bluuebunny/crossref_metadata_2025 huggingface dataset:
Gene expression identifies metabolic and functional differences between intramuscular and subcutaneous adipocytes in cattle
Authors: Hudson Nicholas James , Reverter Antonio , Griffiths William J. , Yutuc Eylan , Wang Yuqin , Jeanes Angela , McWilliam Sean , Pethick David W. , Greenwood Paul L.
Published: September 2019

Background This study used a genome-wide screen of gene expression to better understand the metabolic and functional differences between commercially valuable intramuscular fat (IMF) and commercially wasteful subcutaneous (SC) fat depots in Bos taurus beef cattle.Results We confirmed many findings previously made at the biochemical level and made new discoveries. The fundamental lipogenic machinery, such as ACACA and FASN encoding the rate limiting Acetyl CoA carboxylase and Fatty Acid synthase were expressed at 1.6-1.8 fold lower levels in IMF, consistent with previous findings. The FA elongation pathway including the rate limiting ELOVL6 was also coordinately downregulated in IMF compared to SC as expected. A 2-fold lower expression in IMF of ACSS2 encoding Acetyl Coenzyme A synthetase is consistent with utilisation of less acetate for lipogenesis in IMF compared to SC as previously determined using radioisotope incorporation. Reduced saturation of fat in the SC depot is reflected by 2.4 fold higher expression of the SCD gene encoding the Δ9 desaturase enzyme. Surprisingly, CH25H encoding the cholesterol 25 hydroxylase enzyme was ~36 fold upregulated in IMF compared to SC. Moreover, its expression in whole muscle tissue appears representative of the proportional representation of bovine marbling adipocytes. This suite of observations prompted quantification of a set of oxysterols (oxidised forms of cholesterol) in the plasma of 8 cattle exhibiting varying IMF. Using LC-MS we found the levels of several oxysterols were significantly associated with multiple marbling measurements across the musculature, but (with just one exception) no other carcass phenotypes.Conclusions These data build on our molecular understanding of ruminant fat depot biology and suggest oxysterols represent a promising circulating biomarker for cattle marbling.
Prevalence and factors associated with Helicobacter Pylori infection among children with sickle cell anemia attending Mulago hospital, in Uganda
Authors: MUBIRU IDRIS SWALEH , Kasirye Phillip Gita , Hume Heather , Ndeezi Grace
Published: September 2019

Background Children with sickle cell anemia (SCA) have a high predisposition to a range of infections and gastrointestinal disorders. Studies of children living in low income countries have shown high levels of infection with Helicobacter Pylori (H. Pylori), however, there are no reports in children with sickle cell anemia.Objectives We aimed to describe the prevalence and factors associated with Helicobacter pylori infection among children with sickle cell anemia at Mulago Hospital Sickle Cell Clinic, in Uganda.Methods A cross sectional design was employed to consecutively enroll 369 children with confirmed sickle cell anemia aged 5-18 years, attending the Mulago hospital sickle cell clinic. Assessments included; abdominal pain (current, recurrent, generalized or epigastric), dyspeptic symptoms, other relevant medical and social histories. Blood and stool samples were collected and an antigen test (test kit SD Bioline) was carried out on the latter to determine H.pylori infection. Ethical approval, consent and assent (for children above 8 years of age) were obtained. Data was entered using EPI DATA version 3.1 and analysed using STATA version 12.0. H. pylori prevalence was determined as a proportion of children with a positive stool test expressed as a percentage. Adjusted Odds ratios (aOR) were used to determine factors associated with H.pylori infection.Results H.pylori infection was detected in 47.7% (176/379), 95% CI (42.9-53.1) of the cases. Having epigastric pain was independently associated with H.pylori infection; aOR 2.22, 95%CI: (1.1 – 4.6), p-value= 0.03 . Pneumococcal vaccination aOR 0.41, 95% (CI 0.2-0.9; p=0.019 ) or H.pyroli combination therapy aOR 0.183, 95% (CI 0.1- 0.6; p=0.006 ) were protective against H.pylori. Recurrent abdominal pain did not predict H.pyroli infection. Conclusions H.pylori infection was common among children with sickle cell anemia and was independently associated with epigastric pain but not recurrent pain. Pneumococcal vaccination and combination H. pylori treatment were protective against the infection. Screening for H.Pylori should be carried out in sickle cell anaemia children with epigastric pain.
Correlation between 61 risk factors and vancomycin blood concentration reached based on real world data
Authors: Chen Haiqin , Qing-ping Shi , Kong Lingti , Zhu Yulin , Zhu jinxiu
Published: September 2019

