bluuebunny/crossref_metadata_2025 huggingface dataset:
Determinants of Stroke Mortality through Survival Models: The case of Mettu Karl Referral hospital, Mettu, Ethiopia
Authors: Ababu Dereje Gebeyehu , Getahun Azmeraw Misganaw
Published: April 2021

Introduction: Every year worldwide between five to six million deaths are associated with stroke; on average, one stroke-related death occurs every four min. In Ethiopia, stroke is a frequent cause of mortality and morbidity from non-communicable diseases. Therefore, this study was aimed to determine factors associated to stroke mortality through survival models in Mettu Carl Referral Hospital.Methods: This study was conducted from September 1, 2014 to April 1, 2017, and encompassed 202 stroke patients at Mettu Carl Referral Hospital. The Cox Semi-parametric regression and parametric PH Weibull, Exponential, Log-logistic and log-normal models were used for analyzing survival analysis of stroke patients using R software. Results: A totals of 202 stroke patients were included in the study and among those patients 72.8% and 27.2% were censored and died respectively. According the result of Weibull proportional hazard model, gender of patients (HR=1.5052200, p-value<0.0000207), hypertension (HR= 0.7135953, p-value<0.000737), and baseline complication (HR=0.7246955, p-value<0.00229), had significant effect on survival of the stroke patient.Conclusion: The estimated survival and hazard rate of stroke patients under gender of patients, baseline complication and hypertension had significant difference with p-values less than 0.05. Finally, the findings of this study implied that Hypertension, sex of the patients, and baseline complication were major factors related to survival time of stroke patients. The researcher recommends that the people should aware on the burden of those risk factors and well informed about the disease.
Accuracy Evaluation of Broadcast Ephemeris for BDS-2 and BDS-3
Authors: Jian Hao Jun , Wang Yishi , Zhang Shoujian
Published: April 2021

The BDS-3 system was completed in July 2020 and began to provide services to users around the world. The inspection of its operation, especially the detailed evaluation of the orbit, clock error, TGD and other indicators, plays an important role in the subsequent positioning. This study conducts an investigation of the satellite broadcast ephemeris of the BDS-2 and BDS-3. The difference between the satellite orbit position calculated by the broadcast ephemeris and the position calculated by the precise ephemeris is used for analysis. First, the ephemeris form January 2020 to February 2020 are investigated. The results show that the broadcast ephemeris accuracy of the BDS-2 MEO satellite is the highest, while the GEO satellite broadcast ephemeris accuracy is the lowest. And their three-dimensional orbit difference is 3m and 7.5m, respectively. Second, the BDS-3 MEO satellite broadcast ephemeris accuracy is higher than the BDS-2, its three-dimensional orbit accuracy is about 0.39m, while its clock error is slightly smaller than the BDS-2. The result of ephemeris calculation is basically equivalent to the clock error of satellite-to-earth observation, which is related to the addition of the clock error of the inter-satellite link in the BDS-3. Finally, the clock error of the BDS-3 MEO satellite with the H clock is basically the same as that of the MEO satellite with the Rb clock.
Synthesis of optically inactive cellulose via cationic ring-opening polymerization
Authors: Ikegami Waki , Kamitakahara Hiroshi , Teramoto Yoshikuni , Takano Toshiyuki
Published: April 2021

Cellulose, which comprises D-glucose and L-glucose (D,L-cellulose), was synthesized from D-glucose (1D) and L-glucose (1L) via cationic ring-opening polymerization. Specifically, the ring-opening copolymerization of 3-O-benzyl-2,6-di-O-pivaloyl-β-D-glucopyranoside (2D) and 3-O-benzyl-2,6-di-O-pivaloyl-β-D-glucopyranoside (2L), synthesized from compounds 1D and 1L, respectively, in a 1:1 ratio, afforded 3-O-benzyl-2,6-di-O-β-D,L-glucopyranan (3DL) with a degree of polymerization (DPn) of 28.5 (Mw/Mn = 1.90) in quantitative yield. The deprotection of compound 3DL and subsequent acetylation proceeded smoothly to afford acetylated compound 4DL with a DPn of 18.6 (Mw/Mn = 2.08). The specific rotation of acetylated compound 4DL was + 0.01°, suggesting that acetylated compound 4DL was optically inactive cellulose triacetate. Furthermore, before acetylation, compound 4DL was an optically inactive cellulose comprising an almost racemic mixture of D-glucose and L-glucose. Compound 4DL was an amorphous polymer. This is the first reported synthesis of optically inactive D,L-cellulose.
Improving Understandability of Clinical Practice Guideline Recommendations: a Qualitative Study to Develop a Format for Pediatric Cancer Care
Authors: Santesso Nancy , Beauchemin Melissa , Robinson Paula D. , Walsh Alexandra M. , Sugalski Aaron J. , Lo Tammy , Dang Ha , Fisher Brian , Grimes Allison C. , Wrightson Andrea Rothfus , Yu Lolie C. , Sung Lillian , Dupuis L.Lee
Published: April 2021

