bluuebunny/crossref_metadata_2025 huggingface dataset:
Methodological quality of systematic reviews on interventions for osteoarthritis: a cross-sectional study
Authors: Wu Irene XY , Wang Huan , Zhu Lin , Chen Yancong , Wong Charlene HL , Mao Chen , Chung Vincent CH
Published: September 2020

Background:

Healthcare providers need reliable evidence for supporting the adoption of new interventions, of which the source of evidence often originates from systematic reviews (SRs). However, little assessment on the rigor of SRs related to osteoarthritis interventions has been conducted. This cross-sectional study aimed to evaluate the methodological quality and predictors among SRs on osteoarthritis interventions.

Methods:

Four electronic databases (Cochrane Database of Systematic Reviews, MEDLINE, Embase, and PsycINFO) were searched, from 1 January 2008 to 10 October 2019. An SR was eligible if it focused on osteoarthritis interventions, and we performed at least one meta-analysis. Methodological quality was assessed using the validated AMSTAR 2 instrument. Multivariate regression analyses were conducted to assess predictors of methodological quality.

Results:

In total, 167 SRs were included. The most SRs were non-Cochrane reviews (88.6%), and 54.5% investigated non-pharmacological interventions. Only seven (4.2%) had high methodological quality. Respectively, eight (4.8%), 25 (15.0%), and 127 (76.0%) SRs had moderate, low, and critically low quality. Main methodological weaknesses were as follows: only 16.8% registered protocol a priori, 4.2% searched literature comprehensively, 25.7% included lists of excluded studies with justifications, and 30.5% assessed risk of bias appropriately by considering allocation concealment, blinding of patients and assessors, random sequence generation and selective reported outcomes. Cochrane reviews [adjusted odds ratio (AOR) 251.5, 95% confidence interval (CI) 35.5–1782.6], being updates of previous SRs (AOR 3.9, 95% CI 1.1–13.7), and SRs published after 2017 (AOR 7.7, 95% CI 2.8–21.5) were positively related to higher methodological quality.

Conclusion:

Despite signs of improvement in recent years, most of the SRs on osteoarthritis interventions have critically low methodological quality, especially among non-Cochrane reviews. Future SRs should be improved by conducting comprehensive literature search, justifying excluded studies, publishing a protocol, and assessing the risk of bias of included studies appropriately.
Strain gauge properties of Pd+-ion-implanted polymer
Authors: Di Benedetto Francesca , Esposito Ciro , Protopapa Maria Lucia , Piscopiello Emanuela , Massaro Marcello , Cassano Gennaro , Filiberto Valentino , Palmisano Martino , Tapfer Leander
Published: September 2020

Pd+ ions (90 keV) were implanted at normal incidence and at room temperature in different highly insulating (>200 GΩ) thermoplastic polymers (poly(methyl methacrylate), polypropylene, polyethylene terephthalate glycol-modified, and polycarbonate). At high fluence and optimized process parameters, the ion implantation gives rise to the formation of a nanocomposite thin surface layer constituted by Pd nanoclusters and carbonaceous material (nanographite/amorphous carbon). The morphological, microstructural, and microanalytical properties of the nanocomposite layers were investigated by He-ion microscopy, glancing incidence X-ray diffraction, and Raman scattering, respectively. The electrical properties were characterized by resistance, van der Pauw, and Hall measurements. We performed accurate simultaneous deformation/bending experiments and electrical resistance measurements. We show that the electrical resistance varies linearly with the mechanical deformation (beam deflection) applied. The experimental results are interpreted by “hopping conductivity” model considering the nanostructure configuration of the nanocomposite layers. A gauge factor in the range between 4 and 8, depending on the ion-implanted polymer, was obtained for prototype strain gauge devices.
A Consciously Applied, Design-Driven Dialogue Can Improve Healing Architecture
Authors: Lundin Stefan
Published: September 2020

Objectives:

This article states that a consciously applied, design-driven dialogue can improve healing architecture. There are different forms of knowledge, beyond evidence, which are partly hidden from our consciousness. We call this type of knowledge tacit. By using a design-driven dialogue, where staff and management participate in the design process, this tacit knowledge may transform into a more conscious and explicit one, a kind of knowledge that will inform the architect’s work in a richer way and thereby increase the possibilities for improving healthcare architecture.

Background:

Among proponents of evidence-based design (EBD), there has been an aspiration toward rigor to avoid arbitrary decision making. The concept of evidence has been put forward as a way to achieve this. Some of the advocates of EBD have looked upon subjective and aesthetic decisions with great skepticism. However, today, there is a growing number of architects who have lately become critical of that attitude in design. They search for alternative ways to understand the use of different kinds of knowledge in order to promote better architecture. This article aims to overcome some contradictions between different ways of looking at the design process.

Methods:

This discussion article is based on personal introspection and literature studies. The personal experiences referred to stem from three major design projects for general and forensic psychiatric care facilities.

Results:

This article presents a tentative design theory on how a design-driven dialogue process can be formed in order to achieve better outcomes in healthcare architecture.