Background : Vancomycin, an antibiotic produced by microbial fermentation, is used to treat gram-positive infections. With extensive broad-spectrum antibiotics use, bacterial resistance to vancomycin continues to increase. We explored the factors influencing vancomycin blood concentration compliance rate, established a predictive equation for such concentrations, and provided a reference for individual applications. Methods: We used a single-center, retrospective, case-control study design based on real-world data from the Hospital Information Management System of the First Affiliated Hospital of the Teaching Hospital of Bengbu Medical School from January 1, 2017 to December 31, 2018. Inpatients whose vancomycin blood concentration was monitored were selected. Single factor and multivariate logistic regression analyses were performed using SPSS 21.0 software to screen factors affecting, vancomycin blood concentration compliance rate. Vancomycin blood concentration was then determined. A receiver operator characteristic (ROC) curve of influencing factors was then used to establish a prediction model. Results: In total, 168 patients (122 males and 46 females) were enrolled. Eighty-one had their vancomycin blood concentration monitored, and 87 had concentrations that did not reach the standard. Multivariate logistic model analysis showed that patient drug allergy history, alanine aminotransferase (ALT), aspartate aminotransferase (AST), patient infusion volume, and urine volume influenced vancomycin blood concentration compliance rate. According to logistic model analysis, a history of drug allergy (95% CI: 1.225-24.850, P<0.05), ALT (95% CI: 0.979-0.999, P<0.05), AST (95% CI: 1.003-1.027, P<0.05), patient infusion volume (95% CI: 0.996-0.998, P<0.05), patient urine volume (95% CI: 1.001-1.003, P<0.05), and combined predictors were used to construct ROC curves. For combined predictive factors, area under the ROC curve (0.829, 95% CI: 0.755-0.902, P<0.005) was greater than that of the five individual indicators and was predicted to be the preferred value. Conclusions: In clinical practice, the patient’s daily average infusion and urine volumes can be substituted into the joint predictor calculation formula: P=1/[1+e-(0.940-0.004*X infusion +0.002*X urine )]. By calculating the combined predictive factor to predict vancomycin blood concentration compliance rate, the dosing regimen can be adjusted. Keywords: Real-world research; Vancomycin; Blood concentration monitoring; Influencing factor; Logistic regression analysis
Clinical value of selected markers of angiogenesis, inflammation, insulin resistance and obesity in type 1 endometrial cancer
Authors: Terlikowska Katarzyna M. , Dobrzycka Bozena , Terlikowski Robert , Sienkiewicz Anna , Kinalski Maciej , Terlikowski Sławomir Jerzy
Published: September 2019

Background It is a well-known fact show that the risk of developing endometrial cancer (type 1 EC) is strongly associated with obesity. In this study, selected markers, such as obesity, insulin resistance, angiogenesis and inflammation markers related to EC type 1 progression and patients’ survival data were analyzed.Methods To measure levels of adiponectin, C-reactive protein (CRP), vascular endothelial growth factor-A (VEGF-A), angiopoietin-2 (Ang-2), insulin-like growth factor-1 (IGF-1), insulin and C-peptide in 176 preoperative serum samples, the immunoassay technique (EMIT) has been applied.Results Angiopoietin-2 levels increase with age (P=0.005), FIGO stage (p=0.042), myometrial invasion (P=0.009) and LVSI (P<0.001). The CRP levels increase with age (P=0.01), as well as the advancement of the FIGO stage (P<0.001), higher tumor grade (P=0.012), and myometrial invasion (P<0.001). A positive correlation between serum Ang-2 and CRP levels was demonstrated (r=0.44; p<0.001). Kaplan-Meier survival analysis showed that patients with high CRP levels in serum and Ang-2 presented a worse outcome (P=0.03 and P=0.015, respectively). Cox regression analysis of individual predictors revealed that high serum levels of Ang-2, CRP, advanced clinical FIGO stage (P<0.001, respectively), old age (P=0.013) were all significant overall survival predictors. By means of multivariate analysis, their predictive significance was confirmed.Conclusion Our study provides evidence that serum levels of Ang-2 and CRP may serve as predictors for assessment of the clinical stage of type 1 EC and are significantly associated with poor prognosis. It is likely that angiogenesis and inflammation associated with obesity, not only obesity itself, have a significant impact on EC type 1 progression and survival rate of patients.
The analgesic efficacy of ultrasound-guided transversus abdominis plane block for retroperitoneoscopic renal surgery: A randomized controlled study
Authors: Li Xue , Xu Zhen-Zhen , Li Xue-Ying , Jiang Ting-Ting , Lin Zeng-Mao , Wang Dong-Xin
Published: September 2019

Background Ultrasound-guided lateral transversus abdominis plane (TAP) block can provide definite analgesia to the anterior abdominal wall. However, whether this method is useful in renal surgery through the lateral abdominal wall pathway remains unknown. The study aimed to evaluate the analgesic efficacy of lateral TAP block for retroperitoneoscopic partial or radical nephrectomy.
Method In this prospective, randomized, double-blind, placebo-controlled trial, eligible patients were randomized into two groups. After anaesthesia induction, ultrasound-guided lateral TAP block was performed with either 30 ml of 0.4% ropivacaine (Group T) or an equivalent volume of normal saline (Group C). The primary outcomes were opioid consumption during surgery and in the first 24 hours after surgery. Secondary outcomes included postsurgical pain intensity immediately awakening from anaesthesia and at 0.5, 1, 2, 6, 12, and 24 hours after surgery, as well as recovery variables including the incidence of postoperative nausea and vomiting (PONV), sleep quality, time to first ambulation, drainage and length of hospital stay.
Results A total of 104 patients were enrolled and randomized (53 in Group T and 51 in Group C). Laparoscopic surgery was converted to open surgery in one patient of Group T; this patient was excluded from the outcome analysis . The opioid consumption during surgery ( intravenous morphine equivalent dose: median 35.0 mg [interquartile range 18.0, 49.6] in Group C vs. 40.3 mg [20.9, 59.0] in Group T, P=0.281) and in the first 24 hours after surgery ( 10.8 mg [7.8, 21.7] in Group C vs. 13.2 mg [8.0, 26.6] in Group T , P=0.311) did not differ significantly between groups. There were no significant differences between groups regarding the pain intensity at all time points after surgery and the recovery variables (all P>0.05).
Conclusions Our results showed that, in patients undergoing retroperitoneoscopic renal surgery, preoperative lateral TAP did not decrease intra- and postoperative opioid consumption, nor did it relieve pain intensity or promote postoperative recovery in the first 24 hours after surgery. However, the trial might be underpowered.
Trial registration This study was registered on November 4, 2017, in the Chinese Clinical Trail Registry with the identification number ChiCTR-INR-17013244.
A case study of soil food web components affected by Fallopia japonica (Polygonaceae) in three natural habitats in Central Europe
Authors: Čerevková Andrea , Bobuľská Lenka , Miklisová Dana , Renčo Marek
Published: September 2019