Background: Features of clinical practice guideline (CPG) recommendations may affect understanding and consequently successful uptake and implementation. We aimed to develop a recommendation format to improve understandability among healthcare professionals involved in pediatric cancer care.Methods: We conducted a multi-center qualitative study of health care professionals at participating pediatric oncology sites. We developed an initial format based on the current literature and used the “think-aloud” technique in multiple rounds of one-on-one cognitive interviews to iteratively improve it. Interviews were conducted until the format was well understood and no new, substantive suggestions for revision were raised. We took a directed (deductive) approach to content analysis of the interview notes to identify concerns related to the understandability of the recommendation. Results: Five investigators interviewed 33 healthcare professionals from multiple disciplines in seven rounds. We identified important factors influencing how to communicate recommendations. Regarding the strength of the recommendation, participants found understanding weak recommendations more challenging than strong. Understanding was improved by using the word ‘conditional’ instead of ‘weak’. Participants believed the inclusion of a rationale section to be very helpful. More information was desirable when a recommendation entailed a practice change. Although participants wanted additional information, they were concerned that there could be too much information. They, therefore, suggested that key words and the studies included in the evidence synthesis be hyperlinked to explanatory data. In the final format, the recommendation strength is clearly indicated in the title, highlighted, and defined within a text box. The rationale for the recommendation is in a column on the left, with supporting evidence on the right. In a bulleted list, the rationale section describes the benefits and harms and additional factors, such as implementation, that were balanced by the CPG developers. Each bullet under the supporting evidence section indicates the level of evidence with an explanation and the supporting studies with hyperlinks when applicable. Conclusions: A well-understood recommendation format to present strong and conditional recommendations was created through an iterative interview process. The format is straightforward, making it easy for organizations and CPG developers to use it to communicate recommendations clearly to intended users.
Fast-track Versus Conventional Surgery in Relation to Time of Hospital Discharge Following Total Hip Arthroplasty: a Single-center Prospective Study.
Authors: Almeida Raul Frankllim de Carvalho , Serra Humberto Oliveira , de Oliveira Liszt Palmeira
Published: April 2021

Background: Total hip arthroplasty (THA) has been used for over five decades for treating hip osteoarthritis. THA is a surgical procedure associated with prolonged hospital length of stay (LOS). The aim of this study was to analyze whether a protocol developed for fast-track THA could decrease the time taken to reach functional recovery after surgery and the hospital LOS. Blood transfusion and critical care requirements and the complication rate were evaluated as secondary endpoints. Methods: Ninety-eight patients underwent THA at the University Hospital of the Federal University of Maranhão (São Luís, Brazil). The control group included 51 patients who underwent THA through the conventional method. The fast-track surgery (FTS) group included 47 patients who underwent THA through the FTS approach. The inclusion criteria were that the subjects needed to present hip osteoarthritis and at least one clinical indication for THA, and that their risk classification was in ASA category I or II. The following factors were evaluated: age, sex, diagnosis, laterality, type of arthroplasty, blood transfusion, critical care requirement, complications, LOS and need for re-hospitalization for any reason. For spinal anesthesia, an opioid-free protocol was used. Comparison of categorical variables between the groups was performed using the chi-square test, Shapiro-Wilk test, Student t test and Poisson regression approach.Results: The FTS and control groups were similar in age and sex distribution (p > 0.05). The majority of the patients in the control group required both blood transfusion and use of the critical care unit, thus differing from the patients who underwent FTS (p < 0.001). The mean hospital LOS in the FTS group was 2.3 ± 0.8 days, compared with 6.4 ± 1.5 days in the control group (p < 0.001).Conclusion: Use of FTS was associated with decreased LOS, compared with conventional THA.Trial registration: This research was approved by the institution’s ethics committee under the number 1,786,868.
Achieving Equitable Social Health Insurance Benefits in China: How Does Domestic Migration Pose a Challenge?
Authors: Hou Zhiyuan , Wang Haiqin , Liang Di , Zhang Donglan
Published: April 2021

Background: Universal coverage through social health insurance is promoted by many researchers and policymakers to improve health equity within a country or region. In China, the mass internal migration since 1980s has posed challenges for the social health insurance to ensure equitable benefits for migrant population. This study evaluated the benefit distribution of social health insurance among internal migrants in China.Methods: Using the 2014 China National Internal Migrants Dynamic Monitoring Survey, , by applying a two-part model, we conducted a benefit analysis of social health insurance among a representative sample of migrants in China.Results: The study found that the broader the geographic scope of migration, the lower the probability of receiving reimbursements from the social health insurance and the reimbursement ratio; but among those who received reimbursements, the broader the geographic scope of migration, the larger amounts they were reimbursed for health care use. We attributed this unequal benefit distribution to the current insurance design that replies on localized administration and patients paying services up-front and requesting reimbursement later.Conclusion: To improve the equity in social insurance benefits between migrants and non-migrants and among migrants, policies that promote the insurance portability across regions and immediate reimbursement are warranted, while at the same time efforts should be done to control inflation of health care expenditures and to prevent inverse government subsidies from the regions that have more out-migration to regions that have in-migration.
Impact of Nonpharmacological Public Health Interventions on Epidemiological Parameters of COVID-19 Pandemic in India
Authors: Kharya Pradip , Koparkar Anil Ramesh , Dixit Anand Mohan , Joshi Hari Shanker , Rath Rama Shankar
Published: April 2021