Conclusions:

How the design-process is driven has a vital influence for the physical environment and its impact on treatment outcomes.
Opioid Prescribing Trends and Geographic Variation After Anterior Cruciate Ligament Reconstruction
Authors: Marrache Majd , Best Matthew J. , Raad Micheal , Mikula Jacob D. , Amin Raj M. , Wilckens John H.
Published: September 2020

Introduction:

Opioid prescribing patterns play an important role in the opioid epidemic in the United States. The purpose of this study is to examine the trends and geographic variation in opioid prescribing patterns after anterior cruciate ligament (ACL) reconstruction.

Hypothesis:

Regional differences in opioid prescribing patterns after ACL reconstruction are present.

Study Design:

Descriptive epidemiology study.

Level of Evidence:

Level 4.

Methods:

The Truven Health MarketScan Commercial Claims database was used to analyze all patients with perioperative private insurance coverage who underwent ACL reconstruction from January 1, 2010, to November 31, 2017. Total number and morphine milligram equivalents per day (MMED) of opioid prescriptions were examined, and regional and statewide variation was assessed.

Results:

A total of 90,068 ACL reconstruction patients who underwent surgery between 2010 and 2017 were included in the study. Overall, 67% received an opioid prescription within 30 days of surgery and 17% received an opioid prescription ≥90 MMED. The West (20%) had the highest proportion of patients with an opioid prescription ≥90 MMED and the Northeast had the lowest (12%), P < 0.001. The number of opioid prescriptions as well as proportion of opioid prescriptions ≥90 MMED varied significantly by state, P < 0.001. There was a significant increase in number of opioid prescriptions from 2010 to 2017 (62% in 2010 and 83% in 2017; P < 0.001). A significant change in the proportion of patients being prescribed ≥90 MMED was also present ( P = 0.04; 15% in 2010, 17% in 2011, 17% 2012, 17% in 2013, 15% in 2014, 20% in 2015, 18% in 2016, and 15% in 2017).

Conclusion:

This study shows a trend of increasing opioid prescriptions and geographic variations in the amount and MMED of opioid prescriptions for patients undergoing ACL reconstruction. These data highlight several areas of improvement that state officials and national entities can use to help curb the opioid epidemic and underscore the importance of national guidelines for opioid prescribing.

Clinical Relevance:

Knowledge of prescribing patterns after specific procedures may help provide more direct insight and guidance to surgeons and patients regarding postoperative pain management.
Decreased Observance of Stroke in the Population Associated With COVID-19 Related Distancing Measures
Authors: Knox Daniel B. , Lanspa Michael J. , Brown Samuel M. , Peltan Ithan D. , Donohue Megan M. , Puttgen Adrian
Published: September 2020

Stroke is a catastrophic medical disease with roughly 795,000 cases per year in the US. We strove to explore whether stroke admissions to a comprehensive stroke center in an area with moderately-low COVID-19 burden changed and if so, to better define the characteristics of the patients and their presentation. We performed a retrospective analysis of all patients with strokes admitted to Intermountain Medical Center. There was a 43% reduction in patients’ presentations across all stroke types compared to average April patient volume over the prior 3 years. Likely this was due to a myriad of complex factors which we may retrospectively be able to more fully understand in the years to come.
Increasing influenza vaccination rates in solid organ transplant recipients in an outpatient transplant centre
Authors: Yeo Yan Ting , Song Jielin , Ng Eleanor Gek Theng , Lee Nuraini Lee Binte Ismail , Kee Terence Yi Shern , Tan Chee Kiat , Fan Petrina Yuen Wai , Lee Puay Hoon
Published: September 2020

Although influenza can lead to significant morbidity and mortality in solid organ transplant recipients, its vaccination rate among solid organ transplant recipients remains low. This study evaluates influenza vaccination among solid organ transplant recipients and compares rates before and after introducing a one-stop influenza vaccination service. In a prospective study on influenza vaccination among solid organ transplant recipients followed up from December 2014 to February 2015, 308 solid organ transplant recipients were surveyed, of which 25.0% received their annual influenza vaccination previously. Of those who have not, 60.6% were vaccinated after the education. We found most solid organ transplant recipients to be unaware of the importance of annual influenza vaccination (66.7%). Recipients with a shorter number of years post-transplant (odds ratio (OR) 0.95, 95% confidence interval (CI) 0.91–0.99) and a history of diabetes (OR 0.48, 95% CI 0.23–0.94) were more likely to receive vaccination. The incidence of influenza infection post-implementation was lower (4.9%, 2.6%; P=0.668). Solid organ transplant recipients who had had been vaccinated were associated with a lower incidence of influenza (OR 0.19, 95% CI 0.04–0.99). We conclude that the implementation of the one-stop influenza vaccination service had increased the vaccination uptake rate among solid organ transplant recipients by addressing the barriers and increasing accessibility.
Cutaneous polyarteritis nodosa and concurrent pseudoxanthoma elasticum–like phenotype: A case report
Authors: Mititelu Roxana , Cheung Larry W , Sasseville Denis
Published: September 2020

