bluuebunny/crossref_metadata_2025 huggingface dataset:
Penicillin Allergy Testing Is Cost-Saving: An Economic Evaluation Study
Authors: Sousa-Pinto Bernardo , Blumenthal Kimberly G , Macy Eric , Pereira Ana Margarida , Azevedo Luís Filipe , Delgado Luís , Fonseca João Almeida
Published: February 2020

Background

Having a penicillin allergy label is associated with the use of less appropriate and more expensive antibiotics and increased healthcare utilization. Penicillin allergy testing results in delabeling most allergy claimants and may be cost-saving. This study aimed to project whether penicillin allergy testing in patients reporting a penicillin allergy is cost-saving.

Methods

In this economic evaluation study, we built decision models to project the economic impact of 2 strategies for a patient with a penicillin allergy label: (1) perform diagnostic testing (drug challenges, with or without skin tests); and (2) do not perform diagnostic testing. The health service perspective was adopted, considering costs with penicillin allergy tests, and with hospital bed-days/outpatient visits, antibiotic use, and diagnostic testing. Twenty-four base case decision models were built, accounting for differences in the diagnostic workup, setting (inpatient vs outpatient) and geographic region. Uncertainty was explored via probabilistic sensitivity analyses.

Results

Penicillin allergy testing was cost-saving in all decision models built. For models assessing the performance of both skin tests and drug challenges, allergy testing resulted in average savings (in United States [US] dollars) of $657 for inpatients (US: $1444; Europe: $489) and $2746 for outpatients (US: $256; Europe: $6045). 75% of simulations obtained through probabilistic sensitivity analysis identified testing as the less costly option.

Conclusions

Penicillin allergy testing was projected to be cost-saving across different scenarios. These results are devised to inform guidelines, supporting the adoption of policies promoting widespread testing of patients with a penicillin allergy label.
Genomic Diversity of Severe Acute Respiratory Syndrome–Coronavirus 2 in Patients With Coronavirus Disease 2019
Authors: Shen Zijie , Xiao Yan , Kang Lu , Ma Wentai , Shi Leisheng , Zhang Li , Zhou Zhuo , Yang Jing , Zhong Jiaxin , Yang Donghong , Guo Li , Zhang Guoliang , Li Hongru , Xu Yu , Chen Mingwei , Gao Zhancheng , Wang Jianwei , Ren Lili , Li Mingkun
Published: February 2020

Background

A novel coronavirus (CoV), severe acute respiratory syndrome (SARS)–CoV-2, has infected >75 000 individuals and spread to >20 countries. It is still unclear how fast the virus evolved and how it interacts with other microorganisms in the lung.

Methods

We have conducted metatranscriptome sequencing for bronchoalveolar lavage fluid samples from 8 patients with SARS–CoV-2, and also analyzed data from 25 patients with community-acquired pneumonia (CAP), and 20 healthy controls for comparison.

Results

The median number of intrahost variants was 1–4 in SARS–CoV-2–infected patients, ranged from 0 to 51 in different samples. The distribution of variants on genes was similar to those observed in the population data. However, very few intrahost variants were observed in the population as polymorphisms, implying either a bottleneck or purifying selection involved in the transmission of the virus, or a consequence of the limited diversity represented in the current polymorphism data. Although current evidence did not support the transmission of intrahost variants in a possible person-to-person spread, the risk should not be overlooked. Microbiotas in SARS–CoV-2–infected patients were similar to those in CAP, either dominated by the pathogens or with elevated levels of oral and upper respiratory commensal bacteria.

Conclusion

SARS–CoV-2 evolves in vivo after infection, which may affect its virulence, infectivity, and transmissibility. Although how the intrahost variant spreads in the population is still elusive, it is necessary to strengthen the surveillance of the viral evolution in the population and associated clinical changes.
Circad: a comprehensive manually curated resource of circular RNA associated with diseases
Authors: Rophina Mercy , Sharma Disha , Poojary Mukta , Scaria Vinod
Published: February 2020

Circular RNAs (circRNAs) are unique transcript isoforms characterized by back splicing of exon ends to form a covalently closed loop or circular conformation. These transcript isoforms are now known to be expressed in a variety of organisms across the kingdoms of life. Recent studies have shown the role of circRNAs in a number of diseases and increasing evidence points to their potential application as biomarkers in these diseases. We have created a comprehensive manually curated database of circular RNAs associated with diseases. This database is available at URL http://clingen.igib.res.in/circad/. The Database lists more than 1300 circRNAs associated with 150 diseases and mapping to 113 International Statistical Classification of Diseases (ICD) codes with evidence of association linked to published literature. The database is unique in many ways. Firstly, it provides ready-to-use primers to work with, in order to use circRNAs as biomarkers or to perform functional studies. It additionally lists the assay and PCR primer details including experimentally validated ones as a ready reference to researchers along with fold change and statistical significance. It also provides standard disease nomenclature as per the ICD codes. To the best of our knowledge, circad is the most comprehensive and updated database of disease associated circular RNAs.