Public health interventions are epidemiologically sound cost-effective methods to control the disease burden. Non-pharmacological Interventions are the only mode to control the disease in the absence of medications. To find the impact interventions on the epidemiological indicators of disease progression. This is a secondary data analysis done on COVID-19 data. Median Doubling Time and R0 were calculated for a rolling period of seven days. Interventions were scored from zero to three with the increasing level of stringency. Multivariate linear regression was performed to find the role of individual interventions on R0 and Median Doubling Time. The highest intervention score was reported in the lockdown phase which gradually decreased to lowest level of 22. R0 values settled to a level of 1.25 and the median doubling time increased to 20 days at the end of the study. Public awareness and public health laws were found to be related to both R0 and median doubling time in the Pre-lockdown phase only. Implementation of interventions at the ground level is one of the key factors of the success of PHI. Post implementation poor effectiveness of many interventions is evident from the study. Further studies related to the sequence of interventions is required to further analyse the poor effect of interventions.
The Attitude of Polish Women Planning Pregnancy and Having Children Towards the Prevention Methods of Vertical Infections: a Cross-sectional Survey Study
Authors: Bieńkowski Carlo , Kowalczyk Monika Karolina , Golik Agata Alina , Kacperczyk-Bartnik Joanna , Bartnik Paweł , Dobrowolska-Redo Agnieszka , Romejko-Wolniewicz Ewa , Pokorska-Śpiewak Maria
Published: April 2021

BackgroundInfectious agents can cause serious fetopathy. Some of them can be avoided by implementing appropriate prevention methods while planning pregnancy.MethodsA cross-sectional survey study was performed. The questionnaire investigated attitudes towards the prevention methods of vertical infections. Opinions about anti-vaccine movements and “chicken-pox party” were also checked.ResultsThe study group consisted of 2402 women, age range was 16-54 years (median: 31 years). Most women were from cities > 100,000 inhabitants (49.7%, 1194/2402) and with higher education (71.9%, 1726/2402). Positive attitude towards vaccinations was more common among younger, nulliparous women from big cities (p=0.02, p=0.04 and p=0.01, respectively). 2068/2402 (86.1%) of them have not been vaccinated before pregnancy and 1931/2402 (80.4%) of women have not been vaccinated during pregnancy. 1545/2402 (64.3%) of women considered vaccination safe, and effective (1904/2402, 79.3%) against infectious diseases. Regarding the so-called chickenpox party as many n=296/2402 (12.3%) have no opinion on this matter.ConclusionsMost women in Poland have a positive attitude towards vaccination, they consider vaccines safe and effective against infectious diseases. A significant proportion of women have not been vaccinated, the role of physician leading the patient to be vaccinated is crucial. About 12% of women are the undecided fraction, and the educational role of physicians is essential to convince them of the importance of vaccination.
IL-1β and IL-1ra are key regulators of the inflammatory response to RNA vaccines
Authors: Mellman Ira , Tahtinen Siri , Tong Ann-Jay , Himmels Patricia , Oh Jaehak , Paler-Martinez Andres , Kim Leesun , Wichner Sara , Oei Yoko , McCarron Mark , Freund Emily , Amir Zhainib Adel , Cruz Cecile de la , Haley Benjamin , Blanchette Craig , Schartner Jill , Ye Weilan , Yadav Mahesh , Sahin Ugur , Delamarre Lelia
Published: April 2021

Excessive systemic inflammation is characteristic to various acute conditions including sepsis, viral infections and immunotherapy-induced adverse events such as cytokine release syndrome (CRS). Recently, several clinical trials evaluating variants of lipid-formulated RNA vaccines for either cancer or COVID-19 have reported systemic inflammatory responses that limit vaccine dosing in humans. Preclinical studies in inbred laboratory mice failed to predict these adverse events, suggesting the existence of underlying differences in sensitivity to Toll-like receptor (TLR) or other innate agonists between humans and mice. Here, we identify interleukin 1 receptor antagonist (IL-1ra) as an endogenous, inducible suppressor of systemic inflammation. In humans, stimulation with a TLR7/8 adjuvanted RNA-lipoplex (RNA-LPX) vaccine results in the secretion of inflammasome-activated interleukin-1β (IL-1β) by monocytes. Remarkably, IL-1β was found to control the induction of the broad spectrum of pro-inflammatory cytokines (including IL-6) associated with CRS. Unlike humans, murine leukocytes preferentially upregulate anti-inflammatory IL-1ra relative to IL-1β. IL-1ra deletion in mice leads to CRS-like symptoms, indicating that high levels of IL-1ra protect mice from uncontrolled systemic inflammation. Our results demonstrate that IL-1β and IL-1ra are key regulators that control systemic responses to RNA vaccines and other inflammatory stimuli. These data provide an explanation for the dramatic difference in dose-dependent tolerability between mice and humans and suggest an approach to evaluate pathogen-induced or immunotherapy-related inflammatory toxicities in vivo.
Oral health factors related to the quality of life in elderly urban residents of South-West Poland
Authors: Skośkiewicz-Malinowska Katarzyna , Kaczmarek Urszula , Malicka Barbara
Published: April 2021