We report a unique case of a patient presenting with histologically confirmed pseudoxanthoma elasticum–like phenotype and cutaneous polyarteritis nodosa. Cardiac, gastroenterological, and ophthalmologic evaluations were within normal limits. Genetic evaluation was pertinent for absent ABCC6, ENPP1, and GGCX mutations and a normal array comparative genomic hybridization. Extensive workup revealed skin-limited cutaneous polyarteritis nodosa, and further genetic testing for ADA2 deficiency was negative. The cutaneous polyarteritis nodosa lesions had an excellent response to hydroxychloroquine and methotrexate. Pseudoxanthoma elasticum and polyarteritis nodosa are relatively uncommon, and our patient is among the first reported cases presenting with both pseudoxanthoma elasticum–like and polyarteritis nodosa. Furthermore, this case emphasizes the importance of a thorough cutaneous exam, as the patient had the lesions consistent with pseudoxanthoma elasticum–like since childhood and had previously gone undiagnosed.
Do Republican and Democratic legislators have polarized views of their district’s demographics?
Authors: Butler Daniel M. , Dynes Adam M.
Published: September 2020

Do Republican and Democratic politicians hold the same perceptions about the demographic composition of their district? We test this question by asking state legislators about the size of five key demographic groups in their district and compare their responses to the actual measures. We find that legislators hold misperceptions about some of their district demographics, but not those related to race and ethnicity. Significantly, legislators’ perceptions of their district’s demographics are not polarized along party lines. Misperceptions exist but these are not explained by party affiliation. On a positive note, these results suggest there can be a basis for common ground among politicians on factual matters.
Health App Review Tool: Matching mobile apps to Alzheimer’s populations (HART Match)
Authors: Faieta Julie , Hand Brittany N , Schmeler Mark , Onate James , Digiovine Carmen
Published: September 2020

Aim: This brief report provides an overview of the development and structure of the Health App Review Tool.

Methods: The Health App Review Tool has been designed to assess smart phone health apps according to their compatibility to individuals within the Alzheimer’s disease community. Specifically, app features and functions are characterized according to their appropriateness to the needs, abilities, and preferences of potential users. The Health App Review Tool is comprised of two components, the App and User Assessment; each component includes four complementary domains. Items in these domains can be compared between App and User assessments using a scoring key that will produce a match score. The score indicates the level of appropriateness in reference to the app’s ability to meet the user’s needs.

Discussion: The Health App Review Tool was designed using available evidence and stakeholder preference data to ensure a user-centered design. The result was the development of a tool built on evidence and informed by the perceptions and preferences of those within and working with the Alzheimer’s disease population. App and User domains include usefulness, complexity, accessibility, and external variables. This unique matching approach is anticipated to significantly impact individualized, client-centered care. We anticipate that this study will serve as a model for future development of technology matching tools for other diagnostic populations.

Discussion: The Health App Review Tool was designed using available evidence and stakeholder preference data to ensure a user-centered design. The result was the development of a tool built on evidence and informed by the perceptions and preferences of those within and working with the Alzheimer’s disease population. App and User domains include usefulness, complexity, accessibility, and external variables. This unique matching approach is anticipated to significantly impact individualized, client-centered care. We anticipate that this study will serve as a model for future development of technology matching tools for other diagnostic populations.
Myrcene exerts anti-asthmatic activity in neonatal rats via modulating the matrix remodeling
Authors: Du Yanhui , Luan Jie , Jiang Ren Peng , Liu Juan , Ma Yan
Published: September 2020

Myrcene (MC), an organic hydrocarbon, was found to exert anti-inflammatory, analgesic, antimutagenic and antioxidant properties. However, the protective role of MC has not been reported against neonatal asthma. Wistar rats induced with asthma were administered with MC; while asthma control and vehicle control were maintained without MC administration. At the end of the experimental period, lung histology, inflammatory cell counts, cytokine analysis, matrix protein expressions were elucidated. Rats administered with MC exerted significant ( P < 0.05) defense in protecting the lung tissue with the evidenced restoration of alveolar thickening of the lung tissues. Also, the present study elicited the anti-asthmatic activity of MC, especially via modulating the extracellular matrix protein expression in the asthma-induced animals, while a significant reduction ( P < 0.05) in the fibrotic markers were found in MC treated animals. Moreover, the protective effect of MC was evidenced with reduced leukocyte infiltration in BALF, hypersensitive specific IgE levels with a profound decrease in the inflammatory cytokines such as IL-2, IL-4, IL-18, and IL-21 in MC administered animals compared to the asthma-induced group. To an extent, the markers of asthmatic inflammation such as CD14, MCP-1, and TARC were also found to be attenuated in MC exposed animals. The possible application of MC is a promising drug for the treatment of asthma-mediated complications.
Where Are You? Young Adults With Autism Calling and Texting Location Following Video Modeling Instruction
Authors: Horn Annemarie L. , Layden Selena J. , Bobzien Jonna
Published: September 2020