This study determined the effect of the invasive plant Fallopia japonica on soil physical properties, microbial respiration, microbial biomass carbon content, enzymatic activities, and soil nematode communities. We established in total 30 plots in three natural habitats (forest, grassland, wetland) that were either uninvaded or mostly monospecifically invaded by F. japonica. The soil physical and microbial properties differed among the investigated plots, but the differences were observed to be non-significant between the invaded and the uninvaded plots. Non-metric multidimensional scaling based on nematode species diversity indicated that the total number of identified nematode species and their abundance were higher in the uninvaded compare to the invaded plots. Negative effect of F. japonica on omnivores, plant parasites, and root-fungal feeder nematodes was confirmed by their lower abundance in the invaded compared to the uninvaded plots. In the invaded plots, we also confirmed lower Maturity and Channel index, but higher Enrichment index. Our results thus indicated that the invasive plant F. japonica could affect nematode communities, more than physical or microbial properties, regardless of habitat.
Description of Ektaphelenchus koreanus n. sp. (Nematoda: Ektaphelenchidae) with morphometrical notes on the Ektaphelenchus species
Authors: Gu Jianfeng , Maria Munawar , Fang Yiwu , Liu Lele
Published: September 2019

Ektaphelenchus koreanus n. sp. is isolated from Pinus packaging wood from Korea in Ningbo customs. The new species can be characterized by having four incisures in the lateral field, the excretory pore located posterior to nerve ring, female devoid of vulval flap, and having long post-vulval intestinal sac (55–106 μm), tail with a finely rounded terminus. Six caudal papillae in male and spicule short (12.7–13.7 μm), having broad squared to rounded condylus, triangular rounded rostrum, cucullus absent. Morphologically the species is most similar with E. berbericus, E. joyceae, E. oleae, E. ibericus, and E. taiwanensis but it can be differentiated by plenty of morphometrical and morphological characters. In addition, a morphometry table of Ektaphelenchus is also presented.
A Draft Genome Sequence of the Burrowing Nematode Radopholus similis
Authors: Mathew Reny , Burke Mark , Opperman Charles H.
Published: September 2019

Radopholus similis also known as the burrowing nematode is a devastating pest of banana (Musa spp.) and many economically important crops and ornamentals. In this publication, we present the genome assembly of R. similis.
Grassland Retention in the North America Midwest after Periods of High Commodity Prices and Climate Variability
Authors: Joshi Deepak R. , Ulrich‐Schad Jessica , Wang Tong , Dunn Barry H. , Clay Sharon A. , Bruggeman Stephanie A. , Clay David E.
Published: September 2019

Core Ideas

Land use change models may overestimate the importance of commodity prices.

Nebraska grasslands relative to total working lands decreased 1.7% from 2006 to 2014.

South Dakota grasslands relative to total working lands decreased 3% from 2006 to 2014.

In 2012, 84,900 km2 of grassland suitable for crops remained as grasslands.

Land stewardship most likely was the reason why grassland was retained.

The conversion of grassland, wetlands, and forest to croplands may contribute to environmental degradation and diminished sustainability. This study determined the impact of land use change from 2006 to 2012 and from 2012 to 2014 on the cultivation suitability of grasslands that were not converted to cropland. The model system, which includes Nebraska and South Dakota, was selected because it contains climatic conditions ranging from humid continental to semiarid and a large number of farms that produced both crops and livestock. During the study, commodity prices reached historically high values, and a severe drought occurred in 2012. Land use benchmarks were obtained by visually identifying land use at 81,600 sample sites in high‐resolution remote sensing images obtained from the National Agricultural Imaging Program. Sampling sites with Land Capability Class values ≤4 were identified as suitable for cultivation if appropriate practices were followed. In 2006, 2012, and 2014, grasslands accounted for 11.0, 10.76, and 10.78 million ha in Nebraska, respectively, whereas in South Dakota, grasslands accounted for 12.12, 11.65, and 11.69 million ha, respectively. In Nebraska, the percentage of grasslands relative to working lands (grassland + croplands) decreased from 60.6% in 2006 to 58.9% in 2014, whereas in South Dakota the percentage of grassland decreased from 69.1% in 2006 to 66.0% in 2014. In eastern Nebraska and South Dakota, 74.1% of the nonconverted grasslands in 2012 were suitable for crop production. Lower‐than‐expected conversion rates were attributed to a growing interest in land stewardship and a desire to maintain income diversification.
Soil Water Dynamics with Spring Camelina in a Three‐Year Rotation in Washington's Winter Wheat–Fallow Region
Authors: Wuest Stewart B. , Schillinger William F.
Published: September 2019

Core Ideas

The soil water dynamics of 3‐yr winter wheat–camelina–summer fallow and 2‐yr winter wheat–summer fallow rotations were measured for 8 yr.