BackgroundThe process of human body ageing is an inevitable phenomenon affecting all organs. Hence, the concept of Oral Health-Related Quality of Life (OHRQoL) was introduced, based on the definition of health developed by WHO. The study aimed to evaluate the impact of selected oral health parameters on oral health-related quality of life in elderly residents of South-West Poland.MethodsThe study involved 500 participants who were the citizens of South-West Poland aged 65 and more. There was an oral examination performed, including the assessment of coronal and root caries, periodontal disease, dental prosthetic status and xerostomia. The impact of oral health-related quality of life was measured using the Oral Health Impact Profile-14 (OHIP-14). Furthermore, socio-demographic questionnaires were obtained from participants. Logistic bivariate and multivariate regression analyses of dependent variables and independent variables were carried out as part of the study. ResultsThe mean value of DMFT was 27.5 ± 5.0. A higher number of DMF and extracted teeth resulted in increased values in all seven domains and exhibited a significant negative impact on the quality of life. Moreover, it enabled predicting values in individual domains of the OHIP-14 scale.ConclusionsThe number of missing teeth and teeth with caries constituted the predictors of poorer Oral Health-Related Quality of Life in all domains of the OHIP-14 scale. The impact of gingival bleeding on the quality of life was demonstrated. There was a decrease in the oral health-related quality of life in single individuals with several comorbidities and medications taken.
Physical Therapy Treatments Incorporating Equine Movement: A Pilot Study Exploring Kinetic Interactions between Children with Cerebral Palsy and the Horse
Authors: Lightsey Priscilla , Lee Yonghee , Krenek Nancy , Hur Pilwon
Published: April 2021

BackgroundPhysical therapy treatments incorporating equine movement is recognized as an effective tool to treat functional mobility and balance in children with cerebral palsy (CP). To date, only a few studies examined kinematic outputs of the horses and children when mounted. In this pilot study, we examined the interaction between the horses and children with CP during physical therapy sessions where equine movement was utilized to better understand the effectiveness of this type of treatment.MethodsFour children with CP participated in eight physical therapy sessions incorporating hippotherapy as a treatment intervention. Functional mobility was assessed using the Timed Up Go or 10m Walk Test. Inertial measurement unit sensors, attached to children and horses, recorded movements and tracked acceleration, angular velocity, and body orientation. Correlation between vertical accelerations of children and horses were analyzed. In addition, peak frequencies of vertical accelerations of children and horses were compared.ResultsFunctional tests modestly improved over time. The children’s movements, (quantified in frequency and temporal domains) increasingly synchronized to the vertical movement of the horse’s walk, demonstrated by reduced frequency errors and increased correlation.ConclusionsThe findings suggest that as the sessions progressed, the participants appeared to become more familiar with the horse’s movement. Since the horse’s gait at a walk mimics the human gait this type of treatment may provide individuals with CP, who have abnormal gait patterns, an opportunity for the neuromuscular system to experience a typical gait pattern. The horse’s movement at the walk are consistent, cyclical, rhythmical, reciprocal and multi-dimensional which can facilitate motor learning. Thus, the increased synchronization between horse and the mounted participant suggests that physical therapy utilizing equine movement is a viable treatment tool to enhance functional mobility. This study may provide a useful baseline for future work.Trial registrationTexas A&M University Institutional Review Board. IRB2018-0064. Registered 8 March 2018. Link: https://rcb.tamu.edu/humans/irb and https://github.com/pilwonhur/HPOT
Identification and Characterization of Circular RNA Profiling in Kahin-Beck Disease
Authors: Li Peilin , Wang Ying , Yang Xiaodong , Gao Dalong , Tan Sijia , Li Wenyu , Zhang Feng , Guo Xiong , Wu Cuiyan
Published: April 2021

Objective. Circular RNAs (circRNAs) have been manifested as novel regulatory molecules involved in various diseases processes, but their role in Kashin-Beck disease (KBD) has not been investigated. The aim of this study was to identify their expression profile and functions in KBD.Methods. Primary chondrocytes were isolated from human cartilage and cultured in vitro. The circRNA expression of chondrocytes was performed by microarray analysis. The differentially expressed circRNAs were further characterized by chromosome distribution, circRNA-miRNA correlation analysis, gene ontology (GO) and pathway analysis. Miranda was used to predict the target miRNAs of specific circRNAs. Cytoscape software was used to visualize the circRNA-miRNA interaction network to reveal the gene regulation mechanism of specific circRNAs.Results. In total, 886 circRNAs were discovered to be differentially expressed between the two groups, and of these, 348 were upregulated and 538 were downregulated in the KBD group (≥2-fold change). Gene ontology and pathway analysis revealed that compared to normal group, many processes that were over-represented in KBD group were related to nervous system development, cell periphery, laminin interactions, focal adhesion, extracellular matrix (ECM)-receptor interaction. Conclusion. The study revealed the aberrant expression profile of circRNA between KBD group and normal group, the outcomes may have potential significance in the pathogenesis and diagnostic markers of KBD.
Use of Research Electronic Data Capture (REDCap) in different phases of a COVID-19 randomized controlled trial: A practical example
Authors: Kianersi Sina , Luetke Maya , Ludema Christina , Valenzuela Alexander , Rosenberg Molly
Published: April 2021