The purpose of this study was to evaluate the effects of using video modeling (VM) to teach three young adults with autism spectrum disorder (ASD) and intellectual disability (ID) to independently communicate their physical location via text and phone call. We used a multiple-probe research design across behaviors to evaluate the effects of the intervention. Data indicated most participants required noncontrolling prompts in addition to the VM to acquire and perform the task analysis (TA) steps with accuracy. Yet once participants reached criterion, they independently performed the multistep skills and the newly learned behaviors were generalized and maintained 6 weeks posttreatment. These results extend the potential utility of VM instruction. Implications for research and practical application are discussed.
The Job Coaching Academy for Transition Educators: A Preliminary Evaluation
Authors: Gilson Carly B. , Thompson Christopher G. , Ingles Kristina E. , Stein Kaitlyn E. , Wang Naike , Nygaard Malena A.
Published: September 2020

There is a growing urgency to equip transition-age students with intellectual and developmental disabilities for competitive, integrated employment. Prior research demonstrates the positive effects of job coaching, yet no known training exists for educators to learn how to provide appropriate employment-related supports to promote student independence and social integration. We conducted a stratified quasi-experimental design to evaluate the efficacy and social validity of a professional development pilot program for 46 transition educators across three school districts. Our findings indicate the Job Coaching Academy contributed to increased feelings of self-efficacy related to job coaching and modest growth in educators’ coaching behaviors. We share implications for practice and research in expanding targeted training opportunities for transition educators.
Protocol and Feasibility-Randomized Trial of Telehealth Delivery for a Multicomponent Upper Extremity Intervention in Infants With Asymmetric Cerebral Palsy
Authors: Pietruszewski Lindsay , Burkhardt Stephanie , Yoder Paul J. , Heathcock Jill , Lewandowski Dennis J. , Maitre Nathalie L.
Published: September 2020

Background:

Past work showed that an in-person, therapist-guided, parent-implemented multicomponent intervention increased the motor functioning of the more affected upper extremity (UE) in infants with asymmetric cerebral palsy. The authors document treatment fidelity and provide initial testing of telehealth intervention delivery in a new subject sample.

Methods:

The authors adapted the intervention manual used in the previous trial for telehealth. Infants (6-24 months) were randomly assigned to intervention (n = 7) or waitlist (n = 6). The intervention prescribed soft-constraint wear on the less affected UE for 6 hours, 5 d/wk, and exercises. After an initial in-person training session, three 15- to 45-minute telehealth sessions were performed.

Results:

Median weekly constraint wear was 21 hours (interquartile range = 10.3-29.7); average parent-treatment fidelity was 95.7% (SD 11.2). A significant large (Cohen d = 0.92) between-group differences occurred on fine motor functioning of more affected UEs.

Conclusion:

The telehealth intervention was feasible and potentially effective, but a larger trial is needed to evaluate efficacy.
A suite of ground motion prediction equations for cumulative absolute velocity in shallow crustal earthquakes including epistemic uncertainty
Authors: Bullock Zach , Liel Abbie B , Dashti Shideh , Porter Keith A.
Published: September 2020

Recent research has highlighted the usefulness of cumulative absolute velocity [Formula: see text] in several contexts, including using the [Formula: see text] at the ground surface for earthquake early warning and using the [Formula: see text] at rock reference conditions for evaluation of the liquefaction risk facing structures. However, there are relatively few ground motion prediction equations for CAV, they are based on relatively small data sets, and they give relatively similar results. This study develops nine ground motion prediction equations for [Formula: see text] based on a global database of ground motion records from shallow crustal earthquakes. Its provision of nine models enables characterization of epistemic uncertainty for ranges of earthquake characteristics that are sparsely populated in the regression database. The functional forms provide different perspectives on extrapolation to important ranges of earthquake characteristics, particularly large magnitude events and short distances. The variability and epistemic uncertainty in the models are characterized. Spatial autocorrelation of the models’ errors is investigated. The models’ predictions agree with existing broadly applicable models at small to moderate magnitudes and moderate to long distances. These models can be used to improve hazard analysis of [Formula: see text] that incorporates the influence of epistemic uncertainty.
piRNA-30473 contributes to tumorigenesis and poor prognosis by regulating m6A RNA methylation in DLBCL
Authors: Han Huiying , Fan Gao , Song Sha , Jiang Yunxin , Qian Chen'ao , Zhang Weimin , Su Qi , Xue Xiaofeng , Zhuang Wenzhuo , Li Bingzong
Published: September 2020