At harvest, there was less soil water after camelina than after winter wheat in the 2‐yr rotation.

The water deficit persisted through the 13‐mo fallow period and decreased the yield of 3‐yr vs. 2‐yr winter wheat.

Increased cropping intensity may increase risk and variability in dry environments.

Camelina [Camelina sativa (L.) Crantz] of the Brassicaceae family is a short‐season drought‐ and frost‐tolerant oilseed. Camelina has been promoted as an alternative crop for the low‐precipitation (<350 mm annually) Mediterranean‐like climate region of the US inland Pacific Northwest, where a monoculture 2‐yr winter wheat (Triticum aestivum L.) (WW)–summer fallow (SF) rotation is widely practiced. An 8‐yr experiment was conducted to compare a 3‐yr WW–camelina–SF rotation with the typical 2‐yr WW–SF rotation to analyze the soil water dynamics of these two crop rotations. Growing spring‐planted camelina reduced soil water content at the beginning of the fallow; this reduction resulted in an average of 21 mm less water at WW planting and a 170 kg ha‐1 reduction in grain yield compared with WW–SF. We show that (i) the deep‐rooted broadleaf weed Russian thistle (Salsola tragus L.) present in camelina most years was the most likely reason for greater in‐crop soil water use than with WW–SF, and (ii) the limited camelina residue was probably responsible for greater evaporative loss during the spring to late summer segment of the fallow. We report the first findings from the Pacific Northwest drylands of greater water use by a cool‐season spring crop versus WW and greater evaporative loss during the summer caused by lack of residue in a minimum‐tillage SF comparison. Here, extending the crop rotation to include camelina was costly in terms of water use, surface soil residue cover, soil water storage during the fallow, and WW grain yield.
A fault diagnosis method of bearing using energy spread spectrum and genetic algorithm
Authors: Ding Feng , Qiu Manyi , Chen Xuejiao
Published: September 2019

Considering the shortcomings of the traditional energy spectrum algorithm applied to the rolling bearing fault diagnosis, which can only represent the tendency of fault feature transformation with a certain scale, but not adjacent scales contained. In this paper, we propose a fault diagnosis method of rolling bearing based on Support Vector Machine, combining energy spread spectrum and genetic optimization. The extracted signal is denoised and decomposed using wavelet packets, the energy spectrums and energy spread spectrums are calculated based on the decomposed different frequency signal components. The genetic algorithm is used to select the important parameters of the Support Vector Machine and bring the determined parameter values into the Support Vector Machine to generate the GA-SVM model. Then, energy spectrums and energy spread spectrums are inputted into GA-SVM as the characteristic parameters for identification. The experimental results show the two new points of energy spread spectrums and GA-SVM improve the diagnostic rate by up to 28.5 %, it can effectively improve the fault recognition rate of the rolling bearing.
Nonlinear dynamics of planetary gear wear in multistage gear transmission system
Authors: Wang Xin
Published: September 2019

With the increasing service life of a gear transmission system, the gear teeth become constantly worn, and the gear clearance increases. The increase in the clearance will produce a series of nonlinear changes that change the stability of the system and can even result in loss of stability. In this paper, dimensionless dynamic equations of a multistage gear transmission system that contains a two-stage fixed-axis gear and a one-stage planetary gear were established. Planetary wear fault was simulated by changes in the gear clearance. System bifurcation diagrams with an increase in the clearance were studied. The frequency characteristics of planetary gears under different excitation frequencies and different degrees of wear were studied. The influence of planetary gear wear on the fixed-axis was discovered. The vibration mechanism and a fault diagnostic method in a multistage gear transmission system were obtained.
Quilombolas de Acauã Identidades, relações étnico-raciais e demarcação no Rio Grande do Norte, Brasil.
Authors: Ximenes de Araujo Antônio Ricardo
Published: September 2019

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Petrologic and thermobarometric study of the Riás schists (NW Iberian Massif)
Authors: Solís-Alulima Byron Ernesto , López-Carmona Alicia , Gutiérrez-Alonso Gabriel , Álvarez-Valero Antonio M.
Published: September 2019

The Riás Schists crop out in the so-called Iberian Variscan parautochthon, surrounding the Malpica-Tui Complex (NW Iberian Massif), as part of the westernmost internal areas of the European Variscan belt. Three Variscan metamorphic events have been identified in the Riás Schists (M1, M2 and post-M2). M1 comprise unoriented microinclusions that have only been identified in garnet porphyroblast cores and inside staurolite crystals. M2, comprises the matrix foliation (S2) and the assemblage garnetRIM + staurolite + muscovite + biotite + chlorite + rutile/ilmenite + magnetite + quartz and the development of syntectonic andalusite. Finally, post-M2 (post-S2) includes andalusite and plagioclase together with secondary muscovite, biotite and chlorite and accessory tourmaline, Fe/Ti oxides, apatite and carbonate. Results of multi-equilibrium thermobarometry (pressure-temperature pseudosections), for M2 indicates a medium-pressure Barrovian metamorphic event (0.5-0.6 GPa; 580-570 ºC; ca. 20 km deep), followed by moderate cooling during decompression, together with the extensional collapse of the Variscan orogenic pile (post-M2;0.3 GPa; 540 ºC; ca. 10 km deep). Inferred P T conditions in the Riás Schists, and their spatial relationship with the overlying allochthonous high-pressure pelitic schists (i.e. Ceán Schists), suggest that both lithologies were part of the same continental margin during the beginning of the Variscan orogeny. However, they experienced very different tectonothermal evolutions due to their putative locations in the orogenic wedge.
Density Functional Theory Study of Antioxidant Adsorption onto Single- Wall Boron Nitride Nanotubes: Design of New Antioxidant Delivery Systems
Authors: Ghazanfary Samereh , Oroojalian Fatemeh , Yazdian-Robati Rezvan , Dadmehr Mehdi , Sahebkar Amirhossein
Published: September 2019

