subtype, and the prognostic factors for local recurrence and regional recurrence are similar. Therefore, chest wall and supraclavicular/infraclavicular nodes irradiation should always be considered in post-mastectomy radiotherapy.
Humanism in the narratives of first-year medical students
Authors: Tavares Luciana , Enns Sylvia , Ayres José Ricardo , Tempski Patricia
Published: May 2020

Background: The importance of the humanistic dimension in the medical profession and how socialization during medical programs can promote humanism or have dehumanizing effects are largely discussed in the medical education literature. Reflection exercises can facilitate student engagement in humanistic attitudes.Method: We performed a qualitative study using the narratives of first-year medical students. The data were analyzed through content analysis. The narratives were used as a strategy to stimulate students' reflection and to understand their perspectives and values at the beginning of the medical program. We asked to them tell us about their role models, professional ideals and previous dehumanizing experiences, in contrast to their experiences of good health care.Results: The study included 167 participants: 67 females (40.1%) and 100 males (59.9%). The participants' average age was 20 years. The analysis of the narratives showed three emergent categories: sociopolitical and economic aspects of medicine, medical humanities and experiences of humanism and dehumanization in health care. In their narratives, the students expressed the desire to become doctors, the desire to help people and improve their lives, and the intention to emulate good role models and contribute to the development of the Brazilian healthcare system. The students indicated that a way to promote humanism in healthcare was to cultivate an integral vision of the human being that includes perceiving his or her context, personal history and complexity. The students emphasized the importance of "going beyond the technical dimension" in the relationship between physician and patient. Some students recognized the transdisciplinary aspects of medicine.Conclusions: The students in their first year of the medical program have a clear understanding of humanism in medical practice, regardless of their social and economic conditions, age, gender, and religion. The students' narratives expressed their expectations for a more humane and fair society characterized by respect, solidarity, and compassion. The use of narratives is a strategy to help students develop critical thinking and to help us get to know our students better: who they are, what they think, and how they feel.
Identifying Community Physical Activity and Health Resources by Utilizing Members of a Physical Activity Network
Authors: Sedney Cara L. , Haggerty Treah , Zizzi Sam , Dekeseredy Patricia
Published: June 2020

Background: Back pain is one of the leading causes of health care expenditure in the US and is linked to an increased body mass index. Many evidence-based modalities for the prevention and treatment of back pain closely mirror recommendations for weight loss and include physical activity and health maintenance activities (PAHM). Collaboration was sought with the West Virginia Physical Activity Network (WVPAN) leadership to ascertain community assets, and perceptions of the use of PAHM in the treatment of back pain by WVPAN members. Methods: Participants for the study were recruited from the West Virginia Physical Activity Network. This grassroots organization is filled with volunteers from various sectors who have either signed up via email or liked the WVPAN Facebook page. This network was purposely selected as the study population because of the statewide reach and their familiarity with resources in their local communities. A brief survey instrument was designed to gather their scaled perceptions about various treatment modalities related to back pain, and to gather their local knowledge related to specific providers in their communities. In addition, participants were given a free text box to list any local assets or resources for the nine treatments listed, and county of residence, and the nature of their connection to the physical activity network. Descriptive analyses were used to describe overall patterns of survey data. The qualitative data were compiled manually by the research team to show themes of specific treatments mentioned across different parts of the state. Results: Participants overwhelmingly supported physical therapy, flexibility training, yoga, and core strengthening as treatments for back pain. The majority of respondents were “undecided” about other treatments such as cognitive behavioral therapies and acupuncture. Conclusions: The implementation of PAHM interventions in communities could help treat patients with back pain, and may reduce reliance on the pharmacological treatment for back pain. The current study’s data support the potential of such approaches in many West Virginia counties. Also, local resources, and context can be gleaned from community leader surveys utilizing previously developed infrastructure for PAHM promotion.
Substances use and its association with sociodemographic, family and environment-related factors among technical and vocational education and training college students in Ataye, Ethiopia, 2019. Institution based cross sectional study
Authors: wubetu abate dargie , Getachew Sintayehu , Negash Wassie
Published: June 2020