The initiation and progression of diffuse large B-cell lymphoma (DLBCL) is governed by genetic and epigenetic aberrations. As the most abundant eukaryotic messenger RNA (mRNA) modification, N6-methyladenosine (m6A) is known to influence various fundamental bioprocesses by regulating the target gene; however, the function of m6A modifications in DLBCL is unclear. PIWI-interacting RNAs (piRNAs) have been indicated to be epigenetic effectors in cancer. Here, we show that high expression of piRNA-30473 supports the aggressive phenotype of DLBCL, and piRNA-30473 depletion decreases proliferation and induces cell cycle arrest in DLBCL cells. In xenograft DLBCL models, piRNA-30473 inhibition reduces tumor growth. Moreover, piRNA-30473 is significantly associated with overall survival in a univariate analysis and is statistically significant after adjusting for the National Comprehensive Cancer Network-International Prognostic Index in the multivariate analysis. Additional studies demonstrate that piRNA-30473 exerts its oncogenic role through a mechanism involving the upregulation of WTAP, an m6A mRNA methylase, and thus enhances the global m6A level. Integrating transcriptome and m6A-sequencing analyses reveals that WTAP increases the expression of its critical target gene, hexokinase 2 (HK2), by enhancing the HK2 m6A level, thereby promoting the progression of DLBCL. Together, the piRNA-30473/WTAP/HK2 axis contributes to tumorigenesis by regulating m6A RNA methylation in DLBCL. Furthermore, by comprehensively analyzing our clinical data and data sets, we discover that the m6A regulatory genes piRNA-30473 and WTAP improve survival prediction in DLBCL patients. Our study highlights the functional importance of the m6A modification in DLBCL and might assist in the development of a prognostic stratification and therapeutic approach for DLBCL.
Factors associated with outcomes after a second CD19-targeted CAR T-cell infusion for refractory B-cell malignancies
Authors: Gauthier Jordan , Bezerra Evandro D. , Hirayama Alexandre V. , Fiorenza Salvatore , Sheih Alyssa , Chou Cassie K. , Kimble Erik L. , Pender Barbara S. , Hawkins Reed M. , Vakil Aesha , Phi Tinh-Doan , Steinmetz Rachel N. , Jamieson Abby W. , Bar Merav , Cassaday Ryan D. , Chapuis Aude G. , Cowan Andrew J. , Green Damian J. , Kiem Hans-Peter , Milano Filippo , Shadman Mazyar , Till Brian G. , Riddell Stanley R. , Maloney David G. , Turtle Cameron J.
Published: September 2020

CD19-targeted chimeric antigen receptor-engineered (CD19 CAR) T-cell therapy has shown significant efficacy for relapsed or refractory (R/R) B-cell malignancies. Yet, CD19 CAR T cells fail to induce durable responses in most patients. Second infusions of CD19 CAR T cells (CART2) have been considered as a possible approach to improve outcomes. We analyzed data from 44 patients with R/R B-cell malignancies (acute lymphoblastic leukemia [ALL], n = 14; chronic lymphocytic leukemia [CLL], n = 9; non-Hodgkin lymphoma [NHL], n = 21) who received CART2 on a phase 1/2 trial (NCT01865617) at our institution. Despite a CART2 dose increase in 82% of patients, we observed a low incidence of severe toxicity after CART2 (grade ≥3 cytokine release syndrome, 9%; grade ≥3 neurotoxicity, 11%). After CART2, complete response (CR) was achieved in 22% of CLL, 19% of NHL, and 21% of ALL patients. The median durations of response after CART2 in CLL, NHL, and ALL patients were 33, 6, and 4 months, respectively. Addition of fludarabine to cyclophosphamide-based lymphodepletion before the first CAR T-cell infusion (CART1) and an increase in the CART2 dose compared with CART1 were independently associated with higher overall response rates and longer progression-free survival after CART2. We observed durable CAR T-cell persistence after CART2 in patients who received cyclophosphamide and fludarabine (Cy-Flu) lymphodepletion before CART1 and a higher CART2 compared with CART1 cell dose. The identification of 2 modifiable pretreatment factors independently associated with better outcomes after CART2 suggests strategies to improve in vivo CAR T-cell kinetics and responses after repeat CAR T-cell infusions, and has implications for the design of trials of novel CAR T-cell products after failure of prior CAR T-cell immunotherapies.
Why physical activity matters for older adults in a time of pandemic
Authors: Cunningham Conor , O’ Sullivan Roger
Published: September 2020

Background

The COVID-19 pandemic has impacted communities across the world. Government responses, of promoting ‘social distancing’ at a population level, and ‘self-isolation’ of older adults to mitigate its spread have been unprecedented. Despite the importance of these Public Health and Social Measures (PHSM), they present challenges to maintaining a physically active lifestyle, particularly for older adults.

Context

The importance of physical activity (PA) for health is well documented. There is strong evidence that PA in later life reduces the risk of disease, helps to manage existing conditions, and develops and maintains physical and mental function. Staying physically active is particularly important for older adults currently.