Background:

Boron Nitride Nanotubes (BNNTs) have recently emerged as an interesting field of study, because they could be used for the realization of developed, integrated and compact nanostructures to be formulated. BNNTs with similar surface morphology, alternating B and N atoms completely substitute for C atoms in a graphitic-like sheet with nearly no alterations in atomic spacing, with uniformity in dispersion in the solution, and readily applicable in biomedical applications with no obvious toxicity. Also demonstrating a good cell interaction and cell targeting.

Aim and Objective:

With a purpose of increasing the field of BNNT for drug delivery, a theoretical investigation of the interaction of Melatonin, Vitamin C, Glutathione and lipoic acid antioxidants using (9, 0) zigzag BNNTs is shown using density functional theory.

Methods:

The geometries corresponding to Melatonin, Vitamin C, Glutathione and lipoic acid and BNNT with different lengths were individually optimized with the DMOL3 program at the LDA/ DNP (fine) level of theory.

Results:

In the presence of external electric field Melatonin, Vitamin C, Glutathione and lipoic acid could be absorbed considerably on BNNT with lengths 22 and 29 Å, as the adsorption energy values in the presence of external electric field are considerably increased.

Conclusion:

The external electric field is an appropriate technique for adsorbing and storing antioxidants on BNNTs. Moreover, it is believed that applying the external electric field may be a proper method for controlling release rate of drugs.
Cardiovascular Risk of Synthetic, Non-Biologic Disease-Modifying Anti- Rheumatic Drugs (DMARDs)
Authors: Mourouzis Iordanis S. , Manolis Antonis S. , Pantos Constantinos
Published: September 2019

Patients with rheumatoid diseases have an increased risk of cardiovascular disease (CVD) and CVD-related death compared with the general population. Both the traditional cardiovascular risk factors and systemic inflammation are contributors to this phenomenon. This review examines the available evidence about the effects of synthetic, non-biologic disease-modifying antirheumatic drugs (DMARDs) on CVD risk. This is an important issue for clinicians when deciding on individual treatment plans in patients with rheumatic diseases. Evidence suggests that synthetic, non-biologic DMARDs such as methotrexate, sulfasalazine, hydroxychloroquine, leflunomide and tofacitinib show decreased CVD morbidity and mortality. However, the strongest data in favour of a reduction in CVD events in rheumatoid patients are shown with methotrexate, which has been the focus of most studies. Adequate proof for a favourable effect also exists for hydroxychloroquine. Larger, prospective studies and randomized clinical trials are needed to better characterize the effect of synthetic, non-biologic DMARDs on CVD outcomes in these patients. Design of future studies should include areas with lack of evidence, such as the risk for heart failure, arrhythmias and valvular heart disease. The clinically relevant question whether synthetic, non-biologic DMARDs are inferior to biologic DMARDs in terms of CVD outcomes remains not adequately addressed.
Severe Group A and Group B Streptococcus Diseases at a Pediatric ICU: Are they Still Sensitive to the Penicillins?
Authors: Hon Kam L. , Chow Tai C. , Cheung Tsun S. , Lam Wai T. , Hung Lok T. , So King W. , Margaret I.P. , Qian Su Y.
Published: September 2019

Background:

Group A β-hemolytic streptococcus (GAS) and Group B streptococcus (GBS) are two common pathogens that are associated with many diseases in children. Severe infections as a result of these two streptococci are albeit uncommon but associated with high mortality and morbidity, and often necessitate intensive care support. This paper aims to review mortality and morbidity severe infection associated with GAS and GBS isolations at a Pediatric Intensive Care Unit (PICU).

Methods:

All children admitted to PICU of a teaching hospital between October 2002 and May 2018 with laboratory-proven GAS and GBS isolations were included.

Results:

There were 19 patients (0.7% PICU admissions) with streptococcal isolations (GAS, n=11 and GBS, n=8). Comparing to GAS, GBS affected infants were younger (median age 0.13 versus 5.47 years, 95% CI, 1.7-8.5, p=0.0003), and cerebrospinal fluids more likely positive (p = 0.0181). All GAS and GBS were sensitive to penicillin (CLSI: MICs 0.06 – 2.0 μg/mL), with majority of GAS sensitive to clindamycin and erythromycin, and half of the GBS resistant to clindamycin and erythromycin. Co-infections were prevalent, but viruses were only isolated with GAS (p=0.024). Isolation of GAS and GBS was associated with nearly 40% mortality and high rates of mechanical ventilation and inotropic supports. All non-survivors had high mortality (PIM2) and sepsis scores.