Background: Randomized controlled trials (RCT) are considered the ideal design for evaluating the efficacy of interventions. However, conducting a successful RCT has technological and logistical challenges. Defects in randomization processes (e.g., allocation sequence concealment) and flawed masking could bias an RCT’s findings. Moreover, investigators need to address other logistics common to all study designs, such as study invitations, eligibility screening, consenting procedure, and data confidentiality protocols. Research Electronic Data Capture (REDCap) is a secure, browser-based web application widely used by researchers for survey data collection. REDCap offers unique features that can be used to conduct rigorous RCTs.Methods: In September and November 2020, we conducted a parallel group RCT among Indiana University Bloomington (IUB) undergraduate students regarding their seropositivity for Coronavirus Disease 2019 (COVID-19) antibodies. In the current report, we discuss how we used REDCap to conduct the different components of this RCT. We further share XML REDCap files and instructional videos that investigators can use when designing and conducting their RCTs.Results and Conclusions: We report on the different features that REDCap offers to complete various parts of a large RCT, including sending study invitations and recruitment, eligibility screening, consenting procedures, lab visit appointment and reminders, data collection and confidentiality, randomization, blinding of treatment arm assignment, returning test results, and follow-up surveys. REDCap offers powerful tools for longitudinal data collection and conduct of rigorous and successful RCTs.
Development of a dynamic interactive web tool to enhance understanding of multi-state model analyses: MSMplus
Authors: Skourlis Nikolaos , Crowther Michael J. , Andersson Therese M-L. , Lambert Paul C.
Published: April 2021

Background: Multi-state models are used in complex disease pathways to describe a process where an individual moves from one state to the next, taking into account competing states during each transition. In a multi-state setting, there are various measures to be estimated that are of great epidemiological importance. However, increased complexity of the multi-state setting and predictions over time for individuals with different covariate patterns may lead to increased difficulty in communicating the estimated measures. The need for easy and meaningful communication of the analysis results motivated the development of a web tool to address these issues. Results: MSMplus is a publicly available web tool, developed in RShiny, with the aim of enhancing the understanding of multi-state model analyses results. The results from any multi-state model analysis are uploaded to the application in a pre-specified format. Through a variety of user-tailored interactive graphs, the application contributes to an improvement in communication, reporting and interpretation of multi-state analysis results as well as comparison between different approaches. The predicted measures that can be supported by MSMplus include, among others, the transition probabilities, the transition intensity rates, the length of stay in each state, the probability of ever visiting a state and user defined measures. Representation of differences, ratios and confidence intervals of the aforementioned measures are also supported. MSMplus is a useful tool that enhances communication and understanding of multi-state model analyses results. Conclusions: Further use and development of web tools should be encouraged in the future as a means to communicate scientific research.
Analyzing the Essential Proteins Set of Plasmodium Falciparum PF3D7 for Novel Drug Targets Identification Against Malaria
Authors: Ali Fawad , Wali Hira , Jan Saadia , Aslam Muneeba , Ahmad Imtiaz , Afridi Sahib Gul , Shams Suliaman , Khan Asifullah
Published: April 2021

Background: Plasmodium falciparum is an obligate intracellular parasite of humans that causes malaria. P. falciparum is a major public health threat to human life responsible for high mortality. Currently, the risk of multi-drug resistance of P. falciparum is rapidly increasing. There is a need to address new anti-malarial therapeutics strategies to combat the drug-resistance threat.Methods: We retrieved the P. falciparum essential proteins from the recently published studies. Pathogen essential proteins were initially scanned against human host and its gut microbiome proteome sets by comparative proteomics analyses. The human host non-homologs essential proteins of P. falciparum were additionally analyzed for druggability potential via in silico methods to possibly identify novel therapeutic targets.Results: The analyses identified six P. falciparum essential and human host non-homolog proteins that follow the key druggability features. These druggable targets have not catalogued so far in the Drugbank repository. These prioritized proteins seem novel and promising drug targets against P. falciparum due to their key protein-protein interactions features in pathogen-specific biological pathways and to hold appropriate drug-like molecule binding pockets. Conclusion: The prioritized protein targets may worthy to test in malarial drug discovery program to overcome the anti-malarial resistance issues. The in-vitro and in-vivo studies might be promising for additional validation of these prioritized lists of drug targets against malaria.
Using GAM regression analysis to identify proper heat-warning thresholds: a population-based observational study
Authors: Lung Shih-Chun Candice , Yeh Jou-Chen Joy , Hwang Jing-Shiang
Published: April 2021

Background

Climate change has augmented heat-related illnesses and deaths. Selecting proper thresholds in a heat-warning system is critical to reducing health risks.
Methods