Availability: http://clingen.igib.res.in/circad/
Biodiversity Survey of Flower-Visiting Spiders Based on Literature Review and Field Study
Authors: Su Qichen , Qi Lin , Zhang Wei , Yun Yueli , Zhao Yao , Peng Yu
Published: February 2020

Many arthropods exhibit flower-visiting behavior, including a variety of spider species. However, as spiders are assumed to be strictly predatory, flower-visiting spiders are an often neglected group. We conducted a systematic biodiversity study of flower-visiting spiders based on published papers and field surveys. Most previous studies have focused on the herbivorous behavior of flower-visiting spiders (nectivory or pollinivory) and their effects on host flowers (tritrophic interactions with flower-visiting insects). In our field survey, we utilized standard transect walks (active sampling) and colored pan traps (passive sampling) to investigate species occurrence, diurnal and seasonal variation, and flower color preference of flower-visiting spiders. From the transect walks, crab spider species were found to be the dominant flower-visiting spiders and, based on all spider species, juvenile visitors were significantly more common than adults. Furthermore, in terms of spider number and species richness, tulips were the preferred flower to visit. For the pan traps, wolf spiders were found to be the dominant spider species. No significant differences were observed in the number of spiders caught in different colored pans, suggesting that color may not be an important flower trait in regard to spider preference. To the best of our knowledge, this study is the first to propose the term ‘flower-visiting spiders’ and conduct a systematic investigation of their diversity. However, this is preliminary research and further studies are required, especially as biodiversity is often closely linked to survey sites and ecotopes.
The impact of sectoral shifts on Dutch unmarried women’s labor force participation, 1812–1929
Authors: Boter Corinne , Woltjer Pieter
Published: February 2020

During the nineteenth century, Dutch female labor force participation (FLFP) was relatively low. Most scholars argue that social norms and rising wages were driving this development. However, their conclusions principally apply to married women. We study unmarried women’s LFP (UFLFP) and investigate a third driver: shifting sectoral employment shares. We include all three drivers in a logistic regression based on nearly 2 million marriage records from 1812 to 1929. We conclude that social norms and income levels mattered, but that shifting sectoral employment shares were driving the decline in UFLFP because sectors with low demand for female laborers expanded.
The role of genetics in cardiovascular disease: arrhythmogenic cardiomyopathy
Authors: James Cynthia A , Syrris Petros , van Tintelen J Peter , Calkins Hugh
Published: February 2020

Arrhythmogenic cardiomyopathy (ACM) is a heritable cardiomyopathy characterized by frequent ventricular arrhythmias and progressive ventricular dysfunction. Risk of sudden cardiac death is elevated in ACM patients and can be the presenting symptom particularly in younger individuals and athletes. This review describes current understanding of the genetic architecture of ACM and molecular mechanisms of ACM pathogenesis. We consider an emerging threshold model for ACM inheritance in which multiple factors including pathogenic variants in known ACM genes, genetic modifiers, and environmental exposures, particularly exercise, are required to reach a threshold for disease expression. We also review best practices for integrating genetics—including recent discoveries—in caring for ACM families and emphasize the utility of genotype for both management of affected individuals and predictive testing in family members.
The ‘Digital Twin’ to enable the vision of precision cardiology
Authors: Corral-Acero Jorge , Margara Francesca , Marciniak Maciej , Rodero Cristobal , Loncaric Filip , Feng Yingjing , Gilbert Andrew , Fernandes Joao F , Bukhari Hassaan A , Wajdan Ali , Martinez Manuel Villegas , Santos Mariana Sousa , Shamohammdi Mehrdad , Luo Hongxing , Westphal Philip , Leeson Paul , DiAchille Paolo , Gurev Viatcheslav , Mayr Manuel , Geris Liesbet , Pathmanathan Pras , Morrison Tina , Cornelussen Richard , Prinzen Frits , Delhaas Tammo , Doltra Ada , Sitges Marta , Vigmond Edward J , Zacur Ernesto , Grau Vicente , Rodriguez Blanca , Remme Espen W , Niederer Steven , Mortier Peter , McLeod Kristin , Potse Mark , Pueyo Esther , Bueno-Orovio Alfonso , Lamata Pablo
Published: February 2020

Providing therapies tailored to each patient is the vision of precision medicine, enabled by the increasing ability to capture extensive data about individual patients. In this position paper, we argue that the second enabling pillar towards this vision is the increasing power of computers and algorithms to learn, reason, and build the ‘digital twin’ of a patient. Computational models are boosting the capacity to draw diagnosis and prognosis, and future treatments will be tailored not only to current health status and data, but also to an accurate projection of the pathways to restore health by model predictions. The early steps of the digital twin in the area of cardiovascular medicine are reviewed in this article, together with a discussion of the challenges and opportunities ahead. We emphasize the synergies between mechanistic and statistical models in accelerating cardiovascular research and enabling the vision of precision medicine.
Diagnostic yield in victims of sudden cardiac death and their relatives
Authors: Hansen Benjamin Lautrup , Jacobsen Elisabeth Mütze , Kjerrumgaard Amalie , Tfelt-Hansen Jacob , Winkel Bo Gregers , Bundgaard Henning , Christensen Alex Hørby
Published: February 2020

Aims

International guidelines recommend cardiogenetic screening in families with sudden cardiac death (SCD) if the suspected cause is an inherited cardiac disease. The aim was to assess the diagnostic yield of inherited cardiac diseases in consecutively referred SCD families.