Background: Legal substances use is prevalent in Ethiopia. Substance use can have several health problems that are potentially harmful in educational performance, social issues, psychological and physical wellbeing. This study aimed to know prevalence of lifetime and last month substances use and its associated factors among technical and vocational education and training College students in Ataye town. Methods: an institution based cross-sectional study conducted from 1 March to last May 2019. Participants selected by using simple random sampling technique. Chi-square with its p-value used to identify correlates for each legal/illegal substance use. Bivariate and multivariate binary logistic regression analysis performed to identify associated factors. Backward logistic regression method used. Odds ratio with their 95% confidence interval, and p value less than 0.05 used to declare the statistical significance of associated factors. Results: Four hundred eighty three individuals participated in the study, which was a response rate of 94%. The prevalence of lifetime legal substances use was 32.5% (95% CI: 28.2, 36.5). The prevalence of last month's legal substances use was 21.9% (95% CI= 18.2, 25.5). Among lifetime legal substance users, the majority (25.5%) chewed khat. The others, (19.5%) drunk alcohol, and, 15.3% smoked cigarette in lifetime. Lifetime cannabis and cocaine users were 2.5%, and 7.2% respectively. Among last month's legal substance users, (21.9%) chewed khat followed by alcohol drinking (16.6%), and cigarette smoking (15.3%). In the last month, 1.2% and 3.3% of students used cannabis and cocaine respectively. Multivariate logistic regression showed that, being male, having divorced family, living greater than twenty years in the town, having substance user family member, having intimate friend substance user, and easily availability of substances were independent predictors of lifetime legal substances use.Conclusions: The prevalence of last month and lifetime legal substance use at Ataye Technical and Vocational Education and Training (TVET) college students were analogous with most studies done in Ethiopia. Cannabis and cocaine are illegal drugs in Ethiopia. Nevertheless, the reported proportion of these illegal drug uses informs us there may not be under reporting of legal substances use. It is advisable if furthers emphasis is given for TVET students with the predictor variables.
MicroRNA-182-5p protects human lens epithelial cells against oxidative stress-induced apoptosis by inhibiting NOX4 and p38 MAPK signalling
Authors: Li Zhao-Na , Ge Ming-Xu , Yuan Zhong-Fang
Published: June 2020

Background: MicroRNAs (miRNAs) are abnormally expressed in various ocular diseases, including age-related cataract. However, the role of miR-182-5p in the progression of age-related cataract remains unclear.Methods: The expression of miR-182-5p in HLE-B3 cells was detected by qRT-PCR. HLE-B3 cells were transfected with miR-182-5p mimics. CCK-8, EdU, flow cytometry, 2',7'-dichlorodihydrofluorescein diacetate, JC-1 kit, and western blot were used to assess the cell viability, proliferation, apoptosis, reactive oxygen species (ROS) level, mitochondrial membrane potential (MMP), and protein expression, respectively, in vitro. The relationship between miR-182-5p and NOX4 was confirmed using the dual-luciferase reporter gene analysis.Results: We found that miR-182-5p expression was significantly decreased by the H2O2 exposure. Overexpression of miR-182-5p promoted cell proliferation and inhibited ROS production and apoptosis in H2O2-induced HLE-B3 cells. Moreover, p-p-38, p-ERK, and p-JNK were up-regulated in H2O2-treated HLE-B3 cells, and overexpression of miR-182-5p reversed the effects of H2O2 on HLE-B3 cells. In addition, dual-luciferase reporter assay substantiated that NOX4 was a direct target and downregulated by miR-182-5p.Conclusions: We concluded that miR-182-5p inhibited lens epithelial cells apoptosis through regulating NOX4 and p38 MAPK signaling, providing a novel biomarker for treatment of age-related cataract.
Smokers who have not tried alternative nicotine products: a 2019 survey of adults in Great Britain
Authors: Simonavicius Erikas , McNeill Ann , Cheeseman Hazel , Arnott Deborah , Brose Leonie S.
Published: June 2020