Implications and recommendations

Research suggests that PHSM have already reduced levels of PA for older adults during the COVID-19 pandemic. Prior to COVID-19 many older adults were not engaging in enough PA to attain health benefits. Evidence indicates that there will be an increase in the number of older adults not meeting guidelines for PA due to the impacts of COVID-19. This has implications for population health and public health policy. How to support older adults to remain physically active during and after the COVID-19 crisis will require careful consideration. Going forward it is imperative that policy and practice support all older adults to achieve the recommended levels of PA to ensure that they are not disadvantaged in the short- but also in the longer term by the impact of COVID-19.
Food intake biomarkers for berries and grapes
Authors: Ulaszewska M. , Garcia-Aloy M. , Vázquez-Manjarrez N. , Soria-Florido M. T. , Llorach R. , Mattivi F. , Manach C.
Published: September 2020

Grapes and berries are two types of widely consumed fruits characterized by a high content in different phytochemicals. However, their accurate dietary assessment is particularly arduous, because of the already wide recognized bias associated with self-reporting methods, combined with the large range of species and cultivars and the fact that these fruits are popularly consumed not only in fresh and frozen forms but also as processed and derived products, including dried and canned fruits, beverages, jams, and jellies. Reporting precise type and/or quantity of grape and berries in FFQ or diaries can obviously be affected by errors. Recently, biomarkers of food intake (BFIs) rose as a promising tool to provide accurate information indicating consumption of certain food items. Protocols for performing systematic reviews in this field, as well as for assessing the validity of candidate BFIs have been developed within the Food Biomarker Alliance (FoodBAll) Project. This paper aims to evaluate the putative BIFs for blueberries, strawberries, raspberries, blackberries, cranberries, blackcurrant, and grapes. Candidate BFIs for grapes were resveratrol metabolites and tartaric acid. The metabolites considered as putative BFI for berries consumption were mostly anthocyanins derivatives together with several metabolites of ellagitannins and some aroma compounds. However, identification of BFIs for single berry types encountered more difficulties. In the absence of highly specific metabolites reported to date, we suggested some multi-metabolite panels that may be further investigated as putative biomarkers for some berry fruits.
Metabolic and transcriptome responses of RNAi-mediated AMPKα knockdown in Tribolium castaneum
Authors: Jiang Heng , Zhang Nan , Ji Caihong , Meng Xiangkun , Qian Kun , Zheng Yang , Wang Jianjun
Published: September 2020

Background

The AMP-activated protein kinase (AMPK) is an intracellular fuel sensor for lipid and glucose metabolism. In addition to the short-term regulation of metabolic enzymes by phosphorylation, AMPK may also exert long-term effects on the transcription of downstream genes through the regulation of transcription factors and coactivators. In this study, RNA interference (RNAi) was conducted to investigate the effects of knockdown of TcAMPKα on lipid and carbohydrate metabolism in the red flour beetle, Tribolium castaneum, and the transcriptome profiles of dsTcAMPKα-injected and dsEGFP-injected beetles under normal conditions were compared by RNA-sequencing.

Results

RNAi-mediated suppression of TcAMPKα increased whole-body triglyceride (TG) level and the ratio between glucose and trehalose, as was confirmed by in vivo treatment with the AMPK-activating compound, 5-Aminoimidazole-4-carboxamide1-β-D-ribofuranoside (AICAR). A total of 1184 differentially expressed genes (DEGs) were identified between dsTcAMPKα-injected and dsEGFP-injected beetles. These include genes involved in lipid and carbohydrate metabolism as well as insulin/insulin-like growth factor signaling (IIS). Real-time quantitative polymerase chain reaction analysis confirmed the differential expression of selected genes. Interestingly, metabolism-related transcription factors such as sterol regulatory element-binding protein 1 (SREBP1) and carbohydrate response element-binding protein (ChREBP) were also significantly upregulated in dsTcAMPKα-injected beetles.

Conclusions

AMPK plays a critical role in the regulation of beetle metabolism. The findings of DEGs involved in lipid and carbohydrate metabolism provide valuable insight into the role of AMPK signaling in the transcriptional regulation of insect metabolism.
Mortality in severely injured patients: nearly one of five non-survivors have been already discharged alive from ICU
Authors: Hamsen Uwe , Drotleff Niklas , Lefering Rolf , Gerstmeyer Julius , Schildhauer Thomas Armin , Waydhas Christian ,   TraumaRegister DGU 
Published: September 2020

Background

Most trauma patients admitted to the hospital alive and die later on, decease during the initial care in the emergency department or the intensive care unit (ICU). However, a number of patients pass away after having been discharged from the ICU during the initial hospital stay. On first sight these cases could be seen as “failure to rescue” of potentially salvageable patients. A low rate of such patients might be a potential indicator of quality for trauma care on ICUs and surgical wards.

Methods

Retrospective analysis of the TraumaRegister DGU® with data from 2015 to 2017. Patients that died during the initial ICU stay were compared to those who were discharged from the initial ICU stay for at least 24 h but died later on.

Results

A total of 82,313 trauma patients were included in the TraumaRegister DGU®. In total, 6576 patients (8.0%) died during their hospital stay. Out of those, 5481 were admitted to the ICU alive and 972 patients (17.7%) were discharged from ICU and died later on. Those were older (mean age: 77 vs. 68 years), less severely injured (mean ISS: 23.1 vs. 30.0 points) and had a longer mean ICU length of stay (10 vs. 6 days). A limitation of life-sustaining therapy due to a documented living will was present in 46.1% of all patients who died during their initial ICU stay and in 59.9% of patients who died after discharge from their initial ICU stay.