Methods and results

In this single-centre retrospective study, we consecutively included families referred to our tertiary unit between 2005 and 2018 for screening due to SCD. Following evaluation of premortem medical records and postmortem findings for the proband, the families underwent a guideline-based screening protocol. Relatives were followed and cardiovascular events registered. In total, 304 families with 695 relatives were included. In probands, mean age at death was 39 years (75% males) and in relatives mean age at screening was 35 years (47% males). The proband-diagnosis was established through autopsy findings (n = 89), genetic analyses (n = 7), or based on premortem findings (n = 21). In the remaining 187 families with borderline/no diagnosis in the proband, screening of relatives yielded a diagnosis in 26 additional families. In total, an inherited cardiac disease was identified in 143 out of 304 families (47%). In relatives, 73 (11%) were diagnosed. Arrhythmogenic right ventricular cardiomyopathy (n = 16) was the most common diagnosis. During follow-up (mean 5.5 years), a low rate of serious cardiac events was observed (no SCD events).

Conclusion

Forty-seven percent of SCD families were diagnosed. Eleven percent of the screened relatives received a definite diagnosis and were offered treatment according to guidelines. A low rate of serious cardiovascular events was observed among SCD relatives.
Mental health and satisfaction with primary care services in older adults: a study from the patient perspective on four dimensions of care
Authors: Pitrou Isabelle , Berbiche Djamal , Vasiliadis Helen-Maria
Published: February 2020

Background

Few studies have examined the association between mental health and satisfaction with primary care services in community-dwelling older adults.

Objective

To examine the association between mental health in older adults and low satisfaction with primary care services within four dimensions of care.

Methods

This secondary data analysis included 1624 older adults participating in the ‘Étude sur la Santé des Aînés Services’ (ESA-Services study) and recruited in primary care practices between 2011 and 2013 in the province of Quebec. Patient satisfaction and experience with care were assessed during face-to-face interviews with questions adapted from the Primary Care Assessment Survey. Self-reported mental health indicators included depression, anxiety, suicidal ideation, psychological distress and cognition. We conducted four logistic regressions to examine the associations between mental health and low satisfaction in the following dimensions of care: continuity of care, provider–patient interactions, adequacy of care and physical environment.

Results

Nearly half of participants (48.5%) reported low satisfaction in at least one dimension of care examined. High psychological distress was associated with low satisfaction with provider–patient interactions [odds ratio (OR) = 1.02; 95% confidence interval (CI) = 1.00–1.04] and adequacy of care (OR = 1.04; 95% CI = 1.01–1.06). The presence of an anxiety disorder was associated with low satisfaction in adequacy of care (OR = 1.64; 95% CI = 1.00–2.72). Worse cognitive functioning was associated with low satisfaction in continuity of care, provider–patient interaction and adequacy of care.

Conclusions

Mental health was consistently associated with low satisfaction within dimensions of care. Results support the need for increased attention when delivering care to older adults with mental health problems.
Comparison of microbiota, antimicrobial resistance genes and mobile genetic elements in flies and the feces of sympatric animals
Authors: Poudel Anil , Kang Yuan , Mandal Rabindra K , Kalalah Anwar , Butaye Patrick , Hathcock Terri , Kelly Patrick , Walz Paul , Macklin Kenneth , Cattley Russell , Price Stuart , Adekanmbi Folasade , Zhang Lixin , Kitchens Steven , Kaltenboeck Bernhard , Wang Chengming
Published: February 2020

Flies are well-known vectors of bacterial pathogens, but there are little data on their role in spreading microbial community and antimicrobial resistance. In this study, we compared the bacterial community, antimicrobial resistance genes (ARGs) and mobile genetic elements (MGEs) in flies with those in the feces of sympatric animals. A 16S rRNA-based microbial analysis identified 23 bacterial phyla in fecal samples and 25 phyla in flies; all the phyla identified in the fecal samples were also found in the flies. Bray–Curtis dissimilarity analysis showed that the microbiota of the flies were more similar to the microbiota of the feces of their sympatric animals than those of the feces from the three other animal species studied. The qPCR array amplified 276 ARGs/MGEs in fecal samples, and 216 ARGs/MGEs in the flies, while 198 of these genes were identified in both flies and feces. Long-term studies with larger sample numbers from more geospatially distinct populations and infection trials are indicated to further evaluate the possibility of flies as sentinels for antimicrobial resistance.
Exploring University Age-Friendliness Using Collaborative Citizen Science
Authors: Chesser Stephanie A , Porter Michelle M , Barclay Ruth , King Abby C , Menec Verena H , Ripat Jacquie , Sibley Kathryn M , Sylvestre Gina M , Webber Sandra C
Published: February 2020

Background and Objectives

Since the launch of Dublin City University’s Age-Friendly University (AFU) Initiative in 2012, relatively little empirical research has been published on its feasibility or implementation by institutions of higher learning. This article describes how collaborative citizen science—a research method where professional researchers and community members work together across multiple stages of the research process (e.g., data collection, analysis, and/or knowledge mobilization) to investigate an issue—was used to identify barriers and supports to university age-friendliness at the University of Manitoba (UofM) in Canada.