This work evaluates the applicability of a modified generalized additive model (GAM) at different spatial scales, and identifies proper heat-warning thresholds using empirical morbidity and mortality records of 18 years from a population database and taking into account substantial health risk increases of the lag effects of 0–2 days. Reference-adjusted risk ratio (RaRR), i.e., risk ratio of threshold candidates against that of a reference, was respectively evaluated for heat-related emergency and hospital visits and all-cause mortality. The threshold with the highest RaRR among the candidates with infrequent occurrence is potentially the best one. Wet-bulb globe temperature (WBGT) and temperature were both used heat indicator in the model for comparison.
Results

It was found that WBGT is a more sensitive heat-health indicator than temperature. The highest RaRR with WBGT for the whole Taiwan island was observed to shift from lag 0 in emergency visits (1.44) to lags 0–1 in hospital visits (1.18) and also to lag 1 in all-cause mortality (1.04). For different age groups, children had the highest RaRR with WBGT of emergency visits on lag 0 (1.87) while the elderly had the highest RaRR for all-cause mortality on lag 0 (1.04), for hospital visits on lag 1 (1.23), and for emergency visits on lag 2 (1.38), respectively. Emergency visit is the most sensitive heat-related health record and should thus be employed, if available, to select heat-warning threshold. With the highest RaRR in emergency visits and the occurring frequency considered, the best area-specific thresholds can be chosen for various sizes of population at-risk. The novel RaRR allows comparison of health risks across different categories, providing a solid scientific basis for threshold selection.
Conclusions

This work demonstrated the feasibility and flexibility of the proposed approach which considers substantial enhancement of health risks on lags 0 to 2, removes the rare-event interference, and accommodates at-risk populations of different sizes. This methodology can be applied by authorities worldwide for selecting proper heat-health thresholds according to their own morbidity/mortality records.
Short-term effects of gaseous pollutants on cause-specific cerebrovascular disease among patients with type 2 diabetes: case-crossover evidence from Beijing, China
Authors: Liu Xiangtong , Li Zhiwei , Guo Moning , Lu Feng , Deginet Aklilu , Liu Mengmeng , Xu Xiaolin , Luo Yanxia , Hu Yaoyu , Li Yutong , Wu Mengqiu , Liu Mengyang , Tao Lixin , Guo Xiuhua
Published: April 2021

Background: The association between gaseous pollutants and cerebrovascular morbidity has been widely studied; however, the association in patients with type 2 diabetes has remained unknown in developing countries.Methods: A time-stratified case-crossover design combined with a distributed lag nonlinear model was adopted to estimate the short-term effects of gaseous pollutants (nitrogen dioxide [NO2], sulfur dioxide [SO2], ozone [O3], and carbon monoxide [CO]) on cerebrovascular cases among patients with type 2 diabetes in Beijing. In addition, our study explored the variability across sex and age groups.Results: A total of 223,216 (male 57.6% and elderly 61.7%) cerebrovascular cases were reported from 2014 to 2018. The cumulative exposure-response curves were U-shaped for NO2, J-shaped for SO2, and V-shaped for O3 and CO. Extreme low-O3, low-CO and high-CO increased the risk of cerebrovascular morbidity, with the maximum relative risk (RR) of 1.14 (95% CI: 1.01-1.28) (1st vs median), 1.02 (95% CI: 1.01-1.03) (1st vs median) and 1.25 (95% CI: 1.09-1.45) (99th vs median), respectively, appearing at lag0-13. Elderly individuals aged over 65 years were susceptible to extremely low-O3 (maximum RR: 1.27, 95% CI: 1.08-1.48). Men and elderly individuals were more susceptible to extremely high-CO, and the maximum RR was 10% [1.31 (1.11-1.54) vs. 1.19 (1.00, 1.41)] and 26% higher [1.41(1.17-1.69) vs. 1.12 (0.97, 1.30)] than women and adults, respectively. Conclusions: NO2, SO2, O3 and CO presented nonlinear and lagged effects on cerebrovascular disease among patients with type 2 diabetes, which may vary by sex and age. Our study added to the limited evidence for the risk of cerebrovascular disease due to gaseous pollutants among patients with comorbid type 2 diabetes.
Advancing Health Equity During the COVID-19 Pandemic through Digital Medical Interpretation Platforms
Authors: Sharfuddin Nazia , Mathura Pamela , Ling Emily , Bruseker Ellen , Rajeh Areej , Woods Jennifer , Suranyi Yvonne , Kassam Narmin
Published: April 2021

Background: Medical Interpretation Services (MIS) is the gold-standard that should be used during clinical assessments with patients who have limited English proficiency (LEP) or have hearing loss. The COVID-19 pandemic has highlighted the urgent need for clear, concise medical communication between patients and clinicians to prevent the spread of COVID-19 and ensure public safety. Cost of MIS is covered by the provincial health authority in Alberta; however, it is not consistently utilized across the province.Aim: To implement digital MIS in the Emergency Department (ED) of one urban teaching hospital, improving accuracy of clinical assessment and to provide patient-centered communication. Methods: Applying quality improvement methodology, an intervention comprised of digital MIS technology and education was trialed for 6 months. To assess intervention effect, the number of MIS minutes and calls were measured monthly and a questionnaire was developed and administered to determine ED healthcare providers’ awareness, technology accessibility and perception of MIS integration into the clinical workflow. Results: Digital MIS was utilized consistently in the ED from the beginning of the COVID-19 pandemic (March 2020) and over the subsequent six months. The cost avoidance due to digital MIS usage was estimated to be $19,612.16. ED healthcare providers indicated that digital MIS helped smooth communication with patients and reduced the time it took to gather and provide accurate information. Conclusion: Providing digital MIS access, education and training is a means to advance health equity, by improving accuracy of clinical assessment and patient-centered care in the ED.
Care Model and Effectiveness of Dementia Special Care Units-- a Cross-sectional Survey in China
Authors: Dong Xiaoxin , Sun Tongda , Jia Rangcheng , Zhao Lingbo , Sun Ning
Published: April 2021