Conclusions:

Severe GAS and GBS are rare but associated with high mortality and rates of mechanical ventilation and inotropic supports in PICU. The streptococci are invariably sensitive to penicillin. The high PIM2 and Sepsis scores suggest that prompt recognition of sepsis and timely judicious institution of antibiotics and intensive care support may be life-saving for these devastating infections.
Parental Knowledge, Attitudes, and Behaviors Toward Their Epileptic Children at King Abdulaziz University Hospital: Cross-Sectional Study
Authors: Kinkar Abdulelah , Alqarni Dalya , Alghamdi Abdulaziz , Wali Sahal , Alghamdi Nasser , Saloom Saeed , Aashi Mooataz
Published: September 2019

Background

Epilepsy is a chronic disease characterized by periodic seizures that result from abnormal integrated firing impulses in the brain. It is one of the most common neurological disorders. Over the past few years, there has been increasing awareness about the effect that having a child with epilepsy has on parents and the reciprocal impact of parental knowledge and attitudes regarding epilepsy on the affected child.

Objective

This study aimed to assess parental knowledge, attitudes, and behavior toward their epileptic children.

Methods

A cross-sectional study was conducted in 2018 by the Pediatric Neurology Department of King Abdulaziz University Hospital, Jeddah, the Kingdom of Saudi Arabia. A sample size of 115 of 332 parents who have a child diagnosed with epilepsy and aged 18 years or younger were recruited for this study. Statistical analysis was performed using SPSS version 21. Data analysis was performed using an independent t test, a chi-square test, one-way analysis of variance, and correlation analysis.

Results

A total of 115 participants answered the questionnaire; of these, 65 (56.5%) were men, with an average age of 40.3 years, and the mean age of the children was 9.0 years. Overall, 85 (85/115, 73.9%) children were taken care of by both of their parents. The mean parental knowledge score was 7.49 (SD 2.08) out of 12, and it was significantly related to the educational level of the parent (P=.004). The knowledge question that was most frequently answered incorrectly was “Diagnosis of epilepsy is usually made based on at least two unprovoked seizures.” As only 28.7% (33/115) of participants chose the correct answer, mean parental attitude score was 26.51 (SD 4.284) out of 35, and there was no significant relation with the educational level of parents (P=.13); however, it was negatively correlated with the child’s age (P=.045). Mean parental behavioral score was 23.35 (SD 4.121) out of 35, and there was no significant relation with the educational level of the parents (P=.24). The most negatively answered question for the behavior section was “I can leave my child without supervision,” with a mean score of 2.25 (SD 1.09) out of 5. Gender did not play a significant role in parental knowledge, attitudes, or behavior (P=.44, P=.77, and P=.99, respectively).

Conclusions

Parental knowledge in our sample still needs improvement. Therefore, more awareness campaigns should be made for the community and for the parents of affected children to create a supportive environment for the children and help them thrive and develop.
Impact of Automatic Query Generation and Quality Recognition Using Deep Learning to Curate Evidence From Biomedical Literature: Empirical Study
Authors: Afzal Muhammad , Hussain Maqbool , Malik Khalid Mahmood , Lee Sungyoung
Published: September 2019

Background

The quality of health care is continuously improving and is expected to improve further because of the advancement of machine learning and knowledge-based techniques along with innovation and availability of wearable sensors. With these advancements, health care professionals are now becoming more interested and involved in seeking scientific research evidence from external sources for decision making relevant to medical diagnosis, treatments, and prognosis. Not much work has been done to develop methods for unobtrusive and seamless curation of data from the biomedical literature.

Objective

This study aimed to design a framework that can enable bringing quality publications intelligently to the users’ desk to assist medical practitioners in answering clinical questions and fulfilling their informational needs.

Methods

The proposed framework consists of methods for efficient biomedical literature curation, including the automatic construction of a well-built question, the recognition of evidence quality by proposing extended quality recognition model (E-QRM), and the ranking and summarization of the extracted evidence.

Results

Unlike previous works, the proposed framework systematically integrates the echelons of biomedical literature curation by including methods for searching queries, content quality assessments, and ranking and summarization. Using an ensemble approach, our high-impact classifier E-QRM obtained significantly improved accuracy than the existing quality recognition model (1723/1894, 90.97% vs 1462/1894, 77.21%).

Conclusions

Our proposed methods and evaluation demonstrate the validity and rigorousness of the results, which can be used in different applications, including evidence-based medicine, precision medicine, and medical education.
Factors Associated With Electronic Health Record Usage Among Primary Care Physicians After Hours: Retrospective Cohort Study
Authors: Attipoe Selasi , Huang Yungui , Schweikhart Sharon , Rust Steve , Hoffman Jeffrey , Lin Simon
Published: September 2019

Background

There is limited published data on variation in physician usage of electronic health records (EHRs), particularly after hours. Research in this area could provide insight into the effects of EHR-related workload on physicians.

Objective

This study sought to examine factors associated with after-hours EHR usage among primary care physicians.

Methods

Electronic health records usage information was collected from primary care pediatricians in a large United States hospital. Inclusion criteria consisted solely of being a primary care physician who started employment with the hospital before the study period, so all eligible primary care physicians were included without sampling. Mixed effects statistical modeling was used to investigate the effects of age, gender, workload, normal-hour usage, week to week variation, and provider-to-provider variation on the after-hour usage of EHRs.

Results

There were a total of 3498 weekly records obtained on 50 physicians, of whom 22% were male and 78% were female. Overall, more EHR usage during normal work hours was associated with decreased usage after hours. The more work relative value units generated by physicians, the more time they spent interacting with EHRs after hours (β=.04, P<.001) and overall (ie, during normal hours and after hours) (β=.24, P<.001). Gender was associated with total usage time, with females spending more time than males (P=.03). However, this association was not observed with after-hours EHR usage. provider-to-provider variation was the largest and most dominant source of variation in after-hour EHR usage, which accounted for 52% of variance of total EHR usage.