Conclusions

17.7% of all non-surviving severely injured trauma patients died within the hospital after discharge from their initial ICU treatment. Their death can partially be explained by a limitation of therapy due to a living will. In conclusion, the rate of such late deaths may partially represent patients that died of potentially avoidable or treatable complications.
Assessing risk of bias: a proposal for a unified framework for observational studies and randomized trials
Authors: Luijendijk Hendrika J. , Page Matthew J. , Burger Huibert , Koolman Xander
Published: September 2020

Background

Evidence based medicine aims to integrate scientific evidence, clinical experience, and patient values and preferences. Individual health care professionals need to appraise the evidence from randomized trials and observational studies when guidelines are not yet available. To date, tools for assessment of bias and terminologies for bias are specific for each study design. Moreover, most tools appeal only to methodological knowledge to detect bias, not to subject matter knowledge, i.e. in-depth medical knowledge about a topic. We propose a unified framework that enables the coherent assessment of bias across designs.

Methods

Epidemiologists traditionally distinguish between three types of bias in observational studies: confounding, information bias, and selection bias. These biases result from a common cause, systematic error in the measurement or common effect of the intervention and outcome respectively. We applied this conceptual framework to randomized trials and show how it can be used to identify bias. The three sources of bias were illustrated with graphs that visually represent researchers’ assumptions about the relationships between the investigated variables (causal diagrams).

Results

Critical appraisal of evidence started with the definition of the research question in terms of the population of interest, the compared interventions and the main outcome. Next, we used causal diagrams to illustrate how each source of bias can lead to over- or underestimated treatment effects. Then, we discussed how randomization, blinded outcome measurement and intention-to-treat analysis minimize bias in trials. Finally, we identified study aspects that can only be appraised with subject matter knowledge, irrespective of study design.

Conclusions

The unified framework encompassed the three main sources of bias for the effect of an assigned intervention on an outcome. It facilitated the integration of methodological and subject matter knowledge in the assessment of bias. We hope that graphical diagrams will help clarify debate among professionals by reducing misunderstandings based on different terminology for bias.
Advance care planning with people with dementia: a process evaluation of an educational intervention for general practitioners
Authors: Tilburgs Bram , Koopmans Raymond , Schers Henk , Smits Carolien , Vernooij-Dassen Myrra , Perry Marieke , Engels Yvonne
Published: September 2020

Background

General practitioners (GPs) are advised to offer advance care planning (ACP) to people with dementia (PWD). In a randomized controlled trial, an educational intervention for GPs aimed at initiating and optimizing ACP proved to be effective. During the intervention most GPs were accompanied by their practice nurse (PN). To provide insights into the intervention’s successful components and what could be improved, we conducted a process evaluation and explored implementation, mechanisms of impact and contextual factors.

Methods

We used the Medical Research Council guidance for process evaluations. Implementation was explored identifying reach and acceptability. We performed descriptive analyses of participants’ characteristics; selection, inclusion and intervention attendance; a GP post-intervention survey on initiating ACP; a post intervention focus group with trainers of the intervention.

Mechanisms of impact were explored identifying adoption and appropriateness. We used: participants’ intervention ratings; a GP post-intervention survey on conducting ACP; ACP documentation in PWD’s medical files; post-intervention interviews with PWD/FC dyads. All data was used to identify contextual factors.

Results

The intervention was implemented by a small percentage of the total Dutch GP population invited, who mostly included motivated PWD/FC dyads with relatively little burden, and PWD with limited cognitive decline. The mechanisms of impact for GPs were: interactively learning to initiate ACP with training actors with a heterogeneous group of GPs and PNs. For PWD/FCs dyads, discussing non-medical preferences was most essential regarding their SDM experience and QoL. Some dyads however found ACP stressful and not feasible. Younger female GPs more often initiated ACP. Male PWD and those with mild dementia more often had had ACP. These characteristics and the safe and intimate training setting, were important contextual facilitators.

Conclusion

We recommend Interventions aimed at improving ACP initiation with PWD by GPs to include interactive components and discussion of non-medical preferences. A safe environment and a heterogeneous group of participants facilitates such interventions. However, in practice not all FC/PWD dyads will be ready to start. Therefore, it is necessary to check their willingness when ACP is offered.
Reducing caesarean section rate in an urban hospital serving women attending privately in India – a quality improvement initiative
Authors: Bhartia Abhishek , Sen Gupta Dhar Rinku , Bhartia Saru
Published: September 2020

Background

In line with global trends, India has witnessed a sharp rise in caesarean section (CS) deliveries, especially in the private sector. Despite the urgent need for change, there are few published examples of private hospitals that have successfully lowered their CS rates. Our hospital, serving private patients too, had a CS rate of 79% in 2001. Care was provided by fee-for-service visiting consultant obstetricians without uniform clinical protocols and little clinical governance. Consultants attributed high CS rate to case-mix and maternal demand and showed little inclination for change. We attempted to reduce this rate with the objective of improving the quality of our care and demonstrating that CS could be safely lowered in the private urban Indian healthcare setting.