Background: Dementia special care unit (D-SCU) is a main care mode for the elderly with dementia, and has increased steadily internationally. However, little is known about the D-SCUs of China. The present study aimed to analyze and summarize the types and standards of D-SCUs in China, and evaluate the care efficiency of the D-SCU care model.Methods: A cross-sectional survey was conducted between June 2018 and July 2019 in 6 cities of China. Quantitative data about the basic information and the care satisfaction were collected from 25 care facilities in the 6 cities. Qualitative data about the care status of the elderly with dementia, the standards, the management and the operation of the D-SCUs were collected among the 25 care facilities and the 3 cities that had issued standards for setting D-SCUs. Grounded theory method was used to analyze the qualitative data, and data envelopment analysis (DEA) method was applied to evaluate the care efficiency of the D-SCU care model.Results: The technical efficiency, pure technical efficiency and scale efficiency of care facilities with D-SCUs were higher than those of care facilities without D-SCUs (P=0.016, P=0.022, and P=0.021, respectively). The types of D-SCUs could be divided into independent, semi- independent, semi-dependent and dependent according to the architecture, physical space, and management mode. The standards for the area, environment, beds, service items of the D-SCUs were various among the 3 cities that had issued standards for setting D-SCUs.Conclusions: The care model of D-SCUs is effective and professional, and can be further promoted in China. The exploration and standard research on the D-SCUs should be strengthened in future.
Impact of ICU saturation on hospital mortality from COVID-19 in a secondary care center in Iztapalapa, Mexico City
Authors: Alanís-Naranjo José Martín , Anguiano-Álvarez Víctor Manuel , Hammeken-Larrondo Eduardo Federico
Published: April 2021

INTRODUCTION: A saturated intensive care unit (ICU) setting and socioeconomic factors such as higher poverty rates have been associated with increased rates of in-hospital mortality of COVID-19 patients. Mexico City has become the national epicenter of the pandemic, with Mexico’s highest death toll. Iztapalapa is the delegation with the highest population density and the most notorious conditions of marginalization in Mexico City. We describe the clinical characteristics and risk factors associated with mortality in 164 patients who received care in a hospital ward setting due to ICU saturation in a hospital in Iztapalapa, Mexico City.MATERIALS AND METHODS: In this retrospective cohort study, data from confirmed COVID-19 patients hospitalized between April 1, 2020 and May 31, 2020 were collected. Patients were categorized into different subgroups: alive vs. deceased and intubated vs. non-intubated for analysis between groups. A p-value <0.05 was considered statistically significant.RESULTS: In this setting, 67% of the patients required mechanical ventilation, and 32.3% needed vasopressor support, with in-hospital mortality of 68.3%. The most common complications during hospitalization were acute kidney injury (36%) and acute respiratory distress syndrome (34.8%). We observed similar factors associated with death as previous studies: male sex, older age, comorbidities, laboratory values indicating increased inflammatory/organ failure markers, and severe disease at admission. Additionally, we found that routine use of intravenous antibiotics was associated with a higher rate of in-hospital mortality (RR 3.45, 95% CI 1.69-7.06, p <0.001).CONCLUSIONS: Patients hospitalized due to COVID-19 in a saturated ICU setting had higher mortality than the rates in other studies reported globally.
Combination therapy with PD-1 blockade and radiofrequency ablation for recurrent hepatocellular carcinoma：A retrospective study
Authors: Wang Xiaofei , Chen Shu , Bi Huaqiang , Xia Feng , Feng Kai , Ma Kuansheng , Ni Bing
Published: April 2021

Background: The aim of this study was to evaluate whether combined therapy with PD-1 blockade (anti-PD-1) and radiofrequency ablation (RFA) was superior to RFA monotherapy for recurrent hepatocellular carcinoma (HCC).METHODS: A total of 127 patients who underwent anti-PD-1 plus RFA treatment (n = 41) or RFA alone treatment (n = 86) for recurrent HCC were enrolled in this retrospective study. Clinical data including post-RFA HCC recurrence (the primary end point), overall survival (OS) (the secondary end point), adverse events and toxic effects were retrospectively analyzed.RESULTS: The 1-year recurrence-free survival rates for the anti-PD-1 plus RFA and RFA groups were 36.6% and 16.3%, respectively. The corresponding overall survival rates for the two groups were 95.1% and 74.4%, respectively. There were statistically significant differences between the two groups in recurrence-free survival rate (P = 0.002) or overall survival rate (P = 0.008). Tumor number, TNM stage and anti-PD-1 treatment were demonstrated to be important factors associated with 1-year recurrence-free survival probability by univariate and multivariate analyses. Univariate and multivariate analyses demonstrated that tumor number, TNM stage and anti-PD-1 treatment were significant prognostic factors for OS. RFA treatment-related adverse events were pleural effusion requiring drainage and mild or moderate increase in body temperature. Grade 3 or higher events related to anti-PD-1 treatment occurred in 12.8% (6) patients and were infrequent.CONCLUSIONS: Combination therapy of anti-PD-1 plus RFA was superior to RFA alone in improving survival for recurrent HCC.
Desmoplastic Fibroma of the Left 6th Rib in a 35-year-old Man: a Case Report and Literature Review
Authors: Zhang Kai , Weibin Wu , Jiexia Guan , Yonghui Wu , Huiguo Chen , Xiaojun Li , Lijia Gu , Jian Zhang
Published: April 2021