Research Design and Methods

Ten citizen scientists each completed 1 data collection walk around the UofM campus and used a tablet application to document AFU barriers and supports via photographs and accompanying audio commentaries. The citizen scientists and university researchers then worked together in 2 analysis sessions to identify AFU priority areas and brainstorm recommendations for institutional change. These were then presented to a group of interested university stakeholders.

Results

The citizen scientists collected 157 photos documenting AFU barriers and supports on campus. Accessibility, signage, and transportation were identified as being the most pressing issues for the university to address to improve overall age-friendliness.

Discussion and Implications

We suggest that academic institutions looking to complete assessments of their age-friendliness, particularly those exploring physical barriers and supports, could benefit from incorporating older citizen scientists into the process of collecting, analyzing, and mobilizing findings.
Reconstruction of borehole radar images by a modified f–k migration
Authors: Huo Jianjian , Zhou Binzhong , Zhao Qing , Mason Iain M
Published: February 2020

Borehole radar (BHR) is an effective imaging tool. It can be used to detect and map faults, fractures, folds, domes, partings and mine workings. Most BHRs have azimuthally omnidirectional radiation patterns. The echoes sensed by such BHRs may come from any direction. Considering a radar in a straight borehole that passes through a stack of flat reflection planes, V-shaped events or crosses appear on the time section. One of the arms of each cross is a real image while the other is an ambiguity of known origin. Directional ambiguities such as these obstruct efforts to interpret the data. In this paper, we address this difficulty by using a modified f–k migration algorithm to translate crosses into lines on the final section that are consistent with a priori information about for example bedding. Compared with conventional strategies, for example migration + f–k dip filter, this approach integrates the two separated processes into one and is straightforward, computationally effective and simple to implement. The method is demonstrated using a synthetic model and a real BHR field data set. It allows the interpreter to use a priori information about fault swarms or plausible bedding planes at an early stage. The reconstructed BHR image helps the search for geological anomalies such as fractures, partings, domes and rolls that could be a hazard for mining.
Preferences of healthcare providers for capitation payment in Kenya: a discrete choice experiment
Authors: Obadha Melvin , Chuma Jane , Kazungu Jacob , Abiiro Gilbert Abotisem , Beck Matthew J , Barasa Edwine
Published: February 2020

Provider payment mechanisms (PPMs) are important to the universal health coverage (UHC) agenda as they can influence healthcare provider behaviour and create incentives for health service delivery, quality and efficiency. Therefore, when designing PPMs, it is important to consider providers’ preferences for PPM characteristics. We set out to uncover senior health facility managers’ preferences for the attributes of a capitation payment mechanism in Kenya. We use a discrete choice experiment and focus on four capitation attributes, namely, payment schedule, timeliness of payments, capitation rate per individual per year and services to be paid by the capitation rate. Using a Bayesian efficient experimental design, choice data were collected from 233 senior health facility managers across 98 health facilities in seven Kenyan counties. Panel mixed multinomial logit and latent class models were used in the analysis. We found that capitation arrangements with frequent payment schedules, timelier disbursements, higher payment rates per individual per year and those that paid for a limited set of health services were preferred. The capitation rate per individual per year was the most important attribute. Respondents were willing to accept an increase in the capitation rate to compensate for bundling a broader set of health services under the capitation payment. In addition, we found preference heterogeneity across respondents and latent classes. In conclusion, these attributes can be used as potential targets for interventions aimed at configuring capitation to achieve UHC.
Acceptability and feasibility of a café-based sustainable food intervention in the UK
Authors: Graham Fiona , Barker Margo , Menon Manoj , Holdsworth Michelle
Published: February 2020

Dietary change is needed to improve health and reduce the environmental burden of food production and consumption. Using an Intervention Mapping approach, this study aimed to explore the views caterers and customers held towards point-of-choice interventions that promote healthy and environmentally friendly (EF) food and beverage choices at the University of Sheffield. Intervention options proposed during focus groups were devised using the Nuffield Bioethics ladder of intervention. Ten focus groups were held involving caterers (n = 16) and customers (n = 45). Thematic analysis was conducted on the transcripts of caterer and customer focus groups seperately, and then comparisons were made to identify concerns about the acceptability and feasibility of intervention options. Attitudes towards intervention options varied considerably amongst stakeholders, with the greatest disparity of opinion in the acceptability of interventions that restrict or limit personal choice, particularly with regards to meat consumption. Information provision was favoured as an acceptable intervention by both customers and caterers. However, labelling products in terms of their environmental impact was considered practically unfeasible. Social norms around eating also emerged as influencing the acceptability and feasibility of interventions with concerns raised about: shaming customers who chose meat, the exclusivity of vegan choices and the limited availability and appeal of meatless café options. Financial considerations were the main priority of caterers when discussing point-of-choice interventions. An acceptable and feasible café-based intervention ought to increase awareness and understanding of healthy and EF food choices, protect customer choice and avoid additional costs.
Perceptions of outdoor gymnasiums in National Capital Region, India: creating active environments for health promotion
Authors: Sharma Rachit , Chaudhary Monika
Published: February 2020