Conclusion

The present study found that there is a considerable amount of variability in EHR use among primary care physicians, which suggested that many factors influence after-hours EHR usage by physicians. However, provider-to-provider variation was the largest and most dominant source of variation in after-hours EHR usage. While the results are intuitive, future studies should consider the effect of EHR use variations on workload efficiency.
Factors Associated With Electronic Health Record Usage Among Primary Care Physicians After Hours: Retrospective Cohort Study (Preprint)
Authors: Attipoe Selasi , Huang Yungui , Schweikhart Sharon , Rust Steve , Hoffman Jeffrey , Lin Simon
Published: September 2019

BACKGROUND

There is limited published data on variation in physician usage of electronic health records (EHRs), particularly after hours. Research in this area could provide insight into the effects of EHR-related workload on physicians.

OBJECTIVE

This study sought to examine factors associated with after-hours EHR usage among primary care physicians.

METHODS

Electronic health records usage information was collected from primary care pediatricians in a large United States hospital. Inclusion criteria consisted solely of being a primary care physician who started employment with the hospital before the study period, so all eligible primary care physicians were included without sampling. Mixed effects statistical modeling was used to investigate the effects of age, gender, workload, normal-hour usage, week to week variation, and provider-to-provider variation on the after-hour usage of EHRs.

RESULTS

There were a total of 3498 weekly records obtained on 50 physicians, of whom 22% were male and 78% were female. Overall, more EHR usage during normal work hours was associated with decreased usage after hours. The more work relative value units generated by physicians, the more time they spent interacting with EHRs after hours (β=.04, P<.001) and overall (ie, during normal hours and after hours) (β=.24, P<.001). Gender was associated with total usage time, with females spending more time than males (P=.03). However, this association was not observed with after-hours EHR usage. provider-to-provider variation was the largest and most dominant source of variation in after-hour EHR usage, which accounted for 52% of variance of total EHR usage.

CONCLUSION

The present study found that there is a considerable amount of variability in EHR use among primary care physicians, which suggested that many factors influence after-hours EHR usage by physicians. However, provider-to-provider variation was the largest and most dominant source of variation in after-hours EHR usage. While the results are intuitive, future studies should consider the effect of EHR use variations on workload efficiency.
Impact of Balanced scorecard as, strategic Management System tool, to improve sustainable development: measuring a mediation of organizational performance through PLS-Smart (Preprint)
Authors: Rafiq Muhammad , Zhang XinPing
Published: September 2019

UNSTRUCTURED

The study carried out to investigate the empirical effect of strategic management system on sustainable development using balanced scorecard (BSC) as theoretical lens and organizational performance as intervening variable.The study incorporated positivism research paradigm in order to address the objective nature of research. As the current study is of empirical and impartial nature hence, quantitative method was considered as the best method for achieving the research objectives of the study. The study used questionnaire as data collection instrument. Total three hundred questionnaires were disturbed in Chinese power companies based in Pakistan. Stratified-random sampling approach is adopted to reach relevant sample. Partial least squares-structural equation modeling was used for statistical analysis.
BSC indicated positive significant influence on sustainable development. Additionally, organizational performance depicts partial mediation between BSC and sustainable development. The study underpins the theoretical foundation of resource base view (RBV) and balanced scorecard view of strategic management system.
The findings suggest that non-financial measures have better consequences on employees’ performance especially it makes them ecologically responsive unlike, the financial performance measures which took place in past days. it is suggested to take measures relating to wastage, usage of inimitable resources should be focused on in-addition rather traditional measures who can persuade sustainable development.
Summarizing Complex Graphical Models of Multiple Chronic Conditions Using the Second Eigenvalue of Graph Laplacian: Algorithm Development and Validation (Preprint)
Authors: Faruqui Syed Hasib Akhter , Alaeddini Adel , Chang Mike C , Shirinkam Sara , Jaramillo Carlos , NajafiRad Peyman , Wang Jing , Pugh Mary Jo
Published: September 2019

BACKGROUND

It is important but challenging to understand the interactions of multiple chronic conditions (MCC) and how they develop over time in patients and populations. Clinical data on MCC can now be represented using graphical models to study their interaction and identify the path toward the development of MCC. However, the current graphical models representing MCC are often complex and difficult to analyze. Therefore, it is necessary to develop improved methods for generating these models.

OBJECTIVE

This study aimed to summarize the complex graphical models of MCC interactions to improve comprehension and aid analysis.

METHODS

We examined the emergence of 5 chronic medical conditions (ie, traumatic brain injury [TBI], posttraumatic stress disorder [PTSD], depression [Depr], substance abuse [SuAb], and back pain [BaPa]) over 5 years among 257,633 veteran patients. We developed 3 algorithms that utilize the second eigenvalue of the graph Laplacian to summarize the complex graphical models of MCC by removing less significant edges. The first algorithm learns a sparse probabilistic graphical model of MCC interactions directly from the data. The second algorithm summarizes an existing probabilistic graphical model of MCC interactions when a supporting data set is available. The third algorithm, which is a variation of the second algorithm, summarizes the existing graphical model of MCC interactions with no supporting data. Finally, we examined the coappearance of the 100 most common terms in the literature of MCC to validate the performance of the proposed model.