Background: Desmoplastic fibroma (DF) is a rare, benign tumor. The most common sites are the long tubular bones and mandible. Although generally considered a benign tumor, it can invade surrounding tissues and has a high rate of local recurrence after incomplete surgical excision. However, there is currently no stantard treatment. Here we present a novel case of DF in the left 6th rib in a 35-year-old man.Case presentation: The man presented to our center with left chest pain and swelling. Enhanced computed tomography (CT) showed a 4.5×2.0 cm mass on the left 6th rib with pathological fracture. Wide resection was performed. Open biopsy revealed that the tumor destroyed medullary cavity and partially broke through the bone cortex. Pathologically, the tumor was composed of spindle-shaped cells arranging in a woven pattern on a backgroung of abundant collagenous fiber. No β-catenin were detected. Based on the pathological and radiological findings, a final diagnosis of DF was made. No postoperative adjuvant treatments were administerded. Fortunately, there was no evidence of recurrence 22 months after surgery. Conclusions: DF originated from rib is a kind of extremly rare benign tumor but locally aggressive and show unique biologically features. Wide resection or total resection can effectively reduce the risk of local recurrence when compared with curettage. Rarity of the tumor favors documentation in literature.
Expression analysis and tissue localization of IgZ in the grouper Epinephelus coioides after Vibrio alginolyticus infection and vaccination
Authors: Fu Yao-Wu , Yao Zhan-Juan , Cui Miao , Zhang Qi-Zhong
Published: April 2021

Background
The orange-spotted grouper (Epinephelus coioides) is an important marine farmed fish in China. It is affected by the bacterial pathogen Vibrio alginolyticus, which causes high mortality and substantial economic losses.
Results
We studied the transcriptional changes of the IgZ gene in E. coioides following V. alginolyticus stimulation and investigated the distribution of IgZ in different tissues. The highest expression level of IgZ occurred in the head kidney. When fish were exposed to live and inactivated V. alginolyticus, the expression levels of IgZ in head kidney, spleen, intestine, gill, and blood cell were significantly upregulated. In an in situ hybridization study, IgZ mRNA-positive cells were detected in head kidney, spleen, and gill, but positive signals were not detected in liver and intestine. IgZ-labeled cells increased in the head kidney, spleen, and gill post-infection with V. alginolyticus for 21 days.
Conclusions
The present study provided additional evidence that IgZ was involved in mucosal immune responses against pathogens. These results help explain the role of IgZ in E. coioides defense against V. alginolyticus infection.
Impact of a health educational interventional program on reducing the head lice infestation among pupils in an elementary school of a sub-tropical region
Authors: Najjari Mohsen , Gorouhi Mohammad Amin , Zarrinfar Hossein , Farash Bibi Razieh Hosseini , Jamali Jamshid , Moghaddas Elham , Ebrahimipuor Mohammad
Published: April 2021

Background

Pediculosis is an important social challenge that can be caused by human head louse, Pediculus humanus capitis. This infestation is cosmopolitan, especially in countries with low hygiene and sanitation. Regular health education classes for students and their parents are required to reducing this infestation in schools and families. This study aimed to evaluate the impact of a health education intervention program on reducing of head lice among pupils of an elementary school.
Methods

In a case-control study, a total of 594 pupils, a girl elementary school, were screened for pediculosis (2015–2016). Interventions were applied in two steps, pediculosis cases eradication and training-oriented prevention program. Visual inspection was applied for initial diagnosis of infection. The suspected cases were confirmed by wood lamp examination and potassium hydroxide (KOH) microscopic wet-mount examination. An elementary school in the same area was selected as the control group, with no interference. The prevalence of contamination by the same method was obtained in the study group.
Results

At the beginning of study, the overall prevalence of pediculosis among pupils was 8.4% (49/594). The mean age in all pupils was 9.86 ± 1.83 years old and the most infestation was showed in fourth-grade students with 10 years old. Analysis of statistics demonstrated a significance difference between having infestation and the number of members in the families. The interventions led to a significant increase of parenting knowledge on prevention program of pediculosis (p-value < 0.001), and a decreased prevalence of pediculosis in pupils to 3% (8/594) (p-value < 0.05).
Conclusions

The prevalence of pediculosis was significantly reduced following the interventions in the school. The applied interventions may be implemented in other residual centers to get rid of this important infestation.