Aims: Switching from smoking to using nicotine replacement therapy (NRT), electronic cigarettes (e‑cigarettes) or heated tobacco products can reduce tobacco-related health risks. However, not all smokers in Great Britain have tried these products. This study aimed to identify and describe smokers who have never tried alternative nicotine products.Methods: We analysed cross-sectional survey data of smokers (n=1777) from a representative adult sample from Great Britain. The online survey was run in March 2019. The proportion of smokers who had never used alternative nicotine products was measured. A multivariate logistic regression assessed the association between never having used alternative nicotine products and sociodemographic and smoking characteristics and motivation to stop smoking.Results: One in four smokers (27.8%, 95% CI: 25.8%–29.9%) had never tried NRT, e-cigarettes or heated tobacco products. These smokers were more commonly from Black and Minority than White ethnic groups (AOR=1.55; 95% CI: 1.02–2.31), were more likely to smoke up to 10 versus more cigarettes per day (AOR=1.52; 95% CI: 1.14–2.03) and to report low versus moderate or high motivation to stop smoking (AOR=1.79; 95% CI: 1.20–2.74).Conclusion: Light smokers, those unmotivated to stop and smokers from Black and Minority ethnic groups are less likely to have ever tried alternative nicotine products. Different approaches are needed to facilitate harm reduction and smoking cessation among these groups of smokers.
A qualitative investigation of lived experiences of long-term health condition management with people who are food insecure
Authors: Douglas Flora , MacIver Emma , Yuill Chris
Published: June 2020

Background As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. While international evidence indicates that food insecurity adversely affects individual’s health condition management capability, little is known about how those so affected manage their condition(s) in this context. An investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. notions of the support they might wish to receive from them. Methods Twenty in-depth interviews were conducted with individuals attending a food bank and food pantry in north east Scotland. Interview audio recordings were fully transcribed and thematically analysed.Results Individuals reporting multiple physical and mental health conditions, took part in the study. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in)visibility of participants’ economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system.Conclusions This study, the first of its kind in the UK, indicated that participants’ health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK.
Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey
Authors: Yu Chen , Meng Xiangyu , Ma Li , Zhao Yang , Gu Ye , Jin Hengwei , Gao Dezhi , Li Youxiang , Sun Shibin , Liu Ali , Zhao Yuanli , Chen Xiaolin , Wang Shuo
Published: June 2020

Background: In the benefit of the large population and rapid economic growth, the interventional techniques and equipment for brain arteriovenous malformations (bAVMs) in mainland China have been rapidly improved. Chinese neurosurgical cerebrovascular physicians have accumulated rich experience and made pioneering explorations. This study aims to summarize the experience and treatment progress of bAVMs in mainland China.Methods: We performed a web-based nationwide questionnaire survey among 67 tertiary neurosurgical institutions that had acknowledged treating bAVMs in the primary survey. Our questionnaire included clinical characteristics, radiological findings, intervention indications/contraindications, intervention timing, and intraoperative management of different treatment modalities. Results: A total of 63 participants from 49 (73.1%) tertiary neurosurgical institutions responded to our questionnaire. 42 (66.7%) were neurosurgeons, 13 (20.6%) were neurointerventionists, and 8 (12.7%) were radiosurgeons. Approximately 3500 to 4000 cases of bAVMs were treated annually in these 49 departments. All participants agreed that the conclusions of ARUBA are debatable. Flow-related aneurysms, deep venous drainage, and arteriovenous fistula were considered as common hemorrhagic risk factors. Unruptured SM IV-V bAVMs, giant bAVMs, pediatric bAVMs, elderly bAVMs, and eloquent bAVMs were not absolute contraindications to intervention. Maximum lesion occlusion and minimal functional impairment were the principles of intervention management. Most of the neurosurgeons and neurointerventionists recommended early intervention (<30 days) for ruptured bAVMs, and the radiosurgeons suggested intervention in the chronic phase or recovery phase (P<0.01), and preferably 3 months after bleeding. Multi-modality strategies were thought effective for complex bAVMs and more exploration of individualized intraoperative management was necessary.Conclusions: Intervention was acceptable for specific selected unruptured bAVMs in mainland China, especially in patients with hemorrhagic risk factors. The application of multidisciplinary cerebrovascular team and multicenter large-sample international registry study might be the next work for Chinese neurosurgical cerebrovascular physicians.Trial registration: ClinicalTrials.gov NCT04136860.
The effects of childhood exposure to malaria on cognition and behaviour. A systematic review protocol.
Authors: SSEMATA ANDREW SENTOOGO , NAKITENDE JACQUELLINE ANN , KIZITO SIMON , WHIPPLE ELIZABETH C , BANGIRANA PAUL , NAKASUJJA NOELINE , JOHN CHANDY C , McHENRY MEGAN SONG
Published: June 2020