The prevalence of physical inactivity in India is estimated to be at 34%, the highest among South Asian nations. Interventions, such as outdoor gymnasiums/gyms, aiming to promote physical activity, are becoming popular worldwide, including in India. This paper presents the first empirical evidence on outdoor gyms in India from a qualitative perspective. Semi-structured, in-depth interviews of 56 outdoor gym stakeholders—40 users, 10 non-users, 4 healthcare providers and 2 outdoor gym implementing municipality authorities were conducted in the National Capital Region of India. The interviews were transcribed and analyzed through the Framework Method. The qualitative findings present the perceived benefits, barriers/challenges to using and provide insights for further improving and scaling up outdoor gyms in India. Health enhancement in the form of improved general fitness, body weight control and diversification of physical exercise routines, social connectivity, easy accessibility, affordability, green outdoor surroundings, and a place of intrigue and attraction in respective parks were the major reported benefits of outdoor gyms. Low gym equipment to user ratio was one of the major challenges to gym use across the user group. Healthcare providers and non-users were majorly concerned about the potentially incorrect and unsupervised use of outdoor gym equipment. Major suggestions for improvement were increasing the number of equipment installed, regular equipment maintenance, and the presence of an on-site physical exercise trainer. Outdoor gymnasiums present as a viable option for promoting physical activity and should be scaled up systematically to improve the health of the populations across India and other similar nations.
Mice carrying an analogous heterozygous dynamin 2 K562E mutation that causes neuropathy in humans develop predominant characteristics of a primary myopathy
Authors: Pereira Jorge A , Gerber Joanne , Ghidinelli Monica , Gerber Daniel , Tortola Luigi , Ommer Andrea , Bachofner Sven , Santarella Francesco , Tinelli Elisa , Lin Shuo , Rüegg Markus A , Kopf Manfred , Toyka Klaus V , Suter Ueli
Published: February 2020

Some mutations affecting dynamin 2 (DNM2) can cause dominantly inherited Charcot–Marie–Tooth (CMT) neuropathy. Here, we describe the analysis of mice carrying the DNM2 K562E mutation which has been associated with dominant-intermediate CMT type B (CMTDIB). Contrary to our expectations, heterozygous DNM2 K562E mutant mice did not develop definitive signs of an axonal or demyelinating neuropathy. Rather, we found a primary myopathy-like phenotype in these mice. A likely interpretation of these results is that the lack of a neuropathy in this mouse model has allowed the unmasking of a primary myopathy due to the DNM2 K562E mutation which might be overshadowed by the neuropathy in humans. Consequently, we hypothesize that a primary myopathy may also contribute to the disease mechanism in some CMTDIB patients. We propose that these findings should be considered in the evaluation of patients, the determination of the underlying disease processes and the development of tailored potential treatment strategies.
Circulating Leptin Levels as a Potential Biomarker in Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis
Authors: de Carvalho Larissa Gabriela Ferreira , Lima William Gustavo , Coelho Luiz Gonzaga Vaz , Cardoso Valbert Nascimento , Fernandes Simone Odília Antunes
Published: February 2020

Background

The differential diagnosis of inflammatory bowel diseases (IBDs) between Crohn’s disease (CD) and ulcerative colitis (UC) is important for designing an effective therapeutic regimen. However, without any adequate gold standard method for differential diagnosis currently, therapeutic design remains a major challenge in clinical practice. In this context, recent studies have showed that circulating leptin stands out as a potential biomarker for the categorization of IBDs. Thus, we aimed to summarize the current understanding of the prognostic and diagnostic value of serum leptin in patients with IBDs.

Methods

A systematic search was performed in PubMed/MEDLINE, Scopus, Cochrane Library, and Web of Science databases. Articles that aimed to study the relationship between circulating levels of leptin and IBDs were included. Finally, the meta-analysis was performed with the mean serum leptin levels in patients with IBDs and healthy controls using RevMan 5.3 software, with I2 > 50% as a criterion for substantial heterogeneity.

Results

Nineteen studies were included. Serum leptin levels among patients with IBDs and healthy controls did not show a significant difference (95% CI, −2.15 to 0.57; I2, 86%, P ≤ 0.00001). Similarly, there was no association of leptin levels with the activity of IBDs (95% CI, −0.24 to 0.06; I2, 50%; P = 0.13). However, serum leptin levels were significantly higher in patients with CD than those in patients with UC (95% CI, −2.09 to −0.37; I2, 7%; P ≤ 0.36).