RESULTS

The proposed summarization algorithms demonstrate considerable performance in extracting major connections among MCC without reducing the predictive accuracy of the resulting graphical models. For the model learned directly from the data, the area under the curve (AUC) performance for predicting TBI, PTSD, BaPa, SuAb, and Depr, respectively, during the next 4 years is as follows—year 2: 79.91%, 84.04%, 78.83%, 82.50%, and 81.47%; year 3: 76.23%, 80.61%, 73.51%, 79.84%, and 77.13%; year 4: 72.38%, 78.22%, 72.96%, 77.92%, and 72.65%; and year 5: 69.51%, 76.15%, 73.04%, 76.72%, and 69.99%, respectively. This demonstrates an overall 12.07% increase in the cumulative sum of AUC in comparison with the classic multilevel temporal Bayesian network.

CONCLUSIONS

Using graph summarization can improve the interpretability and the predictive power of the complex graphical models of MCC.
A Possible Mobile Health Solution in Orthopedics and Trauma Surgery: Development Protocol and User Evaluation of the Ankle Joint App (Preprint)
Authors: Dittrich Florian , Back David Alexander , Harren Anna Katharina , Jäger Marcus , Landgraeber Stefan , Reinecke Felix , Beck Sascha
Published: September 2019

BACKGROUND

Ankle sprains are one of the most frequent sports injuries. With respect to the high prevalence of ankle ligament injuries and patients’ young age, optimizing treatment and rehabilitation is mandatory to prevent future complications such as chronic ankle instability or osteoarthritis.

OBJECTIVE

In modern times, an increasing amount of smartphone usage in patient care is evident. Studies investigating mobile health (mHealth)–based rehabilitation programs after ankle sprains are rare. The aim of this study was to expose any issues present in the development process of a medical app as well as associated risks and chances.

METHODS

The development process of the Ankle Joint App was defined in chronological order using a protocol. The app’s quality was evaluated using the (user) German Mobile App Rating Scale (MARS-G) by voluntary foot and ankle surgeons (n=20) and voluntary athletes (n=20).

RESULTS

A multidisciplinary development team built a hybrid app with a corresponding backend structure. The app’s content provides actual medical literature, training videos, and a log function. Excellent interrater reliability (interrater reliability=0.92; 95% CI 0.86-0.96) was obtained. The mean overall score for the Ankle Joint App was 4.4 (SD 0.5). The mean subjective quality scores were 3.6 (surgeons: SD 0.7) and 3.8 (athletes: SD 0.5). Behavioral change had mean scores of 4.1 (surgeons: SD 0.7) and 4.3 (athletes: SD 0.7). The medical gain value, rated by the surgeons only, was 3.9 (SD 0.6).

CONCLUSIONS

The data obtained demonstrate that mHealth-based rehabilitation programs might be a useful tool for patient education and collection of personal data. The achieved (user) MARS-G scores support a high quality of the tested app. Medical app development with an a priori defined target group and a precisely intended purpose, in a multidisciplinary team, is highly promising. Follow-up studies are required to obtain funded evidence for the ankle joints app’s effects on economical and medical aspects in comparison with established nondigital therapy paths.
Effects of binary and quaternary rhythms on motor and non-motor symptoms of individuals with Parkinson's disease: protocol for a randomized trial (Preprint)
Authors: Moratelli Jéssica , Alexandre Kettlyn Hames , Swarowsky Alessandra , Corrêa Clynton Lourenço , Tillmann Ana Cristina , Boing Leonessa , Vieira Melissa De Carvalho Souza , Guimarães Adriana Coutinho De Azevedo
Published: September 2019

BACKGROUND

People with Parkinson's disease constantly have low levels of physical activity, so dancing has become increasingly important for the treatment of the disease and can help improve balance, gait, reduce falls, and improve quality of life. However, there has been no research on the effects of binary and quaternary rhythms on the symptoms of people living with Parkinson's disease, so the study may provide a new treatment option for this population.

OBJECTIVE

To propose a 12-week protocol of binary and quaternary rhythms for individuals with Parkinson’s disease and to evaluate their effectiveness on motor (balance, gait, functional mobility), and non-motor symptoms (quality of life, sleep, sleepiness during daytime, fatigue) through a randomized clinical trial.

METHODS

Sixty individuals with idiopathic Parkinson’s disease, will be enrolled in the study. The participants will be allocated to either the intervention arm (binary rhythm (dance) or quaternary rhythm (dance) 2x/week for 12 weeks). The binary and quaternary rhythm dance classes will be divided into three stages: warm-up and stretching; the main stage and relaxation. Measurements of study outcomes will take place at baseline and post-intervention.

RESULTS

The primary outcome is balance measured by a balance test score (Mini-Bestest). Secondary outcomes include gait, functional mobility, quality of life, sleep, sleepiness during daytime and fatigue.

CONCLUSIONS

Considering the high prevalence of individuals with Parkinson's disease, implementing a specific protocol for binary and quaternary rhythms is important considering the need to improve the quality of life, motor and non-motor symptoms of your life. The study will provide critical information on the efficacy and effects of binary-rhythm interventions on motor and non-motor symptoms of individuals with Parkinson's disease in order to help guide and plan future studies. This is an innovative protocol, being an important tool for the reduction of motor and non-motor symptoms in individuals with Parkinson’s disease.

CLINICALTRIAL

The trial was registered on Clinical Trials number: NCT03235453.