Background: Malaria is one of the major contributing risk factors for poor development of children living in low- and middle- income countries (LMICs). However, little is known about the specific domains of cognition and behaviour that are impacted by malaria, the extent of these deficits, and the different types of the malaria spectrum that are associated with these deficits. The objective of this systematic review is to determine the effect of the different type of malaria infection on cognition and behaviour among children living in LMICs. Methods and analysis: We will systematically search online bibliographic databases including MEDLINE (via PubMed), CINAHL (via EBSCO), PsycINFO (via EBSCO), EMBASE and The Cochrane Central Register of Controlled Trials (CENTRAL) as well as Google Scholar and bibliographies of pertinent articles. We will include studies with a comparison group (e.g., clinical trials, cohort, observational, cross-sectional case–control and controlled before and after or interrupted–time–series studies) involving children under 18 years of age living in LMICs, as determined by World Bank Criteria, with either an active malaria infection or history of malaria. Included articles must also measure cognitive and/or behaviour outcomes determined by standardized psychological assessments (questionnaire-based scales and or neurocognitive assessments). Studies will be excluded if they are not in English, lack a control group, take place in a high-income country, or if a standardized instrument was not used. Two reviewers will independently review all articles to determine if they meet eligibility criteria. Any conflicts will be resolved after discussion with a third reviewer. When a list of included articles is finalized, two reviewers will extract data to populate and then cross check within an electronic table. Risk of bias and the strength of evidence and recommendations will be assessed independently using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, and a final score will be given upon consensus. For sufficiently homogeneous data on measured outcomes in multiple studies, we will investigate the possibility of pooling data to perform a meta-analysis. Discussion: This systematic review will evaluate the evidence of the effect of malaria on the cognitive and behavioural outcomes. Findings from this planned review will generate insight on the domains affected by the different forms malaria infection and may inform subsequent malaria interventions and future research in paediatric care.Systematic review registration: This systematic review has been registered under PROSPERO: CRD42020154777
Physical activity measures in patients with myalgic encephalomyelitis/chronic fatigue syndrome: correlations between peak oxygen consumption, the physical functioning scale of the SF-36 questionnaire, and the number of steps from an activity meter
Authors: Campen C (Linda) MC van , Rowe Peter C , Verheugt Freek WA , Visser Frans C
Published: June 2020

Background most studies to assess effort intolerance in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have used questionnaires. Few studies have compared questionnaires with objective measures like an actometer or an exercise test. Therefore three measures of physical activity in ME/CFS patients, being the physical functioning scale (PFS) of the SF-36, the number of steps/day (Steps) of an actometer and the %peak VO 2 of a cardiopulmonary stress test were compared. Methods female ME/CFS patients were selected from a clinical database if the three types of measurements were available, and the interval between measurements was ≤ three months. Data of the three measures were compared by linear regression. Results in 99 female patients the three different measures were linearly, significantly and positively correlated (PFS vs Steps, PFS vs %peak VO 2 and Steps vs %peak VO 2 : all P<0.001). Subgroup analysis showed that the relations between the three measures were not different in patients with versus without fibromyalgia and with versus without a maximal exercise effort (RER≥1.1). In 20 patients re-evaluated for symptom worsening, the mean of all three measures was significantly lower (P<0.0001), strengthening the observation of the relations between them. Despite the close correlation a large variation was observed between the three measures in individual patients. Conclusions given the large variation in ME/CFS patients, the use of only one type of measurement is inadequate. Integrating the three modalities may be useful for patient care by detecting overt discrepancies and may aid study designs aimed at improving exercise capacity.
Intravenous and oral copper kinetics, biodistribution and dosimetry in healthy humans studied by [64Cu]copper PET/CT
Authors: Kjærgaard Kristoffer , Sandahl Thomas Damgaard , Frisch Kim , Højrup Karina , Keiding Susanne , Vilstrup Hendrik , Ott Peter , Gormsen Lars Christian , Munk Ole Lajord
Published: June 2020

Purpose: Copper is essential for enzymatic processes throughout the body. [64Cu]copper (64Cu) positron emission tomography (PET) has been investigated as a diagnostic tool for certain malignancies, but has not yet been used to study copper homeostasis in humans. In this study, we determined the hepatic removal kinetics, biodistribution and radiation dosimetry of 64Cu in healthy humans by both intravenous and oral administration. Methods: Six healthy participants underwent PET/CT studies with intravenous or oral administration of 64Cu. A 90 min dynamic PET/CT scan of the liver was followed by three whole-body PET/CT scans at 1.5, 6, and 20 h after tracer administration. PET data were used for estimation of hepatic kinetics, biodistribution, effective doses, and absorbed doses for critical organs. Results: After intravenous administration, 64Cu uptake was highest in the liver, intestinal walls and pancreas; the gender-averaged effective dose was 62 ± 5 μSv/MBq (mean ± SD). After oral administration, 64Cu was almost exclusively taken up by the liver while leaving a significant amount of radiotracer in the gastrointestinal lumen, resulting in an effective dose of 113 ± 1 μSv/MBq. Excretion of 64Cu in urine and faeces after intravenous administration was negligible. Hepatic removal kinetics showed that the clearance of 64Cu from blood was 0.10 ± 0.02 mL blood/min/mL liver tissue, and the rate constant for excretion into bile or blood was 0.003 ± 0.002 min-1. Conclusion: 64Cu biodistribution and radiation dosimetry are influenced by the manner of tracer administration with high uptake by the liver, intestinal walls, and pancreas after intravenous administration, and after oral administration, 64Cu is rapidly absorbed from the gastrointestinal tract and deposited primarily in the liver. Administration of 50 MBq 64Cu yielded images of high quality for both administration forms with radiation doses approximately 3.1 and 5.7 mSv, respectively, allowing for sequential studies in humans.Trial Registration Number: EudraCT no. 2016-001975-59. Registration date: 19/09/2016.
An Improved High-Precision Frequency Estimation Algorithm
Authors: CHEN Shihong , PAN Minghai , WANG Xudong
Published: June 2020