Conclusion

This review suggested that serum leptin levels might be a promising biomarker to help in the differentiation between CD and UC.
Saving the European Eel: How Morphological Research Can Help in Effective Conservation Management
Authors: De Meyer Jens , Verhelst Pieterjan , Adriaens Dominique
Published: February 2020

The European eel (Anguilla anguilla) is a critically endangered species, whose recruitment stocks have declined to nearly 1% compared to the late 70s. An amalgam of factors is responsible for this, among them migration barriers, pollution, habitat loss, parasite infection, and overfishing. A lot of recent studies focus on aspects that can increase the mature silver eel escapement rate, such as identifying migration barriers and developing passageways or addressing the impact of pollution on the eel’s health. However, little attention is given to the eel’s morphology in function of management measures. Worryingly, less than 50% of the currently installed management plans reach their goals, strongly indicating that more information is needed about the eel’s ecology and behavior. Functional morphological studies provide insights on how species perform behaviors crucial for survival, such as feeding and locomotion, but also in how environmental changes can affect or limit such behaviors. Consequently, functional morphology represents an important biotic component that should be taken into account when making conservation decisions. Hence, here, we provide an overview of studies on the eel’s morphology that do not only demonstrate its relation with ecology and behavior, but also provide information for developing and installing proper and more specific management measures.
Prognostic stratification of pathological node-negative lung adenocarcinoma by carcinoembryonic antigen level
Authors: Batmunkh Khashchuluun , Cho Sukki , Yum Sungwon , Kim Kwhanmien , Jheon Sanghoon
Published: February 2020

OBJECTIVES

Carcinoembryonic antigen (CEA) is a well-known tumour marker for lung adenocarcinoma (AC). This study was conducted to evaluate the clinical characteristics and prognosis of patients with pathological node-negative lung AC who have a high preoperative level of CEA.

METHODS

Among 2124 patients with lung AC between 2003 and 2016, 858 patients were enrolled. CEA levels were dichotomized as normal (≤5 ng/ml) or high (>5 ng/ml). According to the levels of CEA between 6 and 12 months after surgery, patients were divided into a normalized and a remained-high group. Propensity score matching was used to compare 80 patients without adjuvant chemotherapy (ACT) with 39 patients with ACT. Kaplan–Meier survival analysis with the log-rank test and Cox proportional hazards regression analysis were performed for recurrence-free survival (RFS) and overall survival (OS).

RESULTS

The multivariable analysis showed that high maximum standardized uptake value and T2 stage were more common in patients with high levels of CEA. The median follow-up period was 52.8 months (range 6–169 months). The 5-year RFS and OS rates were 89.3% and 68.9% and 92.8% and 77.2% in normal patients and patients with high levels of CEA, respectively, with a statistically significant difference. The 5-year RFS was 79.4% and 39.2% in the normalized and remained-high groups after surgery, respectively (P = 0.011). The 5-year RFS and OS rates were 68.9% and 62.2% and 80.1% and 82.9% in patients without and with ACT, respectively. After propensity score matching, RFS was not significantly different between patients without and with ACT (P = 0.500); however, OS was significantly better in patients with ACT than in those without ACT (P = 0.001).

CONCLUSIONS

The clinicopathological characteristics, RFS and OS of patients with lung AC might be well discriminated by preoperative CEA levels. In patients with node-negative disease and high CEA levels, those with normalized CEA levels had a significantly better prognosis than those with persistently high CEA levels.
Upregulation of TRPC6 Mediated by PAX6 Hypomethylation Is Involved in the Mechanical Allodynia Induced by Chemotherapeutics in Dorsal Root Ganglion
Authors: Zhang Xiang-Zhong , Luo De-Xing , Bai Xiao-Hui , Ding Huan-Huan , Liu Meng , Deng Jie , Mai Jing-Wen , Yang Yan-Ling , Zhang Su-Bo , Ruan Xiang-Cai , Zhang Xue-Qin , Xin Wen-Jun , Xu Ting
Published: February 2020

Background

Although the action mechanism of antineoplastic agents is different, oxaliplatin, paclitaxel, or bortezomib as first-line antineoplastic drugs can induce painful neuropathy. In rodents, mechanical allodynia is a common phenotype of painful neuropathy for 3 chemotherapeutics. However, whether there is a common molecular involved in the different chemotherapeutics-induced painful peripheral neuropathy remains unclear.

Methods

Mechanical allodynia was tested by von Frey hairs following i.p. injection of vehicle, oxaliplatin, paclitaxel, or bortezomib in Sprague-Dawley rats. Reduced representation bisulfite sequencing and methylated DNA immunoprecipitation were used to detect the change of DNA methylation. Western blot, quantitative polymerase chain reaction, chromatin immunoprecipitation, and immunohistochemistry were employed to explore the molecular mechanisms.

Results

In 3 chemotherapeutic models, oxaliplatin, paclitaxel, or bortezomib accordantly upregulated the expression of transient receptor potential cation channel, subfamily C6 (TRPC6) mRNA and protein without affecting the DNA methylation level of TRPC6 gene in DRG. Inhibition of TRPC6 by using TRPC6 siRNA (i.t., 10 consecutive days) relieved mechanical allodynia significantly following application of chemotherapeutics. Furthermore, the downregulated recruitment of DNA methyltransferase 3 beta (DNMT3b) at paired box protein 6 (PAX6) gene led to the hypomethylation of PAX6 gene and increased PAX6 expression. Finally, the increased PAX6 via binding to the TPRC6 promoter contributes to the TRPC6 increase and mechanical allodynia following chemotherapeutics treatment.