Methods

We hired full-time salaried consultants and began regular audit of CS cases. When this proved inadequate, we joined an improvement collaborative in 2011 and dedicated resources for quality improvement. We adopted practice guidelines, monitored outcomes by consultant, improved labour ward support, strengthened antenatal preparation, and moved to group practice among consultants.

Results

Guidelines ensured admissions in active labour and reduced CS (2011 to 2016) for foetal heart rate abnormalities (23 to 5%; p < 0.001) and delayed progress (19 to 6%; p < 0.001) in low-risk first-birth women. Antenatal preparation increased trial of labour, even among women with prior CS (28 to 79%; p < 0.001). Group practice reduced time pressure and stress, with a decline in CS (52 to 18%; p < 0.001) and low-risk first-birth CS (48 to 12%; p < 0.001). Similar CS rates were maintained in 2017 and 2018. Measures of perinatal harm including post-partum haemorrhage, 3rd-4th degree tears, shoulder dystocia, and Apgar < 7 at 5 min were within acceptable ranges (13, 3, 2% and 3 per thousand respectively in 2016–18,).

Conclusions

It is feasible to substantially reduce CS rate in private healthcare setting of a middle-income country like India. Ideas such as moving to full-time attachment of consultants, joining a collaborative, improving labour ward support, providing resources for data collection, and perseverance could be adopted by other hospitals in their own journey of moving towards a medically justifiable CS rate.
Which is better for mothers and babies: fresh or frozen-thawed blastocyst transfer?
Authors: Yang Meiling , Lin Li , Sha Chunli , Li Taoqiong , Gao Wujiang , Chen Lu , Wu Ying , Ma Yanping , Zhu Xiaolan
Published: September 2020

Background

In recent years, there have been many reports on the pregnancy outcomes of fresh blastocyst transfer (BT) and frozen-thawed BT, but the conclusions are controversial and incomplete. To compare the pregnancy outcomes, maternal complications and neonatal outcomes of fresh and frozen-thawed BT in the context of in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycles, we conducted a meta-analysis.

Methods

A meta-analysis was conducted by searching the PubMed, Embase, and Cochrane Library databases through May 2020. Data were extracted independently by two authors.

Results

Fifty-four studies, including 12 randomized controlled trials (RCTs), met the inclusion criteria. Fresh BT was associated with a lower implantation rate, pregnancy rate, ongoing pregnancy rate, and clinical pregnancy rate and higher ectopic pregnancy rate than frozen-thawed BT according to the results of the RCTs. The risks of moderate or severe ovarian hyperstimulation syndrome, placental abruption, placenta previa and preterm delivery were higher for fresh BT than for frozen-thawed BT. The risk of pregnancy-induced hypertension and pre-eclampsia was lower for fresh BT; however, no significant differences in risks for gestational diabetes mellitus and preterm rupture of membrane were found between the two groups. Compared with frozen-thawed BT, fresh BT appears to be associated with small for gestational age and low birth weight. No differences in the incidences of neonatal mortality or neonatal malformation were observed between fresh and frozen-thawed BT.

Conclusions

At present there is an overall slight preponderance of risks in fresh cycles against frozen, however individualization is required and current knowledge does not permit to address a defintive response.
Surgery improves the prognosis of colon mucinous adenocarcinoma with liver metastases: a SEER-based study
Authors: Huang Jia , Chen Guodong , Liu Huan , Zhang Yiwei , Tang Rong , Huang Qiulin , Fu Kai , Peng Xiuda , Xiao Shuai
Published: September 2020

Background

Mucinous adenocarcinoma (MC) is the second most common pathological type of colon carcinoma (CC). Colon cancer liver metastases (CLMs) are common and lethal, and complete resection of the primary tumour and metastases for CLM patients would be beneficial. However, there is still no consensus on the role of surgery for MC with liver metastases (M-CLM).

Methods

Patients diagnosed with M-CLM or classical adenocarcinoma with CLM (A-CLM) from 2010 to 2013 in the Surveillance, Epidemiology, and End Results (SEER) database were retrieved. The clinicopathological features and overall survival (OS) and cancer-specific survival (CSS) data were compared and analysed.

Results

The results showed that the M-CLM group had a larger tumour size, more right colon localizations, higher pT and pN stages, more female patients, and more retrieved and positive lymph nodes and accounted for a higher proportion of surgeries than the A-CLM group. The OS and CSS of M-CLM patients who underwent any type of surgery were significantly better than those of patients who did not undergo any surgery, but poorer than those of A-CLM patients who underwent surgery. Meanwhile, the OS and CSS of M-CLM and A-CLM patients who did not undergo any surgery were comparable. Compared with hemicolectomy, partial colectomy led to similar or better OS and CSS for M-CLM, and surgery was an independent protective factor for long-term survival in M-CLM.

Conclusions

M-CLM had distinct clinicopathological characteristics from A-CLM, and surgery could improve the survival and is an independent favourable prognostic factor for M-CLM. In addition, partial colectomy might be a non-inferiority choice as hemicolectomy for M-CLM according to the results from this study.