Frequency estimation, one of the key technologies in wireless communication and radar science, has been extensively and deeply studied by scholars. Based on a detailed frequency estimation characteristics analysis of two existing algorithms (the fixed Quinn algorithm and the A&M algorithm), this paper proposes a new and improved high-precision frequency estimation algorithm. The proposed algorithm is a two-step estimation. In the first step, we use the fixed Quinn algorithm to calculate coarse frequency errors, and in the second step, we use the results from the first step as the initial iteration in the A&M algorithm. After the first iteration, we obtain the precise frequency errors, and finally, we obtain the frequency estimate value. Through simulation experiments on MATLAB, the experimental results verify that the improved algorithm greatly enhances the estimation accuracy compared to the fixed Quinn algorithm and the A&M algorithm; moreover, the improved algorithm has excellent anti-noise performance and stronger algorithm robustness.
Epidemiological profile of pain and non-steroid anti-inflammatory drug use in collegiate athletes in the United States
Authors: Christopher Shefali , Tadlock Bailey A , Veroneau Bryanna J , Harnish Christopher , Perera Nirmala KP , Knab Amy M , Vallabhajosula Srikant , Bullock Garrett Scott
Published: June 2020

Background: Although athletic endeavours are associated with a high amount of physical stress and injury, the prevalence of pain is underreported in the sports medicine literature with only a few studies reporting pain on collegiate athletes or exploring sex difference of pain. Impact of pain on athlete availability, training and performance can be mitigated when key epidemiological information is used to inform adequate pain management strategies.To 1) provide an epidemiological profile of self-reported pain experienced by the National Collegiate Athletic Association (NCAA) athletes by sex during the first half of the 2019 season, 2) describe their self-reported non-steroidal anti-inflammatory drug (NSAID) use.Methods: Online survey was completed by athletes at three NCAA institutions from 1 August to 30 September 2019. Descriptive statistics were used to describe player demographic data, self-reported pain and self-reported NSAID use. Pain incidence proportion were calculated.Results: 230 female athletes and 83 male athletes completed the survey. Self-reported pain incidence proportion for female athletes was 45.0 (95% CI 41.5-48.5) vs 34.9 (95% CI 29.4-40.4) for male athletes. Majority of the athletes did not report pain (55% female vs 62% male) during the first half of the 2019 season. Female athletes reported pain in their back (35%), knee (26%), and ankle/foot (23%) whilst male athletes reported pain in their knee (35%), back (28%), and shoulder (24%). Of all athletes, 28% female vs 20% male athletes reported currently taking NSAIDs. Of athletes that reported pain, 46% female vs 38% male athletes currently took NSAIDs. 70% female vs 61% male athletes self-purchased NSAIDs, and 40% female vs 55% male athletes consumed alcohol.Conclusions: Half of female athletes and one in three male athletes reported pain. Back, knee and foot/ankle pain and knee, back and shoulder pain is common in female and male athletes respectively. One in four female athletes and one in five male athletes use NSAIDs for pain or prophylactic purpose. Majority self-purchase these medications indicating need for health literacy interventions to mitigate potential adverse effects.
Partner’s Emotional Reaction to Pregnancy Mediates the Relationship Between Pregnancy Planning and Prenatal Mental Health
Authors: Kazemi Ashraf , Ghaedrahmati Maryam , Kheirabadi Gholamreza
Published: June 2020

Background: An unplanned pregnancy may follow by increasing depression and anxiety and the aim of the present study was to evaluate the mediating role of partner’s emotional reaction to pregnancy (PERP) on the relationship between pregnancy planning and prenatal mental health. Methods: This cross-sectional study was conducted on 303 healthy Iranian pregnant women during their third trimester. The levels of depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory. Further, the PERP score was measured using a researcher-made questionnaire. The data were analyzed using the plug-in application PROCESS macro. Results: The results showed that PERP score was related to pregnancy planning and prenatal depression and anxiety inversely. The effect of the pregnancy planning on depression (β=-1.603; CI: -2.276 to -.978) and anxiety (β=-1.950, CI: -3.717 to -.493) were significant only with mediating role of PERP. Conclusions: The results indicated that the effect of the pregnancy planning on prenatal mental health is mediate by PERP and in unplanned pregnancy, women need to receive their positive partner’s reaction toward pregnancy to preserve their mental health.
Estimation of COVID-19 outbreak size in Harbin, China
Authors: Song Haitao , Jia Zhongwei , Jin Zhen
Published: June 2020

Background: Since the first level response to public health emergencies (FLRPHE) was launched on January 25, 2020 in Heilongjiang province, China, the outbreak of COVID-19 seems to be under control. However, an outbreak of COVID-19 caused by imported case developed in Harbin during April 2020. Here, we provide an estimate of the COVID-19 outbreak size in Harbin in April based on the number of found infected cases, assess the proportion of found and unfound infected cases in infected cases and evaluate the effective reproduction number which shows the transmission risk of COVID-19. Methods: We used data from April 9 to April 30, 2020, on the number of found infected cases from the outbreak in Harbin to infer the number of infections in Harbin in the outbreak of COVID-19 and give the proportion of found and unfound infected cases in infected cases. Data on found infected cases were obtained from the the reports of Health Commission of Heilongjiang Province. A Susceptible-Unfound infected-Found infected-Removed model was used to fit the data on found infected cases of COVID-19 in Harbin using the least square method and simulate the transmission of COVID-19. The effective reproduction number was estimated. Results: The COVID-19 outbreak size estimated in Harbin in April reaches 174, where 54% of infected cases were found and 46% of infected cases were not found out. Our findings suggest that the effective reproduction number decreased drastically in contrast with the value of 3.6 on April 9 after that the effective interventions were implemented by Heilongjiang province government. Finally, the effective reproduction number arrived the value of 0.04 which is immensely below the threshold value 1, which means that Heilongjiang province government got the outbreak of COVID-19 in Harbin under control. Conclusions: The COVID-19 outbreak size in Harbin based on the assumptions that infected people with COVID-19 in the incubation period have the same infectivity with infectious people with COVID-19 could have been overestimated. As an increasing number of imported infected cases got into China and a growing number of asymptomatic infected people were found, our study provides evidence that unfound infected cases would increase the risk of local outbreak of COVID-19 in China.
Clinical Significance of Monitoring Circulating Free DNA and Plasma Heat Shock Protein 90alpha in Patients with Esophageal Squamous Cell Carcinoma
Authors: Zhao Qiang , Miao Congxiu , Lu Qingpu , Wu Weipeng , He Yuan , Wu Shouxin , Liu Huimin , Lian Changhong
Published: June 2020

Background: Esophageal squamous cell carcinoma (ESCC) is the predominant histological type of esophageal cancer in China and has an extremely poor prognosis. Circulating free DNA (cfDNA) and plasma heat shock protein 90alpha (Hsp90a) are two novel noninvasive biomarkers for diagnosis and prognostic prediction of several types of cancer. However, to the best of our knowledge, the roles of the two biomarkers in ESCC are still unknown.Methods: We recruited 93 primary ESCC patients and detected plasma concentrations of the two markers at different time points, including 1–3 days pre-chemotherapy, 1–7 days pre-surgery and 7–14 days post-surgery. Baseline concentrations of the two markers were associated with main characteristics of ESCC patients which were collected at first diagnosis. Correlation between the two markers and traditional serum biomarkers at baseline was also examined. Furthermore, dynamic changes of the cfDNA and Hsp90α concentrations among different time points and the potential clinical significance were assessed.Results: There was no significant association between baseline concentrations of the two markers and clinical features. Especially, cfDNA demonstrated stronger correlation with other circulating biomarkers than Hsp90α at baseline level. Importantly, both cfDNA and Hsp90α concentrations were significantly increased after surgery. Kaplan-Meier survival analysis showed that a change in concentration of cfDNA (ΔcfDNA) but not Hsp90α (ΔHSP90ɑ) between pre-surgery and post-surgery had significant effect on the overall survival of surgical patients with ESCC. Thus, ΔcfDNA evaluation could be a promising prognostic marker for surgical ESCC patients.Conclusions: Our findings may improve the understanding of the function of cfDNA and Hsp90α in ESCC.