Conclusions

The TRPC6 upregulation through DNMT3b-mediated PAX6 gene hypomethylation participated in mechanical allodynia following application of different chemotherapeutic drugs.
Patient-reported outcome measures for inguinal hernia repair are insufficiently validated: a systematic review
Authors: Gram-Hanssen Anders , Tolstrup Anders , Zetner Dennis , Rosenberg Jacob
Published: February 2020

Purpose

To systematically assess the validity of patient-reported outcome measures (PROMs) for patients undergoing inguinal hernia repair.

Data sources

A systematic review was performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline for systematic reviews of PROMs. PubMed, EMBASE and PsycINFO were consulted.

Study selection

Only studies explicitly aimed at validation of PROMs specific for patients with inguinal hernia were included.

Data extraction

Data regarding measurement properties of PROMs were extracted from the included studies. Each study was critically assessed for methodological quality and each PROM was evaluated for sufficient measurement properties.

Results of data synthesis

We included 15 studies, covering 11 different PROMs. The Carolinas Comfort Scale was the most frequently investigated PROM, being covered in five of the included publications. The included PROMs were evaluated according to nine different measurement properties, of which internal consistency and construct validity were the most frequently assessed. Evidence regarding content validity and structural validity was universally inadequate, according to the criteria for good measurement properties, as defined by the COSMIN.

Conclusion

Based on the current evidence, it is not possible to formulate recommendations for application of PROMs for patients undergoing inguinal hernia repair. Further validation of the included PROMs is necessary especially regarding content validity and structural validity.
Understanding unwarranted variation in clinical practice: a focus on network effects, reflective medicine and learning health systems
Authors: Atsma Femke , Elwyn Glyn , Westert Gert
Published: February 2020

In the past decades, extensive research has been performed on the phenomenon of unwarranted clinical variation in clinical practice. Many studies have been performed on signaling, describing and visualizing clinical variation. We argue that it is time for next steps in practice variation research. In addition to describing and signaling variation patterns, we argue that a better understanding of causes of variation should be gained. Moreover, target points for improving and decreasing clinical variation should be created. Key elements in this new focus should be research on the complex interaction of networks, reflective medicine, patient beliefs and objective criteria for treatment choices. By combining these different concepts, alternative research objectives and new targets for improving and reducing unwarranted variation may be defined. In this perspective, we reflect on these concepts and propose target points for future research.
In vitro synergy of ceftolozane/tazobactam in combination with fosfomycin or aztreonam against MDR Pseudomonas aeruginosa
Authors: Cuba Gabriel T , Rocha-Santos Gerlan , Cayô Rodrigo , Streling Ana Paula , Nodari Carolina S , Gales Ana C , Pignatari Antonio C C , Nicolau David P , Kiffer Carlos R V
Published: February 2020

Objectives

Carbapenem-resistant Pseudomonas aeruginosa (CR-PSA) imposes great limitations on empirical therapeutic choices, which are further complicated by metallo-β-lactamase production. This study evaluated in vitro antimicrobial synergy of ceftolozane/tazobactam in combination with aztreonam and fosfomycin against MDR PSA.

Methods

MICs were determined by broth microdilution and gradient strips. The effect of ceftolozane/tazobactam+aztreonam and ceftolozane/tazobactam+fosfomycin combinations were tested against 27 MDR PSA isolates carrying blaSPM-1 (n = 13), blaIMP (n = 4), blaVIM (n = 3), blaGES-1 (n = 2) and blaCTX-M-like (n = 2), and 3 isolates with no acquired β-lactamase production detected by gradient diffusion strip crossing (GDSC). Six genetically unrelated SPM-1-producing isolates were also evaluated by time–kill analysis (TKA).

Results

All CR-PSA isolates harbouring blaSPM-1, blaGES-1 and blaIMP-1 were categorized as resistant to ceftolozane/tazobactam, meropenem and fosfomycin, with 70% being susceptible to aztreonam. Synergism for ceftolozane/tazobactam+fosfomycin and ceftolozane/tazobactam+aztreonam combinations was observed for 88.9% (24/27) and 18.5% (5/27) of the isolates by GDSC, respectively. A 3- to 9-fold reduction in ceftolozane/tazobactam MICs was observed, depending on the combination. Ceftolozane/tazobactam+fosfomycin was synergistic by TKA against one of six SPM-1-producing isolates, with additional non-synergistic bacterial density reduction for another isolate. Aztreonam peak concentrations alone demonstrated a ≥3 log10 cfu/mL reduction against all six isolates, but all strains were within the susceptible range for the drug. No antagonism was observed.

Conclusions

In the context of increasing CR-PSA and the genetic diversity of resistance mechanisms, new combinations and stewardship strategies may need to be explored in the face of increasingly difficult to treat pathogens.
“How did you get to this number?” Stakeholder needs for implementing predictive analytics: a pre-implementation qualitative study
Authors: Benda Natalie C , Das Lala Tanmoy , Abramson Erika L , Blackburn Katherine , Thoman Amy , Kaushal Rainu , Zhang Yongkang , Ancker Jessica S
Published: February 2020

Objective

Predictive analytics are potentially powerful tools, but to improve healthcare delivery, they must be carefully integrated into healthcare organizations. Our objective was to identify facilitators, challenges, and recommendations for implementing a novel predictive algorithm which aims to prospectively identify patients with high preventable utilization to proactively involve them in preventative interventions.

Materials and Methods

In preparation for implementing the predictive algorithm in 3 organizations, we interviewed 3 stakeholder groups: health systems operations (eg, chief medical officers, department chairs), informatics personnel, and potential end users (eg, physicians, nurses, social workers). We applied thematic analysis to derive key themes and categorize them into the dimensions of Sittig and Singh’s original sociotechnical model for studying health information technology in complex adaptive healthcare systems. Recruiting and analysis were conducted iteratively until thematic saturation was achieved.

Results

Forty-nine interviews were conducted in 3 healthcare organizations. Technical components of the implementation (hardware and software) raised fewer concerns than alignment with sociotechnical factors. Stakeholders wanted decision support based on the algorithm to be clear and actionable and incorporated into current workflows. However, how to make this disease-independent classification tool actionable was perceived as a challenge, and appropriate patient interventions informed by the algorithm appeared likely to require substantial external and institutional resources. Stakeholders also described the criticality of trust, credibility, and interpretability of the predictive algorithm.

Conclusions

Although predictive analytics can classify patients with high accuracy, they cannot advance healthcare processes and outcomes without careful implementation that takes into account the sociotechnical system. Key stakeholders have strong perceptions about facilitators and challenges to shape successful implementation.
A systematic review of the impact of health information technology on nurses’ time
Authors: Moore Esther C , Tolley Clare L , Bates David W , Slight Sarah P
Published: February 2020

Objective

Nursing time represents one of the highest costs for most health services. We conducted a systematic review of the literature on the impact of health information technology on nurses’ time.

Materials and Methods

We followed PRISMA guidelines and searched 6 large databases for relevant articles published between Jan 2004 and December 2019. Two authors reviewed the titles, abstracts, and full texts. We included articles that included a comparison group in the design, measured the time taken to carry out documentation or medication administration, documented the quantitative estimates of time differences between the 2, had nurses as subjects, and was conducted in either a care home, hospital, or community clinic.

Results

We identified a total of 1647 articles, of which 33 met our inclusion criteria. Twenty-one studies reported the impact of 12 different health information technology (HIT) implementations on nurses’ documentation time. Weighted averages were calculated for studies that implemented barcode medication administration (BCMA) and 2 weighted averages for those that implemented EHRs, as these studies used different sampling units; both showed an increase in the time spent in documentation (+22% and +46%). However, the time spent carrying out medication administration following BCMA implementation fell by 33% (P < .05). HIT also caused a redistribution of nurses’ time which, in some cases, was spent in more “value-adding” activities, such as delivering direct patient care as well as inter-professional communication.

Discussion and Conclusions

Most of the HIT systems increased nursing documentation time, although time fell for medication administration following BCMA. Many HIT systems also resulted in nurses spending more time in direct care and “value-adding” activities.
Prediction of hydrocarbon reservoirs within coal-bearing formations
Authors: He Faqi , Rao Ying , Wang Weihong , Wang Yanghua
Published: February 2020

This paper presents a case study on the prediction of hydrocarbon reservoirs within coal-bearing formations of the Upper Palaeozoic. The target reservoirs are low-permeability low-pressure tight-sandstone reservoirs in the Daniudi Gas Field, Ordos Basin, China. The prime difficulty in reservoir prediction is caused by the interbedding coal seams within the formations, which generate low-frequency strong-amplitude reflections in seismic profiles. To tackle this difficulty, first, we undertook a careful analysis regarding the stratigraphy and lithology of these coal-bearing formations within the study area. Then, we conducted a geostatistical inversion using 3D seismic data and obtained reservoir parameters including seismic impedance, gamma ray, porosity and density. Finally, we carried out a reservoir prediction in the coal-bearing formations, based on the reservoir parameters obtained from geostatistical inversion and combined with petrophysical analysis results. The prediction result is accurately matched with the actual gas-test data for the targeted four segments of the coal-bearing formations.
Bureaucratic Competence and Procurement Outcomes
Authors: Decarolis Francesco , Giuffrida Leonardo M , Iossa Elisabetta , Mollisi Vincenzo , Spagnolo Giancarlo
Published: February 2020

To what extent does a more competent public bureaucracy contribute to better economic outcomes? We address this question in the context of the US federal procurement of services and works, by combining contract-level data on procurement performance and bureau-level data on competence and workforce characteristics. We use the death occurrences of specific types of employees as instruments and find that an increase in bureau competence causes a significant and economically important reduction in (a) time delays, (b) cost overruns, and (c) number of renegotiations. Cooperation within the office appears to be a key driver of the findings. (JEL D73, H11, H57